The Hidden Burden: A Narrative Review of Depression Prevalence, Risk Factors, and Trajectories in Cancer Caregivers

Abstract

Background: Cancer is a leading cause of mortality and morbidity worldwide, with a growing burden in low- and middle-income countries, including those in Sub-Saharan Africa. As cancer therapy becomes more complex, patients increasingly rely on informal caregivers usually family members for physical, emotional, and practical support. However, these caregivers experience significant psychological distress, particularly depression, which remains underrecognized in clinical practice. Aim: This narrative review aims to synthesize evidence on the prevalence, risk factors, and longitudinal trajectories of depression among informal caregivers of adults with cancer, and to outline implications for nursing assessment and early identification. Methods: Published literature on depression in cancer caregivers was reviewed, focusing on prevalence rates, demographic, psychosocial, physical, and patient-related risk factors, as well as temporal patterns of depressive symptoms across the cancer care continuum. The following electronic databases were searched for peer-reviewed articles published: PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Google Scholar.  Findings: Studies showed that 20–50% of cancer caregivers experience clinically significant depressive symptoms, compared to 5–10% in the general population. Caregivers are predominantly women aged 45–65, often spouses or daughters, with 39% having no formal education and providing an average of 10.9 hours of care daily. Key risk factors include female gender, low income, high subjective caregiver burden, social isolation, sleep disturbance, patient functional decline, and financial toxicity. Longitudinal studies reveal four distinct depressive trajectories: resilient (40–50%), chronic high distress (15–25%), delayed distress (10–15%), and recovery (20–30%). Symptoms peak during active treatment, cancer recurrence, and end-of-life care, with 50–60% of caregivers meeting depression criteria in the palliative phase. For nursing practice, implications include routine screening using brief tools such as the PHQ-2 and PHQ-9, timing assessments to critical cancer trajectory points (diagnosis, mid-treatment, survivorship transition, recurrence, palliative care), and establishing clear referral pathways to social work, psychology, and psychiatry. Conclusion: Depression among cancer caregivers is a pervasive yet underrecognized condition that compromises both caregiver well-being and patient outcomes. Oncology nurses play a pivotal role in early identification through systematic screening and multidisciplinary collaboration. Recognizing the caregiver as a "hidden patient" and integrating mental health support into standard cancer care is a clinical necessity.