4.1. Summary of Findings
This study aimed to explore the prevalence and factors associated with depression among caregivers of geriatric patients in Jeddah, Saudi Arabia, highlighting the relevance of understanding caregiver burden and its impact on mental health. The study involved 269 participants, with an average age of 32 years, a balanced gender distribution, and the majority being single (63.6%). Caregivers were primarily sons or daughters (49.4%) of the patients, with 65.1% providing care for over six months. Most caregivers (60.6%) provided daily care, and 58.7% lived with the patient. Shared caregiving duties were common (81.4%), and only 25.7% had financial responsibility for the patient. Based on the PHQ-9 scale, the most frequent depressive symptoms were tiredness or low energy and difficulty sleeping. The overall prevalence of depression (PHQ-9 score ≥ 10) was 45.4% (95% CI: 39.3, 51.5%). Caregiving burden assessed using the ZBI-12 scale indicated that 20.8% of caregivers experienced high burden, while 22.7% reported mild-to-moderate burden. The most concerning items were the feelings of needing to do more and having taken better care of the relative. While several factors were associated with higher depression likelihood, the multivariate model identified female gender, caregiving frequency, and burden as independent predictors, explaining 46.4% of the variance in depression likelihood. Notably, caregiving frequency showed a paradoxical finding where caregivers providing care for less than 8 h daily or not providing daily care had a higher likelihood of depression compared to those providing care for more than 8 h daily.
4.2. The Burden of Care: Depression and Caregiving
The prevalence of depression among caregivers of geriatric patients is a significant concern that has been extensively studied in various contexts. Studies have consistently shown that caregiving can lead to depression among caregivers, with some research indicating that approximately 52% of caregivers of geriatric patients had depression scores that warranted further evaluation [
25]. This aligns with our findings showing a prevalence of 45.4% with a 95% CI of 39.3 to 51.5%. Furthermore, depression is highlighted as one of the most common psychological consequences of caregiving, affecting caregivers of patients with severe mental illness and dementia [
26]. Caregivers of individuals with chronic illnesses, such as dementia, cancer, or heart failure, are at increased risk of experiencing emotional distress and burnout [
5,
6,
7]. The emotional impact of caregiving, combined with managing the care recipient’s health, can contribute to caregivers’ psychological strain and affect their quality of life [
27].
The present study showed that the caregiving burden is an independent factor for depression, with bivariate analysis showing a positive relationship between the two scores. The analysis of the Zarit-12 scale score indicates that 43.5% of caregivers are likely to experience significant caregiver burden, i.e., moderate or high scores. Caregiver burden encompasses the physical, emotional, social, and financial stressors faced by individuals providing care to impaired or ill individuals, resulting in an imbalance between caregiving demands and personal resources [
3]. Assessing this burden is relevant as it influences the potential need for patient institutionalization [
8].
Consistent with our findings, research indicates a substantial impact of caregiving burden on mental health. Caregiver burden has been linked to adverse psychological outcomes, such as depression and anxiety [
28,
29]. Persistent burden predicts depressive symptoms in dementia caregivers, underscoring the long-term impact on mental health [
30]. Additionally, caregiver burden correlates with symptoms of depression and anxiety and is associated with poorer physical and psychological health outcomes, including increased stress and reduced quality of life [
31,
32].
Additionally, caregiver burden can compromise caregivers’ overall well-being, impacting their ability to provide effective care [
33]. Such effect extends across various caregiving contexts, such as caring for individuals with cancer, Parkinson’s disease, and other chronic conditions [
34,
35]. We observed that the most concerning aspects of caregiving among the participants were feelings of needing to do more and regret for not having taken better care of their relative. These perceptions may indicate a lack of personal resources or conflict between caregiving duties and the caregivers’ own needs. Additionally, given the relatively young age of the participants, such perceptions may relate to a lack of preparedness for caregiving or inadequate social support. Indeed, caregiver burden can interact with factors like preparedness for caregiving and social connectedness to impact caregivers’ health-related quality of life and psychological well-being [
29,
36]. Caregivers lacking support, resources, and coping mechanisms may experience elevated burden, leading to negative health outcomes for both the caregiver and the care recipient [
37]. Seeking social support, building self-efficacy, and interventions focusing on enhancing emotional intelligence and resilience are beneficial for caregivers’ psychological well-being [
27,
38]. Further interventions proposed to alleviate caregiver burden include educational training programs and mindfulness interventions, aiming to reduce strain on caregivers and enhance their overall well-being [
39,
40].
The sum of this evidence indicates that caregiver burden is a multifaceted issue with significant implications for the health and well-being of caregivers and care recipients. Understanding the factors contributing to caregiver burden and implementing support strategies are crucial for promoting caregivers’ overall well-being and ensuring quality care for those in need of assistance.
4.3. Other Factors of Depression
Factors contributing to depression among caregivers of geriatric patients are also multidimensional and can be categorized into caregiver- and care-recipient-related factors. Among caregiver-related factors, younger age, female gender, single status, being a student, and having a low income were all associated with higher depression scores in the present study. However, only the female gender remained significant in the adjusted analysis. In line with these findings, female caregivers, lower education levels, and lower perceived social support have been linked to higher levels of caregiver depression [
41]. These factors may have a differential impact depending on the care recipient’s condition. For example, caregivers of patients with dementia have been found to experience higher levels of depression, with female caregivers often exhibiting significantly higher depression scores compared to male caregivers [
42]. The emphasis on the female gender is consistent with our findings, which show that female caregivers incur the highest risk of depression, as demonstrated in the adjusted analysis. On the other hand, social support was not investigated in the present study, although it constitutes a critical factor for a caregiver’s mental health. Research showed that social support and the caregiver’s perceived control over their lives can impact their risk of depression. Caregivers who experience social isolation, reduced control over their lives, and fear of inadequacy are at higher risk of depression [
43]. This is likely consistent with our findings that show that sole caregivers and those living in the same household as the patient exhibit higher depression scores, although the analysis was not statistically significant. These findings highlight the importance of adequate social support and social connections in preventing depression among caregivers and mitigating eventual depressive symptoms.
On the other hand, we observed a paradoxical finding where caregivers dedicating more than 8 h daily to caregiving experienced the lowest risk of depression compared to those who provided care less frequently, including those who did not provide care daily. This suggests that the caregiving burden in the studied population is likely influenced by other factors, possibly cultural and spiritual. Muslim caregivers often draw strength and guidance from their faith, incorporating Islamic principles into their caregiving practices. The doctrine of Allah and adherence to religious rituals provide comfort, resilience, and a sense of purpose, influencing their emotional well-being and coping strategies [
44]. These beliefs and practices not only shape the caregivers’ approach to providing care but also influence their emotional well-being and coping strategies in the face of the challenges associated with caregiving. This dimension may explain why, in highly dedicated caregivers, the levels of depression are significantly lower, as the levels of dedication may correlate with higher spiritual value for caregiving. This relationship may relate to the dimension of preparedness for caregiving and social connectedness and their positive impact on caregivers’ psychological well-being [
29,
36].
Although not explored in the present study, patient-related factors, including the type and severity of the patient’s condition, cognitive impairment, and behavioral disturbances, also contribute to caregiver depression. Indeed, the burden of caregiving is more substantial when coupled with the challenges of caring for individuals with cognitive impairments, resulting in increased levels of depression among caregivers [
45]. Caregivers of dementia patients, in particular, face challenges related to the care recipients’ cognitive impairments, which can heighten the burden and reduce caregivers’ well-being [
40]. The severity of patients’ cognitive impairment is associated with increased levels of caregiver burden, emphasizing the relationship between patient condition and caregiver well-being [
46]. The presence of chronic illness in elderly patients has also been identified as a risk factor for depression among caregivers [
47]. Furthermore, caregivers of patients near the end of life, including those with dementia, have been found to experience high levels of anxiety and depression, underscoring the emotional toll of end-of-life care [
48].
4.4. Implications for Action
The high prevalence of depression among caregivers of geriatric patients has significant public health implications, placing a considerable burden on healthcare resources and affecting the well-being of caregivers. Addressing this issue is crucial for improving the overall quality of care and societal well-being. Effective strategies should focus on providing mental health support, such as counseling and support groups, to alleviate the psychological strain on caregivers. Additionally, implementing respite care programs can offer temporary relief, reducing caregiver burnout. Respite care can take various forms, including in-home respite, short-term institutionalization, or adult day care, allowing caregivers a break from their caregiving responsibilities [
49]. Studies have shown that respite care can effectively suppress caregiver burden, providing caregivers with much-needed relief from their caregiving duties [
50,
51]. Respite care allows caregivers to engage in self-care activities, reducing stress and improving their quality of life. Additionally, in the context of Saudi Arabia, such programs would be more acceptable culturally than complete institutionalization.
Culturally sensitive interventions that build on Islamic values and practices can enhance the acceptability and effectiveness of these strategies within the community. Incorporating religious principles and rituals into caregiving support programs can provide caregivers with spiritual comfort, resilience, and a sense of purpose. Educational training programs tailored to the cultural context can further support caregivers in managing their burden [
52,
53].
Virtual education programs, such as the one evaluated by [
54], have been effective in enhancing caregiver confidence and self-efficacy, demonstrating the potential of technology in delivering educational support. Moreover, the study by Parmar et al. (2022) emphasizes the importance of optimizing the integration of family caregivers in person-centered care through educational programs for the healthcare workforce [
55].
By understanding and addressing the multifaceted nature of caregiver burden and the related factors and cultural dimensions, we can develop comprehensive support systems that promote caregivers’ mental health and well-being. These initiatives not only benefit caregivers but also improve the quality of care provided to geriatric patients, ultimately contributing to a healthier and more resilient society.
4.5. Limitations
This study has several limitations that should be acknowledged. First, the cross-sectional design limits the ability to establish causality between caregiver burden and depression. Longitudinal studies are needed to explore the temporal relationship between these variables. Second, the use of self-reported questionnaires for assessing depression and caregiver burden may introduce response bias, as participants might underreport or overreport their symptoms and experiences. Third, the snowball sampling technique might have led to selection bias, as the initial participants and their networks may not be representative of the broader population of caregivers. Fourth, the study was conducted at a single hospital in Jeddah, Saudi Arabia, which may limit the generalizability of the findings to other regions and healthcare settings. Additionally, cultural factors specific to Saudi Arabia may influence caregiving experiences and the prevalence of depression, making it difficult to generalize the results to other cultural contexts. Another limitation is the retrospective inclusion of younger caregivers (aged 12–17) despite the initial inclusion criteria specifying participants aged 18 and older. While this decision enriches the cultural context of the findings, it may introduce concerns regarding the validity of the tools used for this younger population. However, given that these participants represent less than 4% of the sample, the overall validity remains largely unaffected. Lastly, the study did not consider care recipients’ demographic and clinical factors, which have valuable implications for caregiver burden and the risk of depression.