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APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v8.i1.2020.15-23 
 

 
 
Original Article                                                                                  

Association between satisfaction with life and 
caregiver burden, among psychiatric patients 
Farkhanda Emad1, Saima Masoom Ali2, Farhan Ishaque3,  
Aftab Ahmed Mirza1, Hayatullah khalid4 & Abid Kamal Ansari5 
1Sindh Institute of Physical Medicine & Rehabilitation, Karachi-Pakistan.  
2Department of Psychology, University of Karachi, Karachi-Pakistan. 
3Dow Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, 
Karachi-Pakistan. 
4Multan College of Physiotherapy, Multan Medical & Dental College, Multan-Pakistan.   
5College of Physiotherapy, Jinnah Postgraduate Medical Centre, Karachi-Pakistan. 
    

Abstract 
Background: People who are dealing with psychological disorders are not able to 
take care of themselves; therefore, their family has to take care of them. While 
dealing with psychological issues is itself difficult for their family members. 
Schizophrenia and Bipolar disorder are psychological severe disorder that has a 
considerable influence not only in the patient but also for the entire family. This 
study aims to determine a relationship between life satisfaction and caregiver 
burden among caregivers of patients suffering from psychiatric illness. 
Methodology: We started the research after approval from the board of study and 
prior consent from the psychiatric hospitals' higher authorities and rehabilitation 
centers in Karachi. The authorities demonstrated the research objectives, the 
consent letter, and the questionnaire to be filled by the researcher.  Zarit Burden 
Interview Scale (ZBIS) and Satisfaction with Life Scale (SWLS) (Pavot & Diener) 
were used. The sample size of this study was 170 psychiatric patients. Psychiatric 
patients were divided into schizophrenia disorder (n=85) and bipolar disorder 
(n=85).  
Results: The result indicates that the caregiver burden is the predictor of 
satisfaction with life in patients with bipolar disorders. It also shows in results that 
there was a significant difference among the different levels of the duration of 
illness on the variable of caregiver burden scale and satisfaction life scale among 
the caregivers of patients with schizophrenia and bipolar disorders. Further, 
findings indicate significant differences between males' and females' caregivers of 
psychiatric patients on the variable of caregiver burden and satisfaction with life 
scale. 
Conclusion: We concluded that caregiver burden significantly affects the mental 
health of the caregivers of patients with psychiatric disorders. Also, caregivers of 
people who are mentally ill patients suffer a lot of burdens. Therefore, 
interventions that can assist them, such as providing them with a support system 
and counselling services, must be created. 
 

Keywords 
Caregiver Burden, Patients, Schizophrenia, Bipolar, Life Satisfaction. 

Citation: Emad F, Ali SA, Ishaque F,  
Mirza AA, Khalid H, Ansari AK. 
Association between satisfaction with life 
and caregiver burden, among psychiatric 
patients. APP.2021; 8(1):15-23 
 
Corresponding Author Email: 
farhan.ishauqe@duhs.edu.pk.com 
 
DOI: 10.29052/2412-3188.v8.i1.2021.15-23 
 
Received 30/12/2020 
 
Accepted 10/05/2020 
 
Published 01/06/2021 
 
Copyright © The Author(s). 2021 This  
 is an open access article distributed 
under the terms of the Creative 
Commons Attribution 4.0 International 
License, which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author 
and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 
 

https://doi.org/10.29052/2412-3188.v8.i1.2020.
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http://creativecommons.org/licenses/by/4.0/)
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Introduction  
The health of caregivers got challenged by 
offering treatment to family members 
suffering from prolonged illness. When the 
family member has a significant 
psychological disorder, the role of providing 
treatment becomes more daunting as the 
stigma of mental illness contributes to this 
strain of caring. The caregiver's burden has 
similar characteristics, either physical or 
mental conditions, or caregivers also 
experience anxiety and depressive disorders 
and many economic and occupational 
symptoms. However, through the signs and 
social response to them, various pathologies 
have particular effects on caregivers, so these 
distinctions create unique needs for patient 
care1. This study's objective was to 
determine the association of satisfaction 
with life and caregiver burden among 
patients with schizophrenia disorder. It 
aimed to estimate any gender differences on 
the variables of caregiver burden and 
satisfaction with life scale among the 
caregivers of patients with psychiatric 
disorders. 
 
Patients suffering from extreme mental 
disorders develop a heavy reliance on 
caregivers, primarily because of their 
disease's significant impairment. This 
dependence and responsibility for providing 
care add to their misery of caregivers' quality 
of life, affecting their health, employment, 
socializing, and relationships2. In terms of its 
impact, the literature distinguishes burden 
as objective (e.g. disturbance in the life of 
caregivers in terms of household routine, 
social activities and financial/employment 
problems) and subjective (emotional distress 
endured by caregivers, e.g. depression, 
anxiety, frustration, shame, loss, stigma and 
rejection3.  Besides, the socio-demographic 
factors and disease-related aspects of care 
recipients and caregivers considered 
contributing to the workload of the 

caregiver4, 5. It may neglect their well-being 
and other social and personal needs of 
caregivers, which decreases their ability to 
cope effectively with care demands. Most 
psychiatric disorders also put a heavy 
burden on caregivers. Still, of these 
disorders, schizophrenia attracts more 
attention because of the deterioration in the 
patient's person and social functioning and 
the symptoms that affect the caregivers' 
quality of life and the severity and early 
breakout of the disorder6. Past research 
indicates that the burden of care should be 
categorized as an objective burden and a 
subjective burden, as factors that relate to 
caregivers' physical and mental health and 
the effect of these types of burden7. Burden 
refers to the inputs pertaining to caregiving 
activities that could be determined by the 
time spent on caregiving and the functional 
level of care recipients. The subjective 
burden focuses on the self-perceived impact 
on caregivers of the objective burden8. The 
critical correlation between objective and 
subjective treatment among family dementia 
caregivers explored in several studies 
identifying higher objective burdens linked 
to higher subjective burdens9, 10. 
 
The physical and mental well-being, social 
relationships, and caregivers' financial life 
are impressed by the family caregiver 
burden11,12. It also correlates with 
psychological morbidity, lower leisure time, 
workload, and caregiver burnout13. Due to 
patients' behaviour and a negative attitude 
towards the patient, they often feel 
frustration, rage, humiliation, anxiety, 
sadness, and stress14, 15. Schizophrenia is one 
of the ten disorders contributing to the loss 
of capacity in individuals, based on research 
carried out by the World Health 
Organization. Schizophrenia is a 
psychological condition that is profoundly 
debilitating and persistent, affecting all 
significant aspects of a patient's life. The 



 
 
 

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World Health Organization reports that 29 
million people worldwide have been 
affected by schizophrenia. The prevalence of 
psychotic disorders is approximately 0.89 
percent in an epidemiological analysis of 
mental disorders done in Iran, with 
schizophrenia being 0.6 percent.  
 

Methodology 
The quasi-experimental study was design to 
draw the association between satisfaction 
with life and caregiver burden among 
psychiatric patients. A sample size of 170 
psychiatric patients was used for data 
collection after the purposive sampling 
technique. The study's objective, operation, 
and material got approval from the Board of 
Advanced Studies and Research. The 
University of Karachi and psychiatric 
hospitals and rehabilitation centers of 
Karachi. The clinical psychologist double-
checked the data by following the DSM-5 
guidelines (APA, 2013), then was 
interviewed them and their caregivers. 
Schizophrenic (N=85) and bipolar disorder 
(N=85), further classified as patients with 
psychiatric disease. We excluded all the 
patients who had any psychiatric or medical 
illness as co-morbidity, the patients who had 
been meeting the research norms but they 

are not taking any medicine, or therapeutic 
intervention, all the intellectually challenged 
and physically disabled population. One 
caregiver against each patient participated in 
the study, and those who have had the prime 
accountability to look after the patients were 
contained in the study. Caregivers who were 
experiencing any kind of psychiatric 
disorder, intellectually challenged or any 
medical disease that can significantly impact 
the cognitive level or psychological function 
were excluded from the study. For the 
current study, a three-part survey 
questionnaire comprising the first part 
consists of informed consent from the 
caregivers. The second part included 
demographic variables, and in the third part, 
the study questionnaire was administered. 
Zarit Burden Interview Scale (ZBIS) and   
Satisfaction with Life Scale (SWLS) were 
used. Regression analysis, t-test and analysis 
of variance tests are also used to find the 
study's best results. The data were 
statistically analyzed using SPSS version   
20.0. 
 

Result 
The demographic characteristics of the 

patient and caregivers are given in table 1 & 

2.

 

Table 1: Demographic characteristics of patients (N= 170) 

Variables  Categories  n(%) 

Gender 
Male 75(44.1) 

Female 95(55.9) 

Qualification 

Primary 14(8.2) 

Middle 16(9.4) 

Matric 34 (20.0) 

Intermediate  39(22.9) 

Graduate 22(12.9) 

Masters 22(12.9) 

Uneducated 23(13.5) 

Marital Status  
Single 94(55.3) 

Married 59(34.7) 



 
 
 

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Divorced 17 (10.0) 

Family System 
Joint 91(53.5) 

Nuclear 79(46.5) 

Diagnosis 
Schizophrenia 85(50.0) 

Bipolar 85(50.0) 

Duration of illness 

0-5 years 54(31.8) 

6-10 years 60(35.3) 

11-15 years 56(32.9) 

Nature of Treatment 

Medication 107(62.9) 

Psychotherapy 16(9.4) 

Combined 47(27.6) 

Treatment Setting  
OPD 139(81.8) 

IPD 31(18.2) 

 

Table 2: Demographic characteristics of caregivers (n=170). 

Variables  Categories  n(%) 

Gender 
Male 95(55.9) 

Female 75(44.1) 

Qualification 

Primary 5(3.3) 

Middle 6(3.5) 

Matric 9(5.3) 

Intermediate 31(18.2) 

Graduate 21(12.4) 

Masters 39(22.9) 

Uneducated 27(15.9) 

Occupation  

Employed 51(30.0) 

Unemployed 96(56.5) 

Housewife 13(7.6) 

Student 10(5.9) 

Qualification 

Primary 6(3.5) 

Middle 9(5.3) 

Matric 31(18.2) 

Intermediate 21(12.4) 

Graduate 39(22.9) 

Masters 27(15.9) 

Uneducated 37(21.8) 

 

 

 



 
 
 

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The result indicates that the caregiver burden is the predictor of satisfaction with life in the 

caregivers of patients with schizophrenia disorders [R2, .554; F (1.84) = 36.711, p<0.000]. 

 

Table 3: Linear Regression Analysis and Analysis of Variance Statistics of life satisfaction 

scale with caregiver Burden scale 

Model R R2 Adj. R2 SS df MS F 
p-

valve 

(Constant) 

Caregiver 

Burden 

.554a .307 .298 1912.035 1 1912.035 36.711 0.000 

   4322.953 83 52.084   

   6234.988 84    

a. Dependent Variable: Satisfaction with life scale  

b. Predictors: (Constant), Caregiver Burden Scale  

 

Further, it was found that the caregiver burden is a strong predictor of satisfaction with life in 

the caregivers of patients with schizophrenia disorders (β=.554, p<0.001). 

 

Table 4: Coefficient statistics of life satisfaction scale and caregiver Burden scale among the 

caregivers of patients with schizophrenia 

Model 
Unstandardized Standardized 

T p-value 
95% CI 

Β SE Beta LB UB 

(Constant) 29.912 2.299  13.008 .000 25.339 34.486 

SWLS -.259 .043 -.554 -6.059 .000 -.344 -.174 

a. Dependent Variable: Satisfaction with Life Scale; SWLS=Satisfaction with Life Scale, SE= Standard Error, LB= 

Lower Bond, UB=Upper Bon 

 

The result indicates that the caregiver burden is the predictor of satisfaction with life in the 

caregivers of patients with bipolar disorders [R2, .701; F (1.84) = 79.97, p<0.000]. 

 

Table 5: Analysis of Variance Statistics of life satisfaction scale with caregiver Burden scale 

among the caregivers of patients with bipolar disorder 

Model R R2 Adj.R2 SS df MS F p-valve 

(Constant) 

Caregiver Burden  

.701a .491 .485 3200.959 1 3200.959 79.975 0.000b 

   3322.029 83 40.024   

   6522.988 84    

a. Dependent Variable: Satisfaction with life scale  

b. Predictors: (Constant), Caregiver Burden Scale  

 

Results indicate that there were a significant difference among the different level of the duration 

of illness on the variable of caregiver burden scale among the caregivers of patients with 

schizophrenia and bipolar disorders [F (2,169) = 396.810; p< .000] 

 



 
 
 

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Table 6: Variance statistics for the duration of illness with caregiver burden among the 

caregivers of patients with schizophrenia and bipolar disorders 

Variable  SS df MS F p-valve 

Between Groups 54890.810 2 27445.405 396.810 0.000 

Within Groups 11550.579 167 69.165   

Total 66441.388 169    

 

Discussion 
The burden of caregivers is the major 
predictor of life-scale satisfaction among 
schizophrenia disorder patients. Getting a 
member of the family with schizophrenia 
disorganizes the familiar dynamics 
according to the function theory. Role-
conflicts arise when the caregiver itself is 
made up of conflicting and incompatible 
specifications16. Role-conflicts have a range 
of adverse effects on caregivers, such as 
physical difficulties, fatigue, burn-out, 
anxiety and other mental disorders17. 
Expressed emotion is a measure of the family 
environment that focuses on how the 
relatives of the psychiatric patient talk about 
the patient spontaneously15. In patients with 
mental illness, such as schizophrenia, high 
levels of expressed emotion in the home may 
worsen the prognosis and may serve as a 
potential risk factor for developing 
psychiatric disorders18. 
 
Also, this study showed that married 
caregivers had greater stress levels than 
unmarried caregivers. The potential cause 
may be the extra burden of infants, 
caregivers, and other family members, 
leading to higher stress levels. The coping 
mechanisms of caregivers need to be 
considered to overcome pressures, as they 
affect the day-to-day functioning of 
caregivers19,20. 
 
As with schizophrenia, the caregivers of 
bipolar patients have similar degrees of 
disrupted habits. Both conditions affect 

families and need the same degree of 
caregiver treatment for their stability. But the 
level of stress and frustration perceived by 
bipolar caregivers due to violent and 
aggressive behaviour is high. These findings 
are not in line with previous studies that we 
refer to in this report. It showed that the 
caregivers of schizophrenia had higher stress 
levels than those of another group21.  
 
 Regression analysis found that the clinical 
function of the patient better explained the 
variance observed in the FEIS variables as 
opposed to the characteristics of the patient, 
which explained no more than 8.5 percent of 
the variance, while caregiver characteristics 
explained 11.7 percent variance in the 
bipolar disorder category for satisfaction 
with services. Past studies have confirmed 
the correlation between the stress of 
caregivers and symptoms of severe mental 
disorders. In patients with mental illness, the 
disease's length has a significant difference 
in satisfaction with the life scale. It was 
noticed that caregivers with two or more 
years of caregiver experience had a higher 
degree of caregiver pressure than those with 
1-6 months and 1-2 years of care length. 
Similar to the study results, it was found that 
longer care durations were positively 
associated with higher caregiver pressures22. 
 
Three key factors associated with caregiver 
frustration with the condition, in general, 
were identified in this analysis included 
inadequate psychosocial functioning of 
patients, insufficient use of medication and 



 
 
 

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rehabilitative services by patients, and living 
with the patient. The frustration of 
caregivers with psychiatric treatment for 
patients is distinct from their general 
dissatisfaction in life. If the patients had 
severe psychotic symptoms or weak life-grip 
maintenance, caregivers were unhappy with 
facilities. The stress and frustration of the 
caregiver are often correlated with 
psychiatric facilities. The most fundamental 
aspect that can ensure clinicians' satisfaction 
is therapeutic interventions that could 
enhance the functional status of patients and 
appropriate medication23. 
 
Past research has shown that treatment is a 
significant public health challenge that 
should not be overlooked combined with 
patient medication and therapeutic 
facilities24, 25. In this research, it was found 
that most caregivers of schizophrenia 
patients are happy with their condition and 
psychiatric services. In Finland, 20-30 
percent of caregivers in psychiatric 
treatment, recovery, and drug care for 
patients with low functional status and 
unmet needs are unhappy and depressed. In 
reality, these caregivers need more 
participation in therapies, data, support, and 
therapy. So, caregivers should also be 
adequately evaluated. Caregivers can only 
serve as a resource in inpatient care if they 
obtain adequate support26,27.  
 

Conclusion 
It is painful to live with a psychiatric illness, 

both for the patients and the families. The 

family members coping with such patients 

were seen to have ranked lower on the scale 

of life satisfaction. It was also seen that, as 

opposed to males, female care providers had 

lower scores on the life satisfaction scale. 

Family support is really important when 

coping with any disorder, whether mental or 

physical. But when an individual is dealing 

with a mental illness, the need to establish 

and sustain interpersonal relationships, take 

care of oneself, complete schooling, and 

maintain jobs interferes with one's ability. 

When supporting their patients, counsellors 

or therapists can also have some counselling 

for their family members, which may help 

family members understand themselves and 

their loved ones. And they should clarify 

that they should not neglect their own needs 

and demands when taking the caregiver 

position. 

 

Acknowledgement 
The author would like to acknowledge Dr. 
Saima Masoom Ali, Assistant Professor, 
University of Karachi, for her valuable 
advice and timely support throughout this 
research. Sincere thanks to Dr. Farhan 
Ishaque Khan, Assistant Professor at 
Institute of Physical Medicine & 
Rehabilitation Dow University of Health 
Sciences, for rendering extraordinary 
support. I would like to extend the deepest 
appreciation to Dr. AQ Khan Centre Institute 
of Behavioral Sciences, Gulshan Psychiatrist 
Hospital, Addicare Rehabilitation Centre,   
who cooperates and helping in data 
collection from their respective 
organizations. 
 

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