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Abstract
Background: Psychiatric morbidities are often underdiagnosed among the primary caregivers of children with neurodevelopmental disorders who attend child clinics; however, they are frequent and are associated with adverse outcomes. An integrated management program, which is an evidence-based approach to psychiatric morbidity management, remains an exception in most hospital settings. This study investigated the prevalence of psychiatric morbidity and its associated factors among primary caregivers of children with neurodevelopmental disorders.
Methods: A descriptive cross-sectional study was conducted with 357 respondents in child clinics at a teaching hospital between January 2023 and December 2023.
Results: Most respondents (225, 63%) had at least one psychiatric morbidity, and the majority had major depressive episodes (147, 41.2%). Lack of family support was associated with at least one psychiatric morbidity (p = 0.009).
Conclusion: Primary caregivers of children with neurodevelopmental disorders attending outpatient child clinics experience psychiatric issues, especially major depressive episodes and anxiety disorders. Primary caregivers without an alternative caregiver or family support are more likely to suffer from psychiatric disorders.
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Copyright (c) 2024 Louise N. Lusimbo, Daniel Kinyanjui , Irene Chesire
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
- Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19(1), 195. https://doi.org/10.1186/s12877-019-1189-9
- Adedeji, I. A., Ogunniyi, A., Henderson, D. C., & Sam-Agudu, N. A. (2022). Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review. Dementia (London, England), 21(3), 995-1011. https://doi.org/10.1177/14713012211065398
- Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., & Lachs, M. S. (2014). Caregiver burden: a clinical review. JAMA, 311(10), 1052–1060. https://doi.org/10.1001/jama.2014.304
- Almogbel, Y. S., Goyal, R., & Sansgiry, S. S. (2017). Association Between Parenting Stress and Functional Impairment Among Children Diagnosed with Neurodevelopmental Disorders. Community Mental Health Journal, 53(4), 405–414. https://doi.org/10.1007/s10597-017-0096-9
- Areia, N. P., Fonseca, G., Major, S., & Relvas, A. P. (2019). Psychological morbidity in family caregivers of people living with terminal cancer: Prevalence and predictors. Palliative & supportive care, 17(3), 286–293. https://doi.org/10.1017/S1478951518000044
- Beard, J. R., Officer, A., de Carvalho, I. A., Sadana, R., Pot, A. M., Michel, J. P., Lloyd Sherlock, P., Epping-Jordan, J. E., Peeters, G. M. E. E. G., Mahanani, W. R., Thiyagarajan, J. A., & Chatterji, S. (2016). The World report on aging and health: a policy framework for healthy ageing. Lancet (London, England), 387(10033), 2145-2154. https://doi.org/10.1016/S0140-6736(15)00516-4
- Bhatia, M. S., Srivastava, S., Gautam, P., Saha, R., & Kaur, J. (2015). Burden assessment, psychiatric morbidity, and their correlates in caregivers of patients with intellectual disability. East Asian Archives of Psychiatry: Official Journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan, 25(4), 159–163.
- Campbell, M. M., de Vries, J., Mqulwana, S. G., Mndini, M. M., Ntola, O. A., Jonker, D., Malan, M., Pretorius, A., Zingela, Z., Van Wyk, S., Stein, D. J., & Susser, E. (2018). Predictors of consent to cell line creation and immortalisation in a South African schizophrenia genomics study. BMC Medical Ethics, 19(1), 72. https://doi.org/10.1186/s12910-018-0313-2
- Cham, C. Q., Ibrahim, N., Siau, C. S., Kalaman, C. R., Ho, M. C., Yahya, A. N., Visvalingam, U., Roslan, S., Abd Rahman, F. N., & Lee, K. W. (2022). Caregiver Burden among Caregivers of Patients with Mental Illness: A Systematic Review and Meta-Analysis. Healthcare (Basel, Switzerland), 10(12), 2423. https://doi.org/10.3390/healthcare10122423
- Chen, S., Ford, T. J., Jones, P. B., & Cardinal, R. N. (2022). Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries. The Lancet regional health. Europe, 17, 100368. https://doi.org/10.1016/j.lanepe.2022.100368
- Chhagan, M. K., Mellins, C. A., Kauchali, S., Craib, M. H., Taylor, M., Kvalsvig, J. D., & Davidson, L. L. (2014). Mental health disorders among caregivers of preschool children in the Asenze study in KwaZulu-Natal, South Africa. Maternal and Child Health Journal, 18(1), 191–199. https://doi.org/10.1007/s10995-013-1254-5
- Coid, J., Petruckevitch, A., Chung, W. S., Richardson, J., Moorey, S., & Feder, G. (2003). Abusive experiences and psychiatric morbidity in women primary care attenders. The British Journal of Psychiatry, 183 (4), 332–341. https://doi.org/10.1192/bjp.183.4.332
- Derajew, H., Tolessa, D., Feyissa, G. T., Addisu, F., & Soboka, M. (2017). Prevalence of depression and its associated factors among primary caregivers of patients with severe mental illness in southwest, Ethiopia. BMC psychiatry, 17(1), 88. https://doi.org/10.1186/s12888-017-1249-7
- Doernberg, E., & Hollander, E. (2016). Neurodevelopmental disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11. CNS spectrums, 21(4), 295–299. https://doi.org/10.1017/S1092852916000262
- Doi, M., Usui, N., & Shimada, S. (2022). Prenatal Environment and Neurodevelopmental Disorders. Frontiers in Endocrinology, 13, 860110. https://doi.org/10.3389/fendo.2022.860110
- Fang, M. L., Sixsmith, J., Sinclair, S., & Horst, G. (2016). A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: Findings from a scoping review. BMC Geriatrics, 16, 107. https://doi.org/10.1186/s12877-016-0282-6
- Fisher, R. A. (1935). The logic of inductive inference. Journal of the Royal Statistical Society, 98(1), 39-82.
- Gugała, B., Penar-Zadarko, B., Pięciak-Kotlarz, D., Wardak, K., Lewicka-Chomont, A., Futyma- Ziaja, M., & Opara, J. (2019). Assessment of Anxiety and Depression in Polish Primary Parental Caregivers of Children with Cerebral Palsy Compared to a Control Group, as well as Identification of Selected Predictors. International Journal of Environmental Research and Public Health, 16(21). https://doi.org/10.3390/IJERPH16214173
- Hareendran, A., Devadas, K., Sreesh, S., Tom Oommen, T., Varghese, J., Lubina, S., Nahaz, N., Krishna, A., & Mullali Mohamed Kunhi, N. (2020). Quality of life, caregiver burden and mental health disorders in primary caregivers of patients with Cirrhosis. Liver Iinternational, 40(12), 2939–2949. https://doi.org/10.1111/liv.14614
- Hsiao, C. Y., Lu, H. L., & Tsai, Y. F. (2022). Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan. Journal of Mental Health, 31(4), 487–495. https://doi.org/10.1080/09638237.2020.1818703
- Huang, Y. C., Hsu, S. T., Hung, C. F., Wang, L. J., & Chong, M. Y. (2018). Mental health of caregivers of individuals with disabilities: Relation to Suicidal Ideation. Comprehensive Psychiatry, 81, 22–27. https://doi.org/10.1016/j.comppsych.2017.11.003
- Kaiser, M. J., Bauer, J. M., Ramsch, C., Uter, W., Guigoz, Y., Cederholm, T., Thomas, D. R., Anthony, P., Charlton, K. E., Maggio, M., Tsai, A. C., Grathwohl, D., Vellas, B., Sieber, C. C., & MNA-International Group (2009). Validation of the mini nutritional assessment short-form (MNA-SF): A practical tool for identification of nutritional status. The Journal of Nutrition, Health & Aging, 13(9), 782–788. https://doi.org/10.1007/s12603-009-0214-7
- Kazdin, A. E. (2000). Encyclopedia of Psychology. American Psychological Association.
- Khalid, H., Arif, S., Hashmat, A., & Farrukh, H. (2021). Psychiatric morbidity among informal caregivers of children suffering from intellectual developmental disorders. JPMA. The Journal of the Pakistan Medical Association, 71(8), 2005–2008. https://doi.org/10.47391/JPMA.20-584
- Kumar, P., Chaudhary, R., Bhalla, J. K., & Mishra, B. P. (2021). Comparison of psychiatric morbidity and quality of life among caregivers of substance abusers. Annals of Indian Psychiatry, 5(2), 164-168.
- Levav, I., & Rutz, W. (2002). The WHO World Health Report 2001 new understanding—new hope. The Israel journal of Psychiatry and Related Sciences, 39(1), 50–56.
- Maridal, H. K., Bjørgaas, H. M., Hagen, K., Jonsbu, E., Mahat, P., Malakar, S., & Dørheim, S. (2021). Psychological Distress among Caregivers of Children with Neurodevelopmental Disorders in Nepal. International Journal of Environmental Research and Public Health, 18(5), 2460. https://doi.org/10.3390/ijerph18052460
- Marimbe, B. D., Cowan, F., Kajawu, L., Muchirahondo, F., & Lund, C. (2016). Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe. African Journal of Disability, 5(1), 209. https://doi.org/10.4102/ajod.v5i1.209
- Minichil, W., Getinet, W., & Kassew, T. (2021). Prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia: Cross-sectional study. PloS One, 16(12), e0261297. https://doi.org/10.1371/journal.pone.0261297
- Molebatsi, K., Ndetei, D. M., & Opondo, P. R. (2017). Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study. Journal of Child and Adolescent Mental Health, 29(2), 117–127. https://doi.org/10.2989/17280583.2017.1340301
- Ocansey, P. M., Kretchy, I. A., Aryeetey, G. C., Agyabeng, K., & Nonvignon, J. (2021). Anxiety, depression, and stress in caregivers of children and adolescents with mental disorders in Ghana and implications for medication adherence. Ghana Medical Journal, 55(3), 173–182. https://doi.org/10.4314/gmj.v55i3.1
- Okewole, A., Dada, M. U., Ogun, O., Bello-Mojeed, M., & Usoh, T. (2011). Prevalence and correlates of psychiatric morbidity among caregivers of children and adolescents with neuropsychiatric disorders in Nigeria. African Journal of Psychiatry, 14(4), 306–309. https://doi.org/10.4314/ajpsy.v14i4.8
- Olagunju, A. T., Oshodi, Y. O., Umeh, C. S., Aina, O. F., Oyibo, W. A., Lamikanra, A. E., ... & Adeyemi, J. D. (2017). Children with neurodevelopmental disorders: The burden and psychological effects on caregivers in Lagos, Nigeria. Journal of Clinical Sciences, 14(1), 2-7.
- Otieno, M. (2013). The prevalence of depressive symptoms among caregivers of children with mental disorders drawn at Kenyatta National Hospital. http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/58678
- Paruk, S., & Ramdhial, M. (2018). Prevalence of caregiver burden, depressive and anxiety symptoms in caregivers of children with psychiatric disorders in Durban, South Africa. South African Journal of Psychiatry, 24(1). https://doi.org/10.4102/sajpsychiatry.v24i0.1314
- Rosa, W. E., & Hassmiller, S. B. (2020). The Sustainable Development Goals and Building a Culture of Health. The American journal of nursing, 120(6), 69–71. https://doi.org/10.1097/01.NAJ.0000668772.33792.1f
- Sadock, B. J., & Sadock, V. A. (2008). Kaplan & Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.
- Schulz, R., & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. The American journal of nursing, 108(9 Suppl), 23–27. https://doi.org/10.1097/01.NAJ.0000336406.45248.4c
- Seaman, J. B., Terhorst, L., Gentry, A., Hunsaker, A., Parker, L. S., & Lingler, J. H. (2015). Psychometric Properties of a Decisional Capacity Screening Tool for Individuals Contemplating Participation in Alzheimer's Disease Research. Journal of Alzheimer's Disease, 46(1), 1–9. https://doi.org/10.3233/JAD-142559
- Sharma, R., Singh, H., Murti, M., Chatterjee, K., & Rakkar, J. S. (2021). Depression and anxiety in parents of children and adolescents with intellectual disability. Industrial Psychiatry Journal, 30(2), 291–298. https://doi.org/10.4103/ipj.ipj_216_20
- Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). The Journal of Clinical Psychiatry, 71(3), 313–326. https://doi.org/10.4088/JCP.09m05305whi
- Siddiqui, S., & Khalid, J. (2019). Determining the caregivers' burden in caregivers of patients with mental illness. Pakistan Journal of Medical Sciences, 35(5), 1329–1333. https://doi.org/10.12669/pjms.35.5.720
- Stansfeld, S., Smuk, M., Onwumere, J., Clark, C., Pike, C., McManus, S., Harris, J., & Bebbington, P. (2014). Stressors and common mental disorder in informal carers—an analysis of the English adult psychiatric morbidity survey 2007. Social Science & Medicine, 120, 190–198. https://doi.org/10.1016/j.socscimed.2014.09.025
- Udoh, E. E., Omorere, D. E., Sunday, O., Osasu, O. S., & Amoo, B. A. (2021). Psychological distress and burden of care among family caregivers of patients with mental illness in a neuropsychiatric outpatient clinic in Nigeria. PloS One, 16(5), e0250309. https://doi.org/10.1371/journal.pone.0250309
- Unsar, S., Erol, O., & Ozdemir, O. (2021). Caregiving burden, depression, and anxiety in family caregivers of patients with cancer. European Journal of Oncology Nursing, 50, 101882. https://doi.org/10.1016/j.ejon.2020.101882
- Zhou, T., Wang, Y., & Yi, C. (2018). Affiliate stigma and depression in caregivers of children with autism spectrum disorders in China: Effects of self-esteem, shame, and family functioning. Psychiatry Research, 264, 260–265. https://doi.org/10.1016/j.psychres.2018.03.071
References
Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19(1), 195. https://doi.org/10.1186/s12877-019-1189-9
Adedeji, I. A., Ogunniyi, A., Henderson, D. C., & Sam-Agudu, N. A. (2022). Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review. Dementia (London, England), 21(3), 995-1011. https://doi.org/10.1177/14713012211065398
Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., & Lachs, M. S. (2014). Caregiver burden: a clinical review. JAMA, 311(10), 1052–1060. https://doi.org/10.1001/jama.2014.304
Almogbel, Y. S., Goyal, R., & Sansgiry, S. S. (2017). Association Between Parenting Stress and Functional Impairment Among Children Diagnosed with Neurodevelopmental Disorders. Community Mental Health Journal, 53(4), 405–414. https://doi.org/10.1007/s10597-017-0096-9
Areia, N. P., Fonseca, G., Major, S., & Relvas, A. P. (2019). Psychological morbidity in family caregivers of people living with terminal cancer: Prevalence and predictors. Palliative & supportive care, 17(3), 286–293. https://doi.org/10.1017/S1478951518000044
Beard, J. R., Officer, A., de Carvalho, I. A., Sadana, R., Pot, A. M., Michel, J. P., Lloyd Sherlock, P., Epping-Jordan, J. E., Peeters, G. M. E. E. G., Mahanani, W. R., Thiyagarajan, J. A., & Chatterji, S. (2016). The World report on aging and health: a policy framework for healthy ageing. Lancet (London, England), 387(10033), 2145-2154. https://doi.org/10.1016/S0140-6736(15)00516-4
Bhatia, M. S., Srivastava, S., Gautam, P., Saha, R., & Kaur, J. (2015). Burden assessment, psychiatric morbidity, and their correlates in caregivers of patients with intellectual disability. East Asian Archives of Psychiatry: Official Journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan, 25(4), 159–163.
Campbell, M. M., de Vries, J., Mqulwana, S. G., Mndini, M. M., Ntola, O. A., Jonker, D., Malan, M., Pretorius, A., Zingela, Z., Van Wyk, S., Stein, D. J., & Susser, E. (2018). Predictors of consent to cell line creation and immortalisation in a South African schizophrenia genomics study. BMC Medical Ethics, 19(1), 72. https://doi.org/10.1186/s12910-018-0313-2
Cham, C. Q., Ibrahim, N., Siau, C. S., Kalaman, C. R., Ho, M. C., Yahya, A. N., Visvalingam, U., Roslan, S., Abd Rahman, F. N., & Lee, K. W. (2022). Caregiver Burden among Caregivers of Patients with Mental Illness: A Systematic Review and Meta-Analysis. Healthcare (Basel, Switzerland), 10(12), 2423. https://doi.org/10.3390/healthcare10122423
Chen, S., Ford, T. J., Jones, P. B., & Cardinal, R. N. (2022). Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries. The Lancet regional health. Europe, 17, 100368. https://doi.org/10.1016/j.lanepe.2022.100368
Chhagan, M. K., Mellins, C. A., Kauchali, S., Craib, M. H., Taylor, M., Kvalsvig, J. D., & Davidson, L. L. (2014). Mental health disorders among caregivers of preschool children in the Asenze study in KwaZulu-Natal, South Africa. Maternal and Child Health Journal, 18(1), 191–199. https://doi.org/10.1007/s10995-013-1254-5
Coid, J., Petruckevitch, A., Chung, W. S., Richardson, J., Moorey, S., & Feder, G. (2003). Abusive experiences and psychiatric morbidity in women primary care attenders. The British Journal of Psychiatry, 183 (4), 332–341. https://doi.org/10.1192/bjp.183.4.332
Derajew, H., Tolessa, D., Feyissa, G. T., Addisu, F., & Soboka, M. (2017). Prevalence of depression and its associated factors among primary caregivers of patients with severe mental illness in southwest, Ethiopia. BMC psychiatry, 17(1), 88. https://doi.org/10.1186/s12888-017-1249-7
Doernberg, E., & Hollander, E. (2016). Neurodevelopmental disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11. CNS spectrums, 21(4), 295–299. https://doi.org/10.1017/S1092852916000262
Doi, M., Usui, N., & Shimada, S. (2022). Prenatal Environment and Neurodevelopmental Disorders. Frontiers in Endocrinology, 13, 860110. https://doi.org/10.3389/fendo.2022.860110
Fang, M. L., Sixsmith, J., Sinclair, S., & Horst, G. (2016). A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: Findings from a scoping review. BMC Geriatrics, 16, 107. https://doi.org/10.1186/s12877-016-0282-6
Fisher, R. A. (1935). The logic of inductive inference. Journal of the Royal Statistical Society, 98(1), 39-82.
Gugała, B., Penar-Zadarko, B., Pięciak-Kotlarz, D., Wardak, K., Lewicka-Chomont, A., Futyma- Ziaja, M., & Opara, J. (2019). Assessment of Anxiety and Depression in Polish Primary Parental Caregivers of Children with Cerebral Palsy Compared to a Control Group, as well as Identification of Selected Predictors. International Journal of Environmental Research and Public Health, 16(21). https://doi.org/10.3390/IJERPH16214173
Hareendran, A., Devadas, K., Sreesh, S., Tom Oommen, T., Varghese, J., Lubina, S., Nahaz, N., Krishna, A., & Mullali Mohamed Kunhi, N. (2020). Quality of life, caregiver burden and mental health disorders in primary caregivers of patients with Cirrhosis. Liver Iinternational, 40(12), 2939–2949. https://doi.org/10.1111/liv.14614
Hsiao, C. Y., Lu, H. L., & Tsai, Y. F. (2022). Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan. Journal of Mental Health, 31(4), 487–495. https://doi.org/10.1080/09638237.2020.1818703
Huang, Y. C., Hsu, S. T., Hung, C. F., Wang, L. J., & Chong, M. Y. (2018). Mental health of caregivers of individuals with disabilities: Relation to Suicidal Ideation. Comprehensive Psychiatry, 81, 22–27. https://doi.org/10.1016/j.comppsych.2017.11.003
Kaiser, M. J., Bauer, J. M., Ramsch, C., Uter, W., Guigoz, Y., Cederholm, T., Thomas, D. R., Anthony, P., Charlton, K. E., Maggio, M., Tsai, A. C., Grathwohl, D., Vellas, B., Sieber, C. C., & MNA-International Group (2009). Validation of the mini nutritional assessment short-form (MNA-SF): A practical tool for identification of nutritional status. The Journal of Nutrition, Health & Aging, 13(9), 782–788. https://doi.org/10.1007/s12603-009-0214-7
Kazdin, A. E. (2000). Encyclopedia of Psychology. American Psychological Association.
Khalid, H., Arif, S., Hashmat, A., & Farrukh, H. (2021). Psychiatric morbidity among informal caregivers of children suffering from intellectual developmental disorders. JPMA. The Journal of the Pakistan Medical Association, 71(8), 2005–2008. https://doi.org/10.47391/JPMA.20-584
Kumar, P., Chaudhary, R., Bhalla, J. K., & Mishra, B. P. (2021). Comparison of psychiatric morbidity and quality of life among caregivers of substance abusers. Annals of Indian Psychiatry, 5(2), 164-168.
Levav, I., & Rutz, W. (2002). The WHO World Health Report 2001 new understanding—new hope. The Israel journal of Psychiatry and Related Sciences, 39(1), 50–56.
Maridal, H. K., Bjørgaas, H. M., Hagen, K., Jonsbu, E., Mahat, P., Malakar, S., & Dørheim, S. (2021). Psychological Distress among Caregivers of Children with Neurodevelopmental Disorders in Nepal. International Journal of Environmental Research and Public Health, 18(5), 2460. https://doi.org/10.3390/ijerph18052460
Marimbe, B. D., Cowan, F., Kajawu, L., Muchirahondo, F., & Lund, C. (2016). Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe. African Journal of Disability, 5(1), 209. https://doi.org/10.4102/ajod.v5i1.209
Minichil, W., Getinet, W., & Kassew, T. (2021). Prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia: Cross-sectional study. PloS One, 16(12), e0261297. https://doi.org/10.1371/journal.pone.0261297
Molebatsi, K., Ndetei, D. M., & Opondo, P. R. (2017). Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study. Journal of Child and Adolescent Mental Health, 29(2), 117–127. https://doi.org/10.2989/17280583.2017.1340301
Ocansey, P. M., Kretchy, I. A., Aryeetey, G. C., Agyabeng, K., & Nonvignon, J. (2021). Anxiety, depression, and stress in caregivers of children and adolescents with mental disorders in Ghana and implications for medication adherence. Ghana Medical Journal, 55(3), 173–182. https://doi.org/10.4314/gmj.v55i3.1
Okewole, A., Dada, M. U., Ogun, O., Bello-Mojeed, M., & Usoh, T. (2011). Prevalence and correlates of psychiatric morbidity among caregivers of children and adolescents with neuropsychiatric disorders in Nigeria. African Journal of Psychiatry, 14(4), 306–309. https://doi.org/10.4314/ajpsy.v14i4.8
Olagunju, A. T., Oshodi, Y. O., Umeh, C. S., Aina, O. F., Oyibo, W. A., Lamikanra, A. E., ... & Adeyemi, J. D. (2017). Children with neurodevelopmental disorders: The burden and psychological effects on caregivers in Lagos, Nigeria. Journal of Clinical Sciences, 14(1), 2-7.
Otieno, M. (2013). The prevalence of depressive symptoms among caregivers of children with mental disorders drawn at Kenyatta National Hospital. http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/58678
Paruk, S., & Ramdhial, M. (2018). Prevalence of caregiver burden, depressive and anxiety symptoms in caregivers of children with psychiatric disorders in Durban, South Africa. South African Journal of Psychiatry, 24(1). https://doi.org/10.4102/sajpsychiatry.v24i0.1314
Rosa, W. E., & Hassmiller, S. B. (2020). The Sustainable Development Goals and Building a Culture of Health. The American journal of nursing, 120(6), 69–71. https://doi.org/10.1097/01.NAJ.0000668772.33792.1f
Sadock, B. J., & Sadock, V. A. (2008). Kaplan & Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.
Schulz, R., & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. The American journal of nursing, 108(9 Suppl), 23–27. https://doi.org/10.1097/01.NAJ.0000336406.45248.4c
Seaman, J. B., Terhorst, L., Gentry, A., Hunsaker, A., Parker, L. S., & Lingler, J. H. (2015). Psychometric Properties of a Decisional Capacity Screening Tool for Individuals Contemplating Participation in Alzheimer's Disease Research. Journal of Alzheimer's Disease, 46(1), 1–9. https://doi.org/10.3233/JAD-142559
Sharma, R., Singh, H., Murti, M., Chatterjee, K., & Rakkar, J. S. (2021). Depression and anxiety in parents of children and adolescents with intellectual disability. Industrial Psychiatry Journal, 30(2), 291–298. https://doi.org/10.4103/ipj.ipj_216_20
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). The Journal of Clinical Psychiatry, 71(3), 313–326. https://doi.org/10.4088/JCP.09m05305whi
Siddiqui, S., & Khalid, J. (2019). Determining the caregivers' burden in caregivers of patients with mental illness. Pakistan Journal of Medical Sciences, 35(5), 1329–1333. https://doi.org/10.12669/pjms.35.5.720
Stansfeld, S., Smuk, M., Onwumere, J., Clark, C., Pike, C., McManus, S., Harris, J., & Bebbington, P. (2014). Stressors and common mental disorder in informal carers—an analysis of the English adult psychiatric morbidity survey 2007. Social Science & Medicine, 120, 190–198. https://doi.org/10.1016/j.socscimed.2014.09.025
Udoh, E. E., Omorere, D. E., Sunday, O., Osasu, O. S., & Amoo, B. A. (2021). Psychological distress and burden of care among family caregivers of patients with mental illness in a neuropsychiatric outpatient clinic in Nigeria. PloS One, 16(5), e0250309. https://doi.org/10.1371/journal.pone.0250309
Unsar, S., Erol, O., & Ozdemir, O. (2021). Caregiving burden, depression, and anxiety in family caregivers of patients with cancer. European Journal of Oncology Nursing, 50, 101882. https://doi.org/10.1016/j.ejon.2020.101882
Zhou, T., Wang, Y., & Yi, C. (2018). Affiliate stigma and depression in caregivers of children with autism spectrum disorders in China: Effects of self-esteem, shame, and family functioning. Psychiatry Research, 264, 260–265. https://doi.org/10.1016/j.psychres.2018.03.071