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J Alzheimers Dis. 2017;59(4):1317-1325. doi: 10.3233/JAD-170172.

Trajectories of Multidimensional Caregiver Burden in Chinese Informal Caregivers for Dementia: Evidence from Exploratory and Confirmatory Factor Analysis of the Zarit Burden Interview.

Li D1,2,3,4,5, Hu N6, Yu Y1,2,3,4,5, Zhou A1,2,3,4,5, Li F1,2,3,4,5, Jia J1,2,3,4,5.

Author information

Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, P.R. China.
Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.
Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, P.R. China.
Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, P.R. China.
National Clinical Research Center for Geriatric Disorders, Beijing, P.R. China.
National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P.R. China.



Despite its popularity, the latent structure of 22-item Zarit Burden Interview (ZBI) remains unclear. There has been no study exploring how caregiver multidimensional burden changed.


The aim of the work was to validate the latent structure of ZBI and to investigate how multidimensional burden evolves with increasing global burden.


We studied 1,132 dyads of dementia patients and their informal caregivers. The caregivers completed the ZBI and a questionnaire regarding caregiving. The total sample was randomly split into two equal subsamples. Exploratory factor analysis (EFA) was performed in the first subsample. In the second subsample, confirmatory factor analysis (CFA) was conducted to validate models generated from EFA. The mean of weighted factor score was calculated to assess the change of dimension burden against the increasing ZBI total score.


The result of EFA and CFA supported that a five-factor structure, including role strain, personal strain, incompetency, dependency, and guilt, had the best goodness-of-fit. The trajectories of multidimensional burden suggested that three different dimensions (guilt, role strain and personal strain) became the main subtype of burden in sequence as the ZBI total score increased from mild to moderate. Factor dependency contributed prominently to the total burden in severe stage.


The five-factor ZBI is a psychometrically robust measure for assessing multidimensional burden in Chinese caregivers. The changes of multidimensional burden have deepened our understanding of the psychological characteristics of caregiving beyond a single total score and may be useful for developing interventions to reduce caregiver burden.


Caregiver burden; Zarit Burden Interview; confirmatory factor analysis; dementia; informal caregiver

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