{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T09:31:11Z","timestamp":1768987871493,"version":"3.49.0"},"reference-count":50,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T00:00:00Z","timestamp":1742428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Portuguese Foundation for Science and Technology","award":["UID\/01662"],"award-info":[{"award-number":["UID\/01662"]}]},{"name":"Portuguese Foundation for Science and Technology","award":["10566\/BI-M-ED_B2\/2023"],"award-info":[{"award-number":["10566\/BI-M-ED_B2\/2023"]}]},{"name":"Portuguese Foundation for Science and Technology","award":["10241\/BI-M-ED_B2\/2023"],"award-info":[{"award-number":["10241\/BI-M-ED_B2\/2023"]}]},{"DOI":"10.13039\/501100001871","name":"Cl\u00e1udia Brito and Beatriz Cepa","doi-asserted-by":"publisher","award":["UID\/01662"],"award-info":[{"award-number":["UID\/01662"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Cl\u00e1udia Brito and Beatriz Cepa","doi-asserted-by":"publisher","award":["10566\/BI-M-ED_B2\/2023"],"award-info":[{"award-number":["10566\/BI-M-ED_B2\/2023"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Cl\u00e1udia Brito and Beatriz Cepa","doi-asserted-by":"publisher","award":["10241\/BI-M-ED_B2\/2023"],"award-info":[{"award-number":["10241\/BI-M-ED_B2\/2023"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EJIHPE"],"abstract":"<jats:p>Alzheimer\u2019s disease (AD) places a profound global challenge, driven by its escalating prevalence and the multifaceted strain it places on individuals, families, and societies. Family caregivers (FCs), who are pivotal in supporting family members with AD, frequently endure substantial emotional, physical, and psychological demands. To better understand the determinants of family caregiving strain, this study employed machine learning (ML) to develop predictive models identifying factors that contribute to caregiver burden over time. Participants were evaluated across sociodemographic clinical, psychophysiological, and psychological domains at baseline (T1; N = 130), six months (T2; N = 114), and twelve months (T3; N = 92). Results revealed three distinct risk profiles, with the first focusing on T2 data, highlighting the importance of distress, forgiveness, age, and heart rate variability. The second profile integrated T1 and T2 data, emphasizing additional factors like family stress. The third profile combined T1 and T2 data with sociodemographic and clinical features, underscoring the importance of both assessment moments on distress at T2 and forgiveness at T1 and T2, as well as family stress at T1. By employing computational methods, this research uncovers nuanced patterns in caregiver burden that conventional statistical approaches might overlook. Key drivers include psychological factors (distress, forgiveness), physiological markers (heart rate variability), contextual stressors (familial dynamics, sociodemographic disparities). The insights revealed enable early identification of FCs at higher risk of burden, paving the way for personalized interventions. Such strategies are urgently needed as AD rates rise globally, underscoring the imperative to safeguard both patients and the caregivers who support them.<\/jats:p>","DOI":"10.3390\/ejihpe15030041","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T07:59:54Z","timestamp":1742457594000},"page":"41","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk Assessment Profiles for Caregiver Burden in Family Caregivers of Persons Living with Alzheimer\u2019s Disease: An Exploratory Study with Machine Learning"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5564-5231","authenticated-orcid":false,"given":"Laura","family":"Brito","sequence":"first","affiliation":[{"name":"Psychology Research Centre, School of Psychology, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7850-5621","authenticated-orcid":false,"given":"Beatriz","family":"Cepa","sequence":"additional","affiliation":[{"name":"INESC TEC, 4200-465 Porto, Portugal"},{"name":"Department of Informatics, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4293-9887","authenticated-orcid":false,"given":"Cl\u00e1udia","family":"Brito","sequence":"additional","affiliation":[{"name":"INESC TEC, 4200-465 Porto, Portugal"},{"name":"Department of Informatics, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0560-1756","authenticated-orcid":false,"given":"\u00c2ngela","family":"Leite","sequence":"additional","affiliation":[{"name":"Centre for Philosophical and Humanistic Studies, Portuguese Catholic University, 4710-362 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7987-2562","authenticated-orcid":false,"given":"M. Gra\u00e7a","family":"Pereira","sequence":"additional","affiliation":[{"name":"Psychology Research Centre, School of Psychology, University of Minho, 4710-057 Braga, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Abulaiti, B., Zhang, X., Guan, T., Wang, M., Jia, S., and Wang, A. (2022). The dyadic care experiences of elderly individuals with disabilities and caregivers in the home setting from the perspective of family resilience: A qualitative study. Frontiers in Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.963101"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1093\/ageing\/afz128","article-title":"Informal caregiving for dementia patients: The contribution of patient characteristics and behaviours to caregiver burden","volume":"49","author":"Allen","year":"2020","journal-title":"Age and Ageing"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11920-019-1049-5","article-title":"Management of behavioral and psychological symptoms of dementia","volume":"21","author":"Bessey","year":"2019","journal-title":"Current Psychiatry Reports"},{"key":"ref_4","unstructured":"Bintamur, D. F. (, January May). The association between forgiveness and life satisfaction. 1st International Conference on Psychology, Banda Aceh, Indonesia."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.jagp.2020.04.010","article-title":"Anticipating and mitigating the impact of the COVID-19 pandemic on Alzheimer\u2019s disease and related dementias","volume":"28","author":"Brown","year":"2020","journal-title":"The American Journal of Geriatric Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1111\/jgs.16644","article-title":"Facing dementia during the COVID-19 outbreak","volume":"68","author":"Canevelli","year":"2020","journal-title":"Journal of the American Geriatrics Society"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7726","DOI":"10.34119\/bjhrv4n2-309","article-title":"Impactos na qualidade de vida de cuidadores de idosos portadores de Alzheimer\/Impacts on the quality of life of caregivers of elderly people with Alzheimer\u2019s","volume":"4","author":"Costa","year":"2021","journal-title":"Brazilian Journal of Health Review"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Damian, A. C., Mih\u0103ilescu, A. I., Anghele, C., Ciobanu, C. A., Petrescu, C., Riga, S., Dionisie, V., and Ciobanu, A. M. (2023). Quality of life predictors in a group of informal caregivers during the COVID-19 pandemic. Medicina, 59, (8).","DOI":"10.3390\/medicina59081486"},{"key":"ref_9","unstructured":"Elite HRV (2024, January 12). CorSense heart rate variability finger sensor by Elite HRV, Available online: https:\/\/elitehrv.com\/corsense."},{"key":"ref_10","first-page":"1","article-title":"Analyzing the situation of older family caregivers with a focus on health-related quality of life and pain: A cross-sectional cohort study","volume":"18","author":"Wranker","year":"2020","journal-title":"Health and Quality of Life Outcomes"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gaspar, T., Raimundo, M., Borges, S., Barata, M., and Cabrita, T. (2023). Relationship between burden, quality of life and difficulties of informal primary caregivers in the context of the COVID-19 pandemic: Analysis of the contributions of public policies. International Journal of Environmental Research and Public Health, 20, (6).","DOI":"10.3390\/ijerph20065205"},{"key":"ref_12","unstructured":"Grupo de Investiga\u00e7\u00e3o em Sa\u00fade & Fam\u00edlia [Health & Family Research Group] (2023). Health behaviors questionnaire for informal caregivers of Alzheimer\u2019s disease patients: Validation of portuguese research version, School of Psychology, University of Minho."},{"key":"ref_13","first-page":"5515","article-title":"Informal care in times of a public health crisis: Objective burden, subjective burden and quality of life of caregivers in the Netherlands during the COVID-19 pandemic","volume":"30","author":"Bremmers","year":"2022","journal-title":"Health & Social Care in the Community"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1037\/tra0000793","article-title":"Impact of COVID-19 pandemic restrictions on community-dwelling caregivers and persons with dementia","volume":"12","author":"Greenberg","year":"2020","journal-title":"Psychological Trauma: Theory, Research, Practice, and Policy"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"H\u00e4iki\u00f6, K., Cloutier, D., and Rugk\u00e5sa, J. (2020). Is health literacy of family carers associated with carer burden, quality of life, and time spent on informal care for older persons living with dementia?. PLoS ONE, 15, (11).","DOI":"10.1371\/journal.pone.0241982"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hellis, E., and Mukaetova-Ladinska, E. B. (2023). Informal caregiving and Alzheimer\u2019s disease: The psychological effect. Medicina, 59, (1).","DOI":"10.3390\/medicina59010048"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1348\/014466505X29657","article-title":"The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample","volume":"44","author":"Henry","year":"2005","journal-title":"British Journal of Clinical Psychology"},{"key":"ref_18","unstructured":"Hudson, W. (1993). The walmyr assessment scales scoring manual: Index of family relations, Walmyr Publishing Company. [1st ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.gerinurse.2021.02.006","article-title":"Heart-focused breathing and perceptions of burden in Alzheimer\u2019s caregivers: An online randomized controlled pilot study","volume":"42","author":"James","year":"2021","journal-title":"Geriatric Nursing"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s11126-020-09759-w","article-title":"The relationship between basic hope and depression: Forgiveness as a mediator","volume":"91","author":"Kaleta","year":"2020","journal-title":"Psychiatric Quarterly"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"235","DOI":"10.30773\/pi.2017.08.17","article-title":"Stress and heart rate variability: A meta-analysis and review of the literature","volume":"15","author":"Kim","year":"2018","journal-title":"Psychiatry Investigation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/her\/cyae005","article-title":"The effect of mindfulness-based compassionate living training for informal caregivers of palliative inpatients on burnout and caregiving burden: A randomized controlled trial","volume":"39","author":"Cengiz","year":"2024","journal-title":"Health Education Research"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-021-11022-1","article-title":"Factors associated with informal caregiving and its effects on health, work, and social activities of adult informal caregivers in Malaysia: Findings from the national health and morbidity survey 2019","volume":"21","author":"Kong","year":"2021","journal-title":"BMC Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1089\/jpm.2020.0521","article-title":"Holding onto hurt: The prevalence of interpersonal hurt and need for forgiveness-focused solutions for hospice family caregivers","volume":"24","author":"Levy","year":"2021","journal-title":"Journal of Palliative Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1136\/bmjspcare-2020-002242","article-title":"Impact of dementia on informal care: A systematic review of family caregivers\u2019 perceptions","volume":"14","author":"Lindeza","year":"2020","journal-title":"BMJ Supportive & Palliative Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"593","DOI":"10.11622\/smedj.2021033","article-title":"Caregiver burden and its prevalence, measurement scales, predictive factors and impact: A review with an Asian perspective","volume":"63","author":"Loo","year":"2022","journal-title":"Singapore Medical Journal"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"L\u00f3pez, J., Serrano, M. I., Gim\u00e9nez, I., and Noriega, C. (2021). Forgiveness interventions for older adults: A review. Journal of Clinical Medicine, 10, (9).","DOI":"10.3390\/jcm10091866"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behaviour Research and Therapy"},{"key":"ref_29","first-page":"1","article-title":"Risk, resilience, and the two-track model of dementia grief among spouses of people living with cognitive decline","volume":"9","author":"Manevich","year":"2023","journal-title":"Gerontology & Geriatric Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1080\/15528030.2021.1934771","article-title":"Caring for a family member with early stage Alzheimer\u2019s disease: Caregiver perceptions, connections, and relational dynamics with the sacred","volume":"34","author":"McGee","year":"2021","journal-title":"Journal of Religion, Spirituality & Aging"},{"key":"ref_31","first-page":"22","article-title":"Characterization of patients with early vs. late-onset Alzheimer\u2019s dementia","volume":"45","year":"2020","journal-title":"Acta M\u00e9dica Colombiana"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1212\/WNL.43.11.2412-a","article-title":"The clinical dementia rating (CDR): Current version and scoring rules","volume":"43","author":"Morris","year":"1993","journal-title":"Neurology"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Nemcikova, M., Katreniakova, Z., and Nagyova, I. (2023). Social support, positive caregiving experience, and caregiver burden in informal caregivers of older adults with dementia. Frontiers in Public Health, 11.","DOI":"10.3389\/fpubh.2023.1104250"},{"key":"ref_34","unstructured":"Organization for Economic Co-Operation and Development [OECD] (2021). Health at a glance 2021: OECD indicators, OECD Publishing."},{"key":"ref_35","doi-asserted-by":"crossref","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":"The gerontologist"},{"key":"ref_36","unstructured":"Pereira, M. G., and Pedras, S. (2009). Lifestyle questionnaire (research version), School of Psychology, University of Minho. Group Studies on Family Health & Illness."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.jagp.2019.02.005","article-title":"Influence of positive and negative dimensions of dementia caregiving on caregiver well-being and satisfaction with life: Findings from the IDEAL study","volume":"27","author":"Quinn","year":"2019","journal-title":"The American Journal of Geriatric Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1080\/08870446.2018.1545906","article-title":"Meta-analytic connections between forgiveness and health: The moderating effects of forgiveness-related distinctions","volume":"34","author":"Rasmussen","year":"2019","journal-title":"Psychology & Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e12579","DOI":"10.1111\/spc3.12579","article-title":"Supervised machine learning methods in psychology: A practical introduction with annotated R code","volume":"15","author":"Rosenbusch","year":"2021","journal-title":"Social and Personality Psychology Compass"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103952","DOI":"10.1016\/j.archger.2019.103952","article-title":"Mediating effect of social support on the relationship between resilience and burden in caregivers of people with dementia","volume":"86","author":"Ruisoto","year":"2020","journal-title":"Archives of Gerontology and Geriatrics"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/17538157.2021.1988955","article-title":"Predicting the burden of family caregivers from their individual characteristics","volume":"47","author":"So","year":"2021","journal-title":"Informatics for Health and Social Care"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"So\u0142tys, A., and Tyburski, E. (2020). Predictors of mental health problems in formal and informal caregivers of patients with Alzheimer\u2019s disease. BMC Psychiatry, 20, (1).","DOI":"10.1186\/s12888-020-02822-7"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Strelan, P. (2020). The stress-and-coping model of forgiveness: Theory, research, and the potential of dyadic coping. Handbook of forgiveness, Routledge.","DOI":"10.4324\/9781351123341-7"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1467-6494.2005.00311.x","article-title":"Dispositional forgiveness of self, others, and situations","volume":"73","author":"Thompson","year":"2005","journal-title":"Journal of Personality"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-021-02007-1","article-title":"Predictors of caregiver burden in aged caregivers of demented older patients","volume":"21","author":"Tsai","year":"2021","journal-title":"BMC Geriatrics"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1080\/01612840.2019.1705945","article-title":"Caregiver burden, quality of life and related factors in family caregivers of dementia patients in Turkey","volume":"41","author":"Tulek","year":"2020","journal-title":"Issues in Mental Health Nursing"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/psyg.12930","article-title":"Factors associated with health-related quality of life of informal caregivers of older patients and the mediating role of subjective caregivers\u2019 burden","volume":"23","author":"Vrettos","year":"2023","journal-title":"Psychogeriatrics"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Witten, I. H., Frank, E., and Hall, M. A. (2011). Chapter 11\u2014The explorer. Data mining: Practical machine learning tools and techniques, Morgan Kaufmann. [3rd ed.]. The Morgan Kaufmann Series in Data Management Systems.","DOI":"10.1016\/B978-0-12-374856-0.00011-0"},{"key":"ref_49","unstructured":"Zarit, S. H., and Zarit, J. M. (1983). The memory and behavior problems checklist and the burden interview, Pennsylvania State University, Gerontology Center."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1159\/000523846","article-title":"Gender differences in mental health, quality of life, and caregiver burden among informal caregivers during the second wave of the COVID-19 pandemic in Germany: A representative, population-based study","volume":"69","author":"Zwar","year":"2023","journal-title":"Gerontology"}],"container-title":["European Journal of Investigation in Health, Psychology and Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2254-9625\/15\/3\/41\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:57:00Z","timestamp":1760029020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2254-9625\/15\/3\/41"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,20]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["ejihpe15030041"],"URL":"https:\/\/doi.org\/10.3390\/ejihpe15030041","relation":{},"ISSN":["2254-9625"],"issn-type":[{"value":"2254-9625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,20]]}}}