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Ishimaru M, Zaitsu T, Kino S, Inoue Y, Taira K, Takahashi H, Tamiya N. Recent dental visits and family caregiving among individuals with dental symptoms: A nationwide cross-sectional study in Japan. Community Dent Oral Epidemiol 2024; 52:406-412. [PMID: 37916539 DOI: 10.1111/cdoe.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES With the increasing number of family caregivers due to the ageing population, physical and mental health problems among caregivers are of concern. However, few studies have evaluated their oral health. This study aimed to evaluate the association between being a family caregiver and recent dental visits for dental symptoms in Japan, with consideration of gender. METHODS A cross-sectional study was conducted using the 2016 Comprehensive Survey of Living Conditions (CSLC) in Japan. Participants with dental symptoms were included in this study. The primary outcome was recent dental visits. The exposure variable of interest was being a primary caregiver for a family member requiring long-term care. A logistic regression analysis was conducted adjusting for contributing factors such as age, gender, marital status, working hours per week, education, household expenditure per month, self-rated health and the interaction between gender and caregiving. A stratified analysis by gender was also performed. RESULTS Of the 5100 eligible participants, 233 (4.6%) were family caregivers. Of all participants, 2746 (53.8%) reported dental visits. The adjusted odds ratio (aOR) of family caregivers having recent dental visits was 0.83 (95% confidence interval [CI], 0.64-1.09). In a gender stratified analysis, family caregivers were less likely to visit dental clinics than were non-family caregivers in the male subsample (aOR: 0.56, 95% CI: 0.34-0.92) but not in the female subsample (aOR: 0.99, 95% CI: 0.72-1.38). CONCLUSIONS The findings indicate that family caregivers, especially male caregivers, had fewer dental visits than non-family caregivers. These findings suggest the need to improve the accessibility of dental clinics to family caregivers with dental symptoms.
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Affiliation(s)
- Miho Ishimaru
- The Institute of Education, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| | - Takashi Zaitsu
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| | - Yuko Inoue
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| | - Kento Taira
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Stanyon D, Nakanishi M, Yamasaki S, Miyashita M, Yamaguchi S, Baba K, Nakajima N, Niimura J, DeVylder J, Hiraiwa-Hasegawa M, Ando S, Kasai K, Nishida A. Investigating the Differential Impact of Short- and Long-Term Informal Caregiving on Mental Health Across Adolescence: Data From the Tokyo Teen Cohort. J Adolesc Health 2024:S1054-139X(24)00288-X. [PMID: 39001751 DOI: 10.1016/j.jadohealth.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Young caregivers experience, on average, poorer mental health outcomes than non-caregiving young people. However, it is unknown to what extent these effects differ with age, or among short-term versus long-term caregivers. Using repeated assessment of young caregiving across multiple waves of a prospective adolescent cohort study, we conducted repeated cross-sectional analyses of caregiver status and contemporaneous depressive symptoms, self-harm, and suicidality in early to middle adolescence. METHODS Four waves of questionnaire data from a large, longitudinal population-based cohort study (Tokyo Teen Cohort) were analyzed. Caregiver status was collected from participants aged 10, 12, 14, and 16 years. Mental health outcomes assessed were depressive symptoms, self-harm and suicidal feelings. Logistic regression analyses were conducted assessing effects of a) young caregiver status and b) new, long-term, and ex-caregiver 2-year categorizations on mental health outcomes at 12, 14, and 16 years, both unadjusted and adjusted for potential confounders (sex, low income, single-parent household, and parental distress). RESULTS Depressive symptoms were elevated among long-term caregivers at 14 years (unadjusted odds ratio (uOR): 3.11 [1.33-7.27], adjusted odds ratio (aOR): 2.49 [1.03-5.99]). Borderline associations between long-term caregiving and self-harm (uOR: 3.14 [1.06-9.35], aOR: 2.51 [0.82-7.63]) and suicidal feelings (uOR: 2.49 [0.98-6.34], aOR: 2.06 [0.80-5.33]) were detected at 16 years. No associations were found at age 12 years in primary analyses; sensitivity analyses indicated possible increased depressive symptoms. DISCUSSION Young caregivers with long-term caregiving roles are at the greatest risk for negative mental health outcomes, with effects concentrated in later adolescence. These findings highlight urgent need for early identification and practical and psychological support for young people shouldering caregiving burdens.
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Affiliation(s)
- Daniel Stanyon
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Miyagi, Japan; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Yamaguchi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kaori Baba
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Naomi Nakajima
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Junko Niimura
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jordan DeVylder
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Silver School of Social Work, New York University, New York, New York
| | - Mariko Hiraiwa-Hasegawa
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Hayama, Kanagawa, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; The International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Zarzycki M, Vilchinsky N, Bei E, Ferraris G, Seddon D, Morrison V. Cross-country variations in the caregiver role: evidence from the ENTWINE-iCohort study. BMC Public Health 2024; 24:898. [PMID: 38532418 DOI: 10.1186/s12889-024-18302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Globally, economically developed countries face similar ageing demographics and the challenge of a 'care gap', yet they vary due to different care and formal support systems, and different cultural and societal norms around illness and care. The aim of this exploratory study was to examine cross-country variations in caregiver motivations, willingness, values, meaning in life, illness beliefs, and experiences of wellbeing, gain, health-related quality of life, burden and depression, across 6 European countries and Israel. Cross-country differences in the above-mentioned informal caregiver experiences are rarely described. METHODS An online survey (ENTWINE-iCohort) was conducted using validated measures wherever possible. This paper utilises data from 879 caregivers and seven countries (Greece, Italy, the Netherlands, Poland, Sweden, the UK, and Israel). RESULTS No consistent finding supporting the concurrent relationship between caregiver support policies/country culture and caregiver motivations/willingness was found. Caregivers in countries typically characterised by individualist cultures reported lower familism, higher self-enhancement values, and greater perceived illness threat compared to more collectivist countries. Search for meaning was higher in poorer countries than in wealthier countries. Higher negative caregiver experiences (e.g., burden) and lower positive experiences (e.g., wellbeing) were generally observed in countries with underdeveloped caregiver support as compared to countries with more developed formal support systems. CONCLUSIONS Cross-country variations can be explained to varying degrees by national policies around care (or their absence) and country cultural contexts. The results emphasise the importance of formal support services for achieving positive caregiver experiences, and help inform the development of policies and measures to support caregivers in Europe and Israel.
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Affiliation(s)
- Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom.
- School of Psychology and Sports Sciences, Bangor University, Bangor, Wales, United Kingdom.
| | - Noa Vilchinsky
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
- Department of Political and Social Sciences, University of Bologna, Bologna, Italy
| | - Giulia Ferraris
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Diane Seddon
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, United Kingdom
| | - Val Morrison
- School of Psychology and Sports Sciences, Bangor University, Bangor, Wales, United Kingdom
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Chavan PP, Weitlauf JC, LaMonte MJ, Sisto SA, Tomita M, Gallagher-Thompson D, Shadyab AH, Bidwell JT, Manson JE, Kroenke CH, Hayden KM, Hirsch CH, Mouton CP, Cannell MB, Hovey KM, Wactawski-Wende J. Caregiving and all-cause mortality in postmenopausal women: Findings from the Women's Health Initiative. J Am Geriatr Soc 2024; 72:24-36. [PMID: 37936486 PMCID: PMC10841917 DOI: 10.1111/jgs.18620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Caregiving is commonly undertaken by older women. Research is mixed, however, about the impact of prolonged caregiving on their health, well-being, and mortality risk. Using a prospective study design, we examined the association of caregiving with mortality in a cohort of older women. METHODS Participants were 158,987 postmenopausal women aged 50-79 years at enrollment into the Women's Health Initiative (WHI) who provided information on current caregiving status and caregiving frequency at baseline (1993-1998) and follow-up (2004-2005). Mortality was ascertained from baseline through March of 2019. Cox regression with caregiving status defined as a time-varying exposure was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality, adjusting for sociodemographic factors, smoking, and history of diabetes, hypertension, cardiovascular disease (CVD), and cancer. Stratified analyses explored whether age, race-ethnicity, depressive symptoms, frequency of caregiving, optimism, and living status modified the association between caregiver status and mortality. RESULTS At baseline, 40.7% of women (mean age 63.3 years) self-identified as caregivers. During a mean 17.5-year follow-up, all-cause mortality (50,526 deaths) was 9% lower (multivariable-adjusted HR = 0.91, 95% CI: 0.89-0.93) in caregivers compared to non-caregivers. The inverse association between caregiving and all-cause mortality did not differ according to caregiving frequency or when stratified by age, race-ethnicity, depressive symptoms, optimism, or living status (interaction p > 0.05, all). Caregiving was inversely associated with CVD and cancer mortality. CONCLUSION Among postmenopausal women residing across the United States, caregiving was associated with lower mortality. Studies detailing the type and amount of caregiving are needed to further determine its impact on older women.
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Affiliation(s)
- Prachi P. Chavan
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
- Master of Public Health Program, School of Health Professions, Eastern Virginia Medical School, Norfolk, VA
| | - Julie C. Weitlauf
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
| | - Sue Ann Sisto
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo-SUNY, NY
| | - Machiko Tomita
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo-SUNY, NY
| | | | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human, University of California San Diego, Longevity Science, La Jolla, CA
| | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, Family Caregiving Institute, University of California Davis, Sacramento, CA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, MA
| | | | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Calvin H. Hirsch
- Division of General Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Charles P. Mouton
- Office of Provost, University of Texas Medical Branch, Galveston, TX
| | - Michael Brad Cannell
- Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center, Dallas, TX
| | - Kathleen M Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
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Fleitas Alfonzo L, Disney G, Singh A, Simons K, King T. The effect of informal caring on mental health among adolescents and young adults in Australia: a population-based longitudinal study. Lancet Public Health 2024; 9:e26-e34. [PMID: 38176839 DOI: 10.1016/s2468-2667(23)00299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Young carers are people aged up to 25 years who provide unpaid care to a relative or a friend living with a long-term condition or a disability. Providing informal care is associated with poor mental health. Longitudinal evidence on this relationship among young people is scarce. To address this gap, we assessed the mental health of people aged 15-25 years when providing informal care compared with when not providing informal care. METHODS We conducted a population-based longitudinal study using 20 years of data between 2001 and 2020 from the Household Income and Labour Dynamics in Australia (HILDA) survey. We included observations of participants aged 15-25 years with at least two observations across 20 waves of HILDA. Informal care was categorised as 0 h per week, 1-19 h per week, and 20 or more h per week. Mental health was measured using the Mental Health Inventory (MHI-5) from the 36-Item Short Form Survey (SF-36). Multivariate linear fixed-effects regression models were fitted to assess within-person changes in mental health when providing different levels of informal care. FINDINGS Of 44 663 people with 410 658 observations who participated in HILDA waves 1 to 20, 32 726 were excluded with 351 445 observations. 11 937 young people (with 59 213 observations) were deemed eligible for this study and, of these, 8996 participants with 43 231 observations were included in the complete case analytical sample. When caring for 1-19 h per week, young carers had an MHI-5 score of -1·98 points (95% CI -3·06 to -0·89) compared with when caring for 0 h per week. Mental health was worse when caring for 20 or more h per week, with participants displaying an MHI-5 score of -3·47 points (95% CI -6·02 to -0·92) compared with when caring for 0 h per week. Our findings were consistent across sensitivity tests. INTERPRETATION Our findings suggest potential mental health effects of informal care in young people, particularly when providing an intense amount of caregiving. Reducing young caring loads could be a possible avenue for intervention. FUNDING Melbourne Disability Institute Scholarship, University of Melbourne Research Training Program Scholarship, Australian Research Council Discovery Early Career Researcher Award, National Health and Medical Research Council of Australia funded Centre of Research Excellence in Disability and Health.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
| | - George Disney
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Koen Simons
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Meireles A, Marques S, Faria S, Lopes JC, Teixeira AR, Alves B, Becker S. Being a Young Carer in Portugal: The Impact of Caring on Adolescents' Life Satisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7017. [PMID: 37947573 PMCID: PMC10648131 DOI: 10.3390/ijerph20217017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Caring for an ill or disabled relative can present significant challenges that may exceed the personal resources of the caregiver. Young carers (YCs) often take on this role, providing support to family members or friends, which can have far-reaching effects on various aspects of their lives. This study involved 235 adolescents, 106 YCs, and 129 non-carers (NCs), who completed questionnaires assessing life satisfaction, satisfaction with social support, family functioning, academic functioning, and caregiving activities. Tests of group differences (MANOVA and MANCOVA controlling for age) showed YCs had more caregiving activities than NCs (as expected) and, critically, significantly lower life satisfaction. Hierarchical regressions with the YCS subsample showed academic functioning, social support, and the negative impact of caregiving were associated with life satisfaction, and that the negative influence of caregiving was linked to family functioning and the quantity of caregiving activities. For NCs, academic functioning, satisfaction with social support, and family functioning were associated with life satisfaction. In conclusion, caregiving in adolescents appears to be linked to lower life satisfaction, but this effect is determined by their social support, academic functioning, and negative impact of caring, which in turn depends on their family functioning and amount of caring activities.
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Affiliation(s)
- Ana Meireles
- Centro de Investigação em Psicologia para o Desenvolvimento, Universidade Lusíada, 4100-348 Porto, Portugal; (S.M.); (S.F.); (J.C.L.)
| | - Sofia Marques
- Centro de Investigação em Psicologia para o Desenvolvimento, Universidade Lusíada, 4100-348 Porto, Portugal; (S.M.); (S.F.); (J.C.L.)
| | - Sara Faria
- Centro de Investigação em Psicologia para o Desenvolvimento, Universidade Lusíada, 4100-348 Porto, Portugal; (S.M.); (S.F.); (J.C.L.)
| | - Joana Correia Lopes
- Centro de Investigação em Psicologia para o Desenvolvimento, Universidade Lusíada, 4100-348 Porto, Portugal; (S.M.); (S.F.); (J.C.L.)
| | - Ana Ribas Teixeira
- Portincarers Associação Cuidadores Portugal, 4200-249 Porto, Portugal; (A.R.T.); (B.A.)
| | - Bruno Alves
- Portincarers Associação Cuidadores Portugal, 4200-249 Porto, Portugal; (A.R.T.); (B.A.)
| | - Saul Becker
- Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BX, UK;
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Alfonzo LF, Singh A, Disney G, King T. The mental health impact of school bullying among young carers in Australia: a causal mediation analysis. Sci Rep 2023; 13:16788. [PMID: 37798299 PMCID: PMC10555989 DOI: 10.1038/s41598-023-43464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
Informal care can exert adverse effects on the mental health of young people. Bullying victimisation is an important determinant of mental disorders. Young carers are at elevated risk of bullying. We quantify the mental health effects of informal care among Australian adolescents and the extent to which these effects are transmitted through school bullying. We used data from the Longitudinal Study of Australian Children. Participants were classified as non-carers, light carers (caring for < 10 h/week) and moderate-to-heavy carers (caring for 10 + h/week). Mental health was measured using the Kessler Psychological Distress Scale (K10). Using a counterfactual approach to mediation analysis, total effects (TE) of informal care on mental health were decomposed into natural direct effects (NDE-mental health effects not transmitted through school bullying) and natural indirect effects (NIE-mental health effects transmitted through school bullying). The TE of informal caring was 0.71 (95%CI - 0.03, 1.49) for light carers and 1.72 (95%CI 0.45, 3.02) for moderate-to-heavy carers. While school bullying explained 27% of the TE among moderate-to-heavy carers (NIE: 0.46; 95%CI 0.12, 0.91) there was weak evidence of mediation for light carers. Our findings indicate that the mental health effects of moderate-to-heavy caregiving can be reduced by school bullying interventions.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Disability and Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Level 4, 207, Bouverie Street, MelbourneParkville, VIC, 3010, Australia.
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - George Disney
- Disability and Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Level 4, 207, Bouverie Street, MelbourneParkville, VIC, 3010, Australia
| | - Tania King
- Disability and Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Level 4, 207, Bouverie Street, MelbourneParkville, VIC, 3010, Australia
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Darabos K, Faust H. Assessing health, psychological distress and financial well-being in informal young adult caregivers compared to matched young adult non-caregivers. PSYCHOL HEALTH MED 2023; 28:2249-2260. [PMID: 36976715 DOI: 10.1080/13548506.2023.2195671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Young adult caregivers (YACs) are faced with the atypical challenge of providing informal (i.e. not paid) care to a family member, while simultaneously at a critical developmental stage in which many major life decisions and milestones are taking place. Adding the challenge of caring for a family member during this already complex time period may have a detrimental impact on young adults' (YAs) own overall health and well-being. The aim of this study was to examine differences in overall health, psychological distress, and financial strain among a propensity matched sample of YACs compared to young adult non-caregivers (YANCs) from a nationally representative database and to examine differences in these outcomes by caregiving role (caring for a child vs. other family member). YAs (aged 18-39, N = 178) identifying as a caregiver (n = 74) were matched with YANCs (n = 74) on age, gender, and race. Results revealed that YACs exhibited higher psychological distress, lower overall health and more sleep disturbance and higher financial strain compared to YANCs. YAs caring for family members other than children also reported higher anxiety and fewer hours spent caregiving compared to YAs caring for a child. YACs appear to be at risk for impairments in health and well-being compared to their matched peers. Longitudinal research is needed to understand how caregiving during young adulthood impacts health and well-being across time.
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Affiliation(s)
- Katie Darabos
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Haley Faust
- Department of Behavioral Oncology Children's Hospital of Philadelphia, Philadelphia, PA, USA
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9
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Use of Parental Disability Trajectories to Identify Adolescents Who are Young Carers. J Youth Adolesc 2023; 52:449-460. [PMID: 35595922 PMCID: PMC9842572 DOI: 10.1007/s10964-022-01627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/01/2022] [Indexed: 01/21/2023]
Abstract
Being a young carer can have significant impacts on the lives of children and adolescents. Identifying young carers is difficult, making the provision of support challenging for service providers. This sample contained 4464 Australian children/adolescents across 11 years (49% female, aged 6/7 years at baseline, and 16/17 years at final wave). Group-based trajectory modeling was applied to examine parental disability trajectories across 5 waves of data collection. Associations between estimated trajectories and unpaid/informal caring at age 16/17 years were then assessed. Three trajectory groups were identified: consistently-low (80%), low-increasing-high (10%) and moderate-high (10%) levels of parental disability. There was strong evidence that caring was elevated in the low-increasing-high group compared to the consistently-low group, and moderate evidence of elevation in the moderate-high group. By identifying adolescents with increased odds of becoming young carers, this study shows that parental disability may be an important way for service providers to identify and support young carers.
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The mental and physical health of young carers: a systematic review. THE LANCET PUBLIC HEALTH 2022; 7:e787-e796. [DOI: 10.1016/s2468-2667(22)00161-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
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Bei E, Mashevich K, Rotem-Mindali O, Galin-Soibelman S, Kalter-Leibovici O, Schifter T, Vilchinsky N. Extremely Distant and Incredibly Close: Physical Proximity, Emotional Attachment and Caregiver Burden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148722. [PMID: 35886574 PMCID: PMC9323703 DOI: 10.3390/ijerph19148722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/05/2022]
Abstract
Informal caregivers are at risk of caregiver burden, and physical proximity to the care recipient may add to this negative outcome. Yet, individual differences in emotional proximity to the care recipient such as attachment orientations may contribute to caregivers’ comfort towards different degrees of physical proximity, leading to varying levels of burden. The current study is the first to explore the role of physical proximity on caregiver burden as moderated by attachment orientations. A sample of 162 Israeli caregivers who are active users of the Camoni website completed our online survey. Sociodemographic characteristics, including a self-reported questionnaire on the physical proximity to the care recipient, were collected. Caregivers’ attachment orientations were assessed with the Experiences in Close Relationships–Relationship Structures questionnaire. Caregiver burden was assessed using the Caregiver Burden Inventory. Multiple regression and simple slope analyses were conducted. Attachment anxiety and avoidance were positively associated with burden, whereas physical proximity was not. Attachment avoidance, but not attachment anxiety, moderated the association between physical proximity and caregiver burden, with caregivers who live closer to their care recipient experiencing greater burden when high levels of avoidance were present. Our findings reveal the complex dynamics between attachment orientations and physical proximity in the context of informal care, highlighting the need for better integration of these two interlinked constructs in both care research and practice.
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Affiliation(s)
- Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
- Correspondence: ; Tel.: +30-69-8204-1162
| | - Karin Mashevich
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
| | - Orit Rotem-Mindali
- Department of Geography and Environment, Bar-Ilan University, Ramat Gan 5290002, Israel;
| | - Shira Galin-Soibelman
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
| | - Ofra Kalter-Leibovici
- The Gertner Institute, Sheba Medical Center, Ramat Gan 5290002, Israel; (O.K.-L.); (T.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv P.O. Box 39040, Israel
| | - Tami Schifter
- The Gertner Institute, Sheba Medical Center, Ramat Gan 5290002, Israel; (O.K.-L.); (T.S.)
| | - Noa Vilchinsky
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
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12
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Tseliou F, Ashfield-Watt P. The association between resilience resources, contextual factors and mental health status: a national population-based study. BMC Public Health 2022; 22:602. [PMID: 35351041 PMCID: PMC8962564 DOI: 10.1186/s12889-022-13013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although a range of risk factors have been linked with poor mental health across the population, the underlying pathways leading to mental ill health remain unclear. There is a need to investigate the effects and interplay of both protective and risk factors. This population-based study aimed to explore the effects of individual and contextual factors on mental health status. Record-linkage was implemented between health and lifestyle data drawn from HealthWise Wales (HWW), a national population health survey of people > 16 years who live or access their healthcare in Wales, and treatment data from primary healthcare records. Mental health status was assessed using three different measures, including the self-reported MHI-5 and WEMWBS scales and mental health treatment in electronic healthcare records (EHR). Result Using cross-sectional data from 27,869 HWW participants aged over 16 years, lifestyle factors, resilience, social cohesion and neighbourhood attraction were associated with mental health across all measures. However, compared to contextual factors, the cluster of individual factors was more closely associated with poor mental health, explaining more of the variance across all measures used (MHI-5: 9.8% versus 5.4%; WEMWBS: 15.9% versus 10.3%; EHR: 5.5% versus 3.0%). Additional analysis on resilience sub-constructs indicated that personal skills were the most closely correlated with poorer mental health. Conclusion Mental health status was more closely linked with individual factors across the population than contextual factors. Interventions focusing on improving individual resilience and coping skills could improve mental health outcomes and reduce the negative effect of contextual factors such as negative neighbourhood perceptions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13013-2.
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13
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Janes E, Forrester D, Reed H, Melendez-Torres GJ. Young carers, mental health and psychosocial wellbeing: A realist synthesis. Child Care Health Dev 2022; 48:190-202. [PMID: 34753209 DOI: 10.1111/cch.12924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/16/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
Growing evidence demonstrates that the mental and psychosocial health impacts of caring vary significantly for individual children, depending on who they are, the person that they care for, their responsibilities and the wider family situation. Although individual studies have made progress in identifying the range of impacts, there is a lack of clarity around which impacts affect who and in what circumstances. This synthesis, based on RAMESES realist protocols, aims to increase clarity concerning how and why the mental and psychosocial health impacts of caring for a family member vary for different children. There were 12 391 unique search results screened at title, abstract and full-paper levels. Forty-four retained studies were analysed, resulting in the development of a model with 17 context-mechanism-outcome configurations. The model divides the configurations into three interlinking domains. The caregiving responsibilities domain considers how the impacts of caring vary with the circumstances of the individual young carer, the person they care for and their family. The identity domain details the development of a caring identity that potentially mitigates the negative effects of caring and enables positive benefits. The support domain concerns the support provided from family, community and services that, depending on quality, can mitigate or exacerbate the impacts of caring. Support also moderates the care identity by affecting self-perception of the caring role. The model has the potential to inform the development of interventions that target particular mechanisms to enable positive change for young carers. This potential can be enhanced by further research to test the model, with a focus on refining configurations where less evidence is available. There is a particular need to focus on identification which is under-represented in the model as both a mechanism and a contextual factor due to unidentified young carers being largely absent from past research.
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Affiliation(s)
- Ed Janes
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Donald Forrester
- Children's Social Care Research and Development Centre (CASCADE), Cardiff University, Cardiff, UK
| | - Hayley Reed
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
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Mental health of young informal carers: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2345-2358. [PMID: 35798995 PMCID: PMC9263065 DOI: 10.1007/s00127-022-02333-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/20/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE This systematic review aims to assess and evaluate quantitative evidence on the association between informal caregiving and mental health in young people. METHODS This review was registered in PROSPERO (CRD42021251666). We conducted our search in the following four databases: Medline (PubMed and OVID), EMBASE, PsycInfo and Web of Science. The last search was performed on the 17th of March of 2021. Quantitative studies that focused on carers aged 25 years or less and compared the mental health status of carers and non-carers were eligible for inclusion. Two reviewers independently assessed articles for eligibility and performed the quality assessment using the Risk of Bias tool in Non-Randomised Studies of Exposures (ROBINS-E). RESULTS We identified a total of ten eligible articles. Mental health outcomes included depression, anxiety and other mental or emotional problems. Nine out of the ten studies showed that being a young carer was consistently associated with poor mental health. However, the overall quality of evidence was low, and longitudinal data were limited to three articles. The primary sources of bias were confounding and outcome measurement. CONCLUSION Young carers experience poorer mental health outcomes than their non-caring peers. However, we identified an overall lack of quantitative evidence of high methodological rigour. To establish if young caring leads to poor mental health, future research should focus on addressing the identified methodological limitations and understanding the mechanisms explaining these associations. Addressing these gaps can better inform the allocation of appropriate support and resources to optimise the mental health of young carers.
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Young carers in the COVID-19 pandemic: risks for mental health. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 16:100307. [PMID: 34723231 PMCID: PMC8548074 DOI: 10.1016/j.lanwpc.2021.100307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022]
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Otsuki N, Yamamoto R, Sakaguchi Y, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Fukui S, Miyashita M. Care needs level in long-term care insurance system and family caregivers' self-perceived time-dependent burden in patients with home palliative care for cancer: a cross-sectional study. Support Care Cancer 2021; 30:1587-1596. [PMID: 34542734 DOI: 10.1007/s00520-021-06579-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Although home care improves patients' quality of life (QOL), several studies have suggested that home care lowers the QOL of family caregivers and decreases their mortality. To alleviate the deleterious impact of home care on caregivers, the major burdens on caregivers and the clinical characteristics of the caregivers vulnerable to the major burden needs to be clarified. METHOD A survey questionnaire was distributed to 710 family caregivers of patients with cancer in Japan, and 342 valid responses were obtained (valid response rate: 48.2%). The Burden Index of Caregivers was used to identify the major burden on caregivers. To assess the associations of the patients' care needs level and other clinically relevant factors with the major burden, a multivariable-adjusted logistic regression model was used. RESULTS The time-dependent burden was identified as a major burden. An adjusted model showed a nonlinear association between the care needs level and the time-dependent burden, in which the caregivers of the patients who required moderate care needs level had the highest time-dependent burden [adjusted odds ratio of none, mild, moderate, and severe care needs levels: 0.50 (95% confidence interval 0.07-2.12), 1.08 (0.43-2.57), 1.87 (1.01-3.52), and 1.00 (reference), respectively]. Additionally, older patients and younger caregivers were significantly associated with a time-dependent burden. CONCLUSION The time-dependent burden was highest in caregivers at the moderate care needs level and younger caregivers. An imbalance between the demand and supply of care services may be improved by considering the clinical characteristics of both patients and caregivers.
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Affiliation(s)
- Naoko Otsuki
- Division of Health Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, Japan
- Tokyo Medical and Dental University Graduate School of Health Care Sciences, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Ryohei Yamamoto
- Health and Counseling Center, Osaka University, 1-17 Machikaneyama, Toyonaka, Osaka, 560-0043, Japan.
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
- Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
| | - Yukihiro Sakaguchi
- Kwansei Gakuin University School of Human Welfare Studies, 1-1-155, Uegahara, Nishinomiya, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara Hospital, 3453 Mikatahara, Kita, Hamamatsu, Japan
| | - Yoshiyuki Kizawa
- Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba, Ibaraki, Japan
| | - Sakiko Fukui
- Tokyo Medical and Dental University Graduate School of Health Care Sciences, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
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King T, Singh A, Disney G. Associations between young informal caring and mental health: a prospective observational study using augmented inverse probability weighting. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100257. [PMID: 34528020 PMCID: PMC8382993 DOI: 10.1016/j.lanwpc.2021.100257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Across the world, many young people are supplying unpaid, informal care. There is growing evidence of the impact of this caring role on the lives of young informal carers, however there has been little quantitative analysis of the mental health impacts. This research aimed to estimate the effect of informal caring at age 14/15 years on mental health at age 18/19 years. METHOD Data was drawn from Waves 5, 6, 8 (2012-2018) of the Longitudinal Study of Australian Children. Effects of caring on mental health were assessed using augmented inverse probability weighting, with adjustment for potential confounders, and using the Kessler-10 measure of mental health. Caring was assessed with both a binary (any caring vs none), and a three category variable (no caring, less than daily caring, daily caring). Multiple imputation was carried out using chained equations, and analysis was conducted on both complete case (n=2165) and the imputed dataset (n=3341). OUTCOMES In complete case models, any caring at age 14/15 years was associated with poorer mental health at age 18/19 years compared to those reporting no caring, with an average treatment effect (ATE) of 1.10 (95%CI 0.37, 1.83). The ATE of daily caring compared to no caring at age 14/15 years of age was 1.94 (95%CI 0.48, 3.39), and caring less than daily (compared to no caring) was associated with a treatment effect of 0.83(95%CI 0.06, 1.61). Associations were robust to several sensitivity analyses. INTERPRETATION These results suggest there is a mental health impact of caring in adolescence on mental health four years later. This highlights the need for support for young informal carers, particularly for those providing more intensive caring. FUNDING This study was supported by an Australian Research Council Discovery Early Career Award (TK, DE200100607).
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Affiliation(s)
- Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
| | - George Disney
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
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18
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Grenard DL, Valencia EJ, Brown JA, Winer RL, Littman AJ. Impact of Caregiving During Emerging Adulthood on Frequent Mental Distress, Smoking, and Drinking Behaviors: United States, 2015-2017. Am J Public Health 2020; 110:1853-1860. [PMID: 33058707 DOI: 10.2105/ajph.2020.305894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine associations between caregiving mental or behavioral health outcomes among emerging US adults, defined as persons aged 18 to 25 years.Methods. The study sample included emerging adult respondents to the 2015-2017 Behavioral Risk Factor Surveillance System's caregiving module. Exposures were caregiver (n = 3087), expectant caregiver (n = 2303), and noncaregiver (n = 12 216) status. Expectant caregivers were defined as persons not currently providing care but anticipating doing so within the next 2 years. Outcomes included frequent mental distress (FMD), drinking (binge or heavy), and current smoking (cigarette or e-cigarette use). We used robust Poisson regression to calculate adjusted prevalence ratios (APRs) and corresponding 95% confidence intervals (CIs). We adjusted all models for income.Results. Caregivers had a similar prevalence of FMD when compared with both expectant caregivers (APR = 1.67; 95% CI = 1.28, 2.17) and noncaregivers (APR = 1.50; 95% CI = 1.23, 1.82). Caregivers had a higher prevalence of current cigarette smoking compared with noncaregivers (APR = 1.44; 95% CI = 1.21, 1.71).Conclusions. Among emerging adults, providing care is associated with poorer mental health. Point estimates looking at FMD were higher when we compared caregivers with expectant caregivers, suggesting a difference in exchangeability between comparison groups.Public Health Implications. This study highlights the importance of including emerging adults in caregiving research.
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Affiliation(s)
- Deborah L Grenard
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Esteban J Valencia
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Jennifer A Brown
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Rachel L Winer
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Alyson J Littman
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
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19
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Mikkola TM, Kautiainen H, Mänty M, von Bonsdorff MB, Kröger T, Eriksson JG. Age-dependency in mortality of family caregivers: a nationwide register-based study. Aging Clin Exp Res 2020; 33:1971-1980. [PMID: 33040307 PMCID: PMC8249300 DOI: 10.1007/s40520-020-01728-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023]
Abstract
Background Evidence on family caregivers' health is conflicting. Aim To investigate all-cause and cause-specific mortality in Finnish family caregivers providing high-intensity care and to assess whether age modifies the association between family caregiver status and mortality using data from multiple national registers. Methods The data include all individuals, who received family caregiver's allowance in Finland in 2012 (n = 42,256, mean age 67 years, 71% women) and a control population matched for age, sex, and municipality of residence (n = 83,618). Information on dates and causes of death between 2012 and 2017 were obtained from the Finnish Causes of Death Register. Results Family caregivers had lower all-cause mortality than the controls over the follow-up (8.1 vs. 11.6%) both among women (socioeconomic status adjusted hazard ratio [HR]: 0.64, 95% CI 0.61–0.68) and men (adjusted HR: 0.73, 95% CI 0.70–0.77). When modelling all-cause mortality as a function of age, younger caregivers had only slightly lower or equal mortality to their controls, but older caregivers had markedly lower mortality than their controls, up to more than 10% lower. Caregivers had a lower mortality rate for all the causes of death studied, namely cardiovascular, cancer, neurological, external, respiratory, gastrointestinal and dementia. The lowest risk was for dementia (subhazard ratio = 0.29, 95% CI 0.25–0.34). Conclusions Older family caregivers had lower mortality than the age-matched general population while mortality did not differ according to caregiver status in young adulthood. This age-dependent advantage in mortality is likely to reflect the selection of healthier individuals into the family caregiver role.
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Affiliation(s)
- Tuija M Mikkola
- Folkhälsan Research Center, Helsinki, Finland.
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Minna Mänty
- City of Vantaa, Vantaa, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Teppo Kröger
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Robison OMEF, Inglis G, Egan J. The health, well-being and future opportunities of young carers: a population approach. Public Health 2020; 185:139-143. [PMID: 32622221 DOI: 10.1016/j.puhe.2020.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/24/2020] [Accepted: 05/05/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES There is a lack of evidence on the health-related impacts of being a young carer. This article takes a population approach to young carer research specifically to investigate the prevalence of young carers and explore differences in their health, well-being and future expectations. STUDY DESIGN This is a cross-sectional regression analysis. METHODS Secondary analysis of a representative Scottish secondary school survey was undertaken. Pupils with caring responsibilities were identified, and their outcomes in terms of physical and mental health and postschool expectations were analysed. RESULTS Almost one in eight (12%) surveyed reported caring for someone in the household. Young carers' physical and mental health and psychosocial outcomes were significantly poorer, and they were significantly less likely to see themselves entering further or higher education. CONCLUSION This research suggests that Glasgow could have many more young carers than previously thought and provides clear evidence that young people's outcomes are influenced by carer status.
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Affiliation(s)
- O M E F Robison
- Glasgow Centre for Population Health, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK.
| | - G Inglis
- University of the West of Scotland, School of Education and Social Sciences, Paisley, PA1 2BE, Scotland, UK.
| | - J Egan
- Glasgow Centre for Population Health, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK.
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Fredman L, Ranker LR, Strunin L, Smith ML, Applebaum KM. Caregiving Intensity and Mortality in Older Women, Accounting for Time-Varying and Lagged Caregiver Status: The Caregiver-Study of Osteoporotic Fractures Study. THE GERONTOLOGIST 2020; 59:e461-e469. [PMID: 30649308 DOI: 10.1093/geront/gny135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Caregiving is associated with reduced mortality in recent studies. Investigations of caregiving intensity may reveal an underlying mechanism. However, studies of caregiving intensity and mortality have mixed results, perhaps due to imprecise measurement of caregiving intensity, not accounting for healthier persons likely having greater caregiving involvement, or temporal changes in intensity. We examined the relationship between caregiving intensity (based on tasks performed) and mortality, treating intensity and health status as time-varying, and lagging exposure. RESEARCH DESIGN AND METHODS Caregiving tasks among 1,069 women in the Caregiver-Study of Osteoporotic Fractures study (35% caregivers) were assessed at 5 interviews conducted between 1999 and 2009. Caregivers were categorized as high intensity if they assisted a person with dressing, transferring, bathing, or toileting; or as low intensity if they assisted with other instrumental or basic activities of daily living (I/ADLs). Alternatively, high intensity was defined as assisting with more than the median number of I/ADL tasks (median-based measure). Mortality was assessed through 2011. Cox proportional hazards models estimated adjusted hazard ratios (aHR) and 95% confidence intervals based on concurrent intensity, and lagging exposure 2 years. RESULTS High-intensity caregivers had significantly lower mortality using the median-based measure after lagging exposure (aHR = 0.55, 0.34-0.89). Similar, but not statistically significant associations were observed in non-lagged analyses (aHR = 0.54, 0.29-1.04) and task-specific intensity (aHRs were 0.61 and 0.51). Low-intensity caregivers had similar mortality rates to noncaregivers in all analyses. DISCUSSION AND IMPLICATIONS Among older women, high-intensity caregivers had lower mortality rates than noncaregivers. Whether this association extends to other populations merits investigation.
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Affiliation(s)
- Lisa Fredman
- Departments of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Lynsie R Ranker
- Departments of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Lee Strunin
- Community Health Sciences, Boston University School of Public Health, Massachusetts
| | - Meghan L Smith
- Departments of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Katie M Applebaum
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington
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22
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Dharampal R, Ani C. The emotional and mental health needs of young carers: what psychiatry can do. BJPsych Bull 2020; 44:112-120. [PMID: 31739811 PMCID: PMC8058813 DOI: 10.1192/bjb.2019.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/22/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD To review the literature on the emotional and mental health needs of young carers of parents with mental illness and the extent to which such needs are recognised and supported by professionals. Three databases were systematically searched from 2008 to 2018, and five studies met the inclusion criteria. RESULTS The key findings were that young caregivers had a significantly higher dose-response mortality risk than their peers; were at increased risk of mental health difficulties, especially where the ill family member was a parent and had mental illness or misused substances; were overlooked by professionals owing to a lack of awareness; but could derive benefits from their caring role when appropriately supported. CLINICAL IMPLICATIONS Young carers are at increased risk regarding emotional and mental health needs; this risk could be mitigated by professionals recognising the young carer's role and including them in their parent's treatment plan.
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Affiliation(s)
| | - Cornelius Ani
- Surrey and Borders Partnership NHS Foundation Trust and Imperial College London, UK
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23
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Ross E, Maguire A, Donnelly M, Mairs A, Hall C, O'Reilly D. Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study. Eur J Public Health 2020; 30:396-401. [PMID: 31834366 DOI: 10.1093/eurpub/ckz220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research from the USA indicates disparities in breast cancer screening uptake for women with poor mental health. However, no attempt has been made to examine the contribution of poor mental health to socio-demographic variations in breast screening uptake. The current study aims to examine the impact of self-reported chronic poor mental health on attendance at breast screening in the UK, and to what extent this explains socio-demographic inequalities in screening uptake. METHODS Breast screening records were linked to 2011 Census records within the Northern Ireland Longitudinal Study. This identified a cohort of 57 328 women who were followed through one 3-year screening cycle of the National Health Service Breast Screening Programme. Information on mental health status, in addition to other individual and household-level attributes, was derived from the 2011 Census. Logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of attendance at screening. RESULTS 10.7% of women in the cohort reported poor mental health, and in fully adjusted analyses, these individuals were 23% less likely to attend breast screening (OR 0.77; 95% CI 0.73-0.82). Although poor mental health was a strong predictor of screening uptake, it did not explain the observed inequalities in uptake by socio-economic status, marital status, or area of residence. CONCLUSIONS This study provides novel evidence of inequalities in breast screening uptake for women with chronic poor mental health in the UK. Targeted interventions are necessary to ensure equitable screening access and to enhance overall mortality benefit.
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Affiliation(s)
- Emma Ross
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Adrian Mairs
- Quality Assurance Reference Centre, Public Health Agency, Belfast, Northern Ireland
| | - Clare Hall
- Quality Assurance Reference Centre, Public Health Agency, Belfast, Northern Ireland
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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24
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Mehri N, Kinney J, Brown S, Rajabi Rostami M. Informal Caregiving and All-Cause Mortality: A Meta-Analysis of Longitudinal Population-Based Studies. J Appl Gerontol 2019; 40:781-791. [PMID: 31838944 DOI: 10.1177/0733464819893603] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using the random-effects meta-analysis model, we investigated the effect of informal caregiving on all-cause mortality across 12 longitudinal population-based studies (seven United States; five international: United Kingdom, Northern Ireland [2], Japan, and Australia). Across the studies, the combined effect of informal caregiving on all-cause mortality was 16% lower in favor of caregivers. Subgroup analyses revealed that the relationship between informal caregiving and all-cause mortality was not significant among the U.S. studies, in contrast to the international studies. Also, the mortality advantage of informal caregivers was not evident among those studies in which informal caregiving was operationalized precisely (Activity of Daily [ADL]/Instrumental Activity of Daily Living [IADL] assistance) as opposed to more broadly. Furthermore, studies in which the kinship tie between the informal caregiver and care recipient was unspecified tended to find a mortality advantage in favor of caregivers. When covariates were considered, the results of this meta-analysis provided more support for stress theory than the healthy caregiver hypothesis.
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