The study revealed a considerable burden experienced by the caregivers of children and adolescents attending the clinic. This burden is predicted by the presence of psychiatric morbidity in the caregiver, the level of functioning as assessed by the clinician, the degree of impairment as assessed by the caregiver, and the level of education of the child.
As in previous studies is this environment [18
], a higher percentage of the patients in this study were males. The gender and age of the patient were however not significantly associated with burden of care. Neither was duration of illness.
The level of education of the patient showed a significant association, and as in a previous study [7
] predicted burden of care, albeit accounting for only 2% of the variance. A lower level of patient's education predicted a higher burden of care. It is possible that children with higher educational attainment may be more mature, suffer less intellectual deficits, and therefore are capable of taking better care of themselves, thereby imposing less burden on the caregivers.
Most caregivers observed in this study were females, with mothers of the patients accounting for 78% of all the caregivers. This highlights the challenges faced by mothers. Gender and relationship with the patient, although predictors of burden in the adult population [8
], were not significantly associated with burden in this study. Although female caregivers especially mothers were predominant and thus merit special attention, the study suggests that caring for a mentally ill child is burdensome on the caregiver, regardless of gender or relationship. Age, marital and employment status were also not associated with burden of care. The duration of illness and the diagnosis of the patient, including the presence or otherwise of psychosis, was not significantly associated with burden of care.
Presence of psychiatric morbidity in the caregiver was however found to predict caregiver burden, accounting for nearly 40% of the variance. This might be a bidirectional relationship in that caregivers with pre-existing psychiatric conditions might find caring for a sick child burdensome, while the burden of caring for a sick child could also precipitate psychological distress.
Available evidence suggests that children with mental health concerns are more likely to have mothers who screen positive for a mental illness [19
]. This also might be reciprocal in that there might be a hereditary component to the child or adolescent's disorder, while the burden of caregiving could be a factor in the onset of psychological symptoms in the parent.
Other factors found to predict caregiver burden are the level of impairment as assessed by the clinician and the level of functioning as assessed by the caregiver. The two are related and imply that a child with more impairment or a lower level of functioning is likely to require more assistance from the caregiver in terms of activities of daily living and as such may impose a greater burden on the caregiver.
The implications of these findings are that caregivers whose children have more impairment or functional difficulties will require more support services in order to lessen the burden of caregiving. This in turn could help to prevent psychiatric morbidity in the caregiver. Child health services also need to make arrangements for attending to caregivers with preexisting mental illness as well as those who develop mental health problems in the process of caregiving. In a resource poor setting, this challenge can be enormous.
This study gives much needed information on the burden of caring for children and adolescents in a resource-constrained developing country like Nigeria. Hitherto there has been a paucity of information in this regard. It is however limited in that it involved only one centre within the country. This fact restricts the extent to which the findings are generalisable. The modest sample size is also a limitation which further studies can improve upon.