Gendered Caregiver Burden and Coping Strategies in Community Mental Health: Evidence From Peru

Gendered Caregiver Burden and Coping Strategies in Community Mental Health: Evidence From Peru | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gendered Caregiver Burden and Coping Strategies in Community Mental Health: Evidence From Peru Manuel Jesus Ortega Zea, Maria Luisa Huamaní Valderrama, Danna Samantha Cuba Serrudo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9138880/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Emotional burden in family caregivers of people with severe mental disorders is a public health problem that affects the quality of life of patients and caregivers. Although coping strategies have been described as potential modulators of the burden, their effectiveness in low-resource community settings remains largely unexplored. This study analyzed the relationship between emotional overload and coping in caregivers of patients treated at a Community Mental Health Center in Cusco in 2025. An observational, analytical, cross-sectional, correlational, non-experimental design was applied to a sample of 150 primary caregivers (90% women; mean age = 40 years), selected for convenience. Overload was assessed using the Zarit Scale and coping strategies using the COPE Inventory, both adapted to the Peruvian context. Analyses included descriptive statistics, nonparametric associations, and multivariate models to assess the role of gender and coping. The results showed that 74% of caregivers experienced moderate or severe overload, with a predominance of problem-focused coping. No significant correlations were identified between coping style and level of burden, while gender emerged as a relevant predictor: women reported higher levels of burden than men. It is concluded that emotional burden persists regardless of coping style, highlighting the weight of structural and gender factors. These findings guide the design of multicomponent interventions in Community Mental Health Centers, with gender-sensitive protocols that integrate family psychoeducation, respite networks, and coordination with community organizations to reduce caregiver burden. Caregiver burden Coping strategies Family caregivers Severe mental disorders Community mental health INTRODUCTION Serious mental disorders such as schizophrenia and bipolar disorder generate substantial disability and impose a significant burden on family caregivers, who assume central roles in treatment adherence, emotional support, and daily management (Khatoon et al., 2021; Marzban et al., 2024; Wan & Wong, 2019). Evidence consistently shows that chronic mental illnesses affect not only patients but also caregivers, who frequently experience stress, fatigue, sleep disturbances, depressive symptoms, interpersonal conflicts, and financial strain (Kargar et al., 2021; Namlı et al., 2023; Özdemir & Gençarslan Özbaş, 2024). This burden includes both objective disruptions in daily functioning and subjective perceptions of exhaustion, guilt, or isolation (Abbaslou et al., 2023; Girdhar & Patil, 2023; Karambelas et al., 2022; Mora-Castañeda et al., 2023). Coping strategies have been identified as potential modulators of caregiver burden. Based on Lazarus and Folkman’s transactional model, coping is conceptualized as cognitive and behavioral efforts to manage stress, typically categorized into problem-focused and emotion-focused strategies (Mora-Castañeda et al., 2023; Carver et al., 1989). While active strategies such as planning or seeking support may reduce distress, emotion-focused or avoidance strategies may intensify it (Mohamed et al., 2023; Sharif et al., 2020; Thomas et al., 2019). However, recent studies highlight that coping effectiveness is shaped by structural, social, and cultural factors, including socioeconomic constraints, caregiving demands, and available support networks (Zhou et al., 2021; Daliri et al., 2024; Al-Dowsari & Khatabeh, 2023). Longitudinal evidence further suggests that coping and burden evolve over time, influenced by adaptation processes and contextual resources (Mora-Castañeda et al., 2023). In Peru, the expansion of Community Mental Health Centers (CMHCs) has increased the role of families in long-term care, particularly in contexts where institutional support remains limited and stigma persists (Iseselo et al., 2016; Ndlovu & Mokwena, 2023; Sharma et al., 2017). Despite this, research on caregiver burden and coping in Peruvian community settings remains scarce, and most international evidence comes from high-income countries (Marimbe et al., 2016; Kafle & Bagale, 2021; Rao et al., 2023). Additionally, gender inequalities—especially women’s disproportionate caregiving responsibilities and time poverty—may intensify burden and shape coping repertoires (Arriagada, 2007). In Andean contexts, practices of reciprocity such as ayni and extended family networks may also influence caregiving dynamics (Curran, 2020). This study examines the relationship between emotional burden and coping strategies among caregivers of individuals with mental disorders receiving services at a CMHC in Cusco. It also evaluates the moderating role of gender. Based on prior evidence, we hypothesized that (1) no significant associations would be found between coping styles and burden, and (2) female caregivers would report higher burden regardless of coping strategies. METHODOLOGY Design and participants A cross-sectional, analytical, correlational, non-experimental design was used. Participants were 150 family caregivers of individuals receiving services at a CMHC in Cusco during the first half of 2025. Inclusion criteria were: age ≥ 18, direct kinship with the patient, continuous caregiving, and voluntary participation. A non-probabilistic convenience sampling method was applied. Instruments Emotional burden Assessed using the 13-item Zarit Caregiver Burden Scale validated in Peru (Boluarte-Carbajal et al., 2022). The scale shows a unidimensional structure, adequate convergent validity, and good internal consistency (ω = 0.871). Coping strategies Measured with the COPE Inventory (Carver et al., 1989), adapted to Peru by Cano & Kristel (2019). It includes 44 items grouped into problem-focused and emotion-focused coping. Reliability was high (ω = 0.96). Internal consistency in this study was acceptable: α = 0.78 (Zarit), α = 0.77 (problem-focused coping), and α = 0.70 (emotion-focused coping). Procedure Data were collected in person at the CMHC. Participants provided written informed consent. Instruments were administered individually in private rooms. Data analysis Analyses were conducted using SPSS 26. Descriptive statistics were computed. Due to non-normal distributions (Kolmogorov–Smirnov p < .05), Spearman correlations were used. Multiple linear regression examined predictors of continuous burden scores, and ordinal logistic regression predicted burden levels (mild, moderate, severe). Gender-stratified analyses assessed robustness. Ethical aspects Informed consent was obtained from all participants, highlighting the voluntary nature of participation and their right to withdraw at any time without consequences. Confidentiality and anonymity were ensured through the use of coded data, avoiding any form of personal identification. RESULTS Sociodemographic characteristics of the sample The sample consisted of 150 family caregivers, of whom 90% were women (n = 135) and 10% were men (n = 15). The mean age was 40 years (M = 40.0; SD = 8.6), with a predominance of participants over 40 years of age (65%, n = 98). Regarding kinship, mothers represented the largest group (55%, n = 83), followed by spouses (30%, n = 45) and adult children (15%, n = 22) (Table 1 ). Table 1 Sociodemographic Data of Caregivers Sociodemographic Variable N % Gender Male 15 10 Female 135 90 Age ≤ 40 52 35 > 40 98 65 Relantionship to patient Mothers 83 55 Spouses 45 30 Adult children 22 15 Descriptive data for the variables The Kolmogorov–Smirnov test indicated that the main variables did not follow a normal distribution: emotional burden (K–S = 0.08, p = .02), problem-focused coping (K–S = 0.15, p < .001), and emotion-focused coping (K–S = 0.15, p < .001). Accordingly, non-parametric procedures were applied for the association analyses (Table 2 ). Table 2 Normality test Variable K-S (Statistic) gl p-value Skewness Kurtosis Emotional burden (Zarit) 0.08 150 0.02 0.31 –0.22 Problem-focused Coping 0.15 150 0.00 1.06 1.52 Emotion-focused Coping 0.15 150 0.00 –0.59 –0.62 Emotional burden scores ranged from 6 to 39, with a mean of 22.41 (SD = 5.96) and a median of 23. Although the theoretical range of the scale is 0 to 52, the observed values in this sample fell between 6 and 39 (Table 3 ). Table 3 Descriptive Statistics of Emotional Burden Statistic Observed Value Theoretical Range Mean 22.41 0–52 Standard Deviation 5.96 Median 23 Minimum Observed 6 0 Maximum Observed 39 52 According to the established cut-off points, 25.3% of caregivers presented mild burden (n = 38), 48.7% moderate burden (n = 73), and 26.0% severe burden (n = 39). Overall, 74% of the sample reported moderate or severe levels of emotional burden (Table 4 ). Table 4 Distribution of Caregivers by Level of Emotional Burden Level of Burden Frequency Percentage Mild 38 25.3 Moderate 73 48.7 Severe 39 26 Regarding coping strategies, participants showed a greater tendency toward problem-focused coping (M = 52.06; SD = 6.71; observed range = 40–76) compared to emotion-focused coping (M = 42.56; SD = 7.68; observed range = 25–56). The median scores were 51 for problem-focused coping and 44 for emotion-focused coping, confirming the predominance of active, problem-solving strategies among caregivers (Table 5 ). Table 5 Descriptive Data of Coping Strategies Statistic Problem-Focused Coping Emotion-Focused Coping Theoretical Range Mean 52.06 42.56 22–88 Standard Deviation 6.71 7.68 Median 51.00 44.00 Minimum Observed 40 25 22 Maximum Observed 76 56 88 Correlation analysis The Spearman correlation analysis did not reveal statistically significant associations between emotional burden and coping strategies. Problem-focused coping showed a weak and non-significant positive correlation with emotional burden (r = 0.11, p = .16), whereas emotion-focused coping showed a minimal and non-significant negative correlation (r = − 0.03, p = .70) (Table 6 ). Table 6 Relationship Between Variables Variable Emotional Burden (Zarit) Spearman’s ρ p (two-tailed) Problem-Focused Coping 0.11 0.16 Emotion-Focused Coping –0.03 0.70 Multivariate analysis The multiple linear regression model—including gender, age, and parental role as predictors—was statistically significant overall (F(3, 146) = 8.78, p < .001), accounting for 15.3% of the variance in emotional burden (R² = .153, adjusted R² = .135). Among the predictors, gender emerged as the only significant factor (B = − 6.47, β = –.33, p < .001, 95% CI [–9.57, − 3.37]), indicating that male caregivers reported lower levels of emotional burden compared to female caregivers. Neither age (B = 1.64, p = .100) nor parental role (B = − 0.84, p = .179) demonstrated statistically significant effects on emotional burden (Table 7 ). Table 7 Multiple Linear Regression Results for Predicting Emotional Burden Predictor B Standard Error Standardized β t p 95% CI (B) Constant 28.16 2.91 — 9.69 < .001 [22.41, 33.90] Gender –6.47 1.57 –.33 –4.12 < .001 [–9.57, − 3.37] Age 1.64 0.99 .13 1.66 .100 [–0.32, 3.59] Parental role –0.84 0.62 –.10 –1.35 .179 [–2.06, 0.39] Note. Dependent variable: Emotional burden (Zarit). R² = .153, adjusted R² = .135, F(3,146) = 8.78, p < .001. Complementarily, the ordinal logistic regression analysis predicting overload level (mild, moderate, severe) yielded a significant overall model (χ²(6, N = 150) = 43.68, p < .001), with a Nagelkerke R² of .288. Once again, gender emerged as the only significant predictor (B = 4.42, OR = 82.9, 95% CI [9.8, 700.7], p < .001), indicating that women were substantially more likely than men to experience higher levels of emotional overload. In contrast, age, parental role, and both coping dimensions showed no significant effects (p > .05), suggesting that these variables did not meaningfully contribute to differentiating among overload levels (Table 8 ). Table 8 Ordinal Logistic Regression Results for Predicting Emotional Burden Predictor B Standard Error Wald p OR (Exp(B)) 95% CI OR Gender (female) 4.42 1.09 16.44 < .001 82.9 [9.8, 700.7] Age (40) –0.36 0.36 1.01 .314 0.70 [0.34, 1.41] Parental role (mother vs. child) 0.51 0.48 1.13 .288 1.67 [0.65, 4.27] Parental role (spouse vs. child) 0.03 0.52 0.00 .951 1.03 [0.37, 2.85] Problem-focused coping 0.03 0.02 1.36 .244 1.03 [0.98, 1.08] Emotion-focused coping 0.04 0.02 2.67 .102 1.04 [0.99, 1.08] Note. Dependent variable: Emotional burden (mild < moderate < severe). OR = Odds Ratio. The Test of Parallel Lines indicated that the proportional odds assumption was met (χ² = 2.84, df = 2, p = .21). The notably high odds ratio for gender (OR = 82.9) should be interpreted with caution due to the substantial sample imbalance (90% women). This value may reflect not only a genuine effect of gender-based disparities on the experience of overload but also a statistical inflation resulting from the sample’s composition. DISCUSSION Most caregivers experienced moderate to severe emotional burden, a pattern consistent with findings from Peru and other countries showing high distress among caregivers of individuals with severe mental disorders (Li-Quiroga et al., 2015; Wan & Wong, 2019; Walke et al., 2018). The predominance of problem-focused coping aligns with studies indicating that caregivers attempt to actively manage caregiving demands (Abbaslou et al., 2023; Kafle & Bagale, 2021). However, the absence of significant associations between coping and burden suggests that structural and contextual factors may overshadow the influence of individual coping strategies, particularly in low-resource settings. International evidence supports this interpretation. Walke et al. (2018) and Abbaslou et al. (2023) argue that chronic caregiving demands, limited institutional support, and socioeconomic constraints can diminish the protective effects of coping. Longitudinal research by Mora-Castañeda et al. (2023) shows that coping and burden fluctuate over time, suggesting that cross-sectional designs may not fully capture these dynamics. Other studies highlight the role of support networks, caregiving skills, and personality traits in shaping burden (Gharavi et al., 2018; Zhou et al., 2021; Özdemir & Gençarslan Özbaş, 2024). Wan and Wong (2019) further emphasize that caregivers of individuals with schizophrenia and early psychosis often experience elevated stress, anxiety, and depressive symptoms, which may limit the effectiveness of coping strategies. Gender emerged as the strongest predictor of burden, reflecting persistent inequalities in caregiving responsibilities. Women’s disproportionate involvement in unpaid care work, combined with limited support networks and time poverty, may intensify emotional strain (Arriagada, 2007). This finding aligns with regional analyses of gendered caregiving and underscores the need for gender-sensitive interventions in CMHCs. In Andean contexts, the limited activation of reciprocity networks such as ayni may further constrain caregivers’ ability to distribute responsibilities (Curran, 2020). Overall, the findings suggest that caregiver burden in Cusco is shaped less by individual coping strategies and more by structural, gendered, and contextual factors. This underscores the need for multicomponent interventions that integrate psychoeducation, respite services, community support networks, and gender-sensitive approaches within CMHCs. LIMITATIONS AND FUTURE RESEARCH DIRECTIONS This study has several limitations that affect the scope of its findings. The community coping framework posits that Andean reciprocity (ayni) and extensive networks modulate caregiver burden. Although standardised measures were used (Zarit, COPE), the findings are interpreted within this framework to translate psychological evidence into operational recommendations for the community care system. Convenience sampling, constrained by CSMC service schedules, may have introduced selection biases (e.g., greater availability of female caregivers) that limit generalisability. Given the cross-sectional design, the results reflect contemporaneous associations and do not allow for causal inference; therefore, interpretative caution is recommended, and longitudinal approaches are proposed. Methodologically, it is recommended to analyse the specific domains of the Zarit Burden Inventory rather than focusing solely on the total score, as this would allow for a more precise identification of the particular dimensions of burden. It is also relevant to consider both the positive and negative aspects of caregiving to achieve a more holistic understanding of the caregiver experience. Incorporating multivariate analyses, such as regression or mediation models, could further clarify the role of structural and clinical variables in the relationship between coping and burden. Another methodological limitation relates to the statistical power of the sample. A post hoc analysis based on the effect size observed in the multiple linear regression (R² = .153; f² = 0.18) indicated that with 150 participants, adequate power (~ .90) was achieved to detect moderate effects. However, the study may have been underpowered to detect small effects, which could explain the absence of significant correlations between coping and burden. Future research should employ more balanced sampling or multilevel models that account for contextual variability in order to estimate effect sizes more accurately. In this study, the consistency of findings across linear and ordinal models supports the relevance of gender as a predictor, although replication in more diverse samples is needed. Longitudinal studies are recommended to analyse the dynamic evolution of caregiver burden and explore potential interactions between gender and coping strategies. Qualitative research focused on family narratives would also provide deeper insight into the meanings attributed to caregiving. Evaluations of community and clinical interventions aimed at caregiver well-being should incorporate indicators of resilience and positive mental health. Additionally, comparisons between urban and rural areas could elucidate cultural and socioeconomic differences, while further exploration of clinical and mediating factors, such as symptom severity and patient functional disability, is warranted. Finally, the economic and cultural dimensions of burden should be addressed, considering the impact of out-of-pocket expenses, poverty, and indebtedness across sociocultural contexts. Such considerations would contribute to the design of more sensitive and sustainable public policies. IMPLICATIONS FOR COMMUNITY SOCIAL PSYCHOLOGY Overall, the findings of this study indicate that the burden experienced by family caregivers in Cusco cannot be explained solely by individual coping strategies, but rather emerges at the intersection of gender, low income, and community ties. This challenges the universal applicability of the transactional model and underscores the need to integrate structural and cultural perspectives into clinical and community psychology. Interventions should go beyond coping skills training to include psychoeducational programmes and support networks, recognising caregivers as central actors in mental health policies. This study contributes to the development of a Latin American community psychology, oriented towards a community coping approach that integrates family reciprocity and collective resilience, thereby enhancing the relevance and sustainability of interventions in low-resource contexts. CONCLUSIONS This study shows that most family caregivers of people with mental disorders in Cusco experience significant levels of burden, confirming the vulnerability of this population and the need to address it as a priority public health issue within the framework of community care. The results indicate that coping strategies, whether problem-focused or emotion-focused, are not significantly associated with the perception of burden. This finding questions the universal applicability of classic coping models and suggests that, in low-resource contexts, caregiver burden is shaped more by structural and sociocultural factors than by individual coping styles. Gender emerged as the main predictor of burden, with female caregivers being disproportionately affected. This finding underscores the need for gender-sensitive policies and interventions that recognise the feminisation of care as a critical issue in community mental health. From a clinical perspective, training exclusively in individual coping is insufficient. Multicomponent programmes integrating psychoeducation, institutional support, and the strengthening of social networks are necessary to reduce burden and improve the quality of care. From a community perspective, there is an urgent need to consolidate territorial mechanisms, such as Community Mental Health Centres, explicitly incorporating caregivers as beneficiaries of services and policies, which would contribute to the sustainability of the community model. At the academic level, this study provides local evidence that challenges traditional coping models and guides future research toward longitudinal and mixed-methods designs capable of capturing the dynamic evolution of burden and its interaction with structural and cultural factors in Latin American contexts. In summary, the absence of a direct association between coping and burden does not diminish the relevance of coping strategies, but rather highlights their subordination to structural conditions. Therefore, CSMCs should incorporate caregiver well-being indicators and gender-sensitive protocols, translating empirical evidence into community action. Declarations Funding: The authors received no specific funding for this work. Competing Interests: The authors have no competing interests to declare that are relevant to the content of this article. Ethical Approval: This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Comité de Ética en Investigación de la Universidad Continental (Approval number: OFICIO N°0221-2025-CIEI-UC). Clinical trial number: Not applicable. Human Ethics and Consent to Participate: All procedures involving human participants were approved by the institutional ethics committee. Written informed consent was obtained from all participants. Participation was voluntary, and confidentiality and anonymity were ensured through coded data. Consent to Publish: The participants have consented to the submission of the manuscript to the journal. Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Authors' Contributions: All authors contributed to the study conception and design. Manuel Jesús Ortega Zea: Conceptualization, methodology, data analysis, writing – original draft. María Luisa Huamaní Valderrama: Data curation, investigation, writing – review & editing. Danna Samantha Cuba Serrudo: Literature review, data collection, writing – review & editing. All authors read and approved the final manuscript. References Abbaslou, T., Farsham, A., Bidaki, R., & Bozorg, B. (2023). 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What is associated with caregiver burden for adults with bipolar affective disorder: Illness severity or financial well being? Industrial Psychiatry Journal, 32(Suppl 1), S86. https://doi.org/10.4103/ipj.ipj_199_23 Sharif, L., Basri, S., Alsahafi, F., Altaylouni, M., Albugumi, S., Banakhar, M., Mahsoon, A., Alasmee, N., & Wright, R. J. (2020). An Exploration of Family Caregiver Experiences of Burden and Coping While Caring for People with Mental Disorders in Saudi Arabia—A Qualitative Study. International Journal of Environmental Research and Public Health, 17(17), Article 17. https://doi.org/10.3390/ijerph17176405 Sharma, R., Sharma, S. C., & Pradhan, S. N. (2017). Assessing Caregiver Burden in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder in Kathmandu Medical College. Journal of Nepal Health Research Council, 15(3), 258-263. http://dx.doi.org/10.3126/jnhrc.v15i3.18851 Siddiqui, S., & Khalid, J. (2019). Determining the caregivers’ burden in caregivers of patients with mental illness: Burden in caregivers of patients with mental illness. Pakistan Journal of Medical Sciences, 35(5). https://doi.org/10.12669/pjms.35.5.720 Tabassum, T. T., Rahman, N.-A.-S., Hossain, S. M. S., Abdullah, F., Nawar, L. T., Lima, F. I., Gupta, M., Kona, S. P., & Podder, V. (2024). Caregiving burden and associated factors among family caregivers of individuals with schizophrenia in Bangladesh: A cross-sectional study. Journal of Family Medicine and Primary Care, 13(1), 278. https://doi.org/10.4103/jfmpc.jfmpc_616_23 Tamizi, Z., Fallahi-Khoshknab, M., Dalvandi, A., Mohammadi-Shahboulaghi, F., Mohammadi, E., & Bakhshi, E. (2020). Caregiving burden in family caregivers of patients with schizophrenia: A qualitative study. Journal of Education and Health Promotion, 9(1), 12. https://doi.org/10.4103/jehp.jehp_356_19 Tanna, K. J. (2021). Evaluation of burden felt by caregivers of patients with schizophrenia and bipolar disorder. Industrial Psychiatry Journal, 30(2), 299. https://doi.org/10.4103/ipj.ipj_28_21 Thomas, M., K.T, N., Tom, S., Thomas, S., & Tm, A. B. (2019). Effectiveness of Coping Strategies Intervention on Caregivers’ Burden among Caregivers of Dependent Elderly. Saudi Journal of Nursing and Health Care, 02(09), 314-316. https://doi.org/10.36348/SJNHC.2019.v02i09.006 Tozoğlu, E. Ö., & Gürbüzer, N. (2024). Internalized stigma level, family self-stigma, and family burden of patients receiving community mental health center services: A comparative, longitudinal study. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1469448 Udoh, E. E., Omorere, D. E., Sunday, O., Osasu, O. S., & Amoo, B. A. (2021). Psychological distress and burden of care among family caregivers of patients with mental illness in a neuropsychiatric outpatient clinic in Nigeria. PLOS ONE, 16(5), e0250309. https://doi.org/10.1371/journal.pone.0250309 Walke, S. C., Chandrasekaran, V., & Mayya, S. S. (2018). Caregiver Burden among Caregivers of Mentally Ill Individuals and Their Coping Mechanisms. Journal of Neurosciences in Rural Practice, 9(2), 180-185. https://doi.org/10.4103/jnrp.jnrp_312_17 Wan, K.-F., & Wong, M. M. C. (2019). Stress and burden faced by family caregivers of people with schizophrenia and early psychosis in Hong Kong. Internal Medicine Journal, 49(S1), 9-15. https://doi.org/10.1111/imj.14166 Zarit, S. H., Reever, K. E., and Bach-Peterson, J. (1980). Relatives of the Impaired Elderly: correlates of Feelings of Burden. Gerontologist 20, 649–655. doi: 10.1093/geront/20.6.649 Zhou, Z., Wang, Y., Feng, P., Li, T., Tebes, J. K., Luan, R., & Yu, Y. (2021). Associations of Caregiving Knowledge and Skills With Caregiver Burden, Psychological Well-Being, and Coping Styles Among Primary Family Caregivers of People Living With Schizophrenia in China. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.631420 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 20 Apr, 2026 Reviewers invited by journal 16 Apr, 2026 Editor invited by journal 31 Mar, 2026 Editor assigned by journal 28 Mar, 2026 Submission checks completed at journal 28 Mar, 2026 First submitted to journal 16 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9138880","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627907753,"identity":"4148df85-3d03-4300-87c7-2b0898cec832","order_by":0,"name":"Manuel Jesus Ortega Zea","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYBADOTCZACaZGxgY2PCqZgSqYDAGM0BaeMACRGhJbIAyCGvRbe99/uDDL7v0/vbe4w8e7rDJs2c/2MDwoewwgzl7A1YtZmeOGzbO7EvOnXHmXGJD4pm0Yh6exAbGGecOM1j2HMCu5UYaYzNvD3PuBokcw4bEtsOJPUBHMvO2HWYwuJGAW8vfnvp0A4iW/4k9/A8bmP+CtNx/gFsLw4/DCVAtBxJ7JIC2MIJtwe59szPHGGf2Nhw3nHHmjOGMxLbkxJ4bDxsO9pxL57HsweGw420MH378qZbnb+8x+PizzS6xvT/54IMfZdZy5uzYvQ8GjG1oAiC1PAa4NQDBH2yC+LWMglEwCkbBCAIAbShpniZDjFsAAAAASUVORK5CYII=","orcid":"","institution":"Universidad Continental","correspondingAuthor":true,"prefix":"","firstName":"Manuel","middleName":"Jesus Ortega","lastName":"Zea","suffix":""},{"id":627907754,"identity":"bf8ba46b-b537-4047-ab89-b719b0676912","order_by":1,"name":"Maria Luisa Huamaní Valderrama","email":"","orcid":"","institution":"Universidad Continental","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Luisa Huamaní","lastName":"Valderrama","suffix":""},{"id":627907755,"identity":"eff4c9b2-7bdc-4db6-b272-09793598dc9a","order_by":2,"name":"Danna Samantha Cuba Serrudo","email":"","orcid":"","institution":"Universidad Continental","correspondingAuthor":false,"prefix":"","firstName":"Danna","middleName":"Samantha Cuba","lastName":"Serrudo","suffix":""}],"badges":[],"createdAt":"2026-03-16 14:09:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9138880/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9138880/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108803483,"identity":"55454385-e0b5-46ae-90f3-3d0d41ae3c6b","added_by":"auto","created_at":"2026-05-08 14:56:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":314122,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9138880/v1/eedb4219-b2c0-45c8-bf9f-24686814bc3f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eGendered Caregiver Burden and Coping Strategies in Community Mental Health: Evidence From Peru\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSerious mental disorders such as schizophrenia and bipolar disorder generate substantial disability and impose a significant burden on family caregivers, who assume central roles in treatment adherence, emotional support, and daily management (Khatoon et al., 2021; Marzban et al., 2024; Wan \u0026amp; Wong, 2019). Evidence consistently shows that chronic mental illnesses affect not only patients but also caregivers, who frequently experience stress, fatigue, sleep disturbances, depressive symptoms, interpersonal conflicts, and financial strain (Kargar et al., 2021; Namlı et al., 2023; \u0026Ouml;zdemir \u0026amp; Gen\u0026ccedil;arslan \u0026Ouml;zbaş, 2024). This burden includes both objective disruptions in daily functioning and subjective perceptions of exhaustion, guilt, or isolation (Abbaslou et al., 2023; Girdhar \u0026amp; Patil, 2023; Karambelas et al., 2022; Mora-Casta\u0026ntilde;eda et al., 2023).\u003c/p\u003e \u003cp\u003eCoping strategies have been identified as potential modulators of caregiver burden. Based on Lazarus and Folkman\u0026rsquo;s transactional model, coping is conceptualized as cognitive and behavioral efforts to manage stress, typically categorized into problem-focused and emotion-focused strategies (Mora-Casta\u0026ntilde;eda et al., 2023; Carver et al., 1989). While active strategies such as planning or seeking support may reduce distress, emotion-focused or avoidance strategies may intensify it (Mohamed et al., 2023; Sharif et al., 2020; Thomas et al., 2019). However, recent studies highlight that coping effectiveness is shaped by structural, social, and cultural factors, including socioeconomic constraints, caregiving demands, and available support networks (Zhou et al., 2021; Daliri et al., 2024; Al-Dowsari \u0026amp; Khatabeh, 2023). Longitudinal evidence further suggests that coping and burden evolve over time, influenced by adaptation processes and contextual resources (Mora-Casta\u0026ntilde;eda et al., 2023).\u003c/p\u003e \u003cp\u003eIn Peru, the expansion of Community Mental Health Centers (CMHCs) has increased the role of families in long-term care, particularly in contexts where institutional support remains limited and stigma persists (Iseselo et al., 2016; Ndlovu \u0026amp; Mokwena, 2023; Sharma et al., 2017). Despite this, research on caregiver burden and coping in Peruvian community settings remains scarce, and most international evidence comes from high-income countries (Marimbe et al., 2016; Kafle \u0026amp; Bagale, 2021; Rao et al., 2023). Additionally, gender inequalities\u0026mdash;especially women\u0026rsquo;s disproportionate caregiving responsibilities and time poverty\u0026mdash;may intensify burden and shape coping repertoires (Arriagada, 2007). In Andean contexts, practices of reciprocity such as ayni and extended family networks may also influence caregiving dynamics (Curran, 2020).\u003c/p\u003e \u003cp\u003eThis study examines the relationship between emotional burden and coping strategies among caregivers of individuals with mental disorders receiving services at a CMHC in Cusco. It also evaluates the moderating role of gender. Based on prior evidence, we hypothesized that (1) no significant associations would be found between coping styles and burden, and (2) female caregivers would report higher burden regardless of coping strategies.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and participants\u003c/h2\u003e \u003cp\u003eA cross-sectional, analytical, correlational, non-experimental design was used. Participants were 150 family caregivers of individuals receiving services at a CMHC in Cusco during the first half of 2025. Inclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;18, direct kinship with the patient, continuous caregiving, and voluntary participation. A non-probabilistic convenience sampling method was applied.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEmotional burden\u003c/h2\u003e \u003cp\u003eAssessed using the 13-item Zarit Caregiver Burden Scale validated in Peru (Boluarte-Carbajal et al., 2022). The scale shows a unidimensional structure, adequate convergent validity, and good internal consistency (ω\u0026thinsp;=\u0026thinsp;0.871).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCoping strategies\u003c/h3\u003e\n\u003cp\u003eMeasured with the COPE Inventory (Carver et al., 1989), adapted to Peru by Cano \u0026amp; Kristel (2019). It includes 44 items grouped into problem-focused and emotion-focused coping. Reliability was high (ω\u0026thinsp;=\u0026thinsp;0.96).\u003c/p\u003e \u003cp\u003eInternal consistency in this study was acceptable: α\u0026thinsp;=\u0026thinsp;0.78 (Zarit), α\u0026thinsp;=\u0026thinsp;0.77 (problem-focused coping), and α\u0026thinsp;=\u0026thinsp;0.70 (emotion-focused coping).\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eData were collected in person at the CMHC. Participants provided written informed consent. Instruments were administered individually in private rooms.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAnalyses were conducted using SPSS 26. Descriptive statistics were computed. Due to non-normal distributions (Kolmogorov\u0026ndash;Smirnov p \u0026lt; .05), Spearman correlations were used. Multiple linear regression examined predictors of continuous burden scores, and ordinal logistic regression predicted burden levels (mild, moderate, severe). Gender-stratified analyses assessed robustness.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical aspects\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003ewas obtained from all participants, highlighting the voluntary nature of participation and their right to withdraw at any time without consequences. Confidentiality and anonymity were ensured through the use of coded data, avoiding any form of personal identification.\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics of the sample\u003c/h2\u003e \u003cp\u003eThe sample consisted of 150 family caregivers, of whom 90% were women (n\u0026thinsp;=\u0026thinsp;135) and 10% were men (n\u0026thinsp;=\u0026thinsp;15). The mean age was 40 years (M\u0026thinsp;=\u0026thinsp;40.0; SD\u0026thinsp;=\u0026thinsp;8.6), with a predominance of participants over 40 years of age (65%, n\u0026thinsp;=\u0026thinsp;98). Regarding kinship, mothers represented the largest group (55%, n\u0026thinsp;=\u0026thinsp;83), followed by spouses (30%, n\u0026thinsp;=\u0026thinsp;45) and adult children (15%, n\u0026thinsp;=\u0026thinsp;22) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSociodemographic Data of Caregivers\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSociodemographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRelantionship to patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpouses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdult children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive data for the variables\u003c/h2\u003e \u003cp\u003eThe Kolmogorov\u0026ndash;Smirnov test indicated that the main variables did not follow a normal distribution: emotional burden (K\u0026ndash;S\u0026thinsp;=\u0026thinsp;0.08, p = .02), problem-focused coping (K\u0026ndash;S\u0026thinsp;=\u0026thinsp;0.15, p \u0026lt; .001), and emotion-focused coping (K\u0026ndash;S\u0026thinsp;=\u0026thinsp;0.15, p \u0026lt; .001). Accordingly, non-parametric procedures were applied for the association analyses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eNormality test\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eK-S (Statistic)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003egl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSkewness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eKurtosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional burden (Zarit)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblem-focused Coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotion-focused Coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026ndash;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEmotional burden scores ranged from 6 to 39, with a mean of 22.41 (SD\u0026thinsp;=\u0026thinsp;5.96) and a median of 23. Although the theoretical range of the scale is 0 to 52, the observed values in this sample fell between 6 and 39 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDescriptive Statistics of Emotional Burden\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTheoretical Range\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimum Observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum Observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the established cut-off points, 25.3% of caregivers presented mild burden (n\u0026thinsp;=\u0026thinsp;38), 48.7% moderate burden (n\u0026thinsp;=\u0026thinsp;73), and 26.0% severe burden (n\u0026thinsp;=\u0026thinsp;39). Overall, 74% of the sample reported moderate or severe levels of emotional burden (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of Caregivers by Level of Emotional Burden\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Burden\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding coping strategies, participants showed a greater tendency toward problem-focused coping (M\u0026thinsp;=\u0026thinsp;52.06; SD\u0026thinsp;=\u0026thinsp;6.71; observed range\u0026thinsp;=\u0026thinsp;40\u0026ndash;76) compared to emotion-focused coping (M\u0026thinsp;=\u0026thinsp;42.56; SD\u0026thinsp;=\u0026thinsp;7.68; observed range\u0026thinsp;=\u0026thinsp;25\u0026ndash;56). The median scores were 51 for problem-focused coping and 44 for emotion-focused coping, confirming the predominance of active, problem-solving strategies among caregivers (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDescriptive Data of Coping Strategies\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProblem-Focused Coping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotion-Focused Coping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTheoretical Range\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u0026ndash;88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimum Observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum Observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis\u003c/h2\u003e \u003cp\u003eThe Spearman correlation analysis did not reveal statistically significant associations between emotional burden and coping strategies. Problem-focused coping showed a weak and non-significant positive correlation with emotional burden (r\u0026thinsp;=\u0026thinsp;0.11, p = .16), whereas emotion-focused coping showed a minimal and non-significant negative correlation (r = \u0026minus;\u0026thinsp;0.03, p = .70) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eRelationship Between Variables\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Burden (Zarit)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (two-tailed)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblem-Focused Coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotion-Focused Coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate analysis\u003c/h2\u003e \u003cp\u003eThe multiple linear regression model\u0026mdash;including gender, age, and parental role as predictors\u0026mdash;was statistically significant overall (F(3, 146)\u0026thinsp;=\u0026thinsp;8.78, p \u0026lt; .001), accounting for 15.3% of the variance in emotional burden (R\u0026sup2; = .153, adjusted R\u0026sup2; = .135). Among the predictors, gender emerged as the only significant factor (B = \u0026minus;\u0026thinsp;6.47, β = \u0026ndash;.33, p \u0026lt; .001, 95% CI [\u0026ndash;9.57, \u0026minus;\u0026thinsp;3.37]), indicating that male caregivers reported lower levels of emotional burden compared to female caregivers. Neither age (B\u0026thinsp;=\u0026thinsp;1.64, p = .100) nor parental role (B = \u0026minus;\u0026thinsp;0.84, p = .179) demonstrated statistically significant effects on emotional burden (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMultiple Linear Regression Results for Predicting Emotional Burden\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized β\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI (B)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[22.41, 33.90]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;6.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026ndash;4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[\u0026ndash;9.57, \u0026minus;\u0026thinsp;3.37]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[\u0026ndash;0.32, 3.59]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental role\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026ndash;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[\u0026ndash;2.06, 0.39]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote.\u003c/b\u003e Dependent variable: Emotional burden (Zarit). R\u0026sup2; = .153, adjusted R\u0026sup2; = .135, F(3,146)\u0026thinsp;=\u0026thinsp;8.78, p \u0026lt; .001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComplementarily, the ordinal logistic regression analysis predicting overload level (mild, moderate, severe) yielded a significant overall model (χ\u0026sup2;(6, N\u0026thinsp;=\u0026thinsp;150)\u0026thinsp;=\u0026thinsp;43.68, p \u0026lt; .001), with a Nagelkerke R\u0026sup2; of .288. Once again, gender emerged as the only significant predictor (B\u0026thinsp;=\u0026thinsp;4.42, OR\u0026thinsp;=\u0026thinsp;82.9, 95% CI [9.8, 700.7], p \u0026lt; .001), indicating that women were substantially more likely than men to experience higher levels of emotional overload. In contrast, age, parental role, and both coping dimensions showed no significant effects (p \u0026gt; .05), suggesting that these variables did not meaningfully contribute to differentiating among overload levels (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eOrdinal Logistic Regression Results for Predicting Emotional Burden\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (Exp(B))\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI OR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e82.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[9.8, 700.7]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u0026lt;\u0026thinsp;40 vs. \u0026gt;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.34, 1.41]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental role (mother vs. child)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.65, 4.27]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental role (spouse vs. child)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.37, 2.85]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblem-focused coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.98, 1.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotion-focused coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.99, 1.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote.\u003c/b\u003e Dependent variable: Emotional burden (mild\u0026thinsp;\u0026lt;\u0026thinsp;moderate\u0026thinsp;\u0026lt;\u0026thinsp;severe). OR\u0026thinsp;=\u0026thinsp;Odds Ratio.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Test of Parallel Lines indicated that the proportional odds assumption was met (χ\u0026sup2; = 2.84, df\u0026thinsp;=\u0026thinsp;2, p = .21). The notably high odds ratio for gender (OR\u0026thinsp;=\u0026thinsp;82.9) should be interpreted with caution due to the substantial sample imbalance (90% women). This value may reflect not only a genuine effect of gender-based disparities on the experience of overload but also a statistical inflation resulting from the sample\u0026rsquo;s composition.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMost caregivers experienced moderate to severe emotional burden, a pattern consistent with findings from Peru and other countries showing high distress among caregivers of individuals with severe mental disorders (Li-Quiroga et al., 2015; Wan \u0026amp; Wong, 2019; Walke et al., 2018). The predominance of problem-focused coping aligns with studies indicating that caregivers attempt to actively manage caregiving demands (Abbaslou et al., 2023; Kafle \u0026amp; Bagale, 2021). However, the absence of significant associations between coping and burden suggests that structural and contextual factors may overshadow the influence of individual coping strategies, particularly in low-resource settings.\u003c/p\u003e \u003cp\u003eInternational evidence supports this interpretation. Walke et al. (2018) and Abbaslou et al. (2023) argue that chronic caregiving demands, limited institutional support, and socioeconomic constraints can diminish the protective effects of coping. Longitudinal research by Mora-Casta\u0026ntilde;eda et al. (2023) shows that coping and burden fluctuate over time, suggesting that cross-sectional designs may not fully capture these dynamics. Other studies highlight the role of support networks, caregiving skills, and personality traits in shaping burden (Gharavi et al., 2018; Zhou et al., 2021; \u0026Ouml;zdemir \u0026amp; Gen\u0026ccedil;arslan \u0026Ouml;zbaş, 2024). Wan and Wong (2019) further emphasize that caregivers of individuals with schizophrenia and early psychosis often experience elevated stress, anxiety, and depressive symptoms, which may limit the effectiveness of coping strategies.\u003c/p\u003e \u003cp\u003eGender emerged as the strongest predictor of burden, reflecting persistent inequalities in caregiving responsibilities. Women\u0026rsquo;s disproportionate involvement in unpaid care work, combined with limited support networks and time poverty, may intensify emotional strain (Arriagada, 2007). This finding aligns with regional analyses of gendered caregiving and underscores the need for gender-sensitive interventions in CMHCs. In Andean contexts, the limited activation of reciprocity networks such as ayni may further constrain caregivers\u0026rsquo; ability to distribute responsibilities (Curran, 2020).\u003c/p\u003e \u003cp\u003eOverall, the findings suggest that caregiver burden in Cusco is shaped less by individual coping strategies and more by structural, gendered, and contextual factors. This underscores the need for multicomponent interventions that integrate psychoeducation, respite services, community support networks, and gender-sensitive approaches within CMHCs.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS AND FUTURE RESEARCH DIRECTIONS\u003c/h2\u003e \u003cp\u003eThis study has several limitations that affect the scope of its findings. The community coping framework posits that Andean reciprocity (ayni) and extensive networks modulate caregiver burden. Although standardised measures were used (Zarit, COPE), the findings are interpreted within this framework to translate psychological evidence into operational recommendations for the community care system. Convenience sampling, constrained by CSMC service schedules, may have introduced selection biases (e.g., greater availability of female caregivers) that limit generalisability. Given the cross-sectional design, the results reflect contemporaneous associations and do not allow for causal inference; therefore, interpretative caution is recommended, and longitudinal approaches are proposed.\u003c/p\u003e \u003cp\u003eMethodologically, it is recommended to analyse the specific domains of the Zarit Burden Inventory rather than focusing solely on the total score, as this would allow for a more precise identification of the particular dimensions of burden. It is also relevant to consider both the positive and negative aspects of caregiving to achieve a more holistic understanding of the caregiver experience. Incorporating multivariate analyses, such as regression or mediation models, could further clarify the role of structural and clinical variables in the relationship between coping and burden. Another methodological limitation relates to the statistical power of the sample. A post hoc analysis based on the effect size observed in the multiple linear regression (R\u0026sup2; = .153; f\u0026sup2; = 0.18) indicated that with 150 participants, adequate power (~\u0026thinsp;.90) was achieved to detect moderate effects. However, the study may have been underpowered to detect small effects, which could explain the absence of significant correlations between coping and burden.\u003c/p\u003e \u003cp\u003eFuture research should employ more balanced sampling or multilevel models that account for contextual variability in order to estimate effect sizes more accurately. In this study, the consistency of findings across linear and ordinal models supports the relevance of gender as a predictor, although replication in more diverse samples is needed. Longitudinal studies are recommended to analyse the dynamic evolution of caregiver burden and explore potential interactions between gender and coping strategies. Qualitative research focused on family narratives would also provide deeper insight into the meanings attributed to caregiving. Evaluations of community and clinical interventions aimed at caregiver well-being should incorporate indicators of resilience and positive mental health. Additionally, comparisons between urban and rural areas could elucidate cultural and socioeconomic differences, while further exploration of clinical and mediating factors, such as symptom severity and patient functional disability, is warranted.\u003c/p\u003e \u003cp\u003eFinally, the economic and cultural dimensions of burden should be addressed, considering the impact of out-of-pocket expenses, poverty, and indebtedness across sociocultural contexts. Such considerations would contribute to the design of more sensitive and sustainable public policies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eIMPLICATIONS FOR COMMUNITY SOCIAL PSYCHOLOGY\u003c/h2\u003e \u003cp\u003eOverall, the findings of this study indicate that the burden experienced by family caregivers in Cusco cannot be explained solely by individual coping strategies, but rather emerges at the intersection of gender, low income, and community ties. This challenges the universal applicability of the transactional model and underscores the need to integrate structural and cultural perspectives into clinical and community psychology. Interventions should go beyond coping skills training to include psychoeducational programmes and support networks, recognising caregivers as central actors in mental health policies. This study contributes to the development of a Latin American community psychology, oriented towards a community coping approach that integrates family reciprocity and collective resilience, thereby enhancing the relevance and sustainability of interventions in low-resource contexts.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study shows that most family caregivers of people with mental disorders in Cusco experience significant levels of burden, confirming the vulnerability of this population and the need to address it as a priority public health issue within the framework of community care.\u003c/p\u003e \u003cp\u003eThe results indicate that coping strategies, whether problem-focused or emotion-focused, are not significantly associated with the perception of burden. This finding questions the universal applicability of classic coping models and suggests that, in low-resource contexts, caregiver burden is shaped more by structural and sociocultural factors than by individual coping styles.\u003c/p\u003e \u003cp\u003eGender emerged as the main predictor of burden, with female caregivers being disproportionately affected. This finding underscores the need for gender-sensitive policies and interventions that recognise the feminisation of care as a critical issue in community mental health.\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, training exclusively in individual coping is insufficient. Multicomponent programmes integrating psychoeducation, institutional support, and the strengthening of social networks are necessary to reduce burden and improve the quality of care. From a community perspective, there is an urgent need to consolidate territorial mechanisms, such as Community Mental Health Centres, explicitly incorporating caregivers as beneficiaries of services and policies, which would contribute to the sustainability of the community model.\u003c/p\u003e \u003cp\u003eAt the academic level, this study provides local evidence that challenges traditional coping models and guides future research toward longitudinal and mixed-methods designs capable of capturing the dynamic evolution of burden and its interaction with structural and cultural factors in Latin American contexts.\u003c/p\u003e \u003cp\u003eIn summary, the absence of a direct association between coping and burden does not diminish the relevance of coping strategies, but rather highlights their subordination to structural conditions. Therefore, CSMCs should incorporate caregiver well-being indicators and gender-sensitive protocols, translating empirical evidence into community action.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: The authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003eCompeting Interests: The authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003eEthical Approval: This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Comité de Ética en Investigación de la Universidad Continental (Approval number: OFICIO N°0221-2025-CIEI-UC).\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable.\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate: All procedures involving human participants were approved by the institutional ethics committee. Written informed consent was obtained from all participants. Participation was voluntary, and confidentiality and anonymity were ensured through coded data.\u003c/p\u003e\n\u003cp\u003eConsent to Publish: The participants have consented to the submission of the manuscript to the journal.\u003c/p\u003e\n\u003cp\u003eData Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAuthors' Contributions: All authors contributed to the study conception and design. Manuel Jesús Ortega Zea: Conceptualization, methodology, data analysis, writing – original draft. María Luisa Huamaní Valderrama: Data curation, investigation, writing – review \u0026amp; editing. Danna Samantha Cuba Serrudo: Literature review, data collection, writing – review \u0026amp; editing. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbbaslou, T., Farsham, A., Bidaki, R., \u0026amp; Bozorg, B. (2023). The relationship between coping styles and family burden in chronic schizophrenic and bipolar type I patients’ caregivers. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 59(1), 7. https://doi.org/10.1186/s41983-023-00609-7\u003c/li\u003e\n \u003cli\u003eAl-Awad, F. (2024). Perceived Burden and Quality of Life in Caregivers of Patients with Schizophrenia in Saudi Arabia’s Eastern Province: A Cross-sectional Study. Clinical Practice \u0026amp; Epidemiology in Mental Health, 10. https://doi.org/10.2174/0117450179314013240417105321\u003c/li\u003e\n \u003cli\u003eAl-Dowsari, H., \u0026amp; Khatabeh, Y. (2023). Strategies for coping with family pressures, psychological and social problems, and families of people with mental disorders attending the Irada Mental Health. 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Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.631420\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Caregiver burden, Coping strategies, Family caregivers, Severe mental disorders, Community mental health","lastPublishedDoi":"10.21203/rs.3.rs-9138880/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9138880/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEmotional burden in family caregivers of people with severe mental disorders is a public health problem that affects the quality of life of patients and caregivers. Although coping strategies have been described as potential modulators of the burden, their effectiveness in low-resource community settings remains largely unexplored. This study analyzed the relationship between emotional overload and coping in caregivers of patients treated at a Community Mental Health Center in Cusco in 2025. An observational, analytical, cross-sectional, correlational, non-experimental design was applied to a sample of 150 primary caregivers (90% women; mean age\u0026thinsp;=\u0026thinsp;40 years), selected for convenience. Overload was assessed using the Zarit Scale and coping strategies using the COPE Inventory, both adapted to the Peruvian context. Analyses included descriptive statistics, nonparametric associations, and multivariate models to assess the role of gender and coping. The results showed that 74% of caregivers experienced moderate or severe overload, with a predominance of problem-focused coping. No significant correlations were identified between coping style and level of burden, while gender emerged as a relevant predictor: women reported higher levels of burden than men. It is concluded that emotional burden persists regardless of coping style, highlighting the weight of structural and gender factors. These findings guide the design of multicomponent interventions in Community Mental Health Centers, with gender-sensitive protocols that integrate family psychoeducation, respite networks, and coordination with community organizations to reduce caregiver burden.\u003c/p\u003e","manuscriptTitle":"Gendered Caregiver Burden and Coping Strategies in Community Mental Health: Evidence From Peru","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 18:33:06","doi":"10.21203/rs.3.rs-9138880/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"52783420481876352185204272592113516608","date":"2026-04-20T11:06:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T08:33:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-31T13:17:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-28T15:28:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T15:28:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2026-03-16T13:58:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5aa80a60-01b1-4387-b184-37aea06c2289","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T18:33:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 18:33:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9138880","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9138880","identity":"rs-9138880","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}