Exploring causal effects of combining work and intergenerational support on depressive symptoms among middle-aged women

Unpaid caregiving and stress among older working-age men and women in Sweden

Many individuals are experiencing the potentially stressful combination of providing care while still employed. In this study, the association between unpaid caregiving to another adult and self-reported stress among men and women aged 45-74 is investigated, using nationally representative time use diary data for Sweden (2000-01 and 2010-11, N = 6689). Multivariate regression analyses established that women were overall more stressed than men with the largest gender stress gap observed among intensive caregivers, providing >60 min of daily care and employed caregivers. The association between unpaid caregiving, employment, and self-reported stress is gendered. Among men, there is no caregiver effect regarding stress, but for women there is a net effect of 6-9%. Combining employment and unpaid caregiving (especially if intensive) is stressful for women but not for men. There are two potential mechanisms for this: less time for leisure and sleep. Unpaid caregiving is positively associated with stress among women when seen in relation to the way caregivers trade off time, not least to aid their recovery. These findings provide a more nuanced understanding of the time trade-offs carers make and uncover gender differences in the association between caregiving and stress that add to an existing gender stress gap. Given that unpaid caregivers are an important source of long-term care services, policymakers should consider that caregiving may be stressful and that stress impacts are gendered when designing and evaluating policies for longer working lives.

Does Caring for Parents Take Its Toll? Gender Differences in Caregiving Intensity, Coresidence, and Psychological Well-Being Across Europe

Given population ageing and the emphasis on in-home care, more working-age adults are facing the demands of providing unpaid care to the elderly with potential implications for their own well-being. Such effects likely vary across Europe because care is differently organized with a differing emphasis on public support, dependence on family, and orientation toward gender equality. We studied the relationship between unpaid caregiving for elderly parents and the psychological well-being of older working-age (50-64) men and women by analysing data from the Survey of Health, Retirement, and Ageing in Europe (SHARE), covering 18 countries between 2004 and 2020 (N = 24,338), using ordinary least squares (OLS). We examined risk of depression by caregiving intensity and tested whether coresidence mediated outcomes. Men and women providing care to parents experience important psychological well-being losses across Europe, especially when caregiving is intensive. A heavier caregiving burden associated with coresidence explains a regime gradient in depression, not least for women in Southern Europe. Results highlight the spillover costs of unpaid caregiving across Europe and the need to address caregiver psychological well-being, especially in contexts where state support for elder care is low and coresidence is common.

"It helps me find balance": older adult perspectives on the intersection of caregiving and volunteering

Caregiving is an increasingly prevalent experience that can negatively impact health and well-being. Volunteerism, long associated with positive benefits for older adults, is one potential strategy that can be used to counteract caregiver stress. A national cohort of existing older adult volunteers was engaged to explore the intersection of volunteering and caregiving through qualitative analysis of respondent comments using the lens of role theory. Survey responses from 533 older volunteers were analyzed. Role conflict and role enhancement themes were examined, with time constraints and reduced energy emerging as the perceived causes of conflict between the caregiver and volunteer roles. Caregivers discussed benefits to their caregiving role, including respite, learning, access to information and resources relevant to caregiving, increased socialization and improved physical and cognitive health. Findings indicate that volunteering can be framed as a health and well-being intervention for caregivers.

Daily Reciprocity and Well-being: A Diary Study of Intergenerational Support between Mothers and Adult Children during the COVID-19 Pandemic

OBJECTIVES

Intergenerational support between aging parents and adult children is important to the well-being of both groups, especially during public health emergencies. However, few previous studies have examined the effects of daily support between parents and children on their well-being during public health emergencies. To fill in this gap, we examined the association between daily support and well-being in mothers and their adult children during the COVID-19 pandemic.

METHODS

Seventy-seven pairs of mothers (aged 44-80 years, M = 53.78, SD = 9.57) and adult children (aged 18-54 years, M = 26.61, SD = 9.46; 19% male) in mainland China participated in a 14-day daily diary study during a 14-day stay-at-home period. All of the participants reported the daily emotional and instrumental support they had given to and received from their mother/child each day for 14 consecutive days. Their daily positive affect and negative affect were also measured.

RESULTS

Receiving more support on a given day was associated with providing more support on that day, suggesting a daily reciprocity. This finding was consistent across mothers and children. A lower level of being under-benefitted on a day was associated with better daily well-being of children, but not that of mothers. Providing support, but not receiving support, was positively associated with mothers' daily well-being, whereas receiving support, but not providing support, was positively associated with children's daily well-being.

DISCUSSION

This study provides evidence of daily intergenerational support during a global public health emergency. The findings shed light on the importance of daily reciprocity and its implications for well-being.

Symptoms of menopause - global prevalence, physiology and implications

The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family and at the workplace. Hormonal changes that begin during the menopausal transition affect many biological systems. Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction. The physiological basis of these manifestations is emerging as complex and related, but not limited to, oestrogen deprivation. Findings generated mainly from longitudinal population studies have shown that ethnic, geographical and individual factors affect symptom prevalence and severity. Moreover, and of great importance to clinical practice, the latest research has highlighted how certain menopausal symptoms can be associated with the onset of other disorders and might therefore serve as predictors of future health risks in postmenopausal women. The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health.

Full-time versus part-time employment: Does it influence frequency of grandparental childcare?

The impact of grandparents' employment on grandparental childcare has been examined repeatedly, but the findings have so far been inconsistent. We contend that these inconsistencies may have resulted from variations in model specification and crude measurement of employment status. Furthermore, we assert that earlier research overlooked gender differences in the ability to combine paid employment and caregiving as well as variations between maternal and paternal grandparents. We also question the causal interpretation of earlier findings that were based on cross-sectional data. We revisit the issue of the impact of the intensity of employment and analyze SHARE data from 19 countries. We find a significant positive association between part-time employment (as compared to full-time employment) and the frequency of grandparental childcare in a cross-sectional sample, but only among paternal grandmothers. Capitalizing on the panel component of SHARE, we use a within-person estimator to show that this association is unlikely to reflect a causal effect of the intensity of labor market attachment on the frequency of the care of grandchildren, but more probably results from omitted variable bias. We argue that grandparents most likely to provide (intensive) childcare are also most likely to adjust their employment in anticipation of caregiving. The paper documents the usefulness of role strain theory among grandparents and highlights that part-time jobs may reduce role conflict and may thus make grandparenting a more easily manageable experience.

Carers' quality of life and experiences of adult social care support in England

Informal carers make a vital contribution to the well-being of the people they care for or look after. Against the policy background in England, the purpose of this study was to explore the views of carers who are in contact with adult social care support services. A qualitative study with 31 carers, who were recruited via local authorities and carers' organisations, was conducted between April and July 2012 to collect data on carers' experiences and perceptions of their quality of life (QoL) with and without adult social care and support for themselves or the person they look after. Through framework analysis, three key themes were identified: (i) definitions of social care services 'for' the carer or 'for' care recipient and social care outcomes; (ii) carers' access to social care services; and (iii) the meaning and value of informal care. We find that carers' QoL is affected by social care support directed at carers and support directed at those they care for, as well as access to services, the experience of stigma in communities, and in how individual needs and preferences are considered when making decisions about care. While there is much to welcome in the direction of policy in England, this study has shown that there are some gaps in thinking around these areas that will need to be addressed if the lives of carers are to be improved.

Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH) surveys

OBJECTIVE

To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide.

METHODS

Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided.

RESULTS

Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings.

CONCLUSIONS

The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.

Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys

BACKGROUND

Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition.

RESULTS

Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings.

CONCLUSIONS

Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.

Family burden, family health and personal mental health

Background

The economic and moral implications of family burden are well recognised. What is less understood is whether or how family health and family burden relate to personal mental health. This study examines family health and perceived family burden as predictors of personal mental health, taking personal and sociodemographic factors into consideration.

Methods

Data used was from the National Comorbidity Study Replication (NCS-R), namely the random 30% of participants (N = 3192) to whom the family burden interview was administered. Measures of family burden and mental health were considered for analysis.

Results

Binary logistic regressions were used as means of analyses. Perception of family burden was associated with an increased vulnerability to personal mental health problems, as was the presence of mental health difficulties within the family health profile. Which member of the family (kinship) was ill bore no relation to prediction of personal mental health. Personal and socio-demographic factors of sex, age, marital status, education and household income were all predictive of increased vulnerability to mental health problems over the last 12 months.

Conclusions

Certain elements of family health profile and its perceived burden on the individuals themselves appears related to risk of personal incidence of mental health problems within the individuals themselves. For moral and economic reasons, further research to understand the dynamics of these relationships is essential to aid developing initiatives to protect and support the mental health and wellbeing of relatives of ill individuals.