Caregiver Depression in a Low-Resource Setting: A Multi-Domain Assessment of PHQ-9, Socio-Demographic Predictors of Major Depressive Disorder Among Family Caregivers of Breast Cancer Patients in Pakistan

Background Caregivers of breast cancer patients experience a significant psychological burden, which may lead to major depressive disorder (MDD). However, limited research has explored the prevalence among caregivers in the Pakistani population. This study aimed to assess the prevalence of MDD among these caregivers and identify contributing socio-demographic and health-related factors, highlighting the psychological burden they endure. Methodology A cross-sectional study was conducted in various tertiary care hospitals of Pakistan. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for MDD, with a score of ≥10 indicating a positive diagnosis. We conducted a multi-step psychometric analysis of PHQ-9 using a sample of 402 participants. Exploratory Factor Analysis (EFA) employed principal axis factoring with Promax rotation, Assumptions were verified using Bartlett’s Test of Sphericity and Kaiser-Meyer-Olkin sampling adequacy. Confirmatory Factor Analysis (CFA) tested the EFA-derived structure, with model fit evaluated using RMSEA, TLI, and χ². Socio-demographic and health-related data were collected through structured questionnaires. Statistical analysis was performed using JAMOVI software, incorporating descriptive statistics, chi-square tests, t-tests/ANOVA, and binomial logistic regression to identify factors associated with MDD. Results Among 402 participants, 46.26% of caregivers experienced major depression disorder, with 27.1% had mild depression, 24.1% moderate, 16.4% moderately severe, and 5.7% severe depression, while 26.6% exhibited no depressive symptoms. EFA revealed a 3-factor solution explaining 46.75% of variance, all primary loadings > 0.52. The CFA confirmed this structure (RMSEA = 0.064; CFI = 0.96; TLI = 0.94), though χ² was significant (*p* < .05). Among caregivers, low monthly income (p = 0.033), living a sedentary lifestyle (p = 0.012) and one living in urban areas (p = 0.044), indicating higher risk of depression. In a multivariate logistic regression analysis, lower education levels were found to be a significant predictor of MDD (p = 0.007). Conclusion A considerable proportion of caregivers supporting breast cancer patients in Pakistan suffer from MDD, with low education, unemployment, sedentary lifestyle, and low monthly income being key contributors. To mitigate the psychological distress faced by these caregivers, targeted mental health interventions and support programs are needed to improve the quality of life of caregivers.