Informal care and the impact on depression and anxiety among Swedish adults: a population-based cohort study

Abstract

Background As the population is ageing, the need for informal caregivers increases, and thus we need to know more about the effects on caregivers. This study aims to determine both cross-sectional and longitudinal associations between perceived limitation of informal caregiving and mental health of caregivers. Methods This population-based cohort study was based on the Swedish Psykisk hälsa, Arbete och RelaTioner (PART) study, and 9346 individuals aged 18–65 were included. Data were collected through questionnaires, interviews and Swedish registers. Informal care was defined as care given to a family member. Self-reported and diagnosed depression and anxiety were included as outcomes. Covariates included sex, age, social support and socio-economic position. Ordinal logistic regression and Cox regression were performed to determine the associations between caregiving and anxiety or depression. Results Self-reported depression and anxiety was only increased among those experiencing limitations (adjusted odds ratios [aOR] 2.00, 95% confidence intervals [CI] 1.63–2.47 for depression; aOR 2.07, 95% CI 1.57–2.74 for anxiety) compared to those not giving care, respectively. The adjusted hazard ratio (aHR) were increased for diagnosed depression (aHR 1.97, 95% CI 1.27–3.05) and for diagnosed anxiety (aHR 1.86, 95% CI 1.06–3.25) among those giving care and experiencing limitations, compared to those not giving care. No significant associations were found in caregivers without limitations. Conclusion Caregivers experiencing limitations showed a significant association with short- and long-term anxiety and depression. This study implies the importance of exploring the degree to which informal caregiving can be provided without adding burden to caregivers.

Longitudinal association between informal unpaid caregiving and mental health amongst working age adults in high-income OECD countries: A systematic review

“…In line with the review inclusion criteria, all thirteen included studies 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 employed a longitudinal study design to examine the relationship between informal unpaid caring and mental health in working age adults, and all were from high-income OECD countries. Longitudinal methodology varied, with half of the studies employing fixed-effects regression methodology to assess within-person changes (changes in caregiving status for the same individual), 38 , 40 , 44 , 46 , 47 , 49 whilst the remainder examined between-person effects, comparing caregivers with non-caring individuals, 39 , 41 , 42 , 43 , 45 , 48 and one study interrogated both.…”

“…In line with the review inclusion criteria, all thirteen included studies 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 employed a longitudinal study design to examine the relationship between informal unpaid caring and mental health in working age adults, and all were from high-income OECD countries. Longitudinal methodology varied, with half of the studies employing fixed-effects regression methodology to assess within-person changes (changes in caregiving status for the same individual), 38 , 40 , 44 , 46 , 47 , 49 whilst the remainder examined between-person effects, comparing caregivers with non-caring individuals, 39 , 41 , 42 , 43 , 45 , 48 and one study interrogated both. 37 Geographically, there were two studies from Australia, 43 , 46 the United Kingdom, 39 , 45 and the United States, 40 , 42 one from Canada, 41 Sweden, 48 Germany, 38 the Netherlands, 37 Israel, 49 and Japan, 47 and one study utilised a European sample (including data from Austria, Germany, Sweden, Netherlands, Spain, Italy, France, Denmark, Switzerland, and Belgium).…”

“… 49 One study categorised caregiving by the limitation imposed by the caring role (no caregiving versus caregiving with no limitations, and caregiving with any degree or dimension of limitations in the caregiver's life). 48 Two studies categorised caregiving by load (no care versus caregiving <19 h/week, 10–19 h/week, or caregiving 20 h or more/week), 45 or frequency (no caring versus daily, weekly, and any frequency of caregiving). 44 Finally, one study categorised caregiving by caregiving episodes and chronicity.…”

“…All included studies employed a validated self-reported survey-based measure of mental health. Five studies utilised validated depressive symptom measures of mental health (CES-D 37 , 40 , 43 EURO-D 44 MDI 48 PHQ-9 49 ), five studies utilised a well-recognised psychological distress measure (K-6 41 , 47 GHQ-12 39 , 45 ), whilst one study used a modified negative affect measure to assess psychological distress. 42 Lastly, two studies employed the validated mental health inventory scale from the SF-36 (MHI-5 46 MCS 38 ) as their mental health measure.…”

“… Informal caregiving was associated with increased psychological distress [b = 0.69, SE = 0.15, p < 0.001]. Stratmann (2021) 48 Sweden Swedish Psykisk hälsa, Arbete och RelaTioner (PART) study 2 waves (1998–2000 & 2010) Logistic regression 5108 Informal caregiving The exposure was defined as informal caregiving to a family member and assessed according to a positive response to the question “Are you currently responsible for the care of a long-time sick or disabled family member?” In order to assess the perceived limitations that informal caregiving can have on the life of the caregiver, three follow up questions were asked regarding conflicts with work, leisure time, and family or friends due to informal caregiving. The exact questions asked were: Are your opportunities for work or leisure activities limited by this care responsibility?…”