Caregiver Burden and Its Socio-Clinical Correlates Among Primary Caregivers of Patients with Schizophrenia in Rural Areas Around Delhi-NCR: A Cross-Sectional Study from Community Health Centers in India

Abstract

Background

In rural India, families shoulder most caregiving responsibilities for schizophrenia amid high treatment gaps and limited services. Rural peripheries around Delhi-NCR face distinctive challenges from agricultural livelihoods and variable access to urban facilities. This study assessed caregiver burden using the Burden Assessment Schedule (BAS) and its socio-clinical correlates.

Methods

A cross-sectional community-based study recruited 160 primary caregivers of patients with schizophrenia (ICD-11, duration ≥1 year) from rural health centers and outreach camps in Sonipat and Jhajjar districts, Haryana (August 2025–January 2026). Burden was measured with the Hindi-validated 40-item BAS. Patient symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS)—multiple linear regression identified independent predictors of burden.

Results

The mean BAS score was 72.6 ± 15.8, with moderate-to-severe burden in 71.3% of caregivers. The highest-burden domains were the caregiver's physical/mental health (19.4 ± 4.3) and the caregiver’s routine (17.8 ± 4.1). Independent predictors included female caregiver gender (β=9.2, 95% CI 4.6–13.8, P<0.001), low education/agricultural occupation (β=8.1, 95% CI 3.4–12.8, P=0.001), illness duration >5 years (β=7.3, 95% CI 2.9–11.7, P=0.002), higher PANSS total score (β=0.35 per unit, 95% CI 0.21–0.49, P<0.001), and lower family income. Joint families reported a marginally lower burden.

Conclusion

Caregiver burden is alarmingly high in these rural Delhi-NCR areas, aligning with or exceeding recent Indian pooled estimates. Routine caregiver screening, gender-sensitive family psychoeducation, livelihood support, and integration into the District Mental Health Programme are urgently recommended.

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