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Background <p>Informal caregivers play a vital role in the long-term community care of individuals with severe mental disorders but often face substantial psychological challenges. China’s national ‘686 Program’ offers free or subsidized medical treatment, follow-up care, and community-based services for people with severe mental disorders on an equitable basis. However, limited evidence exists regarding the mental health status of informal caregivers within this program. This study aimed to assess the prevalence of high caregiver burden, depression, and anxiety, and to identify associated factors among informal caregivers enrolled in the ‘686 Program’.</p> Methods <p>A cross-sectional study was conducted in Hainan Province, China, involving 284 informal caregivers recruited through multistage sampling. Data were collected via structured, face-to-face, in-home interviews between May and September 2024. Caregiver burden, depression, and anxiety were assessed using the 12-item Zarit Burden Interview (ZBI-12), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Binary logistic regression analyses—together with prespecified stratified and sensitivity analyses—were conducted to identify independent predictors of each outcome.</p> Results <p>Among the 284 participants, 63.7% experienced high caregiver burden, 11.6% met criteria for clinically significant depression, and 17.6% for clinically significant anxiety. Multivariate analysis showed that higher PANSS scores and greater social disability (SDSS) in care recipients were the most consistent predictors across outcomes. Depression was independently associated with being female, having a parental relationship to the patient, and caring for individuals with greater functional impairment; longer illness duration (≥ 11 years) was linked to lower risk. Anxiety was more likely among female caregivers and those supporting patients with more severe symptoms. Diagnostic heterogeneity did not materially alter these associations in sensitivity analyses.</p> Conclusion <p>Informal caregivers under China’s ‘686 Program’ experience high rates of burden, depression, and anxiety. Key associated factors include patient symptom severity, caregiver gender, and the caregiving relationship. By focusing on caregivers within a national mental health initiative, this study provides evidence to inform caregiver support strategies both in China and in similar global contexts pursuing community-based mental health reforms. These findings highlight that structural equity in patient services alone is insufficient unless caregiver needs are explicitly incorporated into system design.</p>

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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

  • 期刊论文

  • 发表日期：

    2026年1月29日

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  • Qiqing Liang,
  • Miao Xu,
  • Lei Qiu,
  • Yang Liu,
  • Ye Tian,
  • Xin Zuo,
  • Fenmei Qin,
  • Ying Wang,
  • Yumei Liu

摘要

Background

Informal caregivers play a vital role in the long-term community care of individuals with severe mental disorders but often face substantial psychological challenges. China’s national ‘686 Program’ offers free or subsidized medical treatment, follow-up care, and community-based services for people with severe mental disorders on an equitable basis. However, limited evidence exists regarding the mental health status of informal caregivers within this program. This study aimed to assess the prevalence of high caregiver burden, depression, and anxiety, and to identify associated factors among informal caregivers enrolled in the ‘686 Program’.

Methods

A cross-sectional study was conducted in Hainan Province, China, involving 284 informal caregivers recruited through multistage sampling. Data were collected via structured, face-to-face, in-home interviews between May and September 2024. Caregiver burden, depression, and anxiety were assessed using the 12-item Zarit Burden Interview (ZBI-12), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Binary logistic regression analyses—together with prespecified stratified and sensitivity analyses—were conducted to identify independent predictors of each outcome.

Results

Among the 284 participants, 63.7% experienced high caregiver burden, 11.6% met criteria for clinically significant depression, and 17.6% for clinically significant anxiety. Multivariate analysis showed that higher PANSS scores and greater social disability (SDSS) in care recipients were the most consistent predictors across outcomes. Depression was independently associated with being female, having a parental relationship to the patient, and caring for individuals with greater functional impairment; longer illness duration (≥ 11 years) was linked to lower risk. Anxiety was more likely among female caregivers and those supporting patients with more severe symptoms. Diagnostic heterogeneity did not materially alter these associations in sensitivity analyses.

Conclusion

Informal caregivers under China’s ‘686 Program’ experience high rates of burden, depression, and anxiety. Key associated factors include patient symptom severity, caregiver gender, and the caregiving relationship. By focusing on caregivers within a national mental health initiative, this study provides evidence to inform caregiver support strategies both in China and in similar global contexts pursuing community-based mental health reforms. These findings highlight that structural equity in patient services alone is insufficient unless caregiver needs are explicitly incorporated into system design.