Association between spiritual well-being and caregiver burden among family caregivers of patients with schizophrenia

Schizophrenia, a chronic and severe mental disorder, places significant psychological, emotional, and social burdens on family caregivers, often leading to impairment in their mental health and quality of life. Recent evidence indicates that spiritual well-being may act as a resilience factor against caregiving stress, yet few studies have examined this in the context of schizophrenia. This study aimed to explore the association between spiritual well-being and caregiver burden among family caregivers of schizophrenia patients who were referred to psychiatric centers. This cross-sectional study recruited 150 family caregivers of patients with schizophrenia at Fatemi Hospital in Ardabil, Iran, using consecutive census sampling. Data were collected through a demographic form, the Spiritual Well-Being Scale (SWBS), the Caregiver Burden Scale (CBS), and the Positive and Negative Syndrome Scale (PANSS) for symptom severity assessment. Analyses were conducted using IBM SPSS Statistics version 21, which included Spearman’s rank correlation, Kruskal-Walli’s test, and multiple linear regression ( p < 0.05). The average caregiver burden was 72.76 ± 17.15, indicating a high level of burden, while the average spiritual well-being was 83.81 ± 18.20 (Religious Well-Being: 44.07 ± 7.57; Existential Well-Being: 39.69 ± 9.68). Total caregiver burden was negatively correlated with spiritual well-being, particularly existential health ( r = -0.635, p < 0.01). Kruskal-Wallis tests revealed that monthly income and satisfaction with caregiving role were significantly associated with spiritual well-being. Multiple linear regression indicated that spiritual well-being (β = -0.442, p < 0.001), annual hospitalizations (β = 0.404, p < 0.001), and daily caregiving hours (β = 0.263, p < 0.001) were significant independent predictors, collectively explaining 68.8% of the burden variance (Adjusted R² = 0.681, p < 0.001). Additionally, PANSS-assessed symptom severity showed strong positive correlations with all burden dimensions (rs = 0.76–0.87, p < 0.01). Lower spiritual well-being is associated with higher caregiving burden, while financial resources and satisfaction with the caregiving role appear to support spiritual well-being. These findings suggest the need for multi-level interventions aimed at increasing spiritual well-being, improving spiritual and social support, and thereby reducing the burden on caregivers’ health.