When caring hurts: Chronic back pain, anxiety, and depression among caregivers of chronically ill children in Nigeria

Children with chronic health conditions need substantial care to address all aspects of their health and recovery. Parents (caregivers) often shoulder significant financial, physical, social, and emotional responsibilities in meeting these needs. When access to vital resources such as information, financial support, and respite care is limited, parents' physical and emotional well-being can suffer, exacerbating the stress associated with caregiving. This study aims to determine the prevalence and correlates of chronic back pain, depression, and anxiety in caregivers of children with chronic diseases in three tertiary hospitals in Nigeria and the associations with burden of care. A cross-sectional study of caregivers of children under 18 years with chronic medical conditions from three tertiary hospitals in Nigeria was conducted. A sociodemographic questionnaire, Patient Health Questionnaire 9 (PHQ-9), Hamilton Anxiety Rating Scale (HARS), Zarit Burden Interview (ZBI), and the Oswestry Disability Index (ODI) were administered. Principal component analysis, multiple linear regression, and mediation analyses were conducted. 184 caregivers, mostly females (84%) and mothers (80%) participated. Mean age for this group was approximately 37 years-old (SD = 7.98). Results from multiple regression analyses indicated that the total burden of care predicted higher levels of depression (p < 0.01, 95% CI = [0.32, 0.74]) and higher levels of anxiety (p = 0.02, 95% CI = [0.09, 1.03]). Findings from the mediation analyses indicated that the burden of care did not mediate the relationship between back pain and depression (p = 0.13) and back pain and anxiety (p = 0.53). This study highlights the high prevalence of anxiety, depression, and chronic back pain among caregivers of children with chronic medical conditions in Nigeria. Caregiver burden and chronic back pain are also associated with anxiety and depression.