Unmet needs and functional dependence predict burnout, health outcomes, and institutionalization desire among informal caregivers: a multi-regional path analysis study

The healthcare system primarily focuses on patients without engaging with, supporting, or attending to the needs of informal caregivers. A small portion of the literature pays attention to caregivers’ physical health outcomes. This study aims to examine how care recipients’ functional dependence and informal caregivers’ unmet needs affect caregivers’ somatic symptoms, co-occurring chronic diseases, and the desire to institutionalize care recipients, mediated by burnout, using the Informal Caregiving Integrative Model. A cross-sectional study was conducted by recruiting a random sample of 476 informal caregivers from 11 cities across four regions in Saudi Arabia. Data were collected through structured telephone interviews. Path analysis was used to test the hypothesized model. This study follows the STROBE checklist. Most caregivers were female, providing care for an average of 8.17 years. Unmet caregiver needs (β = 0.490; p < 0.001) and higher care recipient functional dependence (β = -0.161, p = 0.001) significantly predicted caregiver burnout. Burnout, in turn, predicted somatic symptoms (β = 0.656, p < 0.001) and chronic disease co-occurrence (β = 0.215, p < 0.001). Unmet needs directly influenced the desire for institutionalization (β = 0.172, p = 0.012). Both predictors indirectly affected caregiver somatic symptoms (β = 0.321, p < 0.001) and chronic diseases (β = 0.105, p < 0.001) through burnout. Caregiver burnout is driven by high care demands and unmet needs, adversely affecting caregiver health and increasing the likelihood of care recipient institutionalization. The findings highlight the importance of tailoring multi-level nursing interventions to support family informal caregivers’ needs. The study findings can inform clinical practice, standardize caregiver assessments, and focus on the needs of caregivers to provide them with support. Responding to burnout may protect caregiver health and help prevent institutionalization. Conducted in Saudi Arabia, it offers insights for healthcare professionals and policymakers in culturally similar contexts. Not applicable.