Caregiver Stress Research Articles

One is Good, but are Two Really Better? Outcomes for Dual versus Individual Attendees in a Behavioral Parent-Training Program for Caregivers of Young Children

ABSTRACT Background The Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS) BPMT program utilizes positive behavior support principles to help caregivers of children birth-5 years address early childhood disruptive behaviors and common developmental challenges experienced by many young children. Objective The present study examined whether there were differences in child outcomes, attendance rates, homework completion rates, levels of caregiver stress, and treatment satisfaction for individual versus dual caregiver participation in the HOT DOCS BPMT. Method Using a quasi-experimental design, caregivers of children ages 0–5 years were assigned to two non-equivalent groups: individual attendee (n = 141) and dual attendee (n = 123). Independent samples t-tests were utilized to compare means between individual and dual attendee groups for number of sessions attended and homework completion. Paired samples t-tests were calculated to compare means between individual and dual attendee groups on HOT DOCS program outcomes, including child behavior, parenting stress, and treatment satisfaction. Results There were no significant differences in outcomes between individual and dual attendee groups. Child behavior outcomes, parenting stress, treatment satisfaction, attendance, and homework completion were similar across both groups. Conclusions Individual caregiver engagement in the HOT DOCS BPMT program might be sufficiently potent to result in desirable outcomes. Future directions should include examining family structure and treatment modality on BPMT outcomes, maintenance of intervention gains, and perceived child behavior outcomes of BPMT non-attending caregivers.

Assessing caregiver stress and resource needs in pediatric cancer care

BackgroundCaregivers of pediatric cancer patients often face significant stress and emotional strain, which can negatively impact their well-being and the quality of care provided to their children. Understanding the socio-demographic factors influencing caregiver stress and identifying the specific needs and resources required by caregivers are crucial for improving support systems in pediatric cancer care.Aim of the studyThis study aimed to analyze the levels of caregiver stress and their resource needs within pediatric cancer care.MethodsA cross-sectional descriptive design was used, and the study was conducted at El-Minia Oncology Center outpatient clinics, Egypt. The sample included 258 pediatric cancer caregivers selected based on predefined eligibility criteria. Data were collected using the Caregiver Needs and Resources Assessment (CNRA) and the King Stone Caregiver Stress Scale (KCSS), both of which demonstrated strong reliability and validity. Descriptive statistics, t-tests, ANOVA, and Pearson correlation coefficients were employed for data analysis using SPSS version 29, with a significance level set at p < 0.05.ResultsCaregivers reported moderate to high stress levels, with an average stress score of 34.59 (SD = 7.649). Age, education level, marital status, and income were significant predictors of caregiver stress (p < 0.001), with lower income and higher educational levels contributing to increased stress. The number of children, child’s age, and duration since cancer diagnosis also significantly impacted stress levels (p < 0.001). Correlation analysis revealed that psychological needs were positively related to stress (r = 0.488, p < 0.001), while spirituality was negatively associated with stress (r = -0.241, p < 0.001). Regression analysis indicated that physiological needs (ß = 0.331) and role conflict (ß = 0.294) were the strongest predictors of stress (R² = 0.636).Conclusion and implicationsThis study emphasizes the impact of socio-demographic factors on caregiver stress in pediatric cancer care. Targeted interventions that address caregivers’ psychological, social, and financial needs are essential to alleviate stress. Implementing caregiver-centered support programs in pediatric oncology can enhance the well-being of both caregivers and patients. Future research should explore sustainable strategies to further reduce caregiver burden.Clinical trial numberNot applicable.

Correction: Young Children’s Social and Emotional Adjustment and Caregiver Stress During the COVID-19 Pandemic

Correction: Young Children’s Social and Emotional Adjustment and Caregiver Stress During the COVID-19 Pandemic

Developing a theory of change to guide the design and implementation of a caregiver-centric support service

BackgroundSet against the backdrop of a rapidly ageing population and growing emphasis on the importance of ageing-in-place, family members often assume the role of a caregiver. Navigating through a complex healthcare system while simultaneously juggling the daily care needs of their care-recipients, caregivers often become worn out by the intense caregiver stress and burden, neglecting their own well-being. This translates to adverse health and economic outcomes such as prolonged hospital stays and increased nursing home placement of care-recipients. Seeking to better support caregivers, we developed a theory of change to guide the design and implementation of a caregiver support programme – Project Carer Matters.MethodsWe applied theory of change methodology to explain how the Project’s interventions were hypothesised to lead to their identified short-to-long term goals, drawing on a causal analysis based on available evidence. The theory of change was developed with insights garnered from previous research studies conducted on caregiver stress, stakeholder engagement sessions and multiple dialogues with clinical experts and hospital leaders.ResultsOur final theory of change is the result of the evaluation of the Project in its pilot phase. It is populated with the resources, activities and short-to-long term outcomes that can be attributed or linked to the Project. Multiple meetings and discussion with stakeholders over the pilot prompted frequent practice of the Plan, Do, Study, Act model to refine the ongoing implementation process and the theory of change itself.ConclusionsA theory of change is essential in guiding the design, implementation and evaluation of a complex health care intervention such as Project Carer Matters. The development of the theory of change is a journey and not a resultant product. This journey has also led us to learn that 1) a theory of change needs to be dynamic and ever evolving with time and context, 2) the perspectives of relevant stakeholders need to be included in this process to ensure the feasibility and sustainability of the project in the long run and 3) frequent stakeholder engagements are essential in enabling the implementation team to fine-tune the Project in an effective manner.Trial registrationClinicalTrials.gov, NCT05205135, registered on 24/01/2022.

Views on the well-being of groups of informal caregivers. A cluster analysis using the example of Saxony

BackgroundAs a result of demographic change, a further increase in the number of people in need of care in Germany can be expected in the future. Nursing activities performed by family members are a central component of care provision. Providing care for people in need of care is increasingly associated with additional physical and psychological stress for informal caregivers. The aim of this study is to identify and characterize groups of informal caregivers with regard to their well-being.MethodologyThe empirical study was based on a cross-sectional survey on home care in Saxony from 2019, which was intended as exploratory work to provide insights into the care situation in Saxony. The central component is a two-step cluster analysis with exclusively informal caregivers.ResultsThe net sample size for the cluster analysis comprised 178 subjects who were involved in caring for relatives. The cluster analysis revealed two groups of caregiving relatives in Saxony, which were differentiated by a different experience of stress and various sociodemographic factors.DiscussionInformal caregivers in Saxony are not a homogeneous group. Depending on various sociodemographic factors or the care effort and situation, they are confronted with different challenges in caring for relatives, which are directly reflected in their well-being. In order to achieve a targeted reduction in the burden on family caregivers, cooperation and constructive collaboration between political decision-makers, care and health insurers, and the various players in health and care provision is required.

Irritability in stroke: a protocol for a prospective study

BackgroundPoststroke irritability (PSI) is common among stroke survivors and can lead to a poor quality of life, difficulties in social interactions, criticism from caregivers, and caregiver stress. The planned study will evaluate the clinical, neuropsychological, and magnetic resonance imaging (MRI) correlates of PSI in a cohort of stroke survivors. In addition, the study will examine the 15-month progression of PSI.MethodsThis will be a prospective cohort study that will recruit 285 participants. Participants and their caregivers will undergo detailed assessments at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The irritability/lability subscale of the Chinese version of the Neuropsychiatric Inventory (CNPI) will be completed by caregivers. Potential covariates will also be measured. Patients will undergo MRI, including diffusion-weighted imaging, within 1 week of stroke onset. A stepwise logistic regression will be performed to evaluate the importance of lesions in the regions of interest (ROIs) along with other significant variables identified in univariate analyses. These analyses will be repeated for patients with and without PSI at T2 and T3. Repeated measures analysis of covariance (ANCOVA) will be used to assess changes in CNPI scores for the entire sample. In ANCOVA analyses, the frequency of infarcts in the ROIs will be treated as the predictor.DiscussionThis will be the first MRI study on PSI in stroke survivors. The findings will provide insights into the association of the orbitofrontal cortex, anterior cingulate cortex, anterior temporal lobe, insula, amygdala, thalamus, and basal ganglia lesions with the risk of PSI.

Socio-economic and Gender Disparities in Psychological Distress and Marital Adjustment Among Spouses of Hepatitis C Patients: A Quantitative Assessment

The present study examines differences in psychological distress and marital adjustment between spouses of Hepatitis C patients based on socioeconomic and gender status, specifically addressing dissimilarities in emotional and couple functioning due to economic and gender disparities. Hepatitis C is a chronic and progressive disease, and there is a substantial caregiver burden required, which should increase stress and negatively impact marital quality. With the data collected from 200 spouses of Ayub Medical Complex and Combined Military Hospital Abbottabad Pakistan, this research investigates the moderating effects of economic resources and gender roles on psychological distress and other factors pertinent to marital satisfaction, such as affection expressing marital adjustment and dyadic cohesion. Results identified by the study show that compared to spouses with higher SES, participants with lower SES have significantly elevated levels of psychological distress and reduced marital adjustment, indicating the role of economic stress in caregiver stress. The female spouses continue to display higher levels of distress and lower marital satisfaction and cohesiveness than male spouses, replicating the usual female gender role expectations of the traditional caregiver. Also, gender and economic level cross-tabulations show differences in coping and support seeking and, hence, mental health and relationship quality. These results indicate the further imperative of targeting specific psychological and social support for economically disadvantaged and female carers to alleviate their specific known burdens, providing a foundation for developing policies dealing with marital stress in chronic illness situations, among other proposals.

The neural basis of neuropsychiatric symptoms in Alzheimer’s disease

Neuropsychiatric symptoms (NPS) such as depression, anxiety, apathy and aggression affect up to 90% of Alzheimer’s disease (AD) patients. These symptoms significantly increase caregiver stress and institutionalization rates, and more importantly they are correlated with faster cognitive decline. However, the neuronal basis of NPS in AD remains largely unknown. Here, we review current understanding of NPS and related pathology in studies of AD patients and AD mouse models. Clinical studies indicate that NPS prevalence and severity vary across different AD stages and types. Neuroimaging and postmortem studies have suggested that pathological changes in the anterior cingulate cortex, hippocampus, prefrontal cortex, and amygdala are linked to NPS, although the precise mechanisms remain unclear. Studies of AD mouse models have indicated that amyloid-beta and tau-related neurodegeneration in the hippocampus, prefrontal cortex, and anterior cingulate cortex are correlated with NPS-like behavioral deficits. A better understanding of the NPS phenotypes and related pathological changes will pave the way for developing a better management strategy for NPS in AD patients.

Dyadic Comparison of Pain and Stress in Alzheimer's Disease and Caregivers

BackgroundMillions of people live with dementia worldwide, relying heavily on family caregivers. Pain is common in both people living with Alzheimer's disease (PLWAD) and their caregivers, contributing to stress and burden. To our knowledge, this is the first study to examine the relationship between pain, stress, hair cortisol, and mental health in PLWAD and their caregivers, and how these factors are linked to caregiver burden. MethodsThis exploratory pilot study included five PLWAD-caregiver dyads. Participants completed questionnaires on pain, mental health, and demographics. Hair samples were collected for cortisol analysis. Pearson correlation coefficients (r) were used to assess relationships between various factors of the PLWAD and their caregiver. ResultsContrary to expectations, PLWAD's pain and mental health measures displayed a trend of negative correlation with their hair cortisol levels (HCC). Conversely, caregiver pain and mental health measures had a trend of positive correlation with their HCC. There was also a trend that higher pain in PLWAD was associated with higher caregiver burden. ConclusionThis exploratory pilot study found associational trends suggesting a complex relationship between pain, mental health, and stress in PLWAD-caregiver dyads. This preliminary work will inform future studies which can help advance targeted, tailored interventions.

The Relationship Between Social Support and Stress in Family Caregivers of Stroke Patients.

BACKGROUND: Stroke is a significant cause of disability. Family Informal caregivers face numerous stressors. This study examines whether social support during hospitalization would mediate the relationship between care time per day and stress in family caregivers of stroke patients. METHODS: A cross-sectional study design in Taiwan recruited 137 family caregivers. Descriptive information forms, the Caregiver Strain Index, and the Social Support Scale were used to collect data. RESULTS: Social support was negatively correlated with stress ( r = -0.23, P = .006). By contrast, caregiving hours and physical support were significantly associated with psychological stress. Physical support mediated the association between caregiving hours and psychological stress (95% CI = 0.000-0.005), accounting for 22.02% of the total effect. CONCLUSION: Social support decreased family caregiver stress, notably psychological stress, due to prolonged care of 18 hours per day in the hospital. Physical support resources to alleviate caregiver stress.

Family Caregivers' Burden in Taking Care of Older Cancer Patients at Home

The aging population in Taiwan increases the demand for care services for older adult patients with cancer, presenting significant challenges to both healthcare and social systems. Family caregivers perceive caregiver burden since they assist patients with daily activities, health management, and medical decision-making face physical, psychological, economic, and social stressors that impact their overall well-being. Taking care of older patients causes more complicated caregiving tasks because of the treatments and care related to cancer and multiple chronic conditions. Caregiver burden is known to be influenced by age, health, education, and disease awareness. Furthermore, in Taiwan, the participation of foreign spouses and migrant workers in family care increases cultural and resource-related challenges and highlights the need for integrated long-term care resources and social support. Using family caregiver assessments testing caregiver burden and quality of life can specify family caregiver needs that assist healthcare teams in developing family care plans. Interventions, including cancer education, psychological support, caregiving training, and collaborative models involving both patients and caregivers, may alleviate caregiver stress, improve quality of life, and enhance coping abilities. Moving forward, nursing professionals should advocate for integrated care models that incorporate comprehensive geriatric assessments and design interventions tailored to the specific needs of diverse family caregivers of older cancer patients. These approaches will help improve the quality of life for both caregivers and older cancer patients and foster a supportive care environment through interdisciplinary collaboration to address the health challenges of an aging society.

Singular Therapeutic Plan: Strategies For The Well-Being Of The Elderly In Primary Care

Background: Elderly health faces challenges due to increased life expectancy and the prevalence of chronic diseases. In this scenario, the Singular Therapeutic Project (PTS) emerges as an innovative strategy, initially developed in mental health, but now applied in geriatrics. The PTS promotes a personalized care plan, created in collaboration with the elderly person, their family and an interdisciplinary team, focusing on the needs This approach not only improves adherence to treatment, but also promotes autonomy and protagonism, essential for quality of life in old age. Aim: This experience report aims to describe the practical learning experience of medical students in the implementation of a STP for an elderly patient in primary health care, highlighting the impact on medical care and education. Experience Report: During the second semester of 2024, medical students had the opportunity to experience the practice of the Singular Therapeutic Project (PTS) in a real context, through home visits in the territory of Primary Health Care at the Basic Health Unit (UBS) Riozinho in the municipality of Bragança-PA. During the home visit to the patient's home, several instruments were applied for a more complete evaluation of both the elderly woman and her caregiver, her husband, 83 years old. Among these tools, the Adult Stress Symptom Inventory (LIPP) and the Zarit Caregiver Burden Interview (ZBI) scale were used to assess caregiver stress and burden. Conclusion: The participation of medical students in the construction of the Singular Therapeutic Plan (PTS) in primary health care is an essential training experience that significantly enriches the training of future professionals.

Does socioeconomic factors and child behavior contribute to caregiver's stress in families of children with disabilities in Jordan: A cross-sectional study.

This study explored whether socioeconomic factors and child behavior are associated with caregiver stress in families of children with disabilities aged 2 to 17 living in Jordan. This study employed a cross-sectional design using an online survey. The survey, distributed mainly on social media, consisted of questions on demographics, child disability using the Washington Group Short Set on Functioning (WG-SS), caregiver stress levels using the Kessler Psychological Distress Scale (K6), and child behavior using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics, correlation testing (Pearson and Spearman tests), and stepwise multiple regression analysis were used to identify whether caregiver stress was associated with child disability and behavior and 4 socioeconomic factors (caregiver age, employment status, child disability, and child gender). In total, 161 caregivers completed the survey. Being older, employed, and having a female child were associated with less caregiver stress (P = .010, P = .017, and P = .009, respectively). Having a child with a higher disability score and more behavioral problems was associated with higher caregiver stress. Our findings highlight the importance of developing a comprehensive evaluation process to identify how child disability affects different areas of caregivers' lives, and interventions to address caregiver stress. We recommend implementing policies to increase access to mental health services and parenting resources, particularly for young and unemployed caregivers.

Digital Health Interventions for Informal Family Caregivers of People With First-Episode Psychosis: Systematic Review on User Experience and Effectiveness.

First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions-web-based, videoconferences, and mHealth-were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9.

Personality, Aging, and Alzheimer's Disease: Implications for Psychoneuroimmunology and Personalized Medicine.

Psychoneuroimmunology (PNI) advancements may revolutionize personalized medicine by identifying systemic biomarkers that enhance diagnosis and treatment. Inflammatory pathways connect personality traits with cognitive performance, aging-related disorders, and mortality risks. Studies have demonstrated the critical interactions between personality and various biological systems like the hypothalamic-pituitary-adrenal (HPA) axis. The gut-brain axis also affects behaviors and psychological states in older adults, with specific gut microbiota influencing cognition, mood, and personality. These findings underscore the practical implications of understanding personality-biology interactions. They can support preventive and personalized medicine for aging-associated disorders. Specifically, personality changes are prevalent in Alzheimer's disease (AD) patients, impacting clinical management and caregiver stress. Non-cognitive factors, such as personality traits and psychiatric symptoms, may serve as early markers of AD. Traits like high Neuroticism and low Openness can predict initial AD stages, often before a formal diagnosis. Personality alterations in AD are also linked to cerebrospinal fluid (CSF) and vascular imaging biomarkers, which can track AD pathology and serve as predictors. Dynamic personality assessment can aid in timely diagnosis, monitoring progression, and evaluating treatmentsof AD. Understanding personality traits is crucial for predicting burnout, lifespan, and intervention success. Integrating personality and PNI biomarkers into patient profiles will support the development of personalized and systems medicine.

"None of us asked to be in this community." Understanding nephrotic syndrome through TikTok: patient and caregiver perspectives.

TikTok, a popular social media platform, is increasingly used for health information dissemination; however, the accuracy and quality of medical content remain uncertain, including in the context of nephrotic syndrome (NS). This study aims to identify prominent patient and caregiver experiences with NS on TikTok and demonstrate how they may vary. A convenience sample of TikTok videos containing the hashtag "nephrotic syndrome" posted between July 1, 2020, and February 29, 2024, was analyzed. Videos underwent cyclical and inductive coding, followed by content and discourse analysis to identify common themes and narratives. One hundred twenty-three videos were included in the analysis. 62.6% of videos (N = 77) consisted of caregivers sharing their experiences of their child's disease. Three prominent topics included: (1) navigating healthcare and managing illness, where users shared their disease journeys; (2) emotional and physical wellbeing, where caregivers focused on physical disease signs while patients highlighted the mental health toll of the illness; and (3) education, awareness, and support systems, where users shared feelings of social isolation post-diagnosis. The discourse analysis revealed language portraying patients as "warriors," reflecting the resiliency promoted by TikTok support systems. We uncovered a hidden disease burden associated with NS that affects everyday life, reinforcing the importance of the journey and stress patients and caregivers experience outside of the clinician's office. Our findings also highlight that patient priorities may differ from those reported by caregivers, particularly in pediatrics. TikTok may also be an outlet for feelings of isolation and community-building within NS.

Four Alzheimer’s Apps to Implement into a Caregiver’s Daily Routine

Smartphones have become synonymous with modern living, providing users with countless apps to perform endless functions. Harnessing mobile technology to help caregivers of Alzheimer’s Disease patients offers users tools and resources to engage, organize and lessen the stress of caregiving. Medical Librarians, healthcare professionals, family and friends can all benefit from learning about four popular Alzheimer’s Disease caregiver apps to enable them to provide thoughtful recommendations to implement their use in caregivers’ daily lives.

Stress in Family Caregivers of Children with Chronic Health Conditions: A Case-Control Study.

This study analyzed the stress experienced by family caregivers of children with special healthcare needs and identified associated factors. A case-control study was conducted with the "cases" being caregivers of children with chronic conditions and the "controls" being caregivers of healthy children. Recruitment was carried out via social media and complemented by snowball sampling. A sociodemographic questionnaire and the Perceived Stress Scale were applied, with four saliva samples collected in one day (at 8:00 am, 30 min later, and 4 and 12 h later). The Area Under the Curve for total daily cortisol production was calculated using the log-trapezoidal method. The Wilcoxon test and repeated-measures ANOVA were used for statistical analysis. In total, 100 caregivers participated, with 50 in the "case" group and 50 in the "control" group. Significant differences in stress scores and salivary cortisol levels were observed between the groups, with the other variables constant. In both groups, cortisol levels followed a typical circadian pattern. Family income was associated with perceived stress. Caregiver age significantly explained perceived stress (p = 0.0098) and total cortisol production. Caregiver occupation also influenced cortisol results. Caregivers of children with chronic conditions showed higher perceived stress and lower cortisol production compared to those of healthy children. Family income, occupation, and caregiver age were associated with stress.

The Role of Perceived Social Support on Stress, Anxiety, Depression and Care Burden Levels of Caregivers of Cancer Patients: A Turkish Republic of Northern Cyprus (TRNC) Example.

The current study investigated the role of perceived social support in the relationship between stress, depression, anxiety, and caregiving burden on caregivers of cancer patients. The research was conducted in the Turkish Republic of Northern Cyprus. In this sense, the situation in a region that is not often subject to research is reflected in the literature. In the current study, data from 93 caregivers were examined. 61.6% of the participants are women and the mean age of the participants is 40.82. Sociodemographic Information Form, Zarit Caregiver Burden Scale, Multidimensional Scale of Perceived Social Support, Depression Anxiety Stress Scale were used as measurement tools. Caregivers' depression and anxiety levels were found to be normal, and their stress levels were found to be mild. Caregiving burden, depression, anxiety, stress, and perceived social support were found to be interrelated variables. Six models of the role of perceived social support were tested. The analysis results showed that perceived social support had a mediating role, but not a moderating role, in the relationships between stress and caregiving burden, depression and anxiety. This finding, which is not frequently encountered in the related literature, was discussed with the related literature and suggestions for future studies were presented in the light of the findings.

Caregiver burden, attachment and cognitive emotion among the family caregivers of severe mental illness patients

BackgroundSerious mental illness (SMI) is a debilitating medical condition that causes stress and challenges for the family caregivers (FCs) of affected patients, increasing their caregiver burden (CB). This situation can activate attachment styles (AS) and trigger negative emotions, further contributing to CB. Given that AS and cognitive-emotional regulation (CER) can affect the CB of FCs of patients with SMI, the aim of this study was to evaluate the relationship between CB with AS, and CER among the FCs.MethodsThis cross-sectional descriptive-correlational study was carried out in May–November 2022. Participants were 278 FCs of patients with SMI consecutively recruited from Roozbeh leading psychiatric hospital, Tehran, Iran. Data were collected using a patients’ demographic and clinical characteristics questionnaire, an FCs’ demographic characteristics questionnaire, the Attachment Style Questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Burden Scale for Family Caregivers, and were analyzed using the SPSS software (v. 16.0).ResultsCB had significant inverse relationship with secure AS (r = − 0.262) and significant positive relationship with fearful AS (r = 0.194) and dismissive AS (r = 0.242) (P < 0.01). Moreover, CB had significant inverse relationship with adaptive CER strategies and significant positive relationship with maladaptive CER strategies (P < 0.001). Regression analysis also showed that CB had significant relationship with secure AS and catastrophizing, rumination, self-blame, and positive refocusing CER strategies (P < 0.05).ConclusionThis study concludes that AS and CER can impact CB. There is a negative relationship between secure AS and CB, as well as between adaptive CER strategies and CB. Conversely, there is a positive relationship between avoidant AS and increased CB, as well as between maladaptive CER strategies and CB. It is recommended to adopt strategies that promote the use of secure AS and adaptive CER among the FCs of patients with SMI.