Psychological distress among informal caregivers of patients with cancer: a cross- sectional hospital-based study from Nepal

Background Informal cancer caregivers in low- and middle-income countries bear a disproportionate emotional and mental health burden. However, evidence regarding the factors influencing caregiver psychological well-being in these settings remains limited. We assessed psychological distress and factors associated with it among informal cancer caregivers in Nepal. Methods A hospital-based cross-sectional survey was conducted among 408 adult informal caregivers at two tertiary cancer hospitals in Nepal. Data was collected through face-to-face interviews while participants were recruited using purposive consecutive sampling approach. We used validated Nepali Hopkins Symptoms Checklist (HSCL-25) to estimate overall psychological distress; the checklist contained 25 items divided into two primary domain subscales: anxiety (items 1–10) and depression (items 11–25). Data was analyzed using RStudio (version 4.5.1). Bootstrap multivariable linear regression (5,000 replications; BCa 95% Cis was used to identify factors associated with psychological distress. Results Overall, 61.8%, 52.7%, and 58.8% of informal cancer caregivers had symptoms of anxiety, depression, and psychological distress, respectively. Out-of-pocket expenditure demonstrated a significant dose-response association with all three outcomes; caregivers in the highest out-of-pocket expenditure quintile had markedly greater anxiety (B = 9.73), depression (B = 13.52), and psychological distress symptoms (B = 23.25) than those in the lowest quintile. Female caregiver gender, advanced or unknown cancer stage of patient, outpatient chemotherapy follow-up, and non-ambulatory patient mobility were significant factors across all outcomes. Conclusions Cancer caregivers in Nepal face a high symptom burden of psychological distress. Routine caregiver distress screening, targeted financial protection policies, and psychosocial interventions are warranted in resource-constrained oncology settings. Clinical trial registration Not applicable