A multilevel mixed effects analysis of informal carers health in Australia: the role of community participation, social support and trust at small area level

Abstract

Background Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers’ health outcomes. Methods The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life. Results Informal carers suffered from poor mental (Beta = − 0.587, p = 0.003) and general health (Beta = − 0.670, p = 0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12–13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. Conclusion It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.

Health, Work, and Social Problems in Spanish Informal Caregivers: Does Gender Matter? (The CUIDAR-SE Study)

“…Strong support from one’s social networks was associated with a lower likelihood of problems in the three dimensions (health, work/finances, and social/family relationships) for men and in the health dimension for women. This is consistent with the literature, which has shown that social support is an important predictor of population health [ 36 , 37 ] and can help alleviate stress or make problems seem smaller [ 38 , 39 ]. A recent study found that women mainly received help from women with a similar profile, while men had broader, more diverse social networks and received more help from outside the family circle [ 40 ].…”

Social Participation as a Moderator for Caregivers’ Psychological Distress: a Dynamic Panel Data Model Analysis in Japan

“…First, the results confirmed the moderating effect of SP on the association between caregiving and PD, among women and men, consistent with previous studies (Mohanty et al, 2020;Vlachantoni et al, 2020;Wakui et al, 2012). Even after controlling for individual-specific fixed effects and other factors, the DPD model results suggest that SP considerably mitigated the adverse impact of caregiving on caregivers' mental health.…”

“…In this study, we examined the moderating effect of SP on the association between caregiving and PD, using longitudinal data. An increasing number of studies have investigated the contribution of SP in the association between informal caregiving and caregivers' mental health (Mohanty et al, 2020;Schüz et al, 2015;Vlachantoni et al, 2020;Wakui et al, 2012). These studies observed that SP mitigates the adverse impact of SP on caregivers' psychological well-being, consistent with the conventional view of the favorable impact of SP on health outcomes.…”

“…These studies observed that SP mitigates the adverse impact of SP on caregivers' psychological well-being, consistent with the conventional view of the favorable impact of SP on health outcomes. Mohanty et al (2020) further demonstrated that SP is more beneficial for caregivers than non-caregivers, presumably because caregiving results in more activity limitations (Miller & Montgomery, 1990). However, most preceding studies in this field are cross-sectional studies, which could not fully control for endogeneity or simultaneity biases related to an individual's unobserved attributes.…”

Social Capital as a Moderator for Caregivers’ Psychological Distress: A Dynamic Panel Data Model Analysis in Japan

“…However, the role played by SCs in the association between informal caregiving and caregivers' mental health is yet to be effectively studied. A notable exception is Mohanty et al (2019)'s cross-sectional analysis [20], which showed that SC had a favorable impact on both the mental and general health of caregivers and non-caregivers. This study did demonstrate that SC was more bene cial for caregivers than non-caregivers.…”