Caregiver Burden Scale (CBS)

Abstract

The Caregiver’s Burden Scale (CBS), widely recognized as the Zarit Burden Interview (ZBI), is a widely used psychological instrument designed to assess the level of subjective burden experienced by informal caregivers. Developed initially by Zarit, Reever, and Back-Peterson in 1980, the scale quantifies the emotional, social, and financial strain associated with providing long-term care, often to elderly relatives or those suffering from chronic illnesses such as dementia. The ZBI is critical for identifying caregivers at risk of burnout and negative health outcomes, thereby facilitating targeted intervention strategies in clinical and research settings.

Keywords

Caregiver’s Burden Scale, Zarit Burden Interview, ZBI, informal caregiving, psychological strain, elderly care, dementia, psychometric properties

Authors

Steven H. Zarit, Karen E. Reever, Judy Back-Peterson

Purpose

The primary purpose of the Caregiver’s Burden Scale (ZBI) is to provide a reliable and valid measure of the subjective distress and overall burden experienced by individuals acting as primary caregivers. It aims to capture the multidimensional impact of caregiving, moving beyond mere objective time spent to assess the caregiver’s perception of strain across various life domains, including personal time, social life, finances, and emotional health. This assessment is crucial for both research purposes—to study the correlates and outcomes of caregiving—and clinical application, where the scores help determine the need for support services or respite care.

The scale is particularly valuable in settings where caregivers assist loved ones with progressive cognitive or physical impairments, allowing clinicians to monitor changes in burden over time and evaluate the effectiveness of psychoeducational or supportive interventions designed to mitigate caregiver stress.

Construct

The scale measures the construct of caregiver burden, which is defined as the extent to which a caregiver perceives their health, emotional state, social life, and financial status to have suffered as a result of caring for a dependent relative. This construct is typically broken down into several dimensions:

• Personal Strain: Feelings of stress, loss of control, worry, and the perception that one’s own health is deteriorating.
• Role Strain: Difficulties balancing caregiving responsibilities with other life roles, such as work or familial duties toward other members.
• Financial Strain: Concerns regarding the monetary costs associated with the patient’s care.
• Perceived Dependency: The feeling that the dependent relative relies too heavily on the caregiver, sometimes perceived as demanding behavior.

Validity

The Zarit Burden Interview has demonstrated robust psychometric properties across numerous studies and populations. Its construct validity is supported by its strong correlation with other measures of psychological distress, such as scales assessing depression, anxiety, and general quality of life. High scores on the ZBI typically correlate significantly with clinical depression in caregivers.

Furthermore, studies investigating its discriminant validity confirm that the ZBI effectively differentiates between caregivers experiencing high levels of strain and those with lower levels of perceived burden. Research, such as that by Hérbert, Bravo, and Préville (2000), has specifically validated the scale for assessing informal caregivers of older persons with dementia, confirming its suitability and accuracy within this highly stressed population.

Reliability

The reliability of the Caregiver’s Burden Scale is consistently reported as high. Measures of internal consistency, typically assessed using Cronbach’s alpha, usually range from 0.88 to 0.95 across various samples, indicating that the items within the scale measure a unified underlying construct of burden. The scale also exhibits strong test-retest reliability, demonstrating stability over time when administered to caregivers whose objective caregiving situation has not significantly changed, confirming its consistency as a measuring instrument.

Factor Analysis

While originally conceived as a unidimensional measure of overall burden, subsequent factor analyses of the ZBI (particularly the 22-item version) have suggested a multidimensional structure. Researchers often extract between four and six factors, depending on the population studied (e.g., dementia vs. stroke caregivers).

Commonly identified factors include: (1) Personal Burden/Strain (items related to health, stress, and lack of privacy); (2) Guilt/Anger (items related to negative interactions or feeling inadequate); (3) Role Overload/Conflict (items related to balancing responsibilities); and (4) Financial Concerns. This factor structure reinforces the idea that caregiver burden is a complex phenomenon influenced by various interacting domains of stress.

Instrument

Test Type: Self-report Questionnaire/Interview

Format: The full version of the scale contains 29 items, but a widely used short-form version contains 22 items. Responses are scored on a 5-point Likert scale, ranging from 0 (Never) to 4 (Nearly always).

Language Available: English (Original), widely translated and validated in numerous languages including French, Spanish, German, and Chinese.

Population Group: Informal caregivers (family members, spouses, friends).

Age Group: Adults (caregivers of any age).

Population Details: Primarily used for caregivers of older adults and those with chronic conditions, particularly individuals with Alzheimer’s disease or related dementias, stroke, or physical disabilities.

Test Methodology: Summing the scores across all items yields a total burden score. Higher scores indicate greater perceived burden. The scale can be administered via interview or self-completion.

Keywords

Zarit Burden Interview, ZBI, subjective burden, informal care, strain, psychometrics, scale validation, geriatric psychology

Authors

Author ORCID Identifier: Not uniformly available or applicable for all original authors.

Affiliation Email addresses: Not uniformly available.

Correspondence Address: Correspondence generally directed to the primary author, Steven H. Zarit, affiliated with academic institutions focusing on gerontology.

Permissions & Fee and Test Year

The original conceptualization and publication of the scale occurred in 1980 (Zarit, Reever, & Back-Peterson). While the scale is often used freely for non-commercial academic research, formal clinical use or use within proprietary software may require licensing or explicit permission from the authors or associated institutions, depending on the version used.

The original PDF of the scale can be downloaded here: http://www.ftlda.org/wp-content/uploads/2011/12/FTLDA-CARGIVER-BURDEN-SCALE.pdf

Another version (Zarit Burden Interview PDF) can be found here: http://dementiapathways.ie/_filecache/edd/c3c/89-zarit_burden_interview.pdf

Reference’s

• Zarit‚ S. H.‚ Reever‚ K. E.‚ Back-Peterson‚ J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. The Gerontologist‚ 20‚ 649-655.

• Hérbert‚ R.‚ Bravo‚ G.‚ & Préville‚ M. (2000). Reliability‚ validity‚ and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging‚ 19‚ 494-507.

• Deeken‚ J. F.‚ Taylor‚ K. L.‚ Mangan‚ P.‚ Yabroff‚ K. R.‚ Ingham‚ J. M. (2003). Care for the caregivers: a review of self-report instruments developed to measure the burden‚ needs‚ and quality of life of informal caregivers. Journal of Pain and Symptom Management‚ 26(4)‚ 922–953.

• Shroff‚ Havovi B. (2014). Family Resiliency‚ Sense of Coherence‚ Social Support and Psychosocial Interventions: Reducing Caregiver Burden and Determining the Quality of Life in Persons with Alzheimer’s Disease. Florida Atlantic University‚ Doctoral Dissertation.

Items of the Caregiver’s Burden Scale (CBS)

Note: The original source content provided two distinct sets of items, likely reflecting the 22-item short form (referring to “relative”) and the 29-item full version (referring to “spouse”). Both are presented below.

Experience of burden (22-Item Version)

1. Do you feel that your relative asks for more help than he or she needs?
2. Do you feel that because of the time you spend with your relative‚ you do not have enough time for yourself?
3. Do you feel stressed between caring for your relative and trying to meet other responsibilities for your family or work?
4. Do you feel embarrassed over your relative’s behavior?
5. Do you feel angry when you are around your relative?
6. Do you feel that your relative currently affects your relationship with other family members or friends in a negative way?
7. Are you afraid about what the future holds for your relative?
8. Do you feel your relative is dependent on you?
9. Do you feel strained when you are around your relative?
10. Do you feel your health has suffered because of your involvement with your relative?
11. Do you feel that you do not have as much privacy as you would like‚ because of your relative?
12. Do you feel that your social life has suffered because you are caring for your relative?
13. Do you feel uncomfortable about ha‎ving friends over‚ because of your relative?
14. Do you feel that your relative seems to expect you to take care of him or her‚ as if you were the only one he or she could depend on?
15. Do you feel that you do not have enough money to care for your relative‚ in addition to the rest of your expenses?
16. Do you feel that you will be unable to take care of your relative much longer)
17. Do you feel you have lost control of your life since your relative’s illness?
18. Do you wish you could just leave the care of your relative to someone else?
19. Do you feel uncertain about what to do about your relative?
20. Do you feel you should be doing more for your relative?
21. Do you feel you could do a better job in caring for your relative?
22. Overall‚ how burdened do you feel in caring for your relative?

Experience of burden (29-Item Version)

1. Feel resentful of other relatives who could do but do not do things for my spouse.
2. I feel that my spouse makes requests which I perceive to be over and above what he/she needs.
3. Because of my involvement with my spouse‚ I don’t have enough time for myself.
4. I feel stressed between trying to give to my spouse as well as to other family responsibilities‚ job‚ etc.
5. I feel embarrassed over my spouse’s behavior.
6. I feel guilty about my interactions with my spouse.
7. I feel that I don’t do as much for my spouse as I could or should.
8. I feel angry about my interactions with my spouse.
9. I feel that in the past‚ I haven’t done as much for my spouse as I could have or should have.
10. I feel nervous or depressed about my interactions with my spouse.
11. I feel that my spouse currently affects my relationships with other family members and friends in a negative way.
12. I feel resentful about my interactions with my spouse.
13. I am afraid of what the future holds for my spouse.
14. I feel pleased about my interactions with my spouse.
15. It’s painful to watch my spouse age.
16. I feel useful in my interactions with my spouse.
17. I feel my spouse is dependent.
18. I feel strained in my interactions with my spouse.
19. I feel that my health has suffered because of my involvement with my spouse.
20. I feel that I am contributing to the well-being of my spouse.  
21. I feel that the present situation with my spouse doesn’t allow me as much privacy as I like.
22. I feel that my social life has suffered because of my involvement with my spouse.
23. I wish that my spouse and I had a better relationship.
24. I feel that my spouse doesn’t appreciate what I do for him/her as much as I would like.
25. I feel uncomfortable when I have friends over.
26. I feel that my spouse tries to manipulate me.
27. I feel that my spouse seems to expect me to take care of him/her as if I were the only one he/she could depend on.
28. I feel that I don’t have enough money to support my spouse in addition to the rest of our expenses.
29. I feel that I would like to be able to provide more money to support my spouse than I am able to now.

Scoring Key: 0 = Never‚ 1 = Rarely‚ 2 = Sometimes‚ 3 = Quite frequently‚ 4 = Nearly always.