Mental wellbeing of family caregivers of people living with mental illness in Kenya: Who cares? A cross-sectional study

Background: Although about 60% of patients with chronic mental health disorders in sub-Saharan Africa live with their relatives, burden amongst family caregivers has not been studied much. The aim of this study was to evaluate the prevalence and factors associated with caregiver burden among family caregivers of patients with chronic mental illness attending two psychiatric care facilities in Nairobi, Kenya. Methods: A cross-sectional study was conducted among 284 systematically sampled participants who completed a socio-demographic questionnaire and the Zarit Burden Interview. Moderate to severe burden was defined as a ZBI score > 41. Independent associations were examined using bivariable and multivariable logistic regression. Results: The prevalence of moderate to severe caregiver burden among 284 family caregivers was 52.8% (95% CI = 46.8–58.7%). Independent correlates of moderate to severe burden amongst family caregivers were: a patient’s primary diagnosis of other psychiatric conditions, that showed a less likelihood of high burden, compared to a diagnosis of substance use disorder (AOR = 0.31; 95% CI = 0.15–0.62). Patients who were employed had a higher likelihood of their caregiver having moderate to severe burden (AOR = 1.98; 95% CI = 1.07–3.72). Furthermore, for every additional admission, the caregiver was more likely to have moderate to severe burden (AOR = 1.43; 95% CI = 1.20–1.72). Conclusions: More than half of family caregivers experienced moderate to severe burden, particularly those caring for patients with substance use disorders, recurrent admissions, and employed patients. Early, targeted support for high-risk caregivers is needed. Integrating mental health into primary care, strengthening counselling and peer support, and implementing workplace policies that better accommodate employees with mental health conditions may help reduce caregiver burden. Future studies should include rural and community-based populations and develop culturally appropriate measures of caregiver burden. Trial number: Not applicable.