Depression, anxiety and stress among caregivers of adolescents with cerebral palsy in rural Bangladesh

Abstract

Purpose

Prior studies indicate high risk of mental health problems among caregivers of adolescents with cerebral palsy although limited consideration is given to caregivers in low- and middle-income countries. This study aimed to compare the burden of depression, anxiety and stress among caregivers of adolescents with cerebral palsy to caregivers of adolescents without disability in rural Bangladesh; and to identify factors unique to low- and middle-income countries that predict caregiver’s mental health.

Methods

Observational study comparing caregivers of adolescents with cerebral palsy identified through the Bangladesh Cerebral Palsy Register and caregivers of adolescents without disability from neighboring dwellings. Caregiver mental health was assessed using the Depression, Anxiety and Stress Scale-21, adolescent mental health using the Strengths and Difficulties Questionnaire and adolescent health-related quality of life using Kidscreen-27. Hierarchical multivariable regression analysis was performed.

Results

Participants were 154 caregivers of adolescents with cerebral palsy and 173 caregivers of adolescents without disability, matched on adolescent age and sex. Caregivers of adolescents with cerebral palsy reported significantly higher risk of depression and stress than caregivers of adolescents without disability (Effect Size 0.1 to 0.2, p < 0.05) although no difference on anxiety. Caregiver age, adolescent mental health, household overcrowding and adolescent hearing impairment were significant predictors of depression, anxiety and/or stress (0.1 to 2.2, p < 0.05).

Conclusions

Caregivers of adolescents with cerebral palsy in rural Bangladesh are at high risk of depression and stress. Initiatives to improve caregiver mental health are required; we recommend initiatives address adolescent mental health problems and include poverty reduction measures to improve social and economic capital. Improved understanding of the factors predicting caregiver depression, anxiety and stress unique to low and middle-income countries are necessary to guide policies and public health infrastructure development.

Implications for rehabilitation

• Caregivers of adolescents with cerebral palsy in rural Bangladesh are at significantly higher risk of depression and stress than caregivers of adolescents without disability.

• We recommend interventions to improve caregiver mental health give specific consideration to older caregivers, those whose adolescent report mental health problems, families living in crowded households, and/or whose child has hearing impairment.

• We recommend interventions include poverty reduction measures to improve social and economic capital and target both caregivers and adolescents with CP to enhance long term outcomes.

Keywords:

• Cerebral palsy
• caregivers
• mental health
• adolescent
• Bangladesh
• developing countries

Acknowledgements

We acknowledge the CSF Global team in Bangladesh for their cordial support in implementing this project and supporting the families of adolescents with CP in referrals and access to services.

Author contributions

This study was conceived and designed by GK, MM and RP. EH, TK and GK made substantial contributions to the acquisition of data. RP conducted the statistical analysis with input from CG. MM, EH, TK, CG, NB, and GK made substantial contribution to the analysis of data and provided important intellectual content. RP wrote the first draft; all authors critically reviewed each draft. All authors approved the final manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and material

The datasets used and/or during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study has been supported by the Cerebral Palsy Alliance Research Institute Australia Project Grant (PG3615). RP is supported by the Cerebral Palsy Alliance Research Institute Career Development Fellowship (CDG04117). TK is supported by the Cerebral Palsy Alliance Research Institute Career Development Fellowship (CDG04617). GK is supported by the Cerebral Palsy Alliance Research Institute Career Development Fellowship (CDF0116). The study sponsor played no role in study design; collection, analysis, and interpretation of data; writing of the report; and in the decision to submit the paper for publication.