Abstract
Objectives
Caregiver burden has been found in owners of seriously ill pets; however, research to date has been heavily represented by dog owners. Prior caregiver burden work has neither intentionally focused on cat owners nor been appropriately powered to examine differences in owners of cats relative to owners of dogs. We expected that owners of an ill cat would exhibit greater caregiver burden than owners of a healthy cat but lower burden than owners of an ill dog.
Methods
A cross-sectional online assessment of caregiver burden was completed by 1085 pet owners through a pet demographic audience platform, including 333 owners reporting on a cat with current illness, 492 owners of a healthy cat and 260 owners of dogs with a current illness.
Results
Owners of an ill cat, examined across all illnesses represented, had greater burden (P <0.001) than the owners of a healthy cat and somewhat lower burden (P = 0.013) than owners of an ill dog.
Conclusions and relevance
Caregiver burden is present in owners of an ill cat and may differ from that of dog owners. Future work is needed to determine the reasons underlying this difference between species. Given that restricted sample sizes precluded examination across specific conditions, it will also be important to determine whether particular diseases yield greater burden in cat owners relative to dog owners.
Introduction
Caregiver burden, or strain associated with providing care for an ill loved one, 1 is a well-recognized construct in human medicine, but it has only recently been applied to small animal veterinary medicine. Since the first quantitative assessment of caregiver burden in the owners of seriously ill pets, 2 the presence of burden has been robustly shown across disease types. To date, most work has been conducted in samples either mostly or entirely comprising dog owners. Examination of pet caregiver burden studies from the past 5 years that have included cat owners demonstrates that cat owners have typically constituted approximately a quarter to a third (26−34%) of samples,2–5 though that number has been as low as 7.9%. 6 The current literature on pet caregiver burden undoubtedly reflects the experiences of dog owners more heavily than those of cat owners.
Early pet caregiver burden research showed that raw scores of burden were slightly lower in owners of ill cats than owners of dogs, though this difference was not significant. 2 However, this was a post-hoc comparison for which the study was not specifically powered; small sample sizes could have driven the apparent lack of group differences. Another study demonstrated that species (cat vs dog) did not significantly predict caregiver burden, though a similarly low representation of cat owners was present. 3 The human–animal interaction literature shows that attachment differs by species, 7 and that measurement bias can occur when examining human–animal relationships due to species-specific interactions. 8 Such findings underscore the importance of determining whether prior work suggesting no difference in burden is due to actual parity, or if the ostensible similarity reflects a statistical artefact related to the under-representation of cat owners. There is a need to study a large sample of cat owners to better understand caregiver burden in this population.
The current study examined caregiver burden in a large cross-sectional sample of cat owners with a dog-owner comparison group. We hypothesized that owners of an ill cat would exhibit greater burden than those with a healthy cat but lower burden than those with an ill dog. We also sought to describe levels of burden across different diagnoses.
Materials and methods
This cross-sectional observational study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. 9 Data supporting findings of this study are available from the corresponding author (MBS) upon reasonable request. Owing to use of human subjects, this study was reviewed by the Kent State University Institutional Review Board (IRB # 22−165) and deemed exempt.
Participants
De-identified participant data were extracted from a data set developed by Zoetis via a pet demographic audience platform. Participants over 25 years of age were invited to take part in the survey and asked to report on either a dog or cat with illness, or a cat that was healthy. A total of 1155 participants responded. Exclusions were made for respondents who failed response consistency indicators (n = 40) or provided a nonsensical free-text response for disease condition (n = 30). The final sample included 1085 responses.
Measures
Caregiver burden
Caregiver burden was measured using the Zarit Burden Interview (ZBI) 1 adapted for companion animal use.2,10 This tool assesses caregiver burden through self-report items reflecting subjective (eg, feelings of frustration and guilt) and objective (eg, financial strain and impact on physical health) challenges of caregiving. Responses on a scale from 0 to 4 are summed across 18 items for a total score (range 0−72). Higher values indicate greater burden. A score ⩾18 represents clinically meaningful caregiver burden.2,10
Companion animal disease
Diagnosis was provided by the owner via free-text response. A veterinarian on the research team (MWG) reviewed diagnoses to categorize reported conditions (see the supplementary material for a detailed breakdown of this information).
Procedure
Data were collected between December 2021 and June 2022. Registered and eligible owners were approached via the pet demographic audience platform with the opportunity to participate in a survey about caring for their pet. After viewing an advert, measures opened for pet owners who clicked to complete the survey. A US$3 gift card was provided for survey completion.
Power analysis
Prior work has demonstrated medium-to-large effects for differences in caregiver burden in owners of an ill vs a healthy pet. 2 Examination of data from that study indicated a smaller effect size of δ = 0.27 (MB Spitznagel, DM Jacobson, MD Cox, et al, unpublished data) for differences between owners of a dog vs owners of a cat. A priori power analysis with significance set at α = 0.05 and power (1−β = 0.8) for δ = 0.27 suggested a minimum sample size of 217 per group to detect differences.
Statistical analyses
The adapted ZBI score was evaluated across groups for normality, using histograms and examination of skewness and kurtosis; the healthy cat sample showed a non-normal distribution. To ensure this violation of parametric assumptions did not affect patterns of findings, confirmatory analyses using 5000 bootstrap samples were conducted. Independent-sample t-tests examined hypotheses that owners of an ill cat would report greater burden than owners of a healthy cat and lower burden than owners of an ill dog. Familywise, α was set at 0.05 with Bonferroni correction applied to minimize type I error. Descriptive statistics were explored across disease conditions for ill cat and dog groups. Analyses were conducted using IBM SPSS 28.0.
Results
A significant difference in adapted ZBI was noted between owners of an ill cat (n = 333; mean 10.65 ± 8.56) vs owners of a healthy cat (n = 492; mean 5.05 ± 5.43 [t(511.47) = 10.57; P <0.001]). A significant difference in adapted ZBI was also noted in owners of an ill cat vs owners of an ill dog (n = 260; mean 12.62 ± 8.65 [t(591) = −2.77; P = 0.003]). Analyses remained significant after Holm–Bonferroni correction. Parameter estimates were similar following bootstrapping; non-normality did not affect interpretation of significance. Table 1 lists conditions observed in seriously ill animals and the mean caregiver burden for each.
Diseases reported by owners of seriously ill cats and dogs, and descriptive statistics for the adapted Zarit Burden Interview
IQR = interquartile range
Discussion
This work is the first to examine caregiver burden in a large cat owner sample. Prior research on this topic has often included cat owners but has drawn far more heavily from dog owners.2–6 Because mixed-species samples have consistently shown elevated burden in the context of pet illness,2–4 it was expected that elevated burden would be seen in the owners of ill cats relative to the owners of a healthy cat; this hypothesis was confirmed. Raw score differences between owners of ill cats and dogs previously considered negligible 2 were, in the current study, statistically significant. With appropriate power, group discrepancies on the adapted ZBI yielded statistically significant differences.
The reasons for lower burden in owners of an ill cat vs an ill dog are not fully clear. Caregiving requirements may vary as a result of different frequencies of conditions observed by species (see Table 1). It is possible that differences in instrumental challenges of caregiving (eg, bathing the patient) could be such that dog caretaking is more difficult. Alternatively, because many cats do not routinely receive veterinary care even for chronic disease, 11 lack of veterinary oversight may lead to fewer caretaking requirements for cat owners. Findings underscore the importance of attending to species-related differences in caregiver burden research, particularly when utilizing mixed-species samples. However, this statistically significant difference between cat and dog owners may not impact on clinical interpretation. The group mean difference on the adapted ZBI was approximately one-quarter of a standard deviation for ill pet groups, suggesting that, while statistically significant, this difference is not clinically meaningful.
Limitations of the study include the use of a convenience sample recruited via a pet demographic audience platform. Sampling may have over-represented individuals with a particularly strong bond to their pet. This platform also did not allow for examination of owner demographics, which would have been informative, particularly as the mean burden was lower relative to some2-4 (though not all) 6 past work. Though this creates a challenge in understanding the generalizability of the current work, the large sample of 825 cat owners may compensate for reduced detail of this nature. The results of this study should be interpreted in the context of these issues, and replication in other samples is needed. Additionally, comparison of disease groups will be important. In the current study, small and variable individual cell sizes for each disease condition precluded direct species by condition comparisons. However, different illnesses require different intensities of caregiving. For example, advanced chronic kidney disease would be expected to require more complex management than infectious disease that responds well to medication. Interestingly, for some diseases (eg, kidney disease, osteoarthritis and dermatitis), mean caregiver burden scores appear strikingly similar for cat and dog owners. It is possible that for certain diseases, owners experience comparable levels of burden. Future work should recruit samples with the intention of statistical examination of disease types by species and level of required care.
Conclusions
The present work examined caregiver burden in a large sample of cat owners. Burden was greater in owners of an ill cat relative to a healthy cat but not as high as that reported by owners of an ill dog. Findings highlight that caregiver burden in pet owners may differ slightly depending on the animal species.
Supplemental Material
Supplemental Material
Categorization of specific diseases reported by owners
Footnotes
Acknowledgements
The authors wish to acknowledge Good Boys Studios for their assistance in data collection.
Supplementary material
The following file is available online:
Categorization of specific diseases reported by owners.
Conflict of interest
Dr Spitznagel has received research grants from Zoetis and honoraria for presenting scientific work related to caregiver burden. Dr Gober is an employee of Zoetis. No author of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.
Funding
This work was funded by Zoetis.
Ethical approval
This work did not involve the use of animals and therefore ethical approval was not specifically required for publication in JFMS.
Informed consent
This work did not involve the use of animals (including cadavers) and therefore informed consent was not required. No animals or people are identifiable within this publication, and therefore additional informed consent for publication was not required.
References
Supplementary Material
Please find the following supplemental material available below.
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