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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Burden, stress and depression in caregivers of cirrhosis patients before and after liver transplantation
Adriano Virches, Mariana B Claudino, Maria C Miyazaki, Eliane T Miyazaki, Renato F Silva, Rita C Silva, Heitor B Farias, Neide A Domingos, Randolfo Santos Jr, Patricia S Fucuta
Adriano Virches, Mariana B Claudino, Maria C Miyazaki, Eliane T Miyazaki, Neide A Domingos, Randolfo Santos Jr, Department of Psychology, School of Medicine of São José do Rio Preto (FAMERP/Faculdade de Medicina de São José do Rio Preto), São José do Rio Preto 15090-000, São Paulo, Brazil
Renato F Silva, Department of Surgery and Study Group of Liver Tumors - GETF and Liver and Small Intestine Transplantation Unit, School of Medicine of São José do Rio Preto and Base Hospital, São José do Rio Preto 15090-000, São Paulo, Brazil
Rita C Silva, Department of Gastroenterology and Liver and Small Intestine Transplantation Unit, School of Medicine of São José do Rio Preto and Base Hospital, São José do Rio Preto 15090-000, São Paulo, Brazil
Heitor B Farias, Stricto Sensu Graduate Program in Psychology, Pontifical Catholic University of Minas Gerais, Belo Horizonte 32604-115, Minas Gerais, Brazil
Patricia S Fucuta, Stricto Sensu Graduate Program in Psychology and Health, School of Medicine of São José do Rio Preto, São José do Rio Preto 15090-000, São Paulo, Brazil
Patricia S Fucuta, Department of Medicine, Faceres Medical School, São José do Rio Preto 15090-305, São Paulo, Brazil
Author contributions: Virches A, Miyazaki MC, and Fucuta PS designed the study; Virches A, Miyazaki MC, and Farias HB wrote the paper; Virches A, Claudino MB, Miyazaki ET, Domingos NA, Silva RF, and Silva RC conducted the study; Farias HB and Fucuta PS conducted the statistical analysis; Santos Jr R and Fucuta PS supervised the study; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by The Coordination for the Improvement of Higher Education Personnel Brazil, No. 88882.46424/2019-01; and The Brazilian National Council for Scientific and Technological Development, No. 314381/2021-0.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the FAMERP School of Medicine Institutional Review Board, approval No. 3.259.369.
Informed consent statement: All participants received detailed clarifications about the study and ethical aspects, provided written informed consent before inclusion in this study and received a copy of the free and informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Statistical code, and dataset available from the corresponding author at
cmiyazaki@famerp.br. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Maria C Miyazaki, PhD, Department of Psychology, School of Medicine of São José do Rio Preto (FAMERP/Faculdade de Medicina de São José do Rio Preto), 5416 Avenida Brigadeiro Faria Lima, São José do Rio Preto 15090-000, São Paulo, Brazil.
cmiyazaki@famerp.br
Received: October 5, 2024
Revised: November 14, 2024
Accepted: December 2, 2024
Published online: June 18, 2025
Processing time: 139 Days and 6.3 Hours
BACKGROUND
Family caregivers of cirrhosis patients (CPs) often experience burden, stress, and depression. Investigating whether these conditions improve following the patient undergoing liver transplantation (LT) is crucial, as it would elucidate the comprehensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.
AIM
To compare the levels of burden, stress and depression among family caregivers of cirrhotic and liver transplant patients.
METHODS
This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital. Instruments included identification cards, interview scripts, the caregiver burden scale Inventory, Lipp’s Stress Symptom Inventory, and the Beck Depression Inventory-Second Edition. Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability. Factor scores were compared with the Mann-Whitney U test, with effect size as the rank-biserial correlation coefficient (r). Statistical analysis was performed with R software (P < 0.05).
RESULTS
Seventy-seven CP caregivers and 65 LT recipient caregivers were included. Most were female (CP: 85.7% vs LT: 84.6%) and the patients’ spouses (76.6% vs 63.1%). The median age and caregiving duration were 55.4 (23.3-76.3) vs 54.6 (25.7-82.1) and 3.9 (1-20) vs 8 (1.5-24) years, respectively (P = 0.001). LT caregivers were less likely to be at risk of overload (21.5% vs 49.4%), to be under stress (33.8% vs 36.4%) and to show symptoms of depression (15.4% vs 35.1%). Compared with LT caregivers, CP caregivers had greater median factor scores for burden (general tension, P = 0.012; isolation, P = 0.014; disappointment, P = 0.004), depression (P = 0.008), and stress (P = 0.047), with small to moderate effect sizes. The disappointment (r = 0.240) and depression (r = 0.225) dimensions had the largest effect sizes.
CONCLUSION
Family caregivers of LT recipients are less likely to exhibit symptoms of burden, stress, and depression, suggesting that the benefits of LT extend to the patients’ family members.
Core Tip: Family caregivers of patients with chronic illnesses face increased risks of burden and mental health disorders. Liver transplantation is a therapeutic approach whose benefits extend to family members. When comparing the mental health of caregivers of cirrhotic patients and caregivers of liver transplant recipients, the latter group showed lower levels of burden, stress, and depression, suggesting that the benefits of this procedure extend beyond the patients to their families, and consequently, to society. However, elevated levels of these conditions in both groups underscore the importance of addressing the mental health needs of family caregivers.
