A systematic overview of mental and physical disorders of informal caregivers based on population-based studies with good methodological quality is lacking. Therefore, our aim was to systematically summarize mortality, incidence, and prevalence estimates of chronic diseases in informal caregivers compared to non-caregivers. Following PRISMA recommendations, we searched major healthcare databases (CINAHL, MEDLINE and Web of Science) systematically for relevant studies published in the last 10 years (without language restrictions) (PROSPERO registration number: CRD42020200314). We included only observational cross-sectional and cohort studies with low risk of bias (risk scores 0–2 out of max 8) that reported the prevalence, incidence, odds ratio (OR), hazard ratio (HR), mean- or sum-scores for health-related outcomes in informal caregivers and non-caregivers. For a thorough methodological quality assessment, we used a validated checklist. The synthesis of the results was conducted by grouping outcomes. We included 22 studies, which came predominately from the USA and Europe. Informal caregivers had a significantly lower mortality than non-caregivers. Regarding chronic morbidity outcomes, the results from a large longitudinal German health-insurance evaluation showed increased and statistically significant incidences of severe stress, adjustment disorders, depression, diseases of the spine and pain conditions among informal caregivers compared to non-caregivers. In cross-sectional evaluations, informal caregiving seemed to be associated with a higher occurrence of depression and of anxiety (ranging from 4 to 51% and 2 to 38%, respectively), pain, hypertension, diabetes and reduced quality of life. Results from our systematic review suggest that informal caregiving may be associated with several mental and physical disorders. However, these results need to be interpreted with caution, as the cross-sectional studies cannot determine temporal relationships. The lower mortality rates compared to non-caregivers may be due to a healthy-carer bias in longitudinal observational studies; however, these and other potential benefits of informal caregiving deserve further attention by researchers.
Zusammenfassung Hintergrund In ihrer täglichen Arbeit sind Altenpflegekräfte einer Vielzahl von Belastungsfaktoren ausgesetzt. Gesundheitskompetenz (GK) kann hierbei als protektiver Faktor aufgefasst werden. Ziel der Arbeit Ziele der Befragung sind berufliche Belastungen, psychische Beanspruchung und GK von ambulanten Pflegekräften zu erfassen. Darüber hinaus werden die Zusammenhänge zwischen beruflichen Belastungen und häufigen Gedanken an einen Berufswechsel sowie zwischen der GK und häufigen Gedanken an einen Berufswechsel analysiert. Material und Methode Berufliche Belastungen und psychische Beanspruchung wurden mit dem Copenhagen Psychosocial Questionnaire (COPSOQ) und die GK mit der Kurzform des European Health Literacy Questionnaire (HLS-EU-Q16) im Rahmen einer Online-Befragung in sieben bayerischen Großstädten erfasst. Neben uni- und bivariaten Auswertungen wurden auch multivariate statistische Analysen durchgeführt. Ergebnisse Von den 261 befragten Pflegekräften werden innerhalb der beruflichen Belastungen v. a. Work-Privacy-Konflikte (87,4 %) genannt, bei den psychischen Beanspruchungen sind es mit 58,5 % häufige Gedanken an einen Berufswechsel. Ein Großteil der Befragten (51,0 %) berichtet über Schwierigkeiten im Umgang mit gesundheitsbezogenen Informationen. Befragte, die über hohe physische Anforderungen (Odds Ratio [OR]: 6,89; p < 0,001; 95 %-Konfidenzintervall [KI]: 2,75–17,23) und Work-Privacy-Konflikte (OR: 4,45; p < 0,01; 95 %-KI: 1,61–12,26) berichten, sowie Schwierigkeiten im Umgang mit gesundheitsbezogenen Informationen (OR: 13,48; p < 0,001; 95 %-KI: 6,55–27,76) besitzen, weisen ein erhöhtes Risiko auf häufige Gedanken an einen Berufswechsel zu verspüren. Schlussfolgerungen Die Reduktion von beruflichen Belastungen und die Förderung der GK kann eine wirksame Maßnahme darstellen, um Gedanken an einen Berufswechsel zu reduzieren.
The aim of this study was to measure the prevalence, effects and character of psychological abuse in women visiting antenatal clinics. A standardized questionnaire based on four different established scales (PMWI, SVAW, TSC-33, and STAI) was used to estimate the frequency of psychological, physical and sexual abuse, anxiety and depression. In the study 207 pregnant Swedish born women married to or cohabiting with Swedish born men were consecutively chosen from three different antenatal clinics from the city of Göteborg, Sweden. Personal interviews were conducted in connection to their regular visit to the antenatal clinic, ranging from the first to the third trimester. Fifty-one (24.5%) women out of 207 reported threats and/or acts of violence during the last year according to the Severity of Violence Against Women Scale (SVAW). There was 89.4% who had experienced dominance/isolation according to the Psychological Maltreatment of Women Inventory (PMWI) and 44.4% of the women reported emotional/verbal abuse. Occupational status, but not age income or education, was found to be significantly correlated to physical violence, dominance/isolation and to emotional/verbal factor according to Psychological Maltreatment of Women Inventory (PMWI). Threats of moderate violence' and 'serious violence' were strongly correlated to physical violence (correlation coefficient 0.9433 and 0.9405, respectively). Sexual abuse demonstrated a high correlation to physical violence and emotional/verbal factor. The results indicate that sexual violence is highly represented in the abusive relationship and also that depression and anxiety in the childbearing year may be caused by domestic violence. This study emphasises the importance of incorporating screening for threats and actual acts of psychological, physical and sexual abuse into routine care for women, enabling health care providers to identify high-risk patients and improve quality of care.
We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.
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