CHAPTER 23: ZARIT BURDEN INTERVIEW (ZBI)

Description

The Zarit Burden Interview (ZBI), by Zarit and Zarit (1987) is a 22-item questionnaire designed to measure the extent to which a caregiver perceives his or her level of burden as a result of caring for a person with a particular diagnosis. Initially developed to measure strain associated with the care of community-dwelling older persons it has subsequently been validated across many patient populations and is a common measure of caregiver burden. Based on the original 29-item scale, the ZBI has undergone several modifications which has resulted in the current 22-item assessment. ZBI questions comprise 5 domains: (1) burden in the relationship (6 items), (2) emotional well-being (7 items), (3) social and family life (4 items), (4) finances (1 item), and (5) loss of control over one’s life (4 items). Most of the items explore either personal strain (12 items) or role strain (6 items). The ZBI uses a 4-point ordinal scale which describes the degree of burden being experienced from 0 = never to 4 = almost always and takes about 10 minutes to complete. The maximum score is 88 with higher scores indicative of more burden. Example questions include the following: (1) do you feel stressed between caring for your relative and trying to meet other responsibilities for your family work; (2) do you feel embarrassed over your relative’s behavior; and (3) do you feel that your relative asks for more help than he or she needs?

Psychometrics

A study of 152 dyads of community dwelling older adults with neurocognitive disorders (NCD) of the dementia type determined that the primary caregiver was typically a spouse (49.3%), an adult child (44.2%), other (niece, nephew, neighbor, friend; 4.3%), or regular home help (2.2%) of the care recipient. Study results showed the mean ZBI score for those caregivers to be 32.9, which according to established cutoff scores burden was severe for 13 caregivers (8.6%), moderate to severe for 32 caregivers (21%), mild to moderate for 72 caregivers (47.4%), and absent to mild for 35 caregivers or (23%) (Ankri, Andrieu, Beaufils, Grand, & Henrard, 2005). A study by Schreiner, Morimoto, Arai, and Zarit (2006) found that high scores on the ZBI were significantly related to a decrease in mental and physical health, as well as decreased vitality and social functioning, and determined that a cutoff score of 25 correctly identified 77% of high-burden stroke caregivers as having further need of assessment for depression, while a cutoff of 26 identified 64% of general disability caregivers with probable depression. A cutoff of 24 for the combined sample had a positive predictive value of 64% and a negative predictive value of 72%. Research incorporating several studies found that the average estimate of internal consistency as measured by Cronbach’s alpha was α = 0.86 (Bachner & O’Rourke, 2007). Test-retest reliability was also found to be good at r = 0.89 among adult family caregivers (n = 149) of persons with NCD dementia (Seng et al., 2010).

Advantages

The ZBI is a relatively quick measure that is easy to administer and can be completed in less than 10 minutes. There is a significant amount of research in support of its use in clinical practice and it is considered by many to be the gold standard for determining level of caregiver burden. Hérbert, Bravo, and Préville (2000) argue that the ZBI is culturally neutral, as they found scores to be unrelated to age, gender, locale, language, living situation, marital status, or employment status, suggesting its appropriateness across many patient populations. A 12-item brief version is also available by Bédard et al. (2001). Based on the original, it consists of only items with the highest correlations as well as reflecting upon the original domains of personal strain and role strain, which has shown acceptable indices of internal consistency for both (α = 0.88 and a 0.78) (O’Rourke & Tuokko, 2003).

Disadvantages

Wantz and Barker (2012) argue that the self-checklist format of the ZBI can be limiting, and similar to the disadvantages of the CSI discussed in Chapter 22, positive aspects of caregiving that might reduce feelings of burden are not explored. Wantz and Barker (2012) also suggest that a clinician could create a structured interview with the client that could be as effective in determining ongoing problems of caregiver stress.

Administration

The ZBI has standardized instructions and assessment requires the person to consider 22 objective and subjective statements and how they relate to the level of caregiver burden that they may or may not be experiencing. Example questions include: “Do you feel you should be doing more for your relative?” or “Do you feel you have lost control of your life since your relative’s illness?” Where both would be scored as either (0) never, (1) rarely, (2) sometimes, (3) quite frequently, or (4) nearly always. Items are then summed and total scores are interpreted as follows: 0 to 21 little or no burden, 21 to 40 mild to moderate burden, 41 to 60 moderate to severe burden, and 61 to 88 severe burden.

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