Stress-related cognitive–perceptual tendencies and their associations with psychological quality of life in informal Romanian schizophrenia caregivers: an exploratory ESI-based analysis

Background and aim. Family caregivers of individuals with schizophrenia frequently experience substantial emotional and functional strain, yet little is known about the subtle stress-related cognitive–perceptual tendencies that may emerge during long-term caregiving. Such tendencies, measurable with the Eppendorf Schizophrenia Inventory (ESI), have only recently begun to be examined in Romania, and their potential associations with caregiver well-being remain insufficiently explored. The objectives of this study: to compare cognitive–perceptual tendencies between schizophrenia caregivers and matched hybrid controls; to examine associations between ESI subscales and quality of life (QoL), depressive symptoms, and cognitive performance among caregivers; and to interpret these findings within a stress–adaptation and response-shift framework. Methods. In this cross-sectional study, 52 non-professional family caregivers of individuals with schizophrenia were compared with 52 matched hybrid controls comprising individuals with chronic somatic illnesses and their caregiving relatives. Participants completed the Romanian-adapted ESI, WHOQOL-BREF, Beck Depression Inventory (BDI), and Montreal Cognitive Assessment (MoCA). Group comparisons, Pearson correlations, and stratified exploratory comparisons based on Ideas of Reference were conducted. Results. Caregivers showed moderately elevated ESI subscale scores, particularly Ideas of Reference, relative to controls. Higher Ideas of Reference scores were modestly associated with lower psychological QoL and higher depressive symptoms, whereas associations with cognitive performance were minimal. Correlation patterns indicated small-to-moderate associations across cognitive– perceptual tendencies and caregiver well-being domains. Conclusions. In this exploratory, cross-sectional analysis, stress-related cognitive– perceptual tendencies were more pronounced in schizophrenia caregivers than in matched controls and showed modest associations with psychological QoL and depressive symptoms. These findings underscore the relevance of considering cognitive–perceptual stress responses in caregiver research while highlighting the need for longitudinal designs and formal psychometric validation of the Romanian ESI.