Hidden Toll: Caregivers of Adults with Disabilities Face Severe Stress and Shrinking Quality of Life

Caring for a family member with a disability is often described as an act of love, but new research suggests it can also be a slow-burning public health crisis for the caregivers themselves. A new study published in Discover Psychology has found that a large majority of primary caregivers of adults with locomotive disability — people whose mobility is substantially impaired — are living with moderate to extremely severe psychological distress, and that this distress is measurably eroding their quality of life. The findings, drawn from one of the more detailed assessments of this population to date, add hard quantitative evidence to a problem that health systems have long treated as an invisible side effect of home-based care.

The research, conducted by Subha Jayaram and Kalpana B. Kosalram of the SRM School of Public Health at SRM Institute of Science and Technology in Tamil Nadu, India, set out with a deceptively simple objective: to assess the levels of depression, anxiety, stress, and quality of life among primary caregivers of adults with locomotive disability. While the burden of disability itself is routinely measured in clinical settings, the psychological state of the unpaid relatives who carry out the daily work of caregiving is far less frequently quantified, particularly in low- and middle-income countries where formal respite services are scarce. The study was designed to fill that gap with validated psychometric instruments rather than anecdote.

To do so, the team gathered data from 271 primary caregivers through a structured interview schedule. Each participant completed the Depression, Anxiety and Stress Scale, known as DASS-21, a widely used 21-item instrument that partitions emotional distress into three distinct subscales and assigns severity ratings ranging from normal to extremely severe. Quality of life was measured with the World Health Organization Quality of Life BREF, or WHOQOL-BREF, a condensed version of the WHO’s longer instrument that evaluates physical health, psychological well-being, social relationships, and environment. Both tools have been validated across numerous cultural contexts, which strengthens the comparability of the results with the broader international literature on caregiver burden.

The results paint a sobering picture. A major portion of the caregivers surveyed showed moderate depression and moderate anxiety, but the standout finding concerned stress: the largest share of participants fell into the extremely severe stress category. In practical terms, this means that the people shouldering responsibility for bathing, feeding, transporting, and monitoring adults with impaired mobility were not merely feeling occasional strain — many were operating at stress levels that clinicians would classify as clinically significant. Prolonged stress of this magnitude is associated with elevated blood pressure, disrupted sleep, immune dysregulation, and increased risk of cardiovascular disease, which means the findings have implications well beyond mental health.

The statistical analysis also revealed that distress was not distributed evenly across the caregiver population. The researchers found a significant difference in depression according to marital status, and significant differences in both anxiety and stress according to age and marital status. Although the study’s abstract does not detail the direction of every comparison, the pattern indicates that demographic position — whether a caregiver was married or unmarried, younger or older — shaped how intensely the caregiving role registered psychologically. This kind of stratification matters for intervention design: a one-size-fits-all counseling program is unlikely to serve a young unmarried caregiver and an older widowed one equally well, and the data suggest screening efforts should be targeted accordingly.

Quality of life fared no better. Nearly two thirds of the caregivers reported a low level of quality of life on the WHOQOL-BREF, a striking figure given that the instrument captures not just emotional states but also physical health, social functioning, and material circumstances. Caregiving for someone with a locomotive disability is physically demanding — lifting, transferring, and assisting a person with limited mobility takes a toll on the body — and it is socially demanding, often forcing caregivers to withdraw from employment, friendships, and community life. The finding that such a large proportion rated their overall quality of life as low suggests these pressures compound rather than offset one another.

Perhaps the most consequential result is the relationship between psychological distress and quality of life. The study found that depression, anxiety, and stress among the caregivers were significantly and negatively correlated with their quality of life: as each form of distress rose, quality of life fell. Correlation alone cannot establish causation, and it is plausible that poor quality of life feeds back into distress in a vicious cycle. But the strength and consistency of the association across all three DASS-21 subscales underscores that mental health and life quality in this population are tightly coupled, and that addressing one likely requires addressing the other.

To probe which factors actually predicted quality of life, the researchers turned to regression analysis, and the outcome was telling. Education emerged as a positive and significant predictor of quality of life — caregivers with more schooling reported better overall life quality, possibly because education confers greater access to information, resources, coping strategies, and income. Stress, by contrast, was a significant negative predictor: higher stress reliably forecast lower quality of life even when other variables were accounted for. The juxtaposition is instructive. It suggests that while some determinants of caregiver well-being, such as educational attainment, are slow-moving and structural, the single most modifiable lever identified by the data is stress reduction itself — through respite care, peer support, financial assistance, or psychological intervention.

The study was approved by the independent review committee of the Tamil Nadu Directorate of Public Health and Preventive Medicine and conducted in accordance with the Declaration of Helsinki, with written informed consent obtained from all participants and anonymity maintained throughout. The authors received no external financial support for the research itself, and open access publishing costs were borne by the SRM Institute of Science and Technology. The methodological transparency — validated instruments, a defined sample of 271 caregivers, and explicit statistical tests — gives the findings a solidity that much of the caregiver-burden literature, which often relies on smaller or less systematically sampled groups, has lacked.

What the study ultimately argues, implicitly but forcefully, is that caregiver mental health is not a private family matter but a measurable component of public health. When nearly two thirds of a caregiver population reports low quality of life and a major share reports extremely severe stress, the consequences ripple outward: caregiver burnout degrades the quality of care received by adults with disabilities, increases the likelihood of institutionalization, and imposes costs on health systems that are rarely attributed to their true source. The authors’ data point toward concrete policy responses — routine psychological screening of caregivers, education-linked support programs, and targeted interventions for the demographic groups shown to be most affected. As populations age and disability prevalence rises worldwide, the number of people occupying this caregiving role will only grow. The message of this research is that their distress is quantifiable, predictable, and therefore preventable — if health systems choose to look.

Subject of Research: Depression, anxiety, stress, and quality of life among primary caregivers of adults with locomotive disability

Article Title: An assessment of depression, anxiety, stress and quality of life among primary caregivers of adults with disabilities

Article References: Jayaram, S., & Kosalram, K. B. (2026). An assessment of depression, anxiety, stress and quality of life among primary caregivers of adults with disabilities. Discover Psychology. https://doi.org/10.1007/s44202-026-00873-7

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00873-7

Keywords: primary caregivers, locomotive disability, depression, anxiety, stress, quality of life, DASS-21, WHOQOL-BREF, mental health, caregiver burden, disability studies, public health