Development and Validation of a Multidimensional Short Version Zarit Burden Interview (ZBI-9) for Caregivers of Persons With Cognitive Impairment

Author:

Zhi-Xiang Lim1,Lim Wee Shiong23,Chan Ee-Yuee45ORCID

Affiliation:

1. Nursing Research Unit, Nursing Service

2. Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng

3. Lee Kong Chian School of Medicine, Nanyang Technological University

4. Nursing Research Unit

5. Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore

Abstract

Background: There is a lack of appreciation of the full dimensionality of the original 22-item Zarit Burden Interview (ZBI) in the development of short versions. Existing short versions are premised upon a 1-factor or 2-factor structure or statistical techniques for item selection. Thus, there is a need for ZBI short versions that considers the multidimensional constructs of role strain, personal strain, and worry about performance (WaP) during item selection to provide a more holistic and comprehensive evaluation. Purpose: To develop and validate a short version of ZBI through a combined quantitative and qualitative approach that incorporates the validated 4-factor structure of role strain demands; role strain-control; personal strain, and WaP. Patients: We studied 202 caregivers of patients with dementia (84.2%) or mild cognitive impairment (15.8%) attending a memory clinic in Singapore. Methods: Confirmatory factor analysis and qualitative considerations from expert consensus were used for item selection. Confirmatory factor analysis fit statistics support the 4-factor structure. The 9-item ZBI-9 showed good internal consistency (Cronbach’s α=0.87) and convergent validity with anxiety and depression (Pearson correlation: Hospital Anxiety and Depression sub-scales, r≥0.56, P<0.001; ZBI- 22, r=0.95, P<0.001). Using a cut-off score of ≥13, ZBI-9 displayed good discriminatory ability for depressive symptoms (area under curve=0.79, P<0.001; sensitivity=70%, specificity=75%). The ZBI-9 also displayed comparable performance to the 22-item full version and three 12-item short versions. Conclusion: The ZBI-9 is a multidimensional short-version assessment tool for caregivers of persons with dementia and mild cognitive impairment that is reliable, valid, and discriminates depressive symptoms.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Gerontology,Clinical Psychology

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