DEPRESSIVE SYMPTOMS AMONG FAMILY MEMBERS PROVIDING INFORMAL CARE FOR PATIENTS RECEIVING HOME-BASED CARE: A PHQ-9 CROSS-SECTIONAL STUDY
Abstract
Introduction/Objective: Family members providing informal care for patients receiving home-based care represent a population at increased risk of developing depressive symptoms. The aim of this study was to assess the presence and severity of depressive symptoms using the PHQ-9 questionnaire and to examine the association between depressive symptoms and caregivers’ daily functioning.
Methods: A descriptive-analytical cross-sectional study was conducted among 77 family caregivers of patients enrolled in the Home Care Service of the Health Center Subotica between March and September 2025. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included the t-test, Mann–Whitney U test, Kruskal–Wallis test, and Spearman’s correlation coefficient.
Results: The mean PHQ-9 score was 8.48 ± 6.14. A score ≥ 10 was recorded in 30 (38.9%) participants. Minimal or mild depressive symptoms were present in 47 (61.1%) caregivers. No statistically significant differences in PHQ-9 scores were observed according to caregiver sex (p = 0.423) or the patient’s primary diagnosis (p = 0.183). In the overall sample, a statistically significant weak positive correlation was found between PHQ-9 score and the self-reported impact of symptoms on daily functioning (r = 0.294; p = 0.009).
Conclusion: Depressive symptoms are present in a substantial proportion of family caregivers providing home-based care. The intensity of depressive symptoms is associated with greater impairment in daily functioning, highlighting the importance of systematic monitoring of caregivers’ mental health.
References
United Nations Department of Economic and Social Affairs. World population ageing 2020: highlights [Internet]. New York: United Nations; 2020 [cited 2025 Nov 24]. 40 p. Available from: https://digitallibrary.un.org/record/3898412/files/undesa_pd-2020_world_population_ageing_highlights.pdf
Kilmer G, Omura JD, Bouldin ED, Walker J, Spears K, Gore J, et al. Changes in health indicators among caregivers—United States, 2015–2016 to 2021–2022. MMWR Morb Mortal Wkly Rep. 2024 Aug 29;73(34):740-6. doi: 10.15585/mmwr.mm7334a2.
Lane NE, Hoben M, Amuah JE, Hogan DB, Baumbusch J, Gruneir A, et al. Prevalence and correlates of anxiety and depression in caregivers to assisted living residents during COVID-19: a cross-sectional study. BMC Geriatr. 2022 Aug 12;22(1):662. doi: 10.1186/s12877-022-03294-y.
Abdelhalim DS, Ahmed MM, Hussein HA, Khalaf OO, Sarhan MD. Burden of Care, Depression, and Anxiety Among Family Caregivers of People With Dementia. J Prim Care Community Health. 2024 Jan-Dec;15:21501319241288029. doi: 10.1177/21501319241288029.
Pan YC, Lin YS. Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients. Front Psychiatry. 2022 May 12;13:817936. doi: 10.3389/fpsyt.2022.817936.
World Health Organization. WHO calls for urgent transformation of care and support systems for older people [Internet]. Geneva: WHO; 2024 Oct 1 [cited 2025 Nov 24]. Available from: https://www.who.int/news/item/01-10-2024-who-calls-for-urgent-transformation-of-care-and-support-systems-for-older-people
Alaqeel M, Alkhathaami F, Alshangiti A, Alanazi A, Alothri MA, Alqarni AT, et al. Depression and Quality of Life Among Caregivers of Pediatric Cancer Patients. Cureus. 2022 Apr 18;14(4):e24256. doi: 10.7759/cureus.24256.
Polikandrioti M, Tsami A, Tsoulou V, Maggita A. Quality of Life, Anxiety, and Depression in Caregivers of Community-Dwelling Heart Failure Patients. Healthcare (Basel). 2025 Aug 13;13(16):1986. doi: 10.3390/healthcare13161986.
Lin JD, Lin LP, Kuo MT, Hsu SW, Lee TN, Lai CI, et al. Assessment of the 9-item Patient Health Questionnaire (PHQ-9) as a screening tool for symptoms of depression in community caregivers for adults with intellectual disabilities. Res Dev Disabil. 2014 Jan;35(1):178-84. doi: 10.1016/j.ridd.2013.10.008.
Wan Ab Rahman WMA, Mazlan M. The Prevalence of Depression and Its Correlates Among Informal Caregivers of Stroke Patients in an Urban Community. Cureus. 2024 Jan 1;16(1):e51486. doi: 10.7759/cureus.51486.
Yan Y, Li M, Cai T, Wang X, Dong Y, Hu X, et al. Mood assessments of family caregivers of patients with severe brain injury in China. Qual Life Res. 2024 Feb;33(2):481-90. doi: 10.1007/s11136-023-03539-2.
Tan KP, Ang JK, Koh EBY, Pang NTP, Mat Saher Z. Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia. Int J Environ Res Public Health. 2023 Feb 27;20(5):4232. doi: 10.3390/ijerph20054232.
Alemayehu TT, Geremew GW, Tegegne AA, Chanie GS, Walelgn G, Nakie G, et al. The global prevalence of depression and its associated factors among caregivers of stroke survivors. Updated systematic review and meta-analysis. J Public Health (Berl). 2025 Jun 28. doi: 10.1007/s10389-025-02501-5.
Habtie TE, Adisu MA, Feleke SF, Kitaw TA. Burden Beyond the Bedside: A Global Synthesis of Depression in Informal Cancer Caregivers: An Umbrella Review. J Pain Symptom Manage. 2026 Feb;71(2):e123-32. doi: 10.1016/j.jpainsymman.2025.10.033.
Soh XC, Hartanto A, Ling N, Reyes M, Sim L, Majeed NM. Prevalence of depression, anxiety, burden, burnout, and stress in informal caregivers: An umbrella review of meta-analyses. Arch Gerontol Geriatr Plus. 2025;2(3):100197. doi: 10.1016/j.aggp.2025.100197.
Aragonés Barberá I, Sanchis-Sanchis A, Morales-Murillo CP, Grau Sevilla MD; Familia y factores de riesgo y protección en discapacidad y psicopatología. Campus Capacitas. The effect of burden and loneliness on depression in female caregivers through purpose in life. BMC Public Health. 2025 Dec 8;26(1):168. doi: 10.1186/s12889-025-25882-4.
Gutiérrez-Sánchez B, Orgeta V, López-Martínez C, Del-Pino-Casado R. Association between Social Support and Depressive Symptoms in Informal Caregivers of Adult and Older Dependents: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Oct 11;12(20):6468. doi: 10.3390/jcm12206468.
Liang Q, Xu M, Qiu L, Liu Y, Tian Y, Zuo X, et al. Prevalence and associated factors of burden, depression, and anxiety among informal caregivers of individuals with severe mental disorders within the “686 program”: a community-based cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2026 Jan 29. doi: 10.1007/s00127-025-03040-w.
Alreshidi SM. Psychometric properties of the Patient Health Questionnaire-9 for Saudi Caregivers: A Cross-Sectional Study in Saudi Arabia. Inquiry. 2024 Jan-Dec;61:469580231221287. doi: 10.1177/00469580231221287.
Tatomirescu LF, Glavce CS, Prada GI, Borosanu A, Turcu S. Socio-demographic factors linked to psychological well-being in dementia caregivers. Healthcare (Basel). 2025 Sep 7;13(17):2235. doi: 10.3390/healthcare13172235.
