The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains

Abstract

Objectives We estimate the causal impact of intensive caregiving, defined as providing at least 80 hours of care per month, and work, on the mental health of caregivers while considering possible sources of endogeneity in these relationships. Methods We use two linked data sources from the U.S. by matching caregivers in the National Study of Caregiving (NSOC) with corresponding care recipients in the National Health and Aging Trends Study (NHATS) for years 2011-2017. We address possible sources of endogeneity in the relationships between caregiving, work and mental health by using instrumental variables methodology, instrumenting for both caregiving and work behavior. We examine two measures used to screen for depression (PHQ-2 psychodiagnostic test) and anxiety (GAD-2 generalized anxiety disorders screening instrument), a composite measure that combines these measures (PHQ-4), and positive well-being variables to ascertain possible gains from caregiving. Results Providing at least 80 hours of care per month to a parent compared to less intensive caregiving increases the PHQ-4 Scale for anxiety and depression disorders. This is driven by the screening score for anxiety and not psycho-diagnostics test scores for depression. Relationship quality decreases substantially for intensive caregivers, and intensive caregiving leads to less satisfaction that the care recipient is well-cared for. We do not find offsetting mental health gains for intensive caregivers compared to non-intensive caregivers. Work does not independently impact mental health of caregivers. Discussion Caregiver interventions that reduce objective demands or support intensive caregivers could reduce or prevent well-being losses and improve caregiver’s relationship with the recipient.

Rural disparities in use of family and formal caregiving for older adults with disabilities

“…While family caregivers may experience benefits due to caregiving, family caregiving can also result in burden with regards to finances, stressors, and work productivity. [14][15][16] Rural family caregivers are more likely to experience financial strain associated with caregiving and report barriers to accessing caregiver supports and respite than the average caregiver. 17 Thus, rural family caregivers may experience increasing adverse effects due to caregiving due to the increased financial strain and lack of access to robust support services.…”

“…First, our findings of disproportionate reliance on family caregivers for rural older adults are concerning given existing disparities in caregiver burden and access to caregiver supports by rurality. While family caregivers may experience benefits due to caregiving, family caregiving can also result in burden with regards to finances, stressors, and work productivity 14–16 . Rural family caregivers are more likely to experience financial strain associated with caregiving and report barriers to accessing caregiver supports and respite than the average caregiver 17 .…”

Family Caregiving of Patients With Heart Failure and Vascular Dementia in Rural Appalachia: A Mixed-Methods Study

“…This PHQ-4 measure has been used to screen for anxiety and depression symptoms in caregiving studies. 35,36…”

“…This PHQ-4 measure has been used to screen for anxiety and depression symptoms in caregiving studies. 35,36 Caregiver outcomes (dependent variables measures). Caregiving burden was measured by the 12-item, 5-point Likerttype scale Zarit Burden Interview, version 12 (ZBI-12).…”