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RehabMeasures Instrument

Zarit Burden Interview

Purpose

The ABI assesses caregiver perceptions of burden that may inadvertently effect their health, personal, social or financial wellbeing.

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Instrument Details

Acronym ZBI

Area of Assessment

Depression
Mental Health
Negative Affect
Social Support
Stress & Coping

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Contact information and permission to use:
MAPI Research Trust, Lyon, France:
E-mail: PROinformation@mapi-trust.org
Internet: www.mapi-trust.org

Diagnosis/Conditions

  • Stroke Recovery

Key Descriptions

  • Caregivers are asked to indicate the extent of burden experienced while providing care to a loved one.
  • Burden is defined as the extent to which a caregiver perceives emotional, physical health, social life, and financial consequences that impairs one’s ability to provide care.
  • Responses range from "not at all" to "extremely.
  • Total scores are obtained by summing all items endorsed.

Number of Items

22

Time to Administer

30 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

ICF Domain

Participation

Measurement Domain

Emotion

Considerations

  • The scale has also been referred to as the Burden Scale Zarit, The Burden interview, and the Caregiver Burden Index. 

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Non-Specific Patient Population

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Cut-Off Scores

Cut Scores:

(Schreiner et al, 2006; stroke (n = 80) and COPD (n = 48); mean age for entire sample = 60 to 65 years; Japanese sample)

  • A ZBI cut-off score that ranged from 24 to 26 identified caregivers in need of further assessment
  • A ZBI cut-off of 25 correctly identified 77% of high burden stroke caregivers

Normative Data

Caregivers of individuals with Dementia: (Wang et al, 2008; n = 42; mean age = 66 (12.67) years; Chinese sample)

  • Mean ZBI score = 24.40 (14.68) points 

 

Caregivers of individuals with Acute Stroke & COPD: (Schreiner et al, 2006)

  • ZBI with stroke patients; mean score = 28.32 (12.7) points 
  • ZBI with COPD patients; mean score = 20.35 (13)points
  • ZBI among patients with General Disabilities; score = 30.34 (17.7) points

 

Caregivers of individuals with cancer, dementia and acquired brain injury: (Higginson et al, 2010; cancer (n= 105), dementia (n = 131), and acquired brain injury (n= 215); mean ages across samples range from 54 to 60 years)

Descriptive statistics of scores for six short-form and full-scale versions of the ZBI

 

 

 

 

 

 

 

 

Diagnosis

 

 

Version

Stats

Cancer

Dementia

ABI

ZBI-12

Mean (SD)

12.0 (8.5)

15.1 (10.0)

21.7 (10.1)

 

95% CI

10.4-13.7

13.4-16.8

20.4-23.1

ZBI-8

Mean (SD)

5.5 (4.7)

8.8 (6.1)

11.5 (7.2)

 

95% CI

4.6-6.4

7.7-9.8

10.5-12.4

ZBI-7

Mean (SD)

7.4 (5.6)

9.9 (6.8)

14.3 (7.0)

 

95% CI

6.3-8.5

8.7-11.1

13.4-15.3

ZBI-6

Mean (SD)

6.4 (4.9)

8.2 (5.8)

12.3 (6.0)

 

95% CI

5.4-7.3

7.2-9.2

11.5-13.1

ZBI-4

Mean (SD)

4.8 (3.5)

6.1 (4.1)

7.9 (3.8)

 

95% CI

4.2-5.5

5.4-6.8

7.3-8.4

ZBI-1

Mean (SD)

1.0 (1.2)

1.7 (1.3)

2.1 (1.3)

 

95% CI

0.8-1.3

1.5-2.0

1.9-2.2

ZBI-22

Mean (SD)

23.2 (13.4)

27.9 (16.4)

39.1 (17.3)

 

95% CI

20.7-25.8

25.0-30.7

36.8-41.4

 

Caregivers of Patients with Dementia: (Zarit et al, 1986; n = 64; mean male age = 72.27 (6.72), mean female age = 63.37 (7.48) years)

 

 

 

 

 

Interviewed at an initial interview then two years later:

 

 

 

 

 

 

At home

 

Nursing home

 

Deceased

 

Time 1

Time 2

Time 1

Time 2

Time 1

Burden

33.59

29.17

43.54

23.44

39.33

Mental status questionnaire

3.54

2.08

2.36

a

2.87

Frequency of memory and behavior problems

45.72

44.55

48.00

44.50

51.93

Cross product of memory and behavior problems

47.76

19.06

67.36

35.25

65.40

Formal / Informal social supports

12.25

11.70

11.36

12.71

11.00

Subjective social supports

2.22

2.72

1.64

0.75

1.87

Quality of prior relationship

8.35

--

7.64

--

6.67

 

 

 

 

 

a = patients in nursing homes were not tested at Time 2

 

 

 

 

 

 

Caregivers of individuals with Dementia: (Wang et al, 2008; n = 42; mean age = 66 (12.67) years; Chinese sample)

  • Mean ZBI score = 24.40 (14.68) points 

All values = Mean (SD)

Test/Retest Reliability

ZBI Meta Analysis: (Bachner & O'Rourke, 2007; n = 138 data points; mean age 73.64 (11.64) years)

  • Coefficients differed as a function of time between assessments, however, this should not be seen as
    a limitation since caregiver burden should vary over time

Internal Consistency

Caregivers to Patients with Dementia: (Wang et al, 2008)

  • Excellent Internal Consistency (alpha = 0.89)
  • Excellent split half reliability = 0.87

 

Caregivers of individuals with Various Diagnoses: (Siegert et al, 2010; n = 222 caregiver of TBI, stroke, brain infection, hypoxia and other disorders; alpha for a two dimensional model)

  • Excellent: Personal Strain factor (alpha = 0.82)
  • Excellent: Role Strain factor (alpha = 0.80)

 

ZBI Meta Analysis: (Bachner & O'Rourke, 2007; n = 138 data points; mean age 73.64 (11.64) years)

  • Excellent (overall alpha = 0.86)

Criterion Validity (Predictive/Concurrent)

Caregivers of individuals with Dementia: (Wang et al, 2008)

Concurrent Validity 

  • Adequate; ZBI & The Geriatric Depression Scale 30 item Scale (r = 0.57  p < 0.001)
  • Adequate; ZBI & The Hamilton Anxiety Scale (r = 0.44 p = 0.003)
  • Adequate; ZBI & The Mini-Mental State Examination (r = -0.31 p = 0.044)

Construct Validity

Dimensionality of the Zarit: (Siegert et al, 2010) Confirmatory Factor analysis resulted in 2 dimensions:

  • Personal strain
  • Role strain
  • There was no evidence Differential Item Functioning for different types of carer or type of disorder

Responsiveness

Review Article: (Visser-Meily et al, 2004)

  • No change in perceived burden between 2 months and 2-4 years after stroke
  • No change in perceived burden between 3 and 48 months after stroke

Bibliography

Bachner, Y. and O’rourke, N. (2007). "Reliability generalization of responses by care providers to the Zarit Burden Interview." Aging & Mental Health 11(6): 678-685. Find it on PubMed

Higginson, I. J., Gao, W., et al. (2010). "Short-form Zarit Caregiver Burden Interviews were valid in advanced conditions." J Clin Epidemiol 63(5): 535-542. Find it on PubMed

Schreiner, A. S., Morimoto, T., et al. (2006). "Assessing family caregiver's mental health using a statistically derived cut-off score for the Zarit Burden Interview." Aging Ment Health 10(2): 107-111. Find it on PubMed

Siegert, R. J., Jackson, D. M., et al. (2010). "Factor analysis and Rasch analysis of the Zarit Burden Interview for acquired brain injury carer research." J Rehabil Med 42(4): 302-309. Find it on PubMed

Visser-Meily, J., Post, M., et al. (2004). "Measures used to assess burden among caregivers of stroke patients: a review." Clinical Rehabilitation 18(6): 601. Find it on PubMed

Wang, G., Cheng, Q., et al. (2008). "The metric properties of Zarit caregiver burden scale: validation study of a Chinese version." Alzheimer Dis Assoc Disord 22(4): 321-326. Find it on PubMed

Zarit, S., Todd, P., et al. (1986). "Subjective burden of husbands and wives as caregivers: A longitudinal study." The Gerontologist 26(3): 260. Find it on PubMed

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