Abstract
Objective: Although various short forms of Zarit Burden Interview (ZBI) have been developed, there is a lack of standard psychometric testing and comparison among them. The study aims to examine the psychometric properties of ten short versions of the most frequently used ZBI among a sample of schizophrenia caregivers and to find the one with the best performance.Methods: Cross-sectional door-to-door survey of ZBI-22 and a series of validated instrument data from 327 family caregivers of schizophrenia patients in a Chinese rural community were conducted from October 2015 to January 2016. Reliability was assessed using McDonald's omega coefficient (ω). Validity including concurrent validity, known group's validity, and criterion validity were assessed by Spearman correlations and Mann-Whitney U tests. Overall discrimination ability was evaluated using the area under the receiver operating characteristic curve (AUC).Results: Reliability was generally good for all short forms (ω = 0.69–0.84), except for the Gort ZBI-4 (ω = 0.58), which is acceptable considering its small item numbers. Concurrent validity was good across all various ZBI forms with significant negative correlations with patient's function (r = −0.34 to −0.48, p < 0.01), as well as significant positive correlations with caregiver's depression (r = 0.49–0.65, p < 0.01), and anxiety symptoms (r = 0.45–0.58, p < 0.01). Known groups' validity (carers with disease vs. without disease; carers being parents vs. spouse vs. others) showed inconsistent results among various short forms. Criterion validity was generally good for all short forms with significant positive correlations with Family Burden Interview Schedule (r = 0.67–0.75, p < 0.01), except for the Higginson ZBI-1(r = 0.57, p < 0.01). Discriminative ability was also good for all short forms (AUC range: 0.85–0.99), with various cutpoints proposed. Among all ten short forms, the Ballesteros ZBI-12 and the Gort ZBI-7 outperformed others with almost equally good performance in comprehensive psychometric testing.Conclusions: This study provides support for the reliability, validity, and discriminative ability of the ten various short forms of ZBI for use among schizophrenia family caregivers, with the Ballesteros ZBI-12 and the Gort ZBI-7 endorsed as the best ones.
Highlights
The Zarit Burden Interview (ZBI) is one of the oldest and most commonly used instruments for assessing caregiving burden at an international level (Knight et al, 2000)
Comparison of various abridged versions of ZBI have been conducted with consistent findings supporting for the reliability and validity of various short forms, while uniformly endorsing as the best one either the Bedard 12-item ZBI (Higginson et al, 2010; Hagell et al, 2017) or the Ballesteros 12-item ZBI (Lin et al, 2017b)
The care recipient must be registered in the 686 Program and fulfilling the Chinese Classification of Mental Disorders-3(CCMD-3) or the International Classification of Diseases-10 (ICD-10) criteria for schizophrenia as diagnosed by special psychiatrist
Summary
The Zarit Burden Interview (ZBI) is one of the oldest and most commonly used instruments for assessing caregiving burden at an international level (Knight et al, 2000). Developed more than 30 years ago, the ZBI was intended to measure burden and stress experienced by caregivers caring for people with dementia with 29 items on a four-point Likert type scale (Zarit et al, 1980). A revised ZBI (Zarit et al, 1985a,b) was later introduced with 22 items on a five-point Likert type scale, which has been widely translated into various languages, and validated across countries and cultures, such as Europe (Braun et al, 2010; Martin-Carrasco et al, 2010; Chattat et al, 2011), Africa (Imarhiagbe et al, 2017) and Asian countries like China (Wang et al, 2008; Lu et al, 2009) and Japan (Hirono et al, 1998) allowing for international comparison. Comparison of various abridged versions of ZBI have been conducted with consistent findings supporting for the reliability and validity of various short forms, while uniformly endorsing as the best one either the Bedard 12-item ZBI (Higginson et al, 2010; Hagell et al, 2017) or the Ballesteros 12-item ZBI (Lin et al, 2017b)
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