{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:11:45Z","timestamp":1793121105359,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Informal caregiving plays a vital role in supporting dependent individuals; however, prolonged caregiving is associated with significant physical and psychological strain. Understanding factors associated with caregiver burden is essential for designing effective interventions to protect caregiver health and sustain long-term care systems.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the associations between psychological, physical, and contextual factors on caregiver burden and to identify variables independently associated with caregiver burden.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional study was conducted with 73 informal caregivers of people living with dementia or cerebral palsy who required substantial assistance in daily living. Standardized instruments were used to assess caregiver burden (Zarit Burden Interview), anxiety and depression (HADS), mental health and quality of life (SF-36), pain (VAS), and physical activity (IPAQ). Hierarchical multiple regression, mediation, and moderation analyses were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mental health and anxiety showed the strongest independent associations of caregiver burden (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.396,\n p<\/jats:italic>\n \u202f=\u202f0.002;\n \u03b2<\/jats:italic>\n \u202f=\u202f0.243,\n p<\/jats:italic>\n \u202f=\u202f0.049, respectively), followed by musculoskeletal pain in the back and lower limbs. Patient-related variables, such as functional dependence or disability, were not directly associated with burden. Mediation analysis showed that mental health did not mediate the dependence-burden link. Moderation analysis did not reveal a statistically significant interaction effect. The final model explained over 60% of the variance in caregiver burden.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Caregiver mental health is a key determinant of perceived burden of caring for people with dementia and cerebral palsy, exerting a stronger influence than patient dependence or physical demands. Interventions should integrate psychological screening and mental health support to prevent caregiver distress and ensure a sustainable informal care.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1757413","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:41:58Z","timestamp":1772602918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Mental health of caregivers for people with dementia and cerebral palsy as a key determinant of caregiver burden: a multivariable analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Alba","family":"S\u00e1nchez-Gil","sequence":"first","affiliation":[{"name":"National Centre of Reference for People with Alzheimer\u2019s Disease and Other Dementias","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Calleja-Caballero","sequence":"additional","affiliation":[{"name":"Departamento de Enfermer\u00eda y Fisioterapia, Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca (IBSAL), Universidad de Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1tima","family":"P\u00e9rez-Robledo","sequence":"additional","affiliation":[{"name":"Departamento de Enfermer\u00eda y Fisioterapia, Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca (IBSAL), Universidad de Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Mart\u00edn-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Departamento de Enfermer\u00eda y Fisioterapia, Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca (IBSAL), Universidad de Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Rodr\u00edguez-Lorenzo","sequence":"additional","affiliation":[{"name":"Master\u2019s Degree in Intervention for People with Alzheimer\u2019s Disease, Faculty of Medicine, University of Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Mart\u00ednez-Romo","sequence":"additional","affiliation":[{"name":"Master\u2019s Degree in Intervention for People with Alzheimer\u2019s Disease, Faculty of Medicine, University of Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"P\u00e9rez-Saez","sequence":"additional","affiliation":[{"name":"National Centre of Reference for People with Alzheimer\u2019s Disease and Other Dementias","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Manuel","family":"Rodr\u00edguez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda y Fisioterapia, Universidad de Castilla-La Mancha","place":["Toledo, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Rivera-Pic\u00f3n","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda y Fisioterapia, Universidad de Castilla-La Mancha","place":["Talavera de la Reina, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Perez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina, Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca (IBSAL), Universidad de Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Luis","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina, Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca (IBSAL), Universidad de Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1186\/s12877-023-04371-6","article-title":"Association between multimorbidity and informal long-term care use in China: a nationwide cohort study","volume":"23","author":"Chen","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1017\/S0021932021000742","article-title":"Cross-national data on informal caregivers of older people with long-term care needs in the European population: time for a more coordinated and comparable approach","volume":"55","author":"Tur-Sinai","year":"2023","journal-title":"J Biosoc Sci"},{"key":"ref3","article-title":"Health at a glance 2023. OECD indicators","year":"2023"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e575","DOI":"10.1093\/pubmed\/fdae028","article-title":"Unveiling the unseen: informal caregivers as pillars of healthcare systems","volume":"46","author":"Lacsa","year":"2024","journal-title":"J Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"731","DOI":"10.3390\/healthcare13070731","article-title":"Stress as a risk factor for informal caregiver burden","volume":"13","author":"Cejalvo","year":"2025","journal-title":"Healthcare"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1186\/s12889-024-18321-3","article-title":"The impact of caregiver burden on quality of life in family caregivers of patients with advanced cancer: a moderated mediation analysis of the role of psychological distress and family resilience","volume":"24","author":"Cui","year":"2024","journal-title":"BMC Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1186\/s12888-024-06239-4","article-title":"Caregiving burden, depression, and anxiety in informal caregivers of people with mental illness in China: a cross-sectional survey","volume":"24","author":"Yao","year":"2024","journal-title":"BMC Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1093\/geront\/30.5.583","article-title":"Caregiving and the stress process: an overview of concepts and their measures","volume":"30","author":"Pearlin","year":"1990","journal-title":"Gerontologist"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1186\/s12877-023-04358-3","article-title":"Factors associated with subjective burden among informal caregivers of home-dwelling people with dementia: a cross-sectional study","volume":"23","author":"Steinsheim","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e065215","DOI":"10.1136\/bmjopen-2022-065215","article-title":"Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review","volume":"13","author":"Liu","year":"2023","journal-title":"BMJ Open"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s10880-024-10052-2","article-title":"The impact of caregiving on informal caregivers of people with dementia: family functioning, burden, and burnout","volume":"32","author":"Brites","year":"2025","journal-title":"J Clin Psychol Med Settings"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1186\/s12877-024-05221-9","article-title":"Caregiver burden, mental health, quality of life and self-efficacy of family caregivers of persons with dementia in Malaysia: baseline results of a psychoeducational intervention study","volume":"24","author":"Nasreen","year":"2024","journal-title":"BMC Geriatr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e12341","DOI":"10.1111\/opn.12341","article-title":"Life-space mobility in dementia patients and family caregivers: a dyadic approach","volume":"15","author":"Chung","year":"2020","journal-title":"Int J Older People Nursing"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"80","DOI":"10.14744\/bauh.2025.73792","article-title":"Exploring the impact of caregiving on musculoskeletal health: insights from caregivers of children with cerebral palsy","volume":"3","author":"A\u015f\u0131k","year":"2025","journal-title":"BAU Health Innov"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1482011","DOI":"10.3389\/fpubh.2025.1482011","article-title":"The level and factors associated with caregiver experience among parents of children with cerebral palsy: a cross-sectional study in Southwest China","volume":"13","author":"Zhong","year":"2025","journal-title":"Front Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1186\/s12889-025-21679-7","article-title":"Care burden and quality of life among family caregivers of children with cerebral palsy in China: the mediating roles of social support and coping styles","volume":"25","author":"Liu","year":"2025","journal-title":"BMC Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects","volume":"79","year":"2001","journal-title":"Bull World Health Organ"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1093\/geront\/20.6.649","article-title":"Relatives of the impaired elderly: correlates of feelings of burden","volume":"20","author":"Zarit","year":"1980","journal-title":"Gerontologist"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International physical activity questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1017\/S1368980010000157","article-title":"The international physical activity questionnaire modified for the elderly: aspects of validity and feasibility","volume":"13","author":"Hurtig-Wennl\u00f6f","year":"2010","journal-title":"Public Health Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1111\/j.1365-2702.2005.01121.x","article-title":"Pain: a review of three commonly used pain rating scales","volume":"14","author":"Williamson","year":"2005","journal-title":"J Clin Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.jpain.2005.09.011","article-title":"Pain interference in persons with spinal cord injury: classification of mild, moderate, and severe pain","volume":"7","author":"Hanley","year":"2006","journal-title":"J Pain"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1111\/j.1526-4637.2012.01471.x","article-title":"Defining mild, moderate, and severe pain in persons with multiple sclerosis","volume":"13","author":"Alschuler","year":"2012","journal-title":"Pain Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med Care"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1157\/13074369","article-title":"El cuestionario de salud SF-36 Espa\u00f1ol: una d\u00e9cada de experiencia y nuevos desarrollos","volume":"19","author":"Vilagut","year":"","journal-title":"Gac Sanit"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/S1134-282X(02)77506-4","article-title":"Validez del cuestionario de calidad de vida SF-36 como indicador de resultados de procedimientos m\u00e9dicos y quir\u00fargicos","volume":"17","author":"Ruiz De Velasco","year":"2002","journal-title":"Rev Calidad Asistencial"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"59","DOI":"10.18621\/eurj.1292729","article-title":"Fibromyalgia syndrome in mothers of children with cerebral palsy and its relationship with caregiver burden: a cross-sectional study","volume":"10","author":"Aykurt Karlibel","year":"2024","journal-title":"Eur Res J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s12875-023-01985-y","article-title":"Psychosocial factors and caregiver burden among primary family caregivers of frail older adults with multimorbidity","volume":"24","author":"Chan","year":"2023","journal-title":"BMC Prim Care"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1017\/S1041610210001225","article-title":"Predictors of subjective and objective caregiving burden in older female caregivers of adults with intellectual disabilities","volume":"23","author":"Chou","year":"2011","journal-title":"Int Psychogeriatr"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"21501319241288029","DOI":"10.1177\/21501319241288029","article-title":"Burden of care, depression, and anxiety among family caregivers of people with dementia","volume":"15","author":"Abdelhalim","year":"2024","journal-title":"J Prim Care Community Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1111\/jocn.15683","article-title":"Determinants of caregiving burden among informal caregivers of adult care recipients with chronic illness","volume":"30","author":"Rodr\u00edguez-Gonz\u00e1lez","year":"2021","journal-title":"J Clin Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1177\/2049463720925110","article-title":"Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography","volume":"15","author":"Smith","year":"2021","journal-title":"Br J Pain"},{"key":"ref34","article-title":"Global action plan on the public health response to dementia 2017\u20132025","year":"2017"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1757413\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:42:01Z","timestamp":1772602921000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1757413\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":34,"alternative-id":["10.3389\/fpubh.2026.1757413"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1757413","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]},"article-number":"1757413"}}