Prevalence of Anxiety and Depression among Caregivers of Children with Cerebral Palsy Attending Physiotherapy Clinics in Selected Hospitals in Yobe State, Nigeria: A Cross Sectional Study

INTRODUCTION

Cerebral palsy (CP) is a frequent cause of childhood physical disability, resulting from non-progressive disturbances to the developing brain.^[1,2] Global CP prevalence is 1.5–3.3/1,000 live births in high-income countries and 2–10/1,000 in low/middle-income countries, including Nigeria.^{[3, 4]} Birth asphyxia is a common aetiology in West Africa.^[5]

Children with CP experience activity limitations, postural changes, and movement disorders, imposing substantial physical, emotional, and financial burdens on caregivers.^[6,7] Caregivers frequently experience stress, depression, and reduced quality of life.^[8–10] Caregiver depression and burden are documented in Zimbabwe and Nigeria.^[11,12]

Mental health services and psychosocial support remain limited in northern Nigeria, and research on caregiver anxiety and depression in this region is sparse. This study, therefore, aimed to determine the prevalence of anxiety and depression among caregivers of children with CP attending physiotherapy clinics in Yobe State, Nigeria, and to examine associations with socio-demographic factors.

MATERIALS AND METHODS

RESULT

Most caregivers were female (66.7%) and aged 30–39 years (45.1%). Nearly half had a tertiary education (49.0%). Over half (52.9%) provided care for >12 hours daily, and most (58.8%) had 1–2 children. Depressive symptoms occurred in 68.6% (35.3% borderline, 33.3% abnormal), and anxiety in 66.7% (39.2% borderline, 27.5% abnormal) [Table 1].

A significant association was found between caregiver age and anxiety (χ² = 60.77, df = 8, p < 0.005), with the 30–39-year group most affected [Table 2]. No significant associations were observed between anxiety or depression and sex, education, caregiving hours, or number of children (p > 0.05 for all).

DISCUSSION

This study found a high prevalence of anxiety (66.7%) and depression (68.6%) among caregivers of children with CP in Yobe State, Nigeria. These rates are comparable to a previous Nigerian study^[14] and align with a systematic review showing elevated mental health disorders among parents of children with CP.^[15] The prevalence is substantially higher than the general population estimate of depression in Nigeria (3.9%)^[16], underscoring the additional burden of caregiving.

The predominance of female caregivers (66.7%) is consistent with global literature.^[7,11,12] In many African settings, women assume primary responsibility for children with disabilities, often with minimal support.^[17] Although we did not find a statistically significant sex difference in anxiety or depression, this may reflect sample size limitations.

A notable finding was the significant association between caregiver age (30–39 years) and anxiety. Middle-aged caregivers face competing demands of caring for young children, employment, and family relationships while managing chronic stressors of raising a child with CP.^[8] This age group may have less social support than older caregivers and less resilience than younger ones.

Unlike age, other socio-demographic factors (education, caregiving hours, number of children) showed no significant association with anxiety or depression. This contrasts with some studies^[18] but aligns with others^[19], suggesting that caregiving burden may be uniformly distributed across strata in low-resource settings. A recent Indian study similarly found no significant association between caregiver education or income and quality of life, suggesting that psychosocial factors may outweigh socioeconomic determinants.^[20]

Based upon findings, there are a few recommendations for policy practitioners. The Routine psychological screening using the Hospital Anxiety and Depression Scale should be integrated into physiotherapy intake assessments. Hospitals should establish caregiver support groups, counselling services, and stress-management programmes. Rehabilitation models should shift from child-centred to family-centred care. Government financial assistance for families of children with CP is needed. Future larger longitudinal studies should include CP severity measures and evaluate targeted mental health interventions for caregivers.

There are a few limitations in this study, which should be acknowledged. First, the small sample size (n = 51) and convenience sampling limit generalisability and statistical power. Second, the cross-sectional design precludes causal inferences. Third, we did not assess the clinical severity of CP (e.g., Gross Motor Function Classification System level). Fourth, reliance on a self-report screening tool HADS rather than a clinical diagnostic interview may overestimate prevalence. Fifth, social desirability bias may have affected responses.

CONCLUSION

Anxiety and depression are highly prevalent among caregivers of children with cerebral palsy in Yobe State, Nigeria, affecting approximately two-thirds of this population. Caregivers aged 30–39 years are particularly vulnerable to anxiety. These findings highlight an urgent need for routine psychological screening and integrated psychosocial support within physiotherapy and rehabilitation services.