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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

Factors Affecting Caregiver Burden in Caregivers of Patients with Parkinson's Disease

Dong Won Kim1, Eun Sook Bae2
Korean Journal of Adult Nursing 2015;27(3):283-293.
Published online: June 30, 2015

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Corresponding author: Bae, Eun Sook Department of Nursing Science, Dong-Eui University, 995 Eomgwang-ro, Busanjin-gu, Busan 614-714, Korea. Tel: +82-51-890-2861, Fax: +82-505-182-6876, E-mail: baesukkr3966@deu.ac.kr
• Received: February 24, 2015   • Accepted: June 5, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Depression is a common sign of suffering among the patients with Parkinson's disease (PD). Frequent and severe neuropsychiatric symptoms lead to high levels of distress in patients and their caregivers, which results in the high levels of caregiver burden. The aim of this study was to determine the predictors of caregiver burden in caregivers of the patients with Parkinson's disease (PD).
  • Methods
    The study included 183 consecutive PD patients and their caregivers. Patients were assessed using the Hoehn and Yahr scale, Mini Mental State Examination (MMSE), Beck Depression Inventory (BDI), and Schwab and England Activities of Daily Living Scale. Caregivers’ depressive symptoms were evaluated using the Caregiver Burden Inventor (CBI), BDI, and World Health Organization Quality of Life Scale.
  • Results
    All of the patients reported one or more neuropsychiatric symptoms. Patients’ and caregivers' depressive symptoms, caregivers' age and education, time for caregiving, and quality of life were significantly associated with the increased caregiver burden. After controlling the level of education as a potential confounding variable, depression in both patients and caregivers, time for caregiving, and quality of life explained 45.6% of the variance in caregiver burden.
  • Conclusion
    Substantial attention needs to be given to the early identification of depression in PD patients and their caregivers to improve caregivers' quality of life and burden.
  • Key Words: Parkinson's disease; Caregivers; Depression; Quality of life; Burden
Table 1.
The General Characteristics of the Participants
Characteristics Categories Patient (N=183) Caregiver (N=183)
n (%) or M±SD n (%) or M±SD
Gender Female 120 (65.6) 86 (47.0)
Male 63 (34.4) 97 (53.0)
Age (year) M±SD 66.1±12.97 50.2±24.99
＜40 0 (0.0) 24 (13.1)
40~49 2 (1.1) 26 (14.2)
50~59 28 (15.3) 37 (20.2)
60~69 69 (37.7) 45 (24.6)
≥70 84 (45.9) 51 (27.9)
The level of education No schooling 11 (6.0) 4 (2.2)
Elementary school 53 (29.0) 25 (13.6)
Middle school 54 (29.5) 24 (13.1)
High school 40 (21.8) 62 (33.9)
≥College 25 (13.7) 68 (37.2)
Average monthly income (10,000 won) ≤50 79 (43.2) 0 (0.0)
51~100 26 (14.2) 39 (21.3)
101~150 16 (8.7) 27 (14.8)
151~200 13 (7.1) 26 (14.2)
201~250 17 (9.3) 16 (8.7)
≥251 32 (17.5) 75 (41.0)
Table 2.
The Disease-related Characteristics of the Patients (N=183)
Characteristics Categories n (%) or M±SD
Duration of having the illness (month) ＜12 15 (8..2)
13~36 44 (24.0)
37~72 53 (29.0)
73~108 25 (13.7)
109~144 28 (15.3)
≥145 18 (9.8)
Age of onset (year) 40~49 18 (9.8)
50~59 56 (30.6)
60~69 58 (31.7)
≥70 51 (27.9)
Caregiving time per day (hour) ＜3 107 (58.5)
3~6 29 (15.9)
7~10 6 (3.2)
≥11 41 (22.4)
Living together with Spouse 103 (56.3)
Son or daughter 26 (14.2)
No one 23 (12.5)
Spouse and children 31 (17.0)
Hoehn & Yahr stage M±SD 2.41±0.50
1 4 (2.2)
1.5 2 (1.1)
2 70 (38.3)
2.5 61 (33.3)
3 46 (25.1)
SE-ADL (%) M±SD 76.33±16.32
≤60 31 (16.9)
70 26 (14.2)
80 71 (38.8)
90 50 (27.3)
100 5 (2.7)

SE-ADL=Schwab & England activities of daily living.

Table 3.
The Descriptive Statistics of the Study Variables (N=183)
Variables M±SD Range
Patient's depression 16.52±9.90 0~63
Caregiver's depression 9.04±7.91 0~63
Caregiver's quality of life 79.57±13.42 1~130
Caregiver burden 61.32±15.93 1~125
Table 4.
Differences in Depression, Quality of Life and Burden by Caregiver's Characteristics (N=183)
Variables Categories Caregiver's depression Caregiver's quality of life Caregiver burden
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Caregiver gender Female 50.07±10.09 1.57 77.86±13.76 -1.62 51.76±17.67 0.34
Male 47.53±11.77 (.011) 81.09±13.00 (.106) 50.93±14.30 (.730)
Age (year) ＜40 5.43±7.13a 6.04 87.13±10.29a 3.74 43.71±12.82a 5.96
40~49 6.42±6.73b (＜.001) 82.46±10.11b (.006) 44.96±13.31a (＜.001)
50~59 6.68±6.08b a＜b 79.84±13.88b a＞b 48.08±13.76b a＜b
60~69 12.11±7.97b   75.18±12.12b   58.24±16.44b  
≥70 11.14±8.45b   78.24±12.59b   54.37±16.63b  
Education level Elementary school 13.48±8.98b 15.45 74.34±10.64b 11.92 58.00±14.78c 7.78
Middle school 15.83±8.47b (＜.001) 68.79±12.51b (＜.001) 60.88±17.05c (＜.001)
High school 7.48±5.37a a＜b 80.50±12.00a a＞b 50.05±15.22b a＜b, a＜c
College 6.22±7.09a   84.76±13.25a   46.25±14.43a  
Caregiving time (hrs/day) ＜3 7.08±7.18a 10.57 82.57±12.34 5.90 46.53±14.26a 11.24
3~6 8.03±5.64b (＜.001) 79.03±12.58 (.001) 53.66±13.84b (＜.001)
7~10 11.17±7.02b a＜b 74.17±10.18   52.00±9.75b a＜b
≥11 14.56±8.76b   72.93±14.79   67.05±16.95b  
H & Y stage 1 4.75±2.63 0.57 87.75±9.97 1.06 38.75±7.18 1.19
1.5 6.50±2.12 (.679) 94.50±30.40 (.376) 57.50±30.40 (.315)
2 8.66±6.89   79.71±13.27   51.50±16.79  
2.5 9.93±9.28   79.03±13.74   49.69±14.20  
3 8.93±7.84   78.72±12.76   54.02±16.58  
SE-ADL ≤60 10.03±8.07 0.26 77.48±12.01 1.02 59.45±19.62 2.59
70 8.50±8.44 (.897) 83.58±15.08 (.397) 49.85±10.36 (.038)
80 9.23±7.62   78.59±12.54   50.28±14.44  
90 8.66±8.31   79.70±14.52   48.64±15.91  
100 7.00±5.74   84.40±13.37   50.00±24.60  

H & Y stage=Hoehn & Yahr stage; SE-ADL=Schwab & England activities of daily living.

Table 5.
Factors Affecting Caregiver Burden by Multiple Regression Analysis (N=183
Variables B SE β t p
Caregiver's age 0.67 0.76 .05 0.87 .385
Caregiver's education level 0.40 1.01 .03 0.39 .694
Patient's depression 0.32 0.10 .20 3.05 .003
Time for caregiving 1.35 0.85 .11 1.56 .019
Caregiver's depression 0.66 0.15 .34 4.36 ＜.001
Caregiver's quality of life -0.27 0.08 -.23 -3.21 .002

R2=.486, Adjusted R2=.459, F=18.16, p＜.001

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    Factors Affecting Caregiver Burden in Caregivers of Patients with Parkinson's Disease
    Korean J Adult Nurs. 2015;27(3):283-293.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.283
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    Factors Affecting Caregiver Burden in Caregivers of Patients with Parkinson's Disease
    Korean J Adult Nurs. 2015;27(3):283-293.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.283
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    Factors Affecting Caregiver Burden in Caregivers of Patients with Parkinson's Disease
    Factors Affecting Caregiver Burden in Caregivers of Patients with Parkinson's Disease

    The General Characteristics of the Participants

    Characteristics Categories Patient (N=183) Caregiver (N=183)
    n (%) or M±SD n (%) or M±SD
    Gender Female 120 (65.6) 86 (47.0)
    Male 63 (34.4) 97 (53.0)
    Age (year) M±SD 66.1±12.97 50.2±24.99
    ＜40 0 (0.0) 24 (13.1)
    40~49 2 (1.1) 26 (14.2)
    50~59 28 (15.3) 37 (20.2)
    60~69 69 (37.7) 45 (24.6)
    ≥70 84 (45.9) 51 (27.9)
    The level of education No schooling 11 (6.0) 4 (2.2)
    Elementary school 53 (29.0) 25 (13.6)
    Middle school 54 (29.5) 24 (13.1)
    High school 40 (21.8) 62 (33.9)
    ≥College 25 (13.7) 68 (37.2)
    Average monthly income (10,000 won) ≤50 79 (43.2) 0 (0.0)
    51~100 26 (14.2) 39 (21.3)
    101~150 16 (8.7) 27 (14.8)
    151~200 13 (7.1) 26 (14.2)
    201~250 17 (9.3) 16 (8.7)
    ≥251 32 (17.5) 75 (41.0)

    The Disease-related Characteristics of the Patients (N=183)

    Characteristics Categories n (%) or M±SD
    Duration of having the illness (month) ＜12 15 (8..2)
    13~36 44 (24.0)
    37~72 53 (29.0)
    73~108 25 (13.7)
    109~144 28 (15.3)
    ≥145 18 (9.8)
    Age of onset (year) 40~49 18 (9.8)
    50~59 56 (30.6)
    60~69 58 (31.7)
    ≥70 51 (27.9)
    Caregiving time per day (hour) ＜3 107 (58.5)
    3~6 29 (15.9)
    7~10 6 (3.2)
    ≥11 41 (22.4)
    Living together with Spouse 103 (56.3)
    Son or daughter 26 (14.2)
    No one 23 (12.5)
    Spouse and children 31 (17.0)
    Hoehn & Yahr stage M±SD 2.41±0.50
    1 4 (2.2)
    1.5 2 (1.1)
    2 70 (38.3)
    2.5 61 (33.3)
    3 46 (25.1)
    SE-ADL (%) M±SD 76.33±16.32
    ≤60 31 (16.9)
    70 26 (14.2)
    80 71 (38.8)
    90 50 (27.3)
    100 5 (2.7)

    SE-ADL=Schwab & England activities of daily living.

    The Descriptive Statistics of the Study Variables (N=183)

    Variables M±SD Range
    Patient's depression 16.52±9.90 0~63
    Caregiver's depression 9.04±7.91 0~63
    Caregiver's quality of life 79.57±13.42 1~130
    Caregiver burden 61.32±15.93 1~125

    Differences in Depression, Quality of Life and Burden by Caregiver's Characteristics (N=183)

    Variables Categories Caregiver's depression Caregiver's quality of life Caregiver burden
    M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
    Caregiver gender Female 50.07±10.09 1.57 77.86±13.76 -1.62 51.76±17.67 0.34
    Male 47.53±11.77 (.011) 81.09±13.00 (.106) 50.93±14.30 (.730)
    Age (year) ＜40 5.43±7.13a 6.04 87.13±10.29a 3.74 43.71±12.82a 5.96
    40~49 6.42±6.73b (＜.001) 82.46±10.11b (.006) 44.96±13.31a (＜.001)
    50~59 6.68±6.08b a＜b 79.84±13.88b a＞b 48.08±13.76b a＜b
    60~69 12.11±7.97b   75.18±12.12b   58.24±16.44b  
    ≥70 11.14±8.45b   78.24±12.59b   54.37±16.63b  
    Education level Elementary school 13.48±8.98b 15.45 74.34±10.64b 11.92 58.00±14.78c 7.78
    Middle school 15.83±8.47b (＜.001) 68.79±12.51b (＜.001) 60.88±17.05c (＜.001)
    High school 7.48±5.37a a＜b 80.50±12.00a a＞b 50.05±15.22b a＜b, a＜c
    College 6.22±7.09a   84.76±13.25a   46.25±14.43a  
    Caregiving time (hrs/day) ＜3 7.08±7.18a 10.57 82.57±12.34 5.90 46.53±14.26a 11.24
    3~6 8.03±5.64b (＜.001) 79.03±12.58 (.001) 53.66±13.84b (＜.001)
    7~10 11.17±7.02b a＜b 74.17±10.18   52.00±9.75b a＜b
    ≥11 14.56±8.76b   72.93±14.79   67.05±16.95b  
    H & Y stage 1 4.75±2.63 0.57 87.75±9.97 1.06 38.75±7.18 1.19
    1.5 6.50±2.12 (.679) 94.50±30.40 (.376) 57.50±30.40 (.315)
    2 8.66±6.89   79.71±13.27   51.50±16.79  
    2.5 9.93±9.28   79.03±13.74   49.69±14.20  
    3 8.93±7.84   78.72±12.76   54.02±16.58  
    SE-ADL ≤60 10.03±8.07 0.26 77.48±12.01 1.02 59.45±19.62 2.59
    70 8.50±8.44 (.897) 83.58±15.08 (.397) 49.85±10.36 (.038)
    80 9.23±7.62   78.59±12.54   50.28±14.44  
    90 8.66±8.31   79.70±14.52   48.64±15.91  
    100 7.00±5.74   84.40±13.37   50.00±24.60  

    H & Y stage=Hoehn & Yahr stage; SE-ADL=Schwab & England activities of daily living.

    Factors Affecting Caregiver Burden by Multiple Regression Analysis (N=183

    Variables B SE β t p
    Caregiver's age 0.67 0.76 .05 0.87 .385
    Caregiver's education level 0.40 1.01 .03 0.39 .694
    Patient's depression 0.32 0.10 .20 3.05 .003
    Time for caregiving 1.35 0.85 .11 1.56 .019
    Caregiver's depression 0.66 0.15 .34 4.36 ＜.001
    Caregiver's quality of life -0.27 0.08 -.23 -3.21 .002

    R2=.486, Adjusted R2=.459, F=18.16, p＜.001
    Table 1. The General Characteristics of the Participants

    Table 2. The Disease-related Characteristics of the Patients (N=183)

    SE-ADL=Schwab & England activities of daily living.

    Table 3. The Descriptive Statistics of the Study Variables (N=183)

    Table 4. Differences in Depression, Quality of Life and Burden by Caregiver's Characteristics (N=183)

    H & Y stage=Hoehn & Yahr stage; SE-ADL=Schwab & England activities of daily living.

    Table 5. Factors Affecting Caregiver Burden by Multiple Regression Analysis (N=183

    R2=.486, Adjusted R2=.459, F=18.16, p＜.001

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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