Income-based inequalities in caregiving time and depressive symptoms among older family caregivers under the Japanese long-term care insurance system: A cross-sectional analysis

Abstract

AimLong-term care systems may alleviate caregiver burdens, particularly for those with fewer resources. However, it remains unclear whether socioeconomic disparity in caregiver burdens exists under a public, universal long-term care insurance (LTCI) system. This study examined income-based inequalities in caregiving time and depressive symptoms in Japanese older family caregivers. We further compared inequality in depressive symptoms with that of non-caregivers to evaluate whether family caregiving exacerbates this disparity.MethodsData were obtained from a cross-sectional, nationwide survey conducted by the Japan Gerontological Evaluation Study in 2013. Participants were functionally independent older adults aged ≥65 years (N = 21,584). Depressive symptoms were assessed using the Geriatrics Depression Scale (GDS); caregiving hours per week, household income, and other covariates were also assessed.ResultsFamily caregivers occupied 8.3% of the total. A Poisson regression model revealed that caregivers in lower income groups (compared to those in the highest) were 1.32 to 1.95 and 1.63 to 2.68 times more likely to engage in ≥36 and ≥72 hours/week of caregiving, respectively. As for the GDS (≥5), an excess risk was found in the caregivers in lower (compared to higher) income groups (adjusted prevalence ratio: 1.57–3.10). However, an interaction effect of income by caregiving role indicated no significant difference in inequality between caregivers and non-caregivers (p = .603). The excess risk for GDS (≥5) in the caregivers compared to non-caregivers was observed across income groups.ConclusionsOur findings revealed a possible disparity in family caregivers under the public LTCI system. Further studies should examine factors associated with longer caregiving hours in lower income households. Our findings also suggest the necessity for more efforts to alleviate depressive symptoms in family caregivers under the LTCI system regardless of income level, rather than exclusively supporting those with a low income.

Family Caregivers’ Perspectives for the Effect of Social Support on their Care Burden and Quality of Life: A Mixed-Method Study in Rural and Sub-Urban Central Japan

“…Second, this study found that higher income was significantly correlated to lower overall QOL and MCS scores. This result is contrary to previous studies that reported lower income negatively affected QOL (Zhang et al 2015;Saito et al 2018). From qualitative results, we found that most participants felt low burden since the long-term care expenses were covered with care recipients' long-term care insurance.…”

Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability

“…We identified the educational attainment of both the caregiver and care-receiver as the most robust determinant of objective burden. This finding is in line with previous studies that demonstrated a higher level of caregiving intensity in those with lower educational attainment [7, 9, 54, 55]. Since educational status remains relatively stable over the adult life course, education level may reflect an intrinsic resource that captures the capability of caregivers to manage caregiving tasks efficiently and effectively.…”

“…Poor access to stress-buffering resources may not be the only pathway through which SEP impacts upon caregiver burden. Evidence suggests that the prevalence of disability, and therefore the need for informal care, is highest in those with the lowest SEP [6, 7, 19–21]. Not only are disabling conditions more prevalent in those with the lowest SEP, but those already affected by a disability are more prone to secondary health conditions and comorbidities if they are socially disadvantaged [22–24].…”

The Association between Family Caregiver Burden and Subjective Well-Being and the Moderating Effect of Social Participation among Japanese Adults: A Cross-Sectional Study

“…The results of our study showed that higher caregiver burden was associated with lower subjective well-being among women. Previous studies have reported that higher caregiver burden led to impaired psychological health, such as depression [8,9] and low well-being [10,11], due to physical or instrumental provision of aid to care recipients and stress or anxiety [6,7]. Our results supported these previous studies.…”

“…Family caregiving can be a significant burden on caregivers, and includes heavy assistance with activities of daily living, the decline of social connections and financial deprivation, which can cause psychological distress [6,7]. As a result of these issues, family caregivers often have impaired psychological health [8,9] and impaired subjective well-being [10,11]. Especially because the impairment of happiness is associated with various adverse health conditions [12], the caregivers' subjective well-being should be protected to prevent the collapse of the care system in Japan, where the majority of care is dependent on family caregiving.…”