Caregiver Depression in a Low-Resource Setting: A Multi-Domain Assessment of PHQ-9, Socio-Demographic Predictors of Major Depressive Disorder Among Family Caregivers of Breast Cancer Patients in Pakistan

Caregiver Depression in a Low-Resource Setting: A Multi-Domain Assessment of PHQ-9, Socio-Demographic Predictors of Major Depressive Disorder Among Family Caregivers of Breast Cancer Patients in Pakistan | 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 Caregiver Depression in a Low-Resource Setting: A Multi-Domain Assessment of PHQ-9, Socio-Demographic Predictors of Major Depressive Disorder Among Family Caregivers of Breast Cancer Patients in Pakistan Muhammad Usman Hashmi, Pakeezah Tabasum, Imran Saeed, Zainab Azhar, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6785454/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Caregivers of breast cancer patients experience a significant psychological burden, which may lead to major depressive disorder (MDD). However, limited research has explored the prevalence among caregivers in the Pakistani population. This study aimed to assess the prevalence of MDD among these caregivers and identify contributing socio-demographic and health-related factors, highlighting the psychological burden they endure. Methodology A cross-sectional study was conducted in various tertiary care hospitals of Pakistan. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for MDD, with a score of ≥10 indicating a positive diagnosis. We conducted a multi-step psychometric analysis of PHQ-9 using a sample of 402 participants. Exploratory Factor Analysis (EFA) employed principal axis factoring with Promax rotation, Assumptions were verified using Bartlett’s Test of Sphericity and Kaiser-Meyer-Olkin sampling adequacy. Confirmatory Factor Analysis (CFA) tested the EFA-derived structure, with model fit evaluated using RMSEA, TLI, and χ². Socio-demographic and health-related data were collected through structured questionnaires. Statistical analysis was performed using JAMOVI software, incorporating descriptive statistics, chi-square tests, t-tests/ANOVA, and binomial logistic regression to identify factors associated with MDD. Results Among 402 participants, 46.26% of caregivers experienced major depression disorder, with 27.1% had mild depression, 24.1% moderate, 16.4% moderately severe, and 5.7% severe depression, while 26.6% exhibited no depressive symptoms. EFA revealed a 3-factor solution explaining 46.75% of variance, all primary loadings > 0.52. The CFA confirmed this structure (RMSEA = 0.064; CFI = 0.96; TLI = 0.94), though χ² was significant (*p* < .05). Among caregivers, low monthly income (p = 0.033), living a sedentary lifestyle (p = 0.012) and one living in urban areas (p = 0.044), indicating higher risk of depression. In a multivariate logistic regression analysis, lower education levels were found to be a significant predictor of MDD (p = 0.007). Conclusion A considerable proportion of caregivers supporting breast cancer patients in Pakistan suffer from MDD, with low education, unemployment, sedentary lifestyle, and low monthly income being key contributors. To mitigate the psychological distress faced by these caregivers, targeted mental health interventions and support programs are needed to improve the quality of life of caregivers. Figures Figure 1 Introduction Breast cancer is one of the most prevalent malignancies affecting women worldwide. In 2020, approximately 2.3 million new cases and 685,000 deaths were reported, accounting for a significant proportion of cancer diagnoses worldwide ( 1 ). In Pakistan, the burden is particularly pronounced, with the country exhibiting breast cancer as the leading cancer among women, with one in four females affected ( 2 ). In 2020 alone, breast cancer accounted for 28.7% of all new cancer cases and 11.7% of cancer-related deaths in the country ( 3 ). This rising prevalence affects not only patients but also puts significant strain on their caregivers. Caregivers play a pivotal role in the journey of patients with breast cancer, providing emotional, practical, and psychological support ( 4 ). In Pakistan, the healthcare system is predominantly patient-centered, with a limited emphasis on caregiver well-being. Limited awareness, late-stage diagnoses, and inadequate healthcare infrastructure make coping with the disease even more difficult, not just for patients but also for those who care for them ( 5 ). Caregivers, who help navigate complex medical decisions, facilitate communication with oncologists, and provide unwavering strength in the face of uncertainty ( 6 ). However, this continuous responsibility can have severe psychological distress, including stress, anxiety, depression, and potential feelings of helplessness, all while maintaining a supportive environment for the patient ( 7 ). Among these mental health concerns, major depressive disorder (MDD) is one of the most significant, affecting caregivers’ well-being and their ability to provide optimal care. According to a systematic review and meta-analysis, approximately 42% of caregivers for cancer patients experience depression, with a higher prevalence observed among female caregivers ( 8 ). The prevalence of depression among caregivers varies across studies. For instance, a study in India found that 52.5% of caregivers of breast cancer patients experienced depression ( 9 ). Similarly, a cross-sectional study in Jordan revealed 27.9% of participants with symptoms of depression ( 10 ). These findings highlight the substantial mental health burden faced by caregivers. Depression rates among caregivers are influenced by various demographic and clinical factors, including younger age, spousal relationship, lower socioeconomic status, and providing care to patients with advanced-stage cancer ( 9 , 11 ). Moreover, cultural norms significantly influence how depression is expressed and recognized. In many cultures, including Pakistan, mental health issues may be stigmatized, leading individuals to somatize psychological distress or refrain from seeking help. This cultural mindset contributes to the silent suffering of many caregivers that resulting in underreporting and underdiagnosis of depression among caregivers, thereby hindering timely intervention, support, and clinical outcomes of patients ( 12 ). Pakistan, being the most populous country, has a high number of breast cancer cases with limited emphasis on caregiver well-being, making it essential to assess the psychological toll on caregivers. However, despite the evident psychological burden, there is a paucity of research focusing on the mental health of caregivers. Existing studies predominantly concentrate on patients, often overlooking the psychological well-being of those who provide care, which can impair their ability to provide effective care and negatively influence their quality of life. This study aims to assess the prevalence of major depressive disorder (MDD) among caregivers of breast cancer patients in Pakistan. Additionally, the study seeks to identify key risk factors contributing to MDD. Identifying these challenges can aid in developing targeted mental health strategies, ultimately improving the well-being of caregivers and enhancing patient care. Methodology Study design and study setting This cross-sectional study was conducted over a period of three months across tertiary care hospitals in Pakistan, following ethical approval from the institutional review board of Rahmah Health Foundation, Islamabad, Pakistan. The study setting included hospitals with multidisciplinary cancer care teams comprising medical, surgical, radiation, and psycho-oncology specialists. However, at the time of the study, no dedicated caregiver support services were in place. The study population consisted of primary caregivers, both male and female, aged 18 years or older. Paid caregivers, individuals under 18, those with incomplete information, and those unwilling to participate were excluded. Sample Size and Eligibility Criteria A sample size of 384 caregivers was determined using the OpenEpi sample size calculator, with a 95% confidence interval and a 5% margin of error. Participants were recruited using a consecutive non-probability sampling technique, where caregivers were selected sequentially based on availability until the target sample size was reached. This approach was chosen due to the accessibility of participants, ensuring efficient data collection within the study's timeframe. Data collection Data collection was carried out through face-to-face interviews conducted by a trained researcher. Data collection involved a structured questionnaire to gather information on socio-demographic factors, caregiver burden, and health-related variables. The PHQ-9 used in this study was a previously validated Urdu translation, originally developed and validated by Ahmed S et al ( 13 ). This validated instrument has been widely used for assessing depressive symptoms in Urdu-speaking populations. According to PHQ-9 scoring guidelines, depression severity was categorized as minimal (0–4), mild ( 5 – 9 ), moderate ( 10 – 14 ), moderately severe ( 15 – 19 ), and severe (20–27). For analysis, caregivers were grouped based on the presence or absence of moderate to severe depressive symptoms. Individuals with a PHQ-9 score of less than 10 (i.e., minimal or mild depression) were classified as having no moderate to severe depression, whereas those with a PHQ-9 score of 10 or higher (i.e., moderate, moderately severe, or severe depression) were classified as having moderate to severe depression. The data collection process was supervised to ensure accuracy, and participants were assured of the confidentiality and anonymity of their responses. Study Variables The study analyzed various caregiver-related variables, including demographics (age, gender, education, family structure, income, and residential area) and health factors (BMI, chronic conditions, and smoking status). Additionally, caregivers burden including number of caregiving hours, financial support such as contributing significantly to medical bills, rent or mortgage payments, daily living expenses, transportation costs, or other essential needs, transport facilities such as daily commuting, frequent medical visits, therapy sessions, or other essential destinations and domestic support such as cooking, cleaning, laundry, or grocery shopping was assessed. Data quality control was maintained through close supervision, daily monitoring, and a double-entry validation process to eliminate errors. Statistical Analysis Reliability Analysis To assess the internal consistency of the items, we conducted a reliability analysis using both Cronbach’s alpha (α) and McDonald’s omega (ω). These coefficients were computed for the full scale and each item, if deleted, providing insights into the contribution of individual items to overall reliability. Exploratory Factor Analysis (EFA) We performed an EFA to examine the underlying factor structure of the scale. The analysis used principal axis factoring (PAF) as the extraction method, which is robust to non-normality, and a Promax rotation, allowing factors to correlate. The number of factors was determined using parallel analysis, which compares observed eigenvalues to those derived from simulated random data. Assumptions for factor analysis were verified using Bartlett’s test of sphericity (to confirm sufficient item correlations) and the Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy (to ensure the data were suitable for factor analysis). Factor loadings below 0.3 were suppressed for clarity. Additional output included factor summaries (e.g., variance explained), inter-factor correlations, model fit indices, and a scree plot to support factor retention decisions. Model fit was evaluated using multiple indices based on established thresholds. A relative chi-square (χ²/df) value of 3.0 or less was considered indicative of a good fit. The Root Mean Square Error of Approximation (RMSEA) was interpreted as acceptable when values were 0.08 or below, with lower values indicating better fit. The Comparative Fit Index (CFI) was deemed acceptable at values of 0.90 or higher, reflecting adequate model performance compared to a null model. For the Standardized Root Mean Square Residual (SRMR), values of 0.08 or less were considered indicative of a good fit. Lastly, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used for model comparison, with preference given to models showing lower AIC and BIC values, reflecting better overall model parsimony and explanatory power. Confirmatory Factor Analysis (CFA) Following the EFA, a CFA was conducted to validate the identified factor structure. The model was estimated using maximum likelihood estimation, and fit indices—including the comparative fit index (CFI), Tucker-Lewis Index (TLI), root mean square error of approximation (RMSEA), and Bayesian information criterion (BIC) were examined to evaluate model adequacy. Factor covariances and standardized loadings were also reported to assess the relationships between items and their respective latent factors. Post-Factor Analysis: Group Comparisons and Predictors of Depression After the factor analysis of the questionnaire, the statistical analysis was conducted to compare caregivers with moderate-to-severe depression and those without depression across demographic, socioeconomic, health-related, and caregiving-related variables. Descriptive statistics were reported as means and standard deviations for normally distributed continuous variables, medians and interquartile ranges for non-normally distributed data, and frequencies and percentages for categorical variables. For inferential analysis, independent samples t-tests were used for normally distributed continuous variables, while the Wilcoxon rank-sum test was applied for non-normally distributed data. Categorical variables were analyzed using Pearson’s chi-square test, while ordinal variables with multiple categories were assessed using the Kruskal-Wallis test. A p-value of < 0.05 was considered statistically significant. The missing data were handled by excluding cases with incomplete information for the specific analysis. Assumptions for each test, including normality and homogeneity of variance, were verified before analysis. Effect sizes were reported for significant findings to assess the magnitude of observed differences. A binomial logistic regression analysis was performed to assess the relationship between caregiver depression status (binary outcome: no depression vs. moderate-severe depression) and various predictor variables, including demographic, socioeconomic, health-related, and caregiving-related factors. The model was fitted using maximum likelihood estimation to estimate the log-odds of depression status. Model Specification and Evaluation The overall model fit was evaluated using the likelihood ratio test, McFadden’s pseudo R² (R²~McF~), Akaike Information Criterion (AIC), and deviance statistics. Predictor significance was assessed via Wald chi-square tests, with odds ratios (ORs) and 95% confidence intervals (CIs) reported for interpretation. All continuous predictors were checked for linearity in the log-odds assumption, while categorical variables were included as factors. Multicollinearity was examined using the variance inflation factor (VIF) and tolerance statistics, with VIF 0.2 considered acceptable. This approach ensured a robust comparison between caregiver groups while addressing potential confounding factors. All the data analysis was performed using JAMOVI 2.6.26. Ethical Considerations Ethical considerations were strictly adhered to, with informed consent obtained from all participants before data collection. Participants were thoroughly briefed about the study’s objectives and assured of the confidentiality of their responses. Ethical principles, including autonomy, confidentiality, and beneficence, were upheld, and the data were used exclusively for research purposes. The study ensured that caregivers' rights and well-being were prioritized throughout the research process. Results Reliability Analysis The scale demonstrated strong internal consistency, with Cronbach’s α = 0.82 and McDonald’s ω = 0.82. Item-level analysis revealed that removing any single item did not substantially improve reliability (α and ω ranged from 0.79 to 0.83 when items were deleted), supporting the retention of all items in the initial analysis. The loading of factors is illustrated in Table 1 : Table 1 Promax-Rotated Factor Loadings from Exploratory Factor Analysis (n = 402) Factor 1 2 3 Uniqueness PHQ_1 0.7801 0.5199 PHQ_2 0.6997 0.4839 PHQ_3 0.7121 0.4342 PHQ_4 0.4365 0.3681 0.5015 PHQ_5 0.7240 0.5292 PHQ_6 0.5830 0.5537 PHQ_7 0.5834 0.5576 PHQ_8 0.7230 0.4609 PHQ_9 0.5214 0.7514 Note. Loadings < |0.3| omitted for clarity. Bolded values indicate primary factor assignments. Extraction method: Principal axis factoring. Rotation: Promax Exploratory Factor Analysis The KMO measure (0.85) and significant Bartlett’s Test (χ² = 1023, p < .001) confirmed the suitability of the data for factor analysis. Parallel analysis suggested retaining three factors, collectively explaining 46.75% of the total variance. Factor loadings revealed a clear structure: Factor 1 (25.49% variance) included PHQ-1, PHQ-2, PHQ-4, PHQ-7, and PHQ-8 (core affective-cognitive symptoms). Factor 2 (14.00% variance) comprised PHQ-3 and PHQ-5 (somatic symptoms). Factor 3 (7.26% variance) included PHQ-6 and PHQ-9 (suicidality/ and self-worth). Notably, PHQ-4 cross-loaded on Factors 1 and 2, and PHQ-9 had a weak loading (0.52) and high uniqueness (0.75), suggesting potential misfit. The loading of factors is illustrated in Table 1 . The Promax-rotated solution showed moderate correlations between factors (r = 0.35–0.68). The inter-factor correlations are illustrated in the supplementary file. Model fit was acceptable (RMSEA = 0.064, TLI = 0.94). Confirmatory Factor Analysis The CFA supported the three-factor structure, with good fit indices (CFI = 0.96, TLI = 0.94, RMSEA = 0.064), as reported in Table 2 : Table 2 Model Fit Indices for Exploratory and Confirmatory Factor Analysis Fit Index EFA CFA Threshold for Good Fit RMSEA 0.064 0.064 < 0.08 90% CI [0.037, 0.092] [0.045, 0.083] – TLI 0.94 0.94 ≥ 0.90 CFI – 0.96 ≥ 0.90 χ² (df) 31.72 ( 12 ) 63.37 ( 24 ) χ²/df = ≤ 3.0 BIC −40.24 9664 Lower = Better The standardized factor loadings from the confirmatory factor analysis, presented in Table 3 , demonstrate strong and statistically significant associations between all items and their respective latent factors (all p < .001), except for PHQ-9, which showed a weaker but still significant loading. Table 3 Standardized Factor Loadings from Confirmatory Factor Analysis with Standard Errors and Significance Tests Factor Indicator Estimate SE Z p Factor 1 PHQ-1 0.7355 0.05518 13.328 < .001 PHQ-2 0.7945 0.05302 14.985 < .001 PHQ-4 0.7890 0.05499 14.347 < .001 PHQ-7 0.7579 0.05343 14.185 < .001 PHQ-8 0.8179 0.05260 15.549 < .001 Factor 2 PHQ-3 0.9188 0.06371 14.421 < .001 PHQ-5 0.7150 0.05896 12.127 < .001 Factor 3 PHQ-6 0.8725 0.17286 5.047 < .001 PHQ-9 0.1840 0.04635 3.969 < .001 Note. All factor loadings were statistically significant (*p* < .001). PHQ = Patient Health Questionnaire Figure 1 illustrates the path diagram of the three-factor solution. Post-Factor Analysis: Group Comparisons and Predictors of Depression Having established the robust psychometric properties of the three-factor model, we next examined its clinical utility in characterizing depression symptoms among caregivers. The study included a total of 402 caregivers. In terms of participant characteristics, 186 caregivers (46.26%) were diagnosed with Major Depressive Disorder (PHQ-9 > 10), and 216 (53.73%) had no/mild depression. The mean age of participants was 37.84 years (SD = 12.84), with 37.1% identifying as female. The majority of caregivers were married (76.4%) and resided in urban areas (53.5%). Educational attainment varied, with 34.1% having completed secondary education and 27.1% possessing a diploma, bachelor's degree, or higher. In terms of employment, 34.6% were employed full-time, 25.6% part-time, while 37.3% were unemployed. Regarding the caregiver–patient relationship, 42.8% were spouses, 28.6% were offspring, 8.7% were parents, and 10.2% reported other relationships. Most caregivers (93.5%) did not reside with the patient. Nearly half (48.8%) lived in joint family households. The mean number of siblings reported by caregivers was 5.21 (SD = 2.19). Health-related characteristics indicated that 47.8% of caregivers reported good health and 36.1% reported excellent health. A high prevalence of chronic medical conditions was observed, with hypertension being the most common (78.6%), followed by diabetes (8.0%), cardiac conditions (2.5%), asthma (2.0%), and hepatitis (1.7%). The mean body mass index (BMI) was 24.43 kg/m² (SD = 4.42). A small proportion reported smoking tobacco (15.4%) or using sleep-inducing medications (7.5%). The average sleep duration was 7.56 hours per night (SD = 2.47), and the mean duration of physical activity was 0.76 hours per day (SD = 0.91). A history of depression was reported in 9.2% of caregivers. The median monthly income of caregivers was 25,500. Pakistani rupees (PKR) (IQR = 30500 Over half (54.2%) reported providing significant financial support to the patient. The reported median number of caregiving hours per day was 5 (IQR = 5.37. The median distance from caregivers’ residences to the hospital was 40 kilometres (IQR = 80), and patients visited the hospital an average of 1.65 times per week (SD = 1.42). Psychological assessment using the Patient Health Questionnaire-9 (PHQ-9) revealed a mean score of 9.25 (SD = 6.13). Based on PHQ-9 scoring criteria, 73.4% of caregivers were categorized as having depression. Specifically, 27.1% had mild depression, 24.1% moderate, 16.4% moderately severe, and 5.7% severe depression, while 26.6% exhibited no depressive symptoms. Continuous variables are reported as mean (SD) and range; categorical variables are shown as frequencies (%). Group differences were tested using linear model ANOVA for continuous variables and Pearson’s χ² tests for categorical variables. Table 4 presents descriptive statistics comparing caregivers with depression (MDD) and without depression across sociodemographic, economic, and health-related variables. Table 4 Comparison of Demographic, Socioeconomic, Health-Related, and Caregiving-Related Variables Between Caregivers with and without Moderate-to-Severe Depression Variables N Moderate-severe depression No/Mild depression Test Statistic (N = 186) (N = 216) Age of caregiver in years 402 Q1:27.0 Q2 = 38.0 Q3 = 48.0 Q1 = 27.4 Q2 = 37.0 Q3 = 45.0) F(1, 400) = 0.81, P = 0.373 Age of caregiver in years 402 χ²(3, N = 402) = 3.09, p = .3822 Up to 20 15/186 22/216 21–40 91/186 117/216 41–60 72/186 66/216 Greater than 60 8/186 11/216 Gender of the caregiver: female 402 68/186 81/216 χ²(1, N = 402) = 0.04, p = .852 Education of the caregiver 402 χ²(4, N = 402) = 13.46, p = .012 Uneducated 48/186 30/216 Primary 28/186 30/216 Secondary 52/186 85/216 Higher 12/186 8/216 Diploma/Bachelor's and Above 46/186 63/216 Current employment status of the caregiver 402 χ²(3, N = 402) = 4.55, p = .212 Unemployed 68/186 82/216 Employed Full-Time 62/186 77/216 Employed Part-Time 54/186 49/216 Retired 2/186 8/216 Monthly income of the caregiver 402 Q1:13916.7 Q2:25000.0 Q3:32250.0 Q1:12416.7 Q2:30000.0 Q3:50000.0 F(1, 400) = 8.67, p < .013 Monthly income of the caregiver 402 χ²(5, N = 402) = 31.19, p < .012 Up to 30000 PKR 138/186 121/216 30000–50000 PKR 38/186 44/216 50000–75000 PKR 6/186 16/216 75000–125000 0.0 3/186 6/216 125000–200000 PKR 0.0 0/186 4/216 Greater than 2 lacs 1/186 25/216 Residential area of the caregiver: urban 402 90/186 125/216 χ²(1, N = 402) = 3.61, p = .062 Marital status of the caregiver: married 402 144/186 163/216 χ²(1, N = 402) = 0.21, p = .652 BMI of caregiver 402 Q1 = 22.0 Q2 = 25.0 Q3 = 28.0 Q1 = 21.7 Q2 = 23.0Q3 = 26.0 F(1, 400) = 6.21, p = .013 BMI of caregiver - categories 402 χ2(1,N = 402) = 8.70,p = 0.032. Underweight 10/186 0.1 17/216 Normal 45/186 72/216 Overweight 32/186 43/216 Obesity 99/186 84/216 Current tobacco smoking: Smoker 402 33/186 29/216 χ2(1,N = 402) = 1.43,p = 0.232. Average sleep duration in caregivers 402 Q1:7.0 Q2: 8.0 Q3: 9.0 Q1:7.0 Q2: 8.0 Q3: 9.0 F(1, 400) = 0.01, p = .933. Average sleep duration in caregivers - categories 402 χ2(3,N = 402) = 1.68,p = 0.642. Insufficient Sleep 26/186 25/216 Suboptimal Sleep 42/186 60/216 Optimal Sleep 93/186 102/216 Oversleeping 25/186 29/216 Type of family structure caregiver lives in: Joint 402 96/186 100/216 χ2(1,N = 402) = 1.13,p = 0.292. Number of siblings of caregiver 402 Q1:4.0 Q2: 5.0 Q3: 7.0 Q1:4.0 Q2: 5.0 Q3: 7.0 F(1, 400) = 0.31, p = .583. Number of siblings of caregiver 402 χ2(4,N = 402) = 0.86,p = 0.932. Only child 4/186 3/216 Small family 16/186 15/216 Medium-sized family 89/186 107/216 Large family 62/186 75/216 Very large family 15/186 16/216 Overall health status of the caregiver 402 Χ23 = 11.55, P = 0.012 Poor 4/186 4/216 Fair 36/186 21/216 Good 92/186 100/216 Excellent 54/186 91/216 Chronic health conditions diagnosed in the caregiver 402 χ2(5,N = 402) = 3.98,p = 0.552. Hypertension 146/186 170/216 Diabetes 15/186 17/216 Asthma 5/186 3/216 Cardiac Related Disease 3/186 7/216 Hepatitis 5/186 2/216 Other Chronic Conditions 12/186 17/216 Whether caregiver takes sleeping pills or not: No 402 15/186 15/216 χ2(1,N = 402) = 0.18,p = 0.672. Whether the caregiver lives with the patient: No 402 180/186 196/216 χ2(1,N = 402) = 6.01,p = 0.012. Relationship between caregiver and patient 402 χ2(4,N = 402) = 6.42,p = 0.172. Spouse 88/186 84/216 Offspring 53/186 62/216 Parent 13/186 22/216 Sibling 19/186 20/216 Others 13/186 28/216 Duration of physical activity in caregivers - categories 402 χ2(3,N = 402) = 42.72,p < 0.012. Sedentary 126/186 77/216 Light activity 32/186 81/216 Moderate activity 19/186 46/216 High activity 9/186 12/216 Past depression history of the caregiver: No 402 168/186 197/216 χ2(1,N = 402) = 0.09,p = 0.762. Any relative of caregiver diagnosed with depression: No 388 163/181 180/207 Χ21 = 0.90, P = 0.342 χ2(1,N = 402) = 0.90,p = 0.342. Assistance provided by caregiver in household chores 402 χ2(2,N = 402) = 1.71,p = 0.432. None 36/186 36/216 Some 70/186 95/216 Significant 80/186 85/216 Financial support provided by caregiver for patient 402 χ2(2,N = 402) = 3.46,p = 0.182. None 47/186 72/216 Some 34/186 31/216 Significant 105/186 113/216 Transport assistance provided by caregiver for patient 402 χ2(2,N = 402) = 0.34,p = 0.842. None 29/186 36/216 Some 28/186 36/216 Significant 129/186 144/216 The hours caregiver spends per day 401 χ2(3,N = 401) = 16.33,p < .012. Low 62/185 89/216 Moderate 70/185 45/216 High 20/185 21/216 Very High 33/185 61/216 Age of the patient in years 402 Q1:38.0 Q2: 45.0Q3: 54.0 Q1:38.0 Q2:45.0Q3:56.6 F(1, 400) = 0.07, p = .793. Distance of caregiver residence from the hospital 402 Q1:11.9 Q2:50.0Q3: 100.0 Q1:10.0 Q2:30.0Q3:75.6 F(1, 400) = 2.41, p = .123. Distance of caregiver residence from the hospital 402 χ2(4,N = 402) = 8.15,p = 0.092. Very close 45/186 65/216 Close 29/186 45/216 Moderate Distance 34/186 41/216 Far 45/186 31/216 Very far 33/186 34/216 How often the patient visits the hospital in a week 401 Q1: 1.0 Q2: 1.0 Q3: 2.0 Q1: 1.0 Q2: 1.0 Q3: 2.0 F(1, 399) = 1.04, p = .313. How often the patient visits the hospital in a week 401 χ2(3,N = 402) = 6.46,p = 0.092. No hospital visits1 0/186 2/215 Occasional visits 160/186 172/215 Frequent visits 23/186 29/215 Very frequent visits 3/186 12/215 Stage of the patient’s illness 402 χ2(4,N = 402) = 5.80,p = 0.212. Stage 1 11/186 20/216 Stage 2 66/186 68/216 Unknown 5/186 13/216 Stage 3 70/186 69/216 stage 4 34/186 46/216 N is the number of non-missing value. 1: Kruskal-Wallis. 2: Pearson. 3Wilcoxon. The further details of the baseline socio-demographic, health, and caregiving-related characteristics of the caregiver population (N = 402) are summarized in the supplementary material. The study identified several key risk factors and associations with MDD in caregivers. Caregivers not living with the patient had a significantly higher prevalence of depression (p = 0.023). Lower education levels were strongly associated with higher depression rates (p = 0.002), and urban caregivers exhibited a significantly higher prevalence of depression compared to rural caregivers (p = 0.044). Financial instability was also a major determinant, with lower-income caregivers being more affected by depression (p = 0.033). In a multivariate logistic regression analysis, lower education levels were found to be a significant predictor of MDD (p = 0.007), while other variables such as living arrangements, body mass index (BMI), and marital status did not emerge as statistically significant predictors in the adjusted model as observed in Tables 5 and 6 . Table 5 Predictors of Depression Status: Estimates, Odds Ratios, and 95% Confidence Intervals from Binomial Logistic Regression Model Coefficients - Depression Score 95% Confidence Interval Predictor Estimate Lower Upper SE Z p Odds ratio Intercept 0.34041 -1.9358 2.61663 1.16136 0.29311 0.769 1.4055 Education of caregiver: Primary school – Uneducated 0.25152 -0.5116 1.01465 0.38936 0.646 0.518 1.286 Secondary school – Uneducated 0.67255 0.03087 1.31422 0.32739 2.05425 0.04 1.9592 Higher secondary school– Uneducated 0.04219 -1.0386 1.12298 0.55143 0.07651 0.939 1.0431 Diploma/Bachelor's and Above – Uneducated 0.16185 -0.53346 0.85716 0.35476 0.45623 0.648 1.1757 Overall health status of the caregiver: Fair – Poor -0.61042 -2.23889 1.01806 0.83087 -0.73467 0.463 0.5431 Good – Poor -0.16526 -1.71459 1.38407 0.79049 -0.20906 0.834 0.8477 Excellent – Poor 0.27145 -1.29043 1.83332 0.79689 0.34063 0.733 1.3119 BMI of caregiver -0.03397 -0.08301 0.01506 0.02502 -1.35786 0.175 0.9666 Monthly income of the caregiver 1.09E-05 4.53E-06 1.73E-05 3.25E-06 3.35726 < .001 1 Duration of physical activity in caregivers 0.44761 0.18755 0.70768 0.13269 3.37345 < .001 1.5646 How often the patient visits the hospital in a week 0.07322 -0.10675 0.2532 0.09183 0.79741 0.425 1.076 Number of hours caregivers spend caring for patients per day 0.01433 -0.02206 0.05071 0.01856 0.77175 0.44 1.0144 Average sleep duration in caregivers 0.03938 -0.04958 0.12834 0.04539 0.86765 0.386 1.0402 Whether the caregiver lives with the patient No – Yes -0.91901 -1.92663 0.08861 0.5141 -1.7876 0.074 0.3989 Note. Estimates represent the log odds of "depression status = No depression" vs. "depression status = depression" Table 6 Model Coefficients - Binomial Logistic Regression Predictor Estimate SE Z p Odds ratio Intercept -3.0175 0.9202 -3.279 0.001 0.0489 Education of caregiver : Uneducated – Diploma/Bachelor's and Above 0.7545 0.3248 2.323 0.02 2.1265 Primary school– Diploma/Bachelor's and Above 0.2975 0.346 0.86 0.39 1.3465 Secondary school– Diploma/Bachelor's and Above -0.2863 0.2834 -1.01 0.312 0.751 Higher secondary school– Diploma/Bachelor's and Above 0.7474 0.5216 1.433 0.152 2.1116 Relationship between caregiver and patient : Spouse – Off-spring 0.3752 0.3084 1.217 0.224 1.4553 Parent – Off-spring -0.2963 0.4432 -0.669 0.504 0.7436 Sibling – Off-spring 0.0689 0.4115 0.168 0.867 1.0714 Others – Off-spring -0.4437 0.4456 -0.996 0.319 0.6417 Whether the caregiver lives with the patient : No – Yes 0.8262 0.5442 1.518 0.129 2.2846 BMI of caregiver 0.0414 0.0248 1.665 0.096 1.0422 Marital status of the caregiver : married -single -0.4203 0.3151 -1.334 0.182 0.6569 Stage of the patient’s illness : Stage 2 – Stage 1 1.1122 0.5077 2.191 0.028 3.0412 Stage 3 – Stage 1 1.0047 0.5066 1.983 0.047 2.731 Stage 4 – Stage 1 0.7852 0.5312 1.478 0.139 2.1929 Not known – Stage 1 0.5066 0.7222 0.701 0.483 1.6597 Detailed results of the logistic regression analysis, including omnibus tests for individual predictors and overall model fit indices, are presented in the Supplementary files Tables. Discussion The present study identified a culturally informed three-factor structure of the PHQ-9 (somatic, cognitive-affective, and suicidality/sleep symptoms) among caregivers of breast cancer patients in Pakistan, demonstrating both alignment with and divergence from global validations. While the model's robust psychometric properties (BIC = -40.24; RMSEA = 0.064) support its validity in this understudied population, the weaker loading of PHQ-9 (suicidality) and strong somatic-cognitive correlations (r = 0.68) invite critical reflection on how cultural norms and caregiving stress shape depression manifestation. These findings extend prior work on caregiver mental health in low-resource settings while highlighting the need for culturally tailored assessment approaches. Our analysis revealed a culturally nuanced three-factor structure of the PHQ-9 among Pakistani caregivers, reflecting distinct symptom clusters. Factor 1: Affective-Cognitive Symptoms included items on anhedonia, depressed mood, fatigue, concentration difficulties, and psychomotor changes (items 1, 2, 4, 7, and 8). Factor 2: Somatic Symptoms comprised sleep disturbance and appetite change (items 3 and 5), reflecting the physical expression of psychological distress. Factor 3: Self-Worth and Suicidality included self-critical thoughts and suicidal ideation (items 6 and 9), potentially indicating internalized distress shaped by cultural stigma. This structure diverges from typical unidimensional single-factor validations of the PHQ-9 but mirrors findings from other studies, where somatic symptoms often emerge as separate constructs, and suicidality is distanced from core affective symptoms, possibly due to sociocultural sensitivity and stigma surrounding mental illness ( 14 – 16 ). Interestingly, the isolation of sleep/appetite items (factor 2) suggests caregivers may express distress through bodily symptoms first, necessitating clinician vigilance. Furthermore, Item 9’s pairing with self-criticism (Item 6) in factor 3 highlights how guilt and failure perceptions may drive suicidal ideation in this population. About psychomotor signs: Item 8’s loading on factor 1 (with emotional symptoms) indicates observable agitation/retardation may be central to depression diagnosis in caregivers. Beyond establishing the PHQ-9's culturally adapted factor structure, our findings reveal the urgent clinical implications of these psychometric patterns. Our finding indicates a 46.13% of depressive symptoms among caregivers measured on the Patient Health Questionnaire-9 based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, reflecting an immense psychological burden. Previous studies conducted in similar low and middle-income countries have reported comparable findings, where caregivers exhibit high levels of depressive symptoms, anxiety, and stress. A study conducted in India found that 52.5% of caregivers of breast cancer patients experience depression, which is quite similar to our finding ( 9 ). Due to similarity in cultural and social contexts between India and Pakistan, the variation in prevalence rate may be influenced by factors such as socioeconomic factors, political instability, access to mental health support services ( 17 ). A study conducted by Yang et al, evaluated the prevalence and ffound8.90% of population suffered from anxiety and depression among family caregivers ( 18 ). Globally, the pooled depression prevalence rate was 25.14% among caregivers of cancer patients ( 7 ). The higher prevalence in our study compared to above studies, likely reflects systemic gaps in Pakistan, such as limited mental health infrastructure, availability of mental health support services. Consistent with international literature, our study reinforces that caregiving particularly in the context of chronic and emotionally distressing illness like breast cancer, places caregivers at substantial risk for psychological morbidity ( 19 ). The exacerbation of psychological burden like depression may be influenced by multiple factors such as, relationship to the patient, family structure, financial constraints, and socioeconomic status, may influence the severity of depressive symptoms. In our study, spouses were more likely to develop depression. The findings are similar to a study conducted in India where spousal caregivers and those with financial responsibilities were more vulnerable to depression ( 9 ). Financial burden plays a pivotal role in the mental well-being of caregivers. Many breast cancer patients in Pakistan rely on out-of-pocket expenses for treatment, minimal access to insurance or government aid. This can lead to financial toxicity, adding another layer of psychological strain for caregivers, especially if they are also the primary earners of the household ( 20 , 21 ). Similar to previous findings, caregivers who earn less money are more likely to experience depression. The reason could be that people with low monthly income often experience financial toxicity, which refers to the stress and burden of managing expenses with limited resources, ultimately contribute to the development of depression ( 22 ). In Pakistani culture, caregiving is primarily a family responsibility, placing significant emotional and physical strain on caregivers. In Pakistan, joint family systems provide shared support, while nuclear family caregivers often manage responsibilities alone, increasing stress and depression ( 23 ). In contrast to previous studies, our study reported slight increased prevalence of depression in joint families. This can be due to increased domestic and caregiving burden and complex family dynamics ( 24 ). Culturally, caregiving in Pakistan is often considered a familial obligation, predominantly falling upon female family members who are already juggling household responsibilities. This dual burden could contribute to emotional exhaustion and increased risk of depression ( 18 ). Our findings in study reported increase prevelance of depression in males. This is due to increase population of male gender in our study. However, our study reported no relation pf depression with other factors such as age, BMI, and chronic illnesses. Other factors that might influence the higher prevalence rate of depression includes lack of awareness regarding mental health care, scarcity of structured psychosocial interventions tailored to caregivers, stigma surrounding mental health may discourage caregivers from seeking professional help, which may explain why depressive symptoms often go unrecognized and untreated ( 25 ). Furthermore, breast cancer itself is heavily stigma in many parts of the country, adding to the caregiver's psychological distress due to fear, social isolation, and uncertainty about the patient's prognosis ( 26 ). In interpreting the results, it is important to recognize the potential underreporting due to cultural reluctance in disclosing mental health symptoms. The observed prevalence of depression remains alarmingly high, suggesting that the actual rates of depression could be even higher than documented. Our findings call for immediate attention to the mental health needs of mental health screening and support for caregivers within oncology settings. Limitations of the study include the cross-sectional design, which makes it possible that some caregivers may have been depressed before caregiving. Besides, due to the convenience sampling method, the results may not be applied to all caregivers. Additionally, the study was limited to specific regions and healthcare centres, which may affect generalizability across Pakistan. The reliance of self-reported measures may be subject to bias. To alleviate this burden of depression, it is crucial to integrate routine psychological assessments, provide access to counseling services, and establish caregiver support groups in patient care plans. Training healthcare providers to recognize signs of caregiver distress and collaborate with mental health professionals to deliver timely interventions. Additionally, public awareness about caregiver mental health and importance of seeking support is essential. Along with this, development of caregivers’ support services and mental health resources tailored to Pakistani cultural contexts. Conclusion Family caregivers are known as a vulnerable population to psychological distress. The factor analysis revealed three clinically meaningful symptom profiles in this population: affective-cognitive symptoms, somatic manifestations, and a high-risk self-worth/suicidality cluster. These findings collectively signify that caregiver depression in low-resource settings presents distinct patterns, where somatic complaints may mask underlying distress, and self-criticism strongly associates with suicidal ideation. Our study revealed 46.26% of caregivers to breast cancer patients with major depressive disorder, where low education levels, financial burden, and unemployment are found to be key risk factors in causing depression. These findings highlight the substantial psychological burden on this population and underscore the necessity of immediate attention from healthcare, policymakers, and professionals for targeted mental health interventions to support caregivers effectively. Addressing this issue can lead to improved quality of life for both patients and their caregivers, ultimately contributing to better overall treatment outcomes. Abbreviations MDD: Major Depressive Disorder PHQ-9: Patient Health Questionnaire-9 DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition EFA: Exploratory Factor Analysis CFA: Confirmatory Factor Analysis KMO: Kaiser-Meyer-Olkin RMSEA: Root Mean Square Error of Approximation CFI: Comparative Fit Index TLI: Tucker-Lewis Index χ²: Chi-Square OR: Odds Ratio CI: Confidence Interval SD: Standard Deviation BMI: Body Mass Index Declarations Acknowledgements The authors are grateful to the participating hospitals, staff, and patients for their cooperation. Special thanks to the research assistants and data collectors for their contributions to the successful completion of this study. Funding This research received no external funding. Competing interests The authors declare no competing interests. Ethics approval and consent to participate This study was conducted after obtaining ethical approval from the Institutional Review Board of Rahmah Health Foundation, Islamabad, Pakistan (Approval No RHF-04-2024). Written informed consent was obtained from all participants before inclusion in the study. Clinical trial number Not applicable. Consent for publication This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to inclusion in the study. Data availability The data supporting this study's findings are available from the corresponding author upon reasonable request. Authors' contributions Conceptualization: Muhammad Usman Hashmi; Methodology: Muhammad Usman Hashmi , Pakeezah Tabasum, Imran Saeed, Zainab Azhar, Muhammad Huzefa Mehmood, Shahzeena Bibi, Hussain Ramzan, Momina Ahmed, Wajeeha Sarwar Formal analysis and investigation: Muhammad Usman Hashmi, Writing – original draft preparation: Muhammad Usman Hashmi , Pakeezah Tabasum, Imran Saeed, Zainab Azhar, Muhammad Huzefa Mehmood, Shahzeena Bibi, Hussain Ramzan, Momina Ahmed, Wajeeha Sarwar Writing – review and editing: Muhammad Usman Hashmi , Pakeezah Tabasum, Imran Saeed, Zainab Azhar, Muhammad Huzefa Mehmood, Shahzeena Bibi. References Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast Edinb Scotl. 2022 Dec;66:15–23. Ali A, Manzoor MF, Ahmad N, Aadil RM, Qin H, Siddique R, et al. The Burden of Cancer, Government Strategic Policies, and Challenges in Pakistan: A Comprehensive Review. Front Nutr. 2022;9:940514. Zaheer S, Yasmeen F. Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis. Pak J Med Sci. 2024;40(1Part-I):134–9. Laidsaar-Powell R, Butow P, Charles C, Gafni A, Entwistle V, Epstein R, et al. The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making. Patient Educ Couns. 2017 Nov;100(11):2035–46. Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res. 2017 Oct 2;50(1):33. Litzelman K, Blanch-Hartigan D, Lin CC, Han X. Correlates of the positive psychological byproducts of cancer: Role of family caregivers and informational support. Palliat Support Care. 2017 Dec;15(6):693–703. Pan YC, Lin YS. Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients. Front Psychiatry. 2022 May 12;13:817936. Bedaso A, Dejenu G, Duko B. Depression among caregivers of cancer patients: Updated systematic review and meta-analysis. Psychooncology. 2022 Nov;31(11):1809–20. Sahadevan S, Namboodiri V. Depression in caregivers of patients with breast cancer: A cross-sectional study from a cancer research center in South India. Indian J Psychiatry. 2019;61(3):277–82. Rababa’h SY, Alzoubi KH, Alquraan L, Karasneh R, Al-Azzam SI, Alrabadi N. Depression Among the Caregivers of Breast Cancer Patients and its Association with the Quality of Life. Clin Pract Epidemiol Ment Health CP EMH. 2022;18:e174501792208221. Wassie LA, Azagew AW, Bifftu BB. Depression and its associated factors among primary caregivers of adult cancer patients at Northwest Amhara Regional States Referrals Hospitals oncology treatment units, Northwest Ethiopia, 2021. BMC Psychiatry. 2022 Aug 6;22(1):533. Khan SI, Irfan M. Stigmatization and Self-Perception regarding issues related to Mental Health: A qualitative survey from a lower and middle-income country. Pak J Med Sci. 2023;39(5):1411–5. Ahmad S, Hussain S, Akhtar F, Shah FS. Urdu translation and validation of PHQ-9, a reliable identification, severity and treatment outcome tool for depression. J Pak Med Assoc . 2018;68(8):1166-1170. Guo B, Kaylor-Hughes C, Garland A, Nixon N, Sweeney T, Simpson S, et al. Factor structure and longitudinal measurement invariance of PHQ-9 for specialist mental health care patients with persistent major depressive disorder: Exploratory Structural Equation Modelling. J Affect Disord . 2017;219:1-8. Chilcot J, Rayner L, Lee W, Price A, Goodwin L, Monroe B, et al. The factor structure of the PHQ-9 in palliative care. J Psychosom Res . 2013;75(1):60-64. Di Matteo R, Bolgeo T, Simonelli N, Dal Molin A, Bassola B, Lusignani M, et al. Psychometric Properties and Measurement Invariance of the Patient Health Questionnaire 9 in an Italian Coronary Heart Disease Population. J Cardiovasc Nurs . Published online February 10, 2025. Ahmad SS, Koncsol SW. Cultural Factors Influencing Mental Health Stigma: Perceptions of Mental Illness (POMI) in Pakistani Emerging Adults. Religions. 2022 May;13(5):401. Yang M, Ma F, Lan B, Cai J, Sun X, Xu B. Validity of distress thermometer for screening of anxiety and depression in family caregivers of Chinese breast cancer patients receiving postoperative chemotherapy. Chin J Cancer Res Chung-Kuo Yen Cheng Yen Chiu. 2020 Aug;32(4):476–84. Shah SM, Sun T, Xu W, Jiang W, Yuan Y. The mental health of China and Pakistan, mental health laws and COVID-19 mental health policies: a comparative review. Gen Psychiatr . 2022;35(5):e100885. Guan N, Guariglia A, Moore P, Xu F, Al-Janabi H. Financial stress and depression in adults: A systematic review. PLoS ONE. 2022:17(2): e0264041. Costantini H, Ono T, Shogaki N, Tanaka T, Lyu W, Son B-K, et al. The impact of financial pressure on the association between employment and depressive symptoms for community-dwelling older adults. J Ageing Longev. 2024;4(2):41-50. Ustaalioğlu BBÖ, Acar E. The depression and related factors among cancer patients and their family caregivers in Turkish Population. Acta Haematol Oncol Turc. 2017;50(2):115-123. Taqui AM, Itrat A, Qidwai W, Qadri Z. Depression in the elderly: does family system play a role? A cross-sectional study. BMC Psychiatry . 2007;7:57. Sun X, Xu L, Sheng L. Family hardiness among primary caregivers of breast cancer patients in Hunan Province: a cross-sectional study exploring the relationship with attachment and caregiver preparedness. Front Public Health . 2024;12:1367029. Kaggwa MM, Najjuka SM, Mamun MA, Griffiths MD, Nyemara N, Ashaba S. Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma. BMC Psychiatry . 2023;23(1):72. Maheu C, Singh M, Tock WL, Eyrenci A, Galica J, Hébert M, et al. Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. Front Psychol . 2021;12:644932. Additional Declarations No competing interests reported. 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10:12:00","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":107275,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementeryfileMDDFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-6785454/v1/c0b714993fc218a27d03de1d.docx"},{"id":90315237,"identity":"3b749371-42e8-4526-861c-85ccde3ceb5e","added_by":"auto","created_at":"2025-09-01 10:12:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25404,"visible":true,"origin":"","legend":"","description":"","filename":"PatientHealthQuestionnaireUrdu.docx","url":"https://assets-eu.researchsquare.com/files/rs-6785454/v1/8286dab4b2e5ed1ecb2cb790.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Caregiver Depression in a Low-Resource Setting: A Multi-Domain Assessment of PHQ-9, Socio-Demographic Predictors of Major Depressive Disorder Among Family Caregivers of Breast Cancer Patients in Pakistan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer is one of the most prevalent malignancies affecting women worldwide. In 2020, approximately 2.3\u0026nbsp;million new cases and 685,000 deaths were reported, accounting for a significant proportion of cancer diagnoses worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Pakistan, the burden is particularly pronounced, with the country exhibiting breast cancer as the leading cancer among women, with one in four females affected (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In 2020 alone, breast cancer accounted for 28.7% of all new cancer cases and 11.7% of cancer-related deaths in the country (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This rising prevalence affects not only patients but also puts significant strain on their caregivers. Caregivers play a pivotal role in the journey of patients with breast cancer, providing emotional, practical, and psychological support (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In Pakistan, the healthcare system is predominantly patient-centered, with a limited emphasis on caregiver well-being. Limited awareness, late-stage diagnoses, and inadequate healthcare infrastructure make coping with the disease even more difficult, not just for patients but also for those who care for them (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Caregivers, who help navigate complex medical decisions, facilitate communication with oncologists, and provide unwavering strength in the face of uncertainty (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, this continuous responsibility can have severe psychological distress, including stress, anxiety, depression, and potential feelings of helplessness, all while maintaining a supportive environment for the patient (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Among these mental health concerns, major depressive disorder (MDD) is one of the most significant, affecting caregivers\u0026rsquo; well-being and their ability to provide optimal care. According to a systematic review and meta-analysis, approximately 42% of caregivers for cancer patients experience depression, with a higher prevalence observed among female caregivers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe prevalence of depression among caregivers varies across studies. For instance, a study in India found that 52.5% of caregivers of breast cancer patients experienced depression (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, a cross-sectional study in Jordan revealed 27.9% of participants with symptoms of depression (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These findings highlight the substantial mental health burden faced by caregivers. Depression rates among caregivers are influenced by various demographic and clinical factors, including younger age, spousal relationship, lower socioeconomic status, and providing care to patients with advanced-stage cancer (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Moreover, cultural norms significantly influence how depression is expressed and recognized. In many cultures, including Pakistan, mental health issues may be stigmatized, leading individuals to somatize psychological distress or refrain from seeking help. This cultural mindset contributes to the silent suffering of many caregivers that resulting in underreporting and underdiagnosis of depression among caregivers, thereby hindering timely intervention, support, and clinical outcomes of patients (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePakistan, being the most populous country, has a high number of breast cancer cases with limited emphasis on caregiver well-being, making it essential to assess the psychological toll on caregivers. However, despite the evident psychological burden, there is a paucity of research focusing on the mental health of caregivers. Existing studies predominantly concentrate on patients, often overlooking the psychological well-being of those who provide care, which can impair their ability to provide effective care and negatively influence their quality of life. This study aims to assess the prevalence of major depressive disorder (MDD) among caregivers of breast cancer patients in Pakistan. Additionally, the study seeks to identify key risk factors contributing to MDD. Identifying these challenges can aid in developing targeted mental health strategies, ultimately improving the well-being of caregivers and enhancing patient care.\u003c/p\u003e"},{"header":"Methodology","content":"\u003ch2\u003eStudy design and study setting \u003c/h2\u003e\u003cp\u003e This cross-sectional study was conducted over a period of three months across tertiary care hospitals in Pakistan, following ethical approval from the institutional review board of Rahmah Health Foundation, Islamabad, Pakistan. The study setting included hospitals with multidisciplinary cancer care teams comprising medical, surgical, radiation, and psycho-oncology specialists. However, at the time of the study, no dedicated caregiver support services were in place. The study population consisted of primary caregivers, both male and female, aged 18 years or older. Paid caregivers, individuals under 18, those with incomplete information, and those unwilling to participate were excluded.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSample Size and Eligibility Criteria\u003c/h2\u003e\u003cp\u003eA sample size of 384 caregivers was determined using the OpenEpi sample size calculator, with a 95% confidence interval and a 5% margin of error. Participants were recruited using a consecutive non-probability sampling technique, where caregivers were selected sequentially based on availability until the target sample size was reached. This approach was chosen due to the accessibility of participants, ensuring efficient data collection within the study's timeframe.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData collection was carried out through face-to-face interviews conducted by a trained researcher. Data collection involved a structured questionnaire to gather information on socio-demographic factors, caregiver burden, and health-related variables.\u003c/p\u003e\u003cp\u003eThe PHQ-9 used in this study was a previously validated Urdu translation, originally developed and validated by Ahmed S et al (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This validated instrument has been widely used for assessing depressive symptoms in Urdu-speaking populations.\u003c/p\u003e\u003cp\u003eAccording to PHQ-9 scoring guidelines, depression severity was categorized as minimal (0\u0026ndash;4), mild (\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), moderate (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), moderately severe (\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and severe (20\u0026ndash;27). For analysis, caregivers were grouped based on the presence or absence of moderate to severe depressive symptoms. Individuals with a PHQ-9 score of less than 10 (i.e., minimal or mild depression) were classified as having no moderate to severe depression, whereas those with a PHQ-9 score of 10 or higher (i.e., moderate, moderately severe, or severe depression) were classified as having moderate to severe depression. The data collection process was supervised to ensure accuracy, and participants were assured of the confidentiality and anonymity of their responses.\u003c/p\u003e\n\u003ch3\u003eStudy Variables\u003c/h3\u003e\n\u003cp\u003eThe study analyzed various caregiver-related variables, including demographics (age, gender, education, family structure, income, and residential area) and health factors (BMI, chronic conditions, and smoking status). Additionally, caregivers burden including number of caregiving hours, financial support such as contributing significantly to medical bills, rent or mortgage payments, daily living expenses, transportation costs, or other essential needs, transport facilities such as daily commuting, frequent medical visits, therapy sessions, or other essential destinations and domestic support such as cooking, cleaning, laundry, or grocery shopping was assessed. Data quality control was maintained through close supervision, daily monitoring, and a double-entry validation process to eliminate errors.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003eReliability Analysis\u003c/h2\u003e\u003cp\u003eTo assess the internal consistency of the items, we conducted a reliability analysis using both Cronbach\u0026rsquo;s alpha (α) and McDonald\u0026rsquo;s omega (ω). These coefficients were computed for the full scale and each item, if deleted, providing insights into the contribution of individual items to overall reliability.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eExploratory Factor Analysis (EFA)\u003c/h2\u003e\u003cp\u003eWe performed an EFA to examine the underlying factor structure of the scale. The analysis used principal axis factoring (PAF) as the extraction method, which is robust to non-normality, and a Promax rotation, allowing factors to correlate. The number of factors was determined using parallel analysis, which compares observed eigenvalues to those derived from simulated random data. Assumptions for factor analysis were verified using Bartlett\u0026rsquo;s test of sphericity (to confirm sufficient item correlations) and the Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy (to ensure the data were suitable for factor analysis). Factor loadings below 0.3 were suppressed for clarity. Additional output included factor summaries (e.g., variance explained), inter-factor correlations, model fit indices, and a scree plot to support factor retention decisions. Model fit was evaluated using multiple indices based on established thresholds. A relative chi-square (χ\u0026sup2;/df) value of 3.0 or less was considered indicative of a good fit. The Root Mean Square Error of Approximation (RMSEA) was interpreted as acceptable when values were 0.08 or below, with lower values indicating better fit. The Comparative Fit Index (CFI) was deemed acceptable at values of 0.90 or higher, reflecting adequate model performance compared to a null model. For the Standardized Root Mean Square Residual (SRMR), values of 0.08 or less were considered indicative of a good fit. Lastly, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used for model comparison, with preference given to models showing lower AIC and BIC values, reflecting better overall model parsimony and explanatory power.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eConfirmatory Factor Analysis (CFA)\u003c/h3\u003e\n\u003cp\u003eFollowing the EFA, a CFA was conducted to validate the identified factor structure. The model was estimated using maximum likelihood estimation, and fit indices\u0026mdash;including the comparative fit index (CFI), Tucker-Lewis Index (TLI), root mean square error of approximation (RMSEA), and Bayesian information criterion (BIC) were examined to evaluate model adequacy. Factor covariances and standardized loadings were also reported to assess the relationships between items and their respective latent factors.\u003c/p\u003e\n\u003ch3\u003ePost-Factor Analysis: Group Comparisons and Predictors of Depression\u003c/h3\u003e\n\u003cp\u003eAfter the factor analysis of the questionnaire, the statistical analysis was conducted to compare caregivers with moderate-to-severe depression and those without depression across demographic, socioeconomic, health-related, and caregiving-related variables. Descriptive statistics were reported as means and standard deviations for normally distributed continuous variables, medians and interquartile ranges for non-normally distributed data, and frequencies and percentages for categorical variables. For inferential analysis, independent samples t-tests were used for normally distributed continuous variables, while the Wilcoxon rank-sum test was applied for non-normally distributed data. Categorical variables were analyzed using Pearson\u0026rsquo;s chi-square test, while ordinal variables with multiple categories were assessed using the Kruskal-Wallis test. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. The missing data were handled by excluding cases with incomplete information for the specific analysis. Assumptions for each test, including normality and homogeneity of variance, were verified before analysis. Effect sizes were reported for significant findings to assess the magnitude of observed differences.\u003c/p\u003e\u003cp\u003eA binomial logistic regression analysis was performed to assess the relationship between caregiver depression status (binary outcome: no depression vs. moderate-severe depression) and various predictor variables, including demographic, socioeconomic, health-related, and caregiving-related factors. The model was fitted using maximum likelihood estimation to estimate the log-odds of depression status.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eModel Specification and Evaluation\u003c/h2\u003e\u003cp\u003eThe overall model fit was evaluated using the likelihood ratio test, McFadden\u0026rsquo;s pseudo R\u0026sup2; (R\u0026sup2;~McF~), Akaike Information Criterion (AIC), and deviance statistics. Predictor significance was assessed via Wald chi-square tests, with odds ratios (ORs) and 95% confidence intervals (CIs) reported for interpretation.\u003c/p\u003e\u003cp\u003eAll continuous predictors were checked for linearity in the log-odds assumption, while categorical variables were included as factors. Multicollinearity was examined using the variance inflation factor (VIF) and tolerance statistics, with VIF\u0026thinsp;\u0026lt;\u0026thinsp;5 and tolerance\u0026thinsp;\u0026gt;\u0026thinsp;0.2 considered acceptable. This approach ensured a robust comparison between caregiver groups while addressing potential confounding factors. All the data analysis was performed using JAMOVI 2.6.26.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e Ethical considerations were strictly adhered to, with informed consent obtained from all participants before data collection. Participants were thoroughly briefed about the study\u0026rsquo;s objectives and assured of the confidentiality of their responses. Ethical principles, including autonomy, confidentiality, and beneficence, were upheld, and the data were used exclusively for research purposes. The study ensured that caregivers' rights and well-being were prioritized throughout the research process.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eReliability Analysis\u003c/h2\u003e\u003cp\u003eThe scale demonstrated strong internal consistency, with Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.82 and McDonald\u0026rsquo;s ω\u0026thinsp;=\u0026thinsp;0.82. Item-level analysis revealed that removing any single item did not substantially improve reliability (α and ω ranged from 0.79 to 0.83 when items were deleted), supporting the retention of all items in the initial analysis. The loading of factors is illustrated in 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\u003ePromax-Rotated Factor Loadings from Exploratory Factor Analysis (n\u0026thinsp;=\u0026thinsp;402)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniqueness\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7801\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5199\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4839\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4342\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.4365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5292\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5830\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5576\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4609\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePHQ_9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.7514\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eNote. Loadings \u0026lt; |0.3| omitted for clarity. Bolded values indicate primary factor assignments. Extraction method: Principal axis factoring. Rotation: Promax\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=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eExploratory Factor Analysis\u003c/h2\u003e\u003cp\u003eThe KMO measure (0.85) and significant Bartlett\u0026rsquo;s Test (χ\u0026sup2; = 1023, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) confirmed the suitability of the data for factor analysis. Parallel analysis suggested retaining three factors, collectively explaining 46.75% of the total variance. Factor loadings revealed a clear structure:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFactor 1\u003c/b\u003e (25.49% variance) included PHQ-1, PHQ-2, PHQ-4, PHQ-7, and PHQ-8 (core affective-cognitive symptoms).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFactor 2\u003c/b\u003e (14.00% variance) comprised PHQ-3 and PHQ-5 (somatic symptoms).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFactor 3\u003c/b\u003e (7.26% variance) included PHQ-6 and PHQ-9 (suicidality/ and self-worth).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eNotably, PHQ-4 cross-loaded on Factors 1 and 2, and PHQ-9 had a weak loading (0.52) and high uniqueness (0.75), suggesting potential misfit. The loading of factors is illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The Promax-rotated solution showed moderate correlations between factors (r\u0026thinsp;=\u0026thinsp;0.35\u0026ndash;0.68). The inter-factor correlations are illustrated in the supplementary file. Model fit was acceptable (RMSEA\u0026thinsp;=\u0026thinsp;0.064, TLI\u0026thinsp;=\u0026thinsp;0.94).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eConfirmatory Factor Analysis\u003c/h2\u003e\u003cp\u003eThe CFA supported the three-factor structure, with good fit indices (CFI\u0026thinsp;=\u0026thinsp;0.96, TLI\u0026thinsp;=\u0026thinsp;0.94, RMSEA\u0026thinsp;=\u0026thinsp;0.064), as reported in 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\u003eModel Fit Indices for Exploratory and Confirmatory Factor Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFit Index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEFA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCFA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThreshold for Good Fit\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.037, 0.092]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.045, 0.083]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eχ\u0026sup2; (df)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.72 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.37 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;\u0026le;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBIC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;40.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9664\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLower\u0026thinsp;=\u0026thinsp;Better\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\u003eThe standardized factor loadings from the confirmatory factor analysis, presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, demonstrate strong and statistically significant associations between all items and their respective latent factors (all p\u0026thinsp;\u0026lt;\u0026thinsp;.001), except for PHQ-9, which showed a weaker but still significant loading.\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\u003eStandardized Factor Loadings from Confirmatory Factor Analysis with Standard Errors and Significance Tests\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=\"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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEstimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eFactor 1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05518\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.985\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05499\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7579\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.549\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eFactor 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.06371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eFactor 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8725\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.17286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePHQ-9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.1840\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04635\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.969\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e All factor loadings were statistically significant (*p* \u0026lt; .001). PHQ\u0026thinsp;=\u0026thinsp;Patient Health Questionnaire\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigure 1 illustrates the path diagram of the three-factor solution.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePost-Factor Analysis: Group Comparisons and Predictors of Depression\u003c/h2\u003e\u003cp\u003eHaving established the robust psychometric properties of the three-factor model, we next examined its clinical utility in characterizing depression symptoms among caregivers. The study included a total of 402 caregivers. In terms of participant characteristics, 186 caregivers (46.26%) were diagnosed with Major Depressive Disorder (PHQ-9\u0026thinsp;\u0026gt;\u0026thinsp;10), and 216 (53.73%) had no/mild depression. The mean age of participants was 37.84 years (SD\u0026thinsp;=\u0026thinsp;12.84), with 37.1% identifying as female. The majority of caregivers were married (76.4%) and resided in urban areas (53.5%). Educational attainment varied, with 34.1% having completed secondary education and 27.1% possessing a diploma, bachelor's degree, or higher. In terms of employment, 34.6% were employed full-time, 25.6% part-time, while 37.3% were unemployed. Regarding the caregiver\u0026ndash;patient relationship, 42.8% were spouses, 28.6% were offspring, 8.7% were parents, and 10.2% reported other relationships. Most caregivers (93.5%) did not reside with the patient. Nearly half (48.8%) lived in joint family households. The mean number of siblings reported by caregivers was 5.21 (SD\u0026thinsp;=\u0026thinsp;2.19).\u003c/p\u003e\u003cp\u003eHealth-related characteristics indicated that 47.8% of caregivers reported good health and 36.1% reported excellent health. A high prevalence of chronic medical conditions was observed, with hypertension being the most common (78.6%), followed by diabetes (8.0%), cardiac conditions (2.5%), asthma (2.0%), and hepatitis (1.7%). The mean body mass index (BMI) was 24.43 kg/m\u0026sup2; (SD\u0026thinsp;=\u0026thinsp;4.42). A small proportion reported smoking tobacco (15.4%) or using sleep-inducing medications (7.5%). The average sleep duration was 7.56 hours per night (SD\u0026thinsp;=\u0026thinsp;2.47), and the mean duration of physical activity was 0.76 hours per day (SD\u0026thinsp;=\u0026thinsp;0.91). A history of depression was reported in 9.2% of caregivers.\u003c/p\u003e\u003cp\u003eThe median monthly income of caregivers was 25,500. Pakistani rupees (PKR) (IQR\u0026thinsp;=\u0026thinsp;30500 Over half (54.2%) reported providing significant financial support to the patient. The reported median number of caregiving hours per day was 5 (IQR\u0026thinsp;=\u0026thinsp;5.37. The median distance from caregivers\u0026rsquo; residences to the hospital was 40 kilometres (IQR\u0026thinsp;=\u0026thinsp;80), and patients visited the hospital an average of 1.65 times per week (SD\u0026thinsp;=\u0026thinsp;1.42).\u003c/p\u003e\u003cp\u003ePsychological assessment using the Patient Health Questionnaire-9 (PHQ-9) revealed a mean score of 9.25 (SD\u0026thinsp;=\u0026thinsp;6.13). Based on PHQ-9 scoring criteria, 73.4% of caregivers were categorized as having depression. Specifically, 27.1% had mild depression, 24.1% moderate, 16.4% moderately severe, and 5.7% severe depression, while 26.6% exhibited no depressive symptoms. Continuous variables are reported as mean (SD) and range; categorical variables are shown as frequencies (%). Group differences were tested using linear model ANOVA for continuous variables and Pearson\u0026rsquo;s χ\u0026sup2; tests for categorical variables. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents descriptive statistics comparing caregivers with depression (MDD) and without depression across sociodemographic, economic, and health-related variables.\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\u003eComparison of Demographic, Socioeconomic, Health-Related, and Caregiving-Related Variables Between Caregivers with and without Moderate-to-Severe Depression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModerate-severe depression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo/Mild depression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;186)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;216)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of caregiver in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1:27.0 \u003c/p\u003e\u003cp\u003eQ2\u0026thinsp;=\u0026thinsp;38.0\u003c/p\u003e\u003cp\u003eQ3\u0026thinsp;=\u0026thinsp;48.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1\u0026thinsp;=\u0026thinsp;27.4 Q2\u0026thinsp;=\u0026thinsp;37.0\u003c/p\u003e\u003cp\u003eQ3\u0026thinsp;=\u0026thinsp;45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;0.81, P\u0026thinsp;=\u0026thinsp;0.373\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of caregiver in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(3, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;3.09, p\u0026thinsp;=\u0026thinsp;.3822\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to 20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e117/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGreater than 60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender of the caregiver: female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(1, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.04, p\u0026thinsp;=\u0026thinsp;.852\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation of the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(4, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;13.46, p\u0026thinsp;=\u0026thinsp;.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUneducated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma/Bachelor's and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent employment status of the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(3, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;4.55, p\u0026thinsp;=\u0026thinsp;.212\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed Full-Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed Part-Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonthly income of the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1:13916.7 Q2:25000.0 Q3:32250.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1:12416.7 Q2:30000.0 Q3:50000.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;8.67, p\u0026thinsp;\u0026lt;\u0026thinsp;.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonthly income of the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(5, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;31.19, p\u0026thinsp;\u0026lt;\u0026thinsp;.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to 30000 PKR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e138/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30000\u0026ndash;50000 PKR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50000\u0026ndash;75000 PKR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e75000\u0026ndash;125000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0 3/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e125000\u0026ndash;200000 PKR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0 0/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGreater than 2 lacs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidential area of the caregiver: urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(1, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;3.61, p\u0026thinsp;=\u0026thinsp;.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status of the caregiver: married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e163/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;(1, N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.21, p\u0026thinsp;=\u0026thinsp;.652\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI of caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1\u0026thinsp;=\u0026thinsp;22.0 \u003c/p\u003e\u003cp\u003eQ2\u0026thinsp;=\u0026thinsp;25.0\u003c/p\u003e\u003cp\u003eQ3\u0026thinsp;=\u0026thinsp;28.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1\u0026thinsp;=\u0026thinsp;21.7 \u003c/p\u003e\u003cp\u003eQ2\u0026thinsp;=\u0026thinsp;23.0Q3\u0026thinsp;=\u0026thinsp;26.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;6.21, p\u0026thinsp;=\u0026thinsp;.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI of caregiver - categories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;8.70,p\u0026thinsp;=\u0026thinsp;0.032.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1 17/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCurrent tobacco smoking: Smoker\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;1.43,p\u0026thinsp;=\u0026thinsp;0.232.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage sleep duration in caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1:7.0\u003c/p\u003e\u003cp\u003eQ2: 8.0 \u003c/p\u003e\u003cp\u003eQ3: 9.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1:7.0\u003c/p\u003e\u003cp\u003eQ2: 8.0 \u003c/p\u003e\u003cp\u003eQ3: 9.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;0.01, p\u0026thinsp;=\u0026thinsp;.933.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage sleep duration in caregivers - categories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(3,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;1.68,p\u0026thinsp;=\u0026thinsp;0.642.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsufficient Sleep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuboptimal Sleep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptimal Sleep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOversleeping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of family structure caregiver lives in: Joint\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;1.13,p\u0026thinsp;=\u0026thinsp;0.292.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of siblings of caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1:4.0\u003c/p\u003e\u003cp\u003eQ2: 5.0\u003c/p\u003e\u003cp\u003eQ3: 7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1:4.0\u003c/p\u003e\u003cp\u003eQ2: 5.0\u003c/p\u003e\u003cp\u003eQ3: 7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;0.31, p\u0026thinsp;=\u0026thinsp;.583.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of siblings of caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(4,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.86,p\u0026thinsp;=\u0026thinsp;0.932.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium-sized family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery large family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall health status of the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eΧ23\u0026thinsp;=\u0026thinsp;11.55, P\u0026thinsp;=\u0026thinsp;0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic health conditions diagnosed in the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(5,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;3.98,p\u0026thinsp;=\u0026thinsp;0.552.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e170/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsthma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiac Related Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHepatitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Chronic Conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether caregiver takes sleeping pills or not: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.18,p\u0026thinsp;=\u0026thinsp;0.672.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether the caregiver lives with the patient: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e180/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e196/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;6.01,p\u0026thinsp;=\u0026thinsp;0.012.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship between caregiver and patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(4,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;6.42,p\u0026thinsp;=\u0026thinsp;0.172.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOffspring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSibling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of physical activity in caregivers - categories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(3,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;42.72,p\u0026thinsp;\u0026lt;\u0026thinsp;0.012.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSedentary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLight activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePast depression history of the caregiver: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e168/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e197/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.09,p\u0026thinsp;=\u0026thinsp;0.762.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAny relative of caregiver diagnosed with depression: No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163/181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180/207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eΧ21\u0026thinsp;=\u0026thinsp;0.90, P\u0026thinsp;=\u0026thinsp;0.342\u003c/p\u003e\u003cp\u003eχ2(1,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.90,p\u0026thinsp;=\u0026thinsp;0.342.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssistance provided by caregiver in household chores\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(2,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;1.71,p\u0026thinsp;=\u0026thinsp;0.432.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinancial support provided by caregiver for patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(2,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;3.46,p\u0026thinsp;=\u0026thinsp;0.182.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e113/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransport assistance provided by caregiver for patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(2,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;0.34,p\u0026thinsp;=\u0026thinsp;0.842.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe hours caregiver spends per day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(3,N\u0026thinsp;=\u0026thinsp;401)\u0026thinsp;=\u0026thinsp;16.33,p\u0026thinsp;\u0026lt;\u0026thinsp;.012.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62/185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70/185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20/185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33/185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of the patient in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1:38.0 Q2: 45.0Q3: 54.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1:38.0 Q2:45.0Q3:56.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;0.07, p\u0026thinsp;=\u0026thinsp;.793.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance of caregiver residence from the hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1:11.9 Q2:50.0Q3: 100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1:10.0 Q2:30.0Q3:75.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 400)\u0026thinsp;=\u0026thinsp;2.41, p\u0026thinsp;=\u0026thinsp;.123.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance of caregiver residence from the hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(4,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;8.15,p\u0026thinsp;=\u0026thinsp;0.092.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery close\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate Distance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery far\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow often the patient visits the hospital in a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1: 1.0 \u003c/p\u003e\u003cp\u003eQ2: 1.0\u003c/p\u003e\u003cp\u003eQ3: 2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ1: 1.0 \u003c/p\u003e\u003cp\u003eQ2: 1.0\u003c/p\u003e\u003cp\u003eQ3: 2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF(1, 399)\u0026thinsp;=\u0026thinsp;1.04, p\u0026thinsp;=\u0026thinsp;.313.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow often the patient visits the hospital in a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(3,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;6.46,p\u0026thinsp;=\u0026thinsp;0.092.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo hospital visits1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2/215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccasional visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e160/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e172/215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrequent visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29/215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery frequent visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12/215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage of the patient\u0026rsquo;s illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2(4,N\u0026thinsp;=\u0026thinsp;402)\u0026thinsp;=\u0026thinsp;5.80,p\u0026thinsp;=\u0026thinsp;0.212.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003estage 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34/186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46/216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eN is the number of non-missing value. 1: Kruskal-Wallis. 2: Pearson. 3Wilcoxon.\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\u003eThe further details of the baseline socio-demographic, health, and caregiving-related characteristics of the caregiver population (N\u0026thinsp;=\u0026thinsp;402) are summarized in the supplementary material.\u003c/p\u003e\u003cp\u003eThe study identified several key risk factors and associations with MDD in caregivers. Caregivers not living with the patient had a significantly higher prevalence of depression (p\u0026thinsp;=\u0026thinsp;0.023). Lower education levels were strongly associated with higher depression rates (p\u0026thinsp;=\u0026thinsp;0.002), and urban caregivers exhibited a significantly higher prevalence of depression compared to rural caregivers (p\u0026thinsp;=\u0026thinsp;0.044). Financial instability was also a major determinant, with lower-income caregivers being more affected by depression (p\u0026thinsp;=\u0026thinsp;0.033). In a multivariate logistic regression analysis, lower education levels were found to be a significant predictor of MDD (p\u0026thinsp;=\u0026thinsp;0.007), while other variables such as living arrangements, body mass index (BMI), and marital status did not emerge as statistically significant predictors in the adjusted model as observed in Tables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\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\u003ePredictors of Depression Status: Estimates, Odds Ratios, and 95% Confidence Intervals from Binomial Logistic Regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\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\u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eModel Coefficients - Depression Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e95% Confidence Interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEstimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.34041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.9358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.61663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.16136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.29311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.4055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eEducation of caregiver:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school \u0026ndash; Uneducated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.5116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.646\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.518\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.286\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school \u0026ndash; Uneducated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.67255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.31422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.32739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.05425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.9592\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher secondary school\u0026ndash; Uneducated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.04219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.0386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.07651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0431\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma/Bachelor's and Above \u0026ndash; Uneducated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.16185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.53346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.35476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45623\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.648\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.1757\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eOverall health status of the caregiver:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFair \u0026ndash; Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.61042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.23889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01806\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.73467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.5431\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood \u0026ndash; Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.16526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.71459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.38407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.79049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.20906\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.8477\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcellent \u0026ndash; Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.27145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.29043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.83332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.79689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.34063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.733\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.3119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI of caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.03397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.08301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01506\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.35786\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.9666\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonthly income of the caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.09E-05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.53E-06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.73E-05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.25E-06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.35726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of physical activity in caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.44761\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.18755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70768\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.13269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.37345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.5646\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow often the patient visits the hospital in a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.07322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.10675\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.79741\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of hours caregivers spend caring for patients per day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.02206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01856\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.77175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0144\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage sleep duration in caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.03938\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.04958\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86765\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0402\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether the caregiver lives with the patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo \u0026ndash; Yes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.91901\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.92663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.08861\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.7876\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.3989\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNote. Estimates represent the log odds of \"depression status\u0026thinsp;=\u0026thinsp;No depression\" vs. \"depression status\u0026thinsp;=\u0026thinsp;depression\"\u003c/b\u003e\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\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\u003eModel Coefficients - Binomial Logistic Regression\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=\"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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\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\u003eEstimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ\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\u003eOdds ratio\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.0175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0489\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation of caregiver\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUneducated \u0026ndash; Diploma/Bachelor's and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7545\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.1265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u0026ndash; Diploma/Bachelor's and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.2975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.3465\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school\u0026ndash; Diploma/Bachelor's and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.2863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.2834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.751\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher secondary school\u0026ndash; Diploma/Bachelor's and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.1116\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRelationship between caregiver and patient\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse \u0026ndash; Off-spring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.3752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.4553\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParent \u0026ndash; Off-spring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.2963\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.669\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSibling \u0026ndash; Off-spring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.867\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.0714\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers \u0026ndash; Off-spring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.4437\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.6417\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhether the caregiver lives with the patient\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo \u0026ndash; Yes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.8262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.518\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.2846\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI of caregiver\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.0422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status of the caregiver\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emarried -single\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.4203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.6569\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStage of the patient\u0026rsquo;s illness\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 2 \u0026ndash; Stage 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.0412\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 3 \u0026ndash; Stage 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.731\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 4 \u0026ndash; Stage 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.1929\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot known \u0026ndash; Stage 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.701\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.483\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.6597\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\u003eDetailed results of the logistic regression analysis, including omnibus tests for individual predictors and overall model fit indices, are presented in the Supplementary files Tables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e The present study identified a culturally informed three-factor structure of the PHQ-9 (somatic, cognitive-affective, and suicidality/sleep symptoms) among caregivers of breast cancer patients in Pakistan, demonstrating both alignment with and divergence from global validations. While the model's robust psychometric properties (BIC = -40.24; RMSEA\u0026thinsp;=\u0026thinsp;0.064) support its validity in this understudied population, the weaker loading of PHQ-9 (suicidality) and strong somatic-cognitive correlations (r\u0026thinsp;=\u0026thinsp;0.68) invite critical reflection on how cultural norms and caregiving stress shape depression manifestation. These findings extend prior work on caregiver mental health in low-resource settings while highlighting the need for culturally tailored assessment approaches.\u003c/p\u003e\u003cp\u003eOur analysis revealed a culturally nuanced three-factor structure of the PHQ-9 among Pakistani caregivers, reflecting distinct symptom clusters.\u003c/p\u003e\u003cp\u003eFactor 1: Affective-Cognitive Symptoms included items on anhedonia, depressed mood, fatigue, concentration difficulties, and psychomotor changes (items 1, 2, 4, 7, and 8).\u003c/p\u003e\u003cp\u003eFactor 2: Somatic Symptoms comprised sleep disturbance and appetite change (items 3 and 5), reflecting the physical expression of psychological distress.\u003c/p\u003e\u003cp\u003eFactor 3: Self-Worth and Suicidality included self-critical thoughts and suicidal ideation (items 6 and 9), potentially indicating internalized distress shaped by cultural stigma.\u003c/p\u003e\u003cp\u003eThis structure diverges from typical unidimensional single-factor validations of the PHQ-9 but mirrors findings from other studies, where somatic symptoms often emerge as separate constructs, and suicidality is distanced from core affective symptoms, possibly due to sociocultural sensitivity and stigma surrounding mental illness (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInterestingly, the isolation of sleep/appetite items (factor 2) suggests caregivers may express distress through bodily symptoms first, necessitating clinician vigilance. Furthermore, Item 9\u0026rsquo;s pairing with self-criticism (Item 6) in factor 3 highlights how guilt and failure perceptions may drive suicidal ideation in this population. About psychomotor signs: Item 8\u0026rsquo;s loading on factor 1 (with emotional symptoms) indicates observable agitation/retardation may be central to depression diagnosis in caregivers. Beyond establishing the PHQ-9's culturally adapted factor structure, our findings reveal the urgent clinical implications of these psychometric patterns. Our finding indicates a 46.13% of depressive symptoms among caregivers measured on the Patient Health Questionnaire-9 based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, reflecting an immense psychological burden.\u003c/p\u003e\u003cp\u003ePrevious studies conducted in similar low and middle-income countries have reported comparable findings, where caregivers exhibit high levels of depressive symptoms, anxiety, and stress. A study conducted in India found that 52.5% of caregivers of breast cancer patients experience depression, which is quite similar to our finding (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Due to similarity in cultural and social contexts between India and Pakistan, the variation in prevalence rate may be influenced by factors such as socioeconomic factors, political instability, access to mental health support services (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A study conducted by Yang et al, evaluated the prevalence and ffound8.90% of population suffered from anxiety and depression among family caregivers (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Globally, the pooled depression prevalence rate was 25.14% among caregivers of cancer patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The higher prevalence in our study compared to above studies, likely reflects systemic gaps in Pakistan, such as limited mental health infrastructure, availability of mental health support services. Consistent with international literature, our study reinforces that caregiving particularly in the context of chronic and emotionally distressing illness like breast cancer, places caregivers at substantial risk for psychological morbidity (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe exacerbation of psychological burden like depression may be influenced by multiple factors such as, relationship to the patient, family structure, financial constraints, and socioeconomic status, may influence the severity of depressive symptoms. In our study, spouses were more likely to develop depression. The findings are similar to a study conducted in India where spousal caregivers and those with financial responsibilities were more vulnerable to depression (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFinancial burden plays a pivotal role in the mental well-being of caregivers. Many breast cancer patients in Pakistan rely on out-of-pocket expenses for treatment, minimal access to insurance or government aid. This can lead to financial toxicity, adding another layer of psychological strain for caregivers, especially if they are also the primary earners of the household (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Similar to previous findings, caregivers who earn less money are more likely to experience depression. The reason could be that people with low monthly income often experience financial toxicity, which refers to the stress and burden of managing expenses with limited resources, ultimately contribute to the development of depression (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Pakistani culture, caregiving is primarily a family responsibility, placing significant emotional and physical strain on caregivers. In Pakistan, joint family systems provide shared support, while nuclear family caregivers often manage responsibilities alone, increasing stress and depression (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In contrast to previous studies, our study reported slight increased prevalence of depression in joint families. This can be due to increased domestic and caregiving burden and complex family dynamics (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCulturally, caregiving in Pakistan is often considered a familial obligation, predominantly falling upon female family members who are already juggling household responsibilities. This dual burden could contribute to emotional exhaustion and increased risk of depression (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Our findings in study reported increase prevelance of depression in males. This is due to increase population of male gender in our study. However, our study reported no relation pf depression with other factors such as age, BMI, and chronic illnesses.\u003c/p\u003e\u003cp\u003eOther factors that might influence the higher prevalence rate of depression includes lack of awareness regarding mental health care, scarcity of structured psychosocial interventions tailored to caregivers, stigma surrounding mental health may discourage caregivers from seeking professional help, which may explain why depressive symptoms often go unrecognized and untreated (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, breast cancer itself is heavily stigma in many parts of the country, adding to the caregiver's psychological distress due to fear, social isolation, and uncertainty about the patient's prognosis (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn interpreting the results, it is important to recognize the potential underreporting due to cultural reluctance in disclosing mental health symptoms. The observed prevalence of depression remains alarmingly high, suggesting that the actual rates of depression could be even higher than documented. Our findings call for immediate attention to the mental health needs of mental health screening and support for caregivers within oncology settings.\u003c/p\u003e\u003cp\u003eLimitations of the study include the cross-sectional design, which makes it possible that some caregivers may have been depressed before caregiving. Besides, due to the convenience sampling method, the results may not be applied to all caregivers. Additionally, the study was limited to specific regions and healthcare centres, which may affect generalizability across Pakistan. The reliance of self-reported measures may be subject to bias.\u003c/p\u003e\u003cp\u003eTo alleviate this burden of depression, it is crucial to integrate routine psychological assessments, provide access to counseling services, and establish caregiver support groups in patient care plans. Training healthcare providers to recognize signs of caregiver distress and collaborate with mental health professionals to deliver timely interventions. Additionally, public awareness about caregiver mental health and importance of seeking support is essential. Along with this, development of caregivers\u0026rsquo; support services and mental health resources tailored to Pakistani cultural contexts.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFamily caregivers are known as a vulnerable population to psychological distress. The factor analysis revealed three clinically meaningful symptom profiles in this population: affective-cognitive symptoms, somatic manifestations, and a high-risk self-worth/suicidality cluster. These findings collectively signify that caregiver depression in low-resource settings presents distinct patterns, where somatic complaints may mask underlying distress, and self-criticism strongly associates with suicidal ideation. Our study revealed 46.26% of caregivers to breast cancer patients with major depressive disorder, where low education levels, financial burden, and unemployment are found to be key risk factors in causing depression. These findings highlight the substantial psychological burden on this population and underscore the necessity of immediate attention from healthcare, policymakers, and professionals for targeted mental health interventions to support caregivers effectively. Addressing this issue can lead to improved quality of life for both patients and their caregivers, ultimately contributing to better overall treatment outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMDD: Major Depressive Disorder\u003c/p\u003e\n\u003cp\u003ePHQ-9: Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003eDSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition\u003c/p\u003e\n\u003cp\u003eEFA: Exploratory Factor Analysis\u003c/p\u003e\n\u003cp\u003eCFA: Confirmatory Factor Analysis\u003c/p\u003e\n\u003cp\u003eKMO: Kaiser-Meyer-Olkin\u003c/p\u003e\n\u003cp\u003eRMSEA: Root Mean Square Error of Approximation\u003c/p\u003e\n\u003cp\u003eCFI: Comparative Fit Index\u003c/p\u003e\n\u003cp\u003eTLI: Tucker-Lewis Index\u003c/p\u003e\n\u003cp\u003e\u0026chi;\u0026sup2;: Chi-Square\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u003c/p\u003e\n\u003cp\u003eSD: Standard Deviation\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the participating hospitals, staff, and patients for their cooperation. Special thanks to the research assistants and data collectors for their contributions to the successful completion of this study.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted after obtaining ethical approval from the Institutional Review Board of Rahmah Health Foundation, Islamabad, Pakistan (Approval No RHF-04-2024). Written informed consent was obtained from all participants before inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Clinical trial number\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. \u0026nbsp;Written informed consent was obtained from all participants prior to inclusion in the study.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data supporting this study's findings are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Muhammad Usman Hashmi;\u003cbr\u003e\u003cstrong\u003eMethodology:\u0026nbsp;\u003c/strong\u003eMuhammad Usman Hashmi\u003cstrong\u003e,\u003c/strong\u003e Pakeezah Tabasum, Imran Saeed, Zainab Azhar, Muhammad Huzefa Mehmood, Shahzeena Bibi, Hussain Ramzan, Momina Ahmed, Wajeeha Sarwar\u003cbr\u003e\u003cstrong\u003eFormal analysis and investigation:\u003c/strong\u003e Muhammad Usman Hashmi,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting – original draft preparation:\u003c/strong\u003e Muhammad Usman Hashmi\u003cstrong\u003e,\u003c/strong\u003e Pakeezah Tabasum, Imran Saeed, Zainab Azhar, Muhammad Huzefa Mehmood, Shahzeena Bibi, Hussain Ramzan, Momina Ahmed, Wajeeha Sarwar\u003cbr\u003e\u003cstrong\u003eWriting – review and editing:\u003c/strong\u003e Muhammad Usman Hashmi\u003cstrong\u003e,\u003c/strong\u003e Pakeezah Tabasum, Imran Saeed, Zainab Azhar, Muhammad Huzefa Mehmood, Shahzeena Bibi.\u003cbr\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. 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Indian J Psychiatry. 2019;61(3):277\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eRababa\u0026rsquo;h SY, Alzoubi KH, Alquraan L, Karasneh R, Al-Azzam SI, Alrabadi N. Depression Among the Caregivers of Breast Cancer Patients and its Association with the Quality of Life. Clin Pract Epidemiol Ment Health CP EMH. 2022;18:e174501792208221.\u003c/li\u003e\n\u003cli\u003eWassie LA, Azagew AW, Bifftu BB. Depression and its associated factors among primary caregivers of adult cancer patients at Northwest Amhara Regional States Referrals Hospitals oncology treatment units, Northwest Ethiopia, 2021. BMC Psychiatry. 2022 Aug 6;22(1):533.\u003c/li\u003e\n\u003cli\u003eKhan SI, Irfan M. Stigmatization and Self-Perception regarding issues related to Mental Health: A qualitative survey from a lower and middle-income country. Pak J Med Sci. 2023;39(5):1411\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eAhmad S, Hussain S, Akhtar F, Shah FS. Urdu translation and validation of PHQ-9, a reliable identification, severity and treatment outcome tool for depression. \u003cem\u003eJ Pak Med Assoc\u003c/em\u003e. 2018;68(8):1166-1170.\u003c/li\u003e\n\u003cli\u003eGuo B, Kaylor-Hughes C, Garland A, Nixon N, Sweeney T, Simpson S, et al. Factor structure and longitudinal measurement invariance of PHQ-9 for specialist mental health care patients with persistent major depressive disorder: Exploratory Structural Equation Modelling. \u003cem\u003eJ Affect Disord\u003c/em\u003e. 2017;219:1-8. \u003c/li\u003e\n\u003cli\u003eChilcot J, Rayner L, Lee W, Price A, Goodwin L, Monroe B, et al. The factor structure of the PHQ-9 in palliative care. \u003cem\u003eJ Psychosom Res\u003c/em\u003e. 2013;75(1):60-64.\u003c/li\u003e\n\u003cli\u003eDi Matteo R, Bolgeo T, Simonelli N, Dal Molin A, Bassola B, Lusignani M, et al. Psychometric Properties and Measurement Invariance of the Patient Health Questionnaire 9 in an Italian Coronary Heart Disease Population. \u003cem\u003eJ Cardiovasc Nurs\u003c/em\u003e. Published online February 10, 2025. \u003c/li\u003e\n\u003cli\u003eAhmad SS, Koncsol SW. Cultural Factors Influencing Mental Health Stigma: Perceptions of Mental Illness (POMI) in Pakistani Emerging Adults. Religions. 2022 May;13(5):401. \u003c/li\u003e\n\u003cli\u003eYang M, Ma F, Lan B, Cai J, Sun X, Xu B. Validity of distress thermometer for screening of anxiety and depression in family caregivers of Chinese breast cancer patients receiving postoperative chemotherapy. Chin J Cancer Res Chung-Kuo Yen Cheng Yen Chiu. 2020 Aug;32(4):476\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eShah SM, Sun T, Xu W, Jiang W, Yuan Y. The mental health of China and Pakistan, mental health laws and COVID-19 mental health policies: a comparative review. \u003cem\u003eGen Psychiatr\u003c/em\u003e. 2022;35(5):e100885.\u003c/li\u003e\n\u003cli\u003eGuan N, Guariglia A, Moore P, Xu F, Al-Janabi H. Financial stress and depression in adults: A systematic review. PLoS ONE. 2022:17(2): e0264041.\u003c/li\u003e\n\u003cli\u003eCostantini H, Ono T, Shogaki N, Tanaka T, Lyu W, Son B-K, et al. The impact of financial pressure on the association between employment and depressive symptoms for community-dwelling older adults. J Ageing Longev. 2024;4(2):41-50. \u003c/li\u003e\n\u003cli\u003eUstaalioğlu BB\u0026Ouml;, Acar E. The depression and related factors among cancer patients and their family caregivers in Turkish Population. Acta Haematol Oncol Turc. 2017;50(2):115-123. \u003c/li\u003e\n\u003cli\u003eTaqui AM, Itrat A, Qidwai W, Qadri Z. Depression in the elderly: does family system play a role? A cross-sectional study. \u003cem\u003eBMC Psychiatry\u003c/em\u003e. 2007;7:57. \u003c/li\u003e\n\u003cli\u003eSun X, Xu L, Sheng L. Family hardiness among primary caregivers of breast cancer patients in Hunan Province: a cross-sectional study exploring the relationship with attachment and caregiver preparedness. \u003cem\u003eFront Public Health\u003c/em\u003e. 2024;12:1367029. \u003c/li\u003e\n\u003cli\u003eKaggwa MM, Najjuka SM, Mamun MA, Griffiths MD, Nyemara N, Ashaba S. Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma. \u003cem\u003eBMC Psychiatry\u003c/em\u003e. 2023;23(1):72.\u003c/li\u003e\n\u003cli\u003eMaheu C, Singh M, Tock WL, Eyrenci A, Galica J, H\u0026eacute;bert M, et al. Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. \u003cem\u003eFront Psychol\u003c/em\u003e. 2021;12:644932. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6785454/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6785454/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eCaregivers of breast cancer patients experience a significant psychological burden, which may lead to major depressive disorder (MDD). However, limited research has explored the prevalence among caregivers in the Pakistani population. This study aimed to assess the prevalence of MDD among these caregivers and identify contributing socio-demographic and health-related factors, highlighting the psychological burden they endure.\u003c/p\u003e\n\u003cp\u003eMethodology\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted in various tertiary care hospitals of Pakistan. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for MDD, with a score of ≥10 indicating a positive diagnosis. We conducted a multi-step psychometric analysis of PHQ-9 using a sample of 402 participants. Exploratory Factor Analysis (EFA) employed principal axis factoring with Promax rotation, Assumptions were verified using Bartlett’s Test of Sphericity and Kaiser-Meyer-Olkin sampling adequacy. Confirmatory Factor Analysis (CFA) tested the EFA-derived structure, with model fit evaluated using RMSEA, TLI, and χ². Socio-demographic and health-related data were collected through structured questionnaires. Statistical analysis was performed using JAMOVI software, incorporating descriptive statistics, chi-square tests, t-tests/ANOVA, and binomial logistic regression to identify factors associated with MDD.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eAmong 402 participants, 46.26% of caregivers experienced major depression disorder, with 27.1% had mild depression, 24.1% moderate, 16.4% moderately severe, and 5.7% severe depression, while 26.6% exhibited no depressive symptoms. EFA revealed a 3-factor solution explaining 46.75% of variance, all primary loadings \u0026gt; 0.52. The CFA confirmed this structure (RMSEA = 0.064; CFI = 0.96; TLI = 0.94), though χ² was significant (*p* \u0026lt; .05). Among caregivers, low monthly income (p = 0.033), living a sedentary lifestyle (p = 0.012) and one living in urban areas (p = 0.044), indicating higher risk of depression. In a multivariate logistic regression analysis, lower education levels were found to be a significant predictor of MDD (p = 0.007).\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eA considerable proportion of caregivers supporting breast cancer patients in Pakistan suffer from MDD, with low education, unemployment, sedentary lifestyle, and low monthly income being key contributors. To mitigate the psychological distress faced by these caregivers, targeted mental health interventions and support programs are needed to improve the quality of life of caregivers.\u003c/p\u003e","manuscriptTitle":"Caregiver Depression in a Low-Resource Setting: A Multi-Domain Assessment of PHQ-9, Socio-Demographic Predictors of Major Depressive Disorder Among Family Caregivers of Breast Cancer Patients in Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 10:11:48","doi":"10.21203/rs.3.rs-6785454/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-10T07:21:59+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"149874866331789842545470290949461163554","date":"2025-10-09T15:23:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T14:44:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227399558565273488796646286994965152293","date":"2025-10-09T14:40:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T05:55:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89273214346711505033031966184993886741","date":"2025-09-09T04:33:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219319666507644130057891339183128453715","date":"2025-08-03T15:22:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23624467362091308673790243531454395388","date":"2025-06-26T08:29:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-26T07:17:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-19T06:23:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-09T04:44:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-07T23:08:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-06-07T23:05:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ed05494-ef6e-4396-96c3-0ffd10341f51","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T10:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 10:11:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6785454","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6785454","identity":"rs-6785454","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}