Risk and protective factors of depression among caregivers of children with disabilities in rural Rwanda

Clinical Snapshot

Key Findings

• P Value: Economic hardship p<0.001, Food insecurity p<0.01, Family unity p<0.001

• Effect Size: Economic hardship β=0.158, IPV β=0.306, Family unity β=-0.013

• Primary Outcome: 65% of caregivers met clinical cut-off for likely depression

• Nnt Or Sensitivity: Depression prevalence 65% vs general population baseline not provided

• Confidence Interval: Not reported in abstract

Clinical Application

Screening tools appear feasible for clinical use. Interventions targeting economic support and family unity are implementable Relevant for Indigenous communities and disadvantaged populations. NDIS participants' families may benefit from mental health screening. GP Mental Health Care Plans could incorporate caregiver assessment Caregivers of children with developmental disabilities, particularly in resource-limited settings

Abstract

BACKGROUND: Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. METHODS: This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12-36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. RESULTS: Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=-0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. CONCLUSIONS: Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.

References

1. 1.Ahishakiye, A., Dal Santo, L., Smith Fawzi, M. C., Miller, A. C., Placencio-Castro, M., Gilbert, H., Jensen, S. K. G., Wilson, K., Kirk, C. M., Sezibera, V., & Betancourt, T. S. (2026). Risk and protective factors of depression among caregivers of children with disabilities in rural Rwanda. BMJ Global Health, 11(4), e020491. https://doi.org/10.1136/bmjgh-2025-020491