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Cutoff of the Zarit Burden Interview in predicting depression and anxiety

Quality of Life Research volume 28, pages 2525–2533 (2019)Cite this article

Abstract

Background

The purpose of the present study was to determine a statistically valid cutoff score for the Zarit Burden Interview (ZBI) in order to identify family caregivers at risk for depression and anxiety to guide for further assessment and future intervention.

Methods

The ZBI, the Patient Health Questionnaire (PHQ), and the Generalized Anxiety Disorder Scale (GAD) were administered to a representative community sample of 327 family caregivers of schizophrenia individuals. A ZBI cutoff score was determined using three different statistical methods: tree-based modeling, K-means clustering technique and linear regression, followed by contingency analysis and receiver operating characteristic (ROC) curve to compare between depression and anxiety scale scores with the ZBI cutoff.

Results

Findings suggest that a cutoff score of 48 in ZBI has significant predictive validity for identifying caregivers at risk for both depression and anxiety. A ZBI cutoff of 48 showed sensitivity of 73% for PHQ and 70% for GAD, specificity of 80% for PHQ and 79% for GAD, PPV (positive predictive value) of 75% for PHQ and 73% for GAD, NPV (negative predictive value) of 78% for PHQ and 76% for GAD.

Conclusions

This cutoff score would enable health care providers to assess family caregivers at risk and provide necessary interventions to improve their quality of life in this important role.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ZBI:

Zarit Burden Interview

PHQ:

Patient Health Questionnaire-9

GAD:

Generalized Anxiety Disorder Scale-7

CCMD-3:

Chinese Classification of Mental Disorders-3

ICD-10:

International Classification of Diseases-10

ROC:

Receiver operating characteristic

AUC:

Areas under the curves

PPV:

Positive predictive values

NPV:

Negative predictive values

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Acknowledgements

The authors would like to thank all the families of the schizophrenia individuals we interviewed during the study for openly sharing their feelings and experiences. We’d also like to thank the health and family planning bureau of Ningxiang County and the government of the Liushahe town, Shungfupu town, Chengjiao xiang and Yutan town for their administrative support, as well as all village/community doctors for guiding us to visit each household of the schizophrenia individuals in the rural areas of Ningxiang County, Hunan province.

Funding

This work was supported by “CMB-CSU” Collaborative Program for Mental Health Policy Development (II) (Grant Number 14-188) and the National Natural Science Foundation of China (Grant Number 71804197). The funders have no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Author information

Author notes

  1. Yu Yu and Zi-Wei Liu have contributed equally to this work.

Affiliations

  1. Hospital Evaluation Office, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China

    Yu Yu

  2. Department of Psychiatry, The Second Xiangya Hospital, Central South University, Renmin Middle Road 139, Changsha, 410011, Hunan, China

    Zi-Wei Liu

  3. Hospital Administration Institute, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China

    Wei Zhou

  4. Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, 410008, Hunan, China

    Mei Zhao, Dan Qiu & Yi-Lu Li

  5. Mental Health Center, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China

    Shui-Yuan Xiao

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  1. Yu Yu
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Contributions

YY, ZWL, and SYX contributed to the conception and design of the study, YY, ZWL, WZ, MZ, DQ, YLL, and SYX contributed to the research conduction and data collection, YY, ZWL, and WZ contributed to data analyses and interpretation. YY and ZWL drafted the article while WZ, MZ, DQ, YLL, and SYX critically appraised it and revised it. All authors approved the final version of manuscript for submission and publication and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Shui-Yuan Xiao.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Ethical approval was obtained from the Institutional Review Committee of the Xiangya School of Public Health of Central South University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Yu, Y., Liu, ZW., Zhou, W. et al. Cutoff of the Zarit Burden Interview in predicting depression and anxiety. Qual Life Res 28, 2525–2533 (2019). https://doi.org/10.1007/s11136-019-02208-7

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  • DOI: https://doi.org/10.1007/s11136-019-02208-7

Keywords

  • Cutoff
  • The Zarit Burden Interview (ZBI)
  • Depression
  • Anxiety
  • Schizophrenia