Zarit Burden Interview

Purpose

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

Link to Instrument

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

Non-Specific Patient Population

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

30 minutes

Required Training

No Training

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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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