Living in the shadow of addiction: Psychiatric comorbidities, quality of life, and burden in caregivers of alcohol dependence

ABSTRACT Background: Alcohol dependence syndrome (ADS) imposes substantial psychosocial and economic burdens on families, yet caregiver mental health, quality of life (QoL), and burden remain underexplored in India. Aim: The aim is to determine the frequency of depression and anxiety among primary caregivers of ADS patients, evaluate caregiver QoL and burden, and examine associations between caregiver outcomes and patient alcohol-dependence severity. Materials and Methods: In this cross-sectional study at a tertiary center in Central India, 123 patient–caregiver dyads were enrolled (Aug 2023–Aug 2024). Patients met International Classification of Disease - mental and behavioural disorders ICD-10 criteria for ADS. Caregivers completed Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Family Burden Interview Schedule (FBIS), and World Health Organization QoL (WHOQOL)-Brief version; patients were assessed with Severity of Alcohol Dependence Questionnaire (SADQ). Descriptive statistics, Spearman correlations, and linear regression identified relationships and predictors of caregiver burden. Result: Mean caregiver age was 40.7 ± 13.4 years; 56.9% were male. Patients showed a mean SADQ of 28.7 ± 14.7 with 47.2% moderate dependence. Caregiver mean HAM-A and HAM-D scores were 23.01 ± 4.16 and 23.33 ± 5.01, respectively; FBIS mean was 29.01 ± 3.28. Two-thirds of caregivers had moderate-to-severe anxiety and depression. SADQ scores, duration, and earlier onset of alcohol use correlated positively with caregiver HAM-A, HAM-D, and FBIS ( P < 0.05). Regression identified caregiver HAM-D, WHOQOL psychological domain, caregiver age, and relationship to the patient as significant predictors of FBIS ( P < 0.05). Conclusion: Caregivers of ADS patients experience high psychiatric morbidity and burden closely linked to patient dependence severity. Findings advocate routine screening, family-inclusive interventions, financial and psychosocial support, and policy measures to integrate caregiver support into addiction services and clinical practice; community-based interventions are essential.