International Psychogeriatrics


A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia

Claudia Cooper a1c1, T. B. S. Balamurali a2 and Gill Livingston a1
a1 Department of Mental Health Services, University College London, and Camden and Islington Mental Health and Social Care Trust
a2 Camden and Islington Mental Health and Social Care Trust

Article author query
cooper c   [PubMed][Google Scholar] 
balamurali tb   [PubMed][Google Scholar] 
livingston g   [PubMed][Google Scholar] 


Background: Caregiving for people with dementia has consistently been linked with psychological problems, usually in terms of caregiver burden, general psychological distress and depressive symptomatology, while morbidity due to anxiety has been relatively neglected in this group.

Methods: We conducted a systematic review of the literature, searching electronic databases, reference lists, relevant systematic reviews and contacting experts in the field. We used Centre for Evidence Based Medicine (CEBM) criteria for inclusion and rating the validity of all studies that reported (1) the prevalence, predictors and covariates of anxiety disorders or anxiety caseness, and (2) covariates and predictors of the level of anxiety symptoms.

Results: Thirty-three studies met our inclusion criteria. Clinically, significant anxiety affects about a quarter of caregivers for people with dementia and was more common than in matched controls. Such caregivers have higher anxiety levels than controls, and that confrontative and escape avoidance coping, caregiver burden and poorer caregiver physical health are factors associated with higher anxiety levels from cross-sectional studies.

Conclusions: Coping style may be more associated with anxiety than depression while other covariates (burden and poor physical health) are similar to those for caregiver depression. We found no conclusive evidence about factors associated with anxiety disorders or predicting anxiety from longitudinal studies. Neither care recipient cognition nor ADL impairment; nor caregiver age nor duration of caring are associated with caregiver anxiety levels. Good quality cohort studies are needed to determine whether these factors also predict anxiety disorders.

(Received February 28 2006)
(revision requested March 23 2006)
(revised version received July 20 2006)
(Accepted July 20 2006)
(Published Online September 28 2006)

Key Words: caregiver; dementia; anxiety.

c1 Correspondence should be addressed to: Dr. Claudia Cooper, Department of Mental Health Sciences, University College London (Hampstead Campus), Rowland Hill Street, London, NW3 2PF, U.K. Phone +44 (0)20 7561 4218; Fax: +44 (0)20 7561 4236. Email: