Psychological Vulnerabilities, Caregiver Burden, and Social Support among Caregivers of Dialysis Patients in Pakistan

Abstract

Caregivers of dialysis patients experience considerable emotional, physical, and social strain arising from the prolonged demands of chronic illness management. This study examined psychological vulnerabilities (anxiety, depression, and caregiver burden) and perceived social support among informal caregivers of dialysis patients in Pakistan, guided by the Stress-Process Model. A quantitative cross-sectional survey design was employed with 182 informal caregivers recruited from tertiary care dialysis centres in Karachi, Lahore, and Islamabad. Data were collected using the Hospital Anxiety and Depression Scale (HADS), the Zarit Burden Interview (ZBI), and the Multidimensional Scale of Perceived Social Support (MSPSS), together with a demographic questionnaire. Data were analysed using descriptive statistics, Pearson correlation, independent-samples t-tests, one-way ANOVA, and hierarchical multiple regression. Results showed that 89.0% of caregivers reported at least borderline anxiety (M = 11.54, SD = 3.10) and 67.6% reported at least borderline depression (M = 9.06, SD = 2.86), while 41.2% reported moderate-to-severe or severe caregiver burden (M = 33.59, SD = 14.25). Perceived social support was moderate overall (M = 3.25, SD = 1.20) and was significantly negatively associated with anxiety (r = -.377, p < .001) but was unrelated to depression (r = .007, p = .927) and, unexpectedly, was positively associated with caregiver burden (r = .588, p < .001). Hierarchical regression confirmed social support as the strongest predictor of lower anxiety (β = -.298, p < .001) and, in the same final model, of higher burden (β = .488, p < .001) after controlling for sociodemographic and caregiving variables. Female and non-employed caregivers reported significantly greater burden, and caregivers with lower education reported significantly greater anxiety. The findings partly support the Stress-Process Model and point to the need for routine psychological screening, practical task-sharing support, and caregiver-inclusive policy within Pakistan's renal care services.