Burden of Care: Stress, Anxiety, Depression, and Quality of Life in Cancer Caregivers in Kuwait: A Cross-Sectional Study

Introduction: Cancer care frequently relies on unpaid family caregivers who face substantial psychological strain that may diminish their quality of life (QoL). Local evidence from Kuwait is limited. In Kuwait, where family-based caregiving is culturally normative, the "hidden workload" of caregiving may be substantial yet under-recognized within routine cancer services. Objective: To estimate the prevalence of mental health symptoms including stress, anxiety, and depression among cancer caregivers in Kuwait; to assess caregivers' health-related QoL; and to identify mental health symptoms predictors. Methods: We conducted a cross-sectional survey of unpaid family adult caregivers (n=201) of in- and out-patients receiving treatment at major cancer centers in Kuwait. Participants completed a demographics form, the 21-item Depression, Anxiety and Stress Scale (DASS-21), and the SF-36 Health Survey. Descriptive statistics summarized caregiver and patient characteristics. Multiple linear regression analyses were conducted to identify predictors of depression, anxiety, and stress among caregivers. Results: Caregivers were predominantly female (70.6%) and Kuwaiti (78.1%); most supported non-hospitalized patients. Mental health symptoms mean scores measured by DASS-21 were 6 (±3.8) for depression, 5.6 (±4) for anxiety, and 7 (±4.1) for stress, prevalence of mental health symptoms was 61.2% for depression, 44.8% for stress, and 67.2 for anxiety. SF-36 Physical Composite Score (PCS) mean score was 59.2 (±19.4) and Mental Composite Score (MCS) was 52.5 (±20.4). Mental health symptoms were significantly predicted by SF-36 physical and mental composite scores, educational level, duration of caregiving, living with the patient, and type of help received. Conclusion: About half of cancer caregivers in Kuwait reported depressive symptoms and nearly one in two reported anxiety, with marked role limitations in daily and emotional functioning. Emotional distress was inversely related to health-related QoL. The findings suggest potential implications for caregiver screening and culturally sensitive psychosocial and rehabilitative supports, including occupational therapy to safeguard caregiver well-being and, by extension, the quality of cancer care. Longitudinal studies could explore trajectories of caregiver mental health and evaluate targeted interventions in the Kuwaiti context.