Caregiver Burden Scale (CBS)

Abstract

The Caregiver’s Burden Scale (CBS), widely recognized as the Zarit Burden Interview (ZBI), is a widely utilized self-report instrument designed to measure the subjective burden experienced by informal caregivers. Developed by Zarit, Reever, and Bach-Peterson in 1980, this scale provides a comprehensive assessment of the emotional, physical, social, and financial difficulties faced by individuals caring for a chronically ill, disabled, or elderly relative, particularly those with dementia or Alzheimer’s disease. The instrument helps clinicians and researchers quantify the level of strain and distress, allowing for targeted psychosocial interventions.

The scale typically assesses feelings related to loss of control, personal strain, role strain, and financial difficulties resulting from the caregiving role. Its robust psychometrics have made it a cornerstone in caregiver burden research globally.

Keywords

Caregiver burden, Zarit Burden Interview, ZBI, informal caregiving, elder care, dementia, psychological strain, psychosocial assessment, stress.

Authors

Zarit, S. H., Reever, K. E., Bach-Peterson, J.

Purpose

The primary purpose of the Caregiver’s Burden Scale (CBS) is to quantify the subjective distress or burden experienced by informal caregivers. This quantification is crucial for identifying individuals at high risk for negative health outcomes, including depression, anxiety, and physical illness, which are often correlated with severe caregiver burden.

By assessing specific domains of strain—such as the impact on personal time, relationships, finances, and emotional health—the CBS helps professionals determine the need for support services, respite care, and educational interventions. It serves as a vital clinical tool for monitoring caregiver well-being over time and evaluating the efficacy of support programs.

Construct

The CBS measures the construct of caregiver burden, defined as the multidimensional negative reaction resulting from the health demands and functional impairments of the care recipient. This construct is understood to encompass various types of strain:

• Personal Strain: Feelings of stress, loss of control over one’s life, and physical health deterioration.
• Role Strain: Conflicts arising between caregiving responsibilities and other roles (e.g., spouse, parent, employee).
• Financial Strain: Economic hardship resulting from costs associated with care or loss of income due to reduced work hours.
• Emotional Strain: Feelings of guilt, anger, embarrassment, or resentment related to the care recipient’s behavior or condition.

The scale operates on the premise that burden is a subjective experience, meaning the same objective care demands may result in vastly different levels of perceived strain across different caregivers.

Validity

The Zarit Burden Interview (ZBI) has demonstrated strong evidence of validity across numerous studies, particularly among caregivers of older adults with dementia. Research confirms its ability to measure the intended construct effectively.

Construct Validity: Studies have shown that scores on the CBS correlate significantly with measures of psychological distress, such as depression (e.g., the Beck Depression Inventory) and anxiety, supporting its convergent validity. Furthermore, it differentiates effectively between caregivers receiving support and those who are not, establishing its known-groups validity. Hérbert et al. (2000) confirmed its utility in assessing informal caregivers of community-dwelling older persons with dementia.

Reliability

The CBS exhibits high internal consistency and test-retest Reliability, indicating that the scale items consistently measure the same underlying construct and that scores remain stable over short periods when the caregiver’s situation has not changed significantly.

Internal consistency, typically measured by Cronbach’s alpha, often ranges from 0.88 to 0.95 across various samples, demonstrating excellent reliability. This high degree of consistency reinforces the scale’s suitability for clinical and research applications requiring precise measurement of caregiver burden.

Factor Analysis

While the CBS was originally conceived as a unidimensional measure of overall burden, subsequent factor analytic studies have frequently explored its underlying structure, often revealing multiple correlated factors. Common factor structures extracted include:

• Personal Strain/Emotional Distress
• Role Conflict/Interference with Daily Life
• Financial Concerns
• Perceived Dependency/Guilt

The specific factor structure can vary depending on the population studied (e.g., caregivers of dementia patients versus caregivers of stroke survivors). However, for routine screening purposes, the total score is generally accepted as the primary index of overall burden severity.

Instrument

Test Type: Self-report questionnaire / Interview

Format: The standard version (ZBI) consists of 22 items rated on a 5-point Likert scale.

Language Available: English, Spanish, French, Chinese, and numerous other translations, reflecting its global adoption.

Population Group: Informal caregivers, typically family members or friends, providing long-term care.

Age Group: Adults (caregivers) of all ages.

Population Details: Most commonly used with caregivers of elderly individuals suffering from cognitive impairment, chronic illness, or physical disability, such as Alzheimer’s disease or other forms of dementia.

Test Methodology: Each item is rated based on the frequency of the feeling or experience, using the following scoring system: 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Quite frequently, 4 = Nearly always. Scores are summed, with higher scores indicating greater subjective burden. The total score ranges from 0 to 88 (for the 22-item version).

Keywords

Psychological assessment, Zarit, Reever, Bach-Peterson, informal care, chronic illness, psychosocial support, caregiving stress, psychometrics, scale.

Authors

Author ORCID Identifier: Not publicly standardized for all original authors.

Affiliation Email addresses: Unavailable.

Correspondence Address: Unavailable.

Permissions & Fee and Test Year

Test Year: 1980 (Original publication of the scale concept).

Permissions and Fee: The Zarit Burden Interview (CBS) is widely used in non-commercial academic research and clinical settings and is generally considered to be in the public domain or available for use without specific permission from the original authors, though proper citation is required. For commercial use, contact with the original authors or copyright holders may be necessary.

The original PDF instruments can be downloaded here: http://www.ftlda.org/wp-content/uploads/2011/12/FTLDA-CARGIVER-BURDEN-SCALE.pdf and http://dementiapathways.ie/_filecache/edd/c3c/89-zarit_burden_interview.pdf.

Reference’s

1. 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.

2. 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.

3. 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.

4. 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)

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

Experience of burden (Relative Version – 22 items):

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?

Alternative/Extended Items (Spouse Version – 29 items):

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.