Relationship between sleep quality and psychological well-being among caregivers of patients with mental illness


  • T A Sameera Government Mental Health Centre, Kozhikode
  • Leji K Jose Government College of Nursing, Kozhikode, Kerala
  • Varsha Vidyadharan Department of Psychiatry, Government Medical College, Kozhikode, Kerala
  • T K Saleem Government College of Nursing, Kozhikode, Kerala



Caregiver, mental illness, sleep quality, psychological wellbeing


Background: Caregivers of patients with serious mental illness suffer from poor sleep quality and quality of life due to strong dependency of patients on caregivers. Addressing the caregiver burden and its effect on their physiological and psychological aspect of well-being can improve patient outcomes. Objectives: The study aimed to assess the correlation between sleep quality and psychological well-being among caregivers of patients with mental illness. The study also examined the association between the sleep quality of caregivers and selected variables such as age, gender, education, and occupation. Methods: A cross-sectional survey was used. Data were collected from 112 caregivers, who attended the outpatient psychiatry clinics of Government Medical College Hospital, Kozhikode, Kerala. Socio-personal data of caregivers as well as socio-personal and clinical data of patients were collected using a semi-structured interview schedule and record review. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) and psychological well-being was assessed using Ryff’s Psychological Wellbeing Scale (RPWBS). Data were subjected to descriptive and inferential analysis. Results: Findings revealed that 59 (52.6%) caregivers experienced poor sleep quality (global PSQI score >5). A significant negative correlation was observed between the sleep quality index (PSQI score) and the psychological well-being (RPWBS score) of the caregivers. Findings also showed that the male gender, higher educational level, Above Poverty Line socioeconomic status, absence of lifestyle diseases, and joint/extended family were associated with better sleep quality. Conclusion: It is important to understand various psychological and physiological effects of caregiver burden in mental illness. Interventions targeting families where relatives experience mental health problems are important to prevent relapse and promote recovery in the patients. The psychological health of caregivers is affected by insufficient sleep, which can negatively impact patient outcomes. These results suggest close monitoring of the caregivers’ mental health and the provision of family-focused interventions.


Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A, et al. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. The Lancet Psychiatry 2020;7:148.

Thara R, Henrietta M, Joseph A, Rajkumar S, Eaton WW. Ten-year course of schizophrenia – the Madras longitudinal study. Acta Psychiatr Scand 1994;90:329–36.

Chang HY, Chiou CJ, Chen N Sen. Impact of mental health and caregiver burden on family caregivers’ physical health. Arch Gerontol Geriatr 2010;50:267–71.

Pinquart M, Sörensen S. Correlates of physical health of informal caregivers: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 2007;62.

Harvey R Colten BMA. Sleep disorders and sleep deprivation: an unmet public health problem. 1st ed. Washington (DC): Nat’l Acad Press; 2006. pp.19–22.

Gao C, Chapagain NY, Scullin MK. Sleep duration and sleep quality in caregivers of patients with dementia: a systematic review and meta-analysis. JAMA Netw Open 2019;2:e199891. Available from: doi: 10.1001/jamanetworkopen.2019.9891.

Litzelman K, Kent EE, Mollica M, Rowland JH. How does caregiver well-being relate to perceived quality of care in patients with cancer? Exploring associations and pathways. J Clin Oncol 2016;34:3554–61.

Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest2014 Nov 1;146:1387–94.

Walke SC, Chandrasekaran V, Mayya SS. Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms. J Neurosci Rural Pract 2018;9:180.

Janardhana N, Raghunandan S, Naidu DM, Saraswathi L, Seshan V. Caregiving of people with severe mental illness: an Indian experience. Indian J Psychol Med 2015;37:184.

Schulz R, Sherwood PR. Physical and mental health effects of family caregiving. Am J Nurs 2008;108(9 Suppl):23.

Zhai K, Gao X, Wang G. The role of sleep quality in the psychological well-being of final year undergraduate students in China. Int J Environ Res Public Health 2018;15:.

World Health Organization. International classification of diseases and related health problems, 10th revision. Geneva: World Health Organization; 1992.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213.

Ryff CD, Keyes CLM. The structure of psychological well-being revisited. J Pers Soc Psychol 1995;69:719–27.

Basheer S, Anurag K, Garg R, Kumar R, Vashisht S. Quality of life of caregivers of mentally ill patients in a tertiary care hospital. Ind Psychiatry J 2015;24:144.

Byun E, Lerdal A, Gay CL, Lee KA. How adult caregiving impacts sleep: a systematic review. Curr Sleep Med Reports. 2016;2:191.

Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999;282:2215–9.

Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull 2003;129:946–72.

Hamann J, Heres S. Why and how family caregivers should participate in shared decision making in mental health. Psychiatr Serv 2019;70:418–21.

Pavitra KS, Kalmane S, Kumar A, Gowda M. Family matters! – The caregivers’ perspective of Mental Healthcare Act 2017. Indian J Psychiatry 2019;61(Suppl 4):S832.

Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989;57:1069–81.

Leipold B, Schacke C, Zank S. Personal growth and cognitive complexity in caregivers of patients with dementia. Eur J Ageing 2008;5:203.

Jütten LH, Mark RE, Sitskoorn MM. Predicting self-esteem in informal caregivers of people with dementia: modifiable and non-modifiable factors. Aging Ment Heal 2020;24:221–6.

Medic G, Wille M, Hemels MEH. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep 2017;9:151.

Gadie A, Shafto M, Leng Y, Kievit RA, Cam-CAN. How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults. BMJ Open 2017;7:

Inogbo CF, Olotu SO, James BO, Nna EO. Burden of care amongst caregivers who are first degree relatives of patients with schizophrenia. Pan Afr Med J 2017;28.

Krishnan V, Collop NA. Gender differences in sleep disorders. Curr Opin Pulm Med 2006;12:383–9.

Sharma N, Chakrabarti S, Grover S. Gender differences in caregiving among family - caregivers of people with mental illnesses. World J Psychiatry 2016;6:7.

Reis C, Dias S, Rodrigues AM, Sousa RD, Gregório MJ, Branco J, et al. Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study. Sleep Sci 2018;11:217.




How to Cite

Sameera, T. A., L. K. . Jose, V. Vidyadharan, and T. K. Saleem. “Relationship Between Sleep Quality and Psychological Well-Being Among Caregivers of Patients With Mental Illness”. Kerala Journal of Psychiatry, vol. 36, no. 1, July 2023, pp. 4-11, doi:10.30834/KJP.36.1.2023.350.



Research Report