Distinct impacts of high intensity caregiving on caregivers’ mental health and continuation of caregiving

Study Aim/Purpose: This study sought to measure the impacts of high intensity caregiving for older adults on informal caregivers’ mental health and continuation of caregiving as well as how those outcomes varied by level of caregiving intensity, certain caregiver characteristics, and receipt of respite. 

Summary of Methods: The author analyzed data collected from the nationwide five-wave panel Longitudinal Survey of Middle-aged and Elderly Persons conducted by the Japanese Ministry of Health, Labor and Welfare. The main dependent variable was distress, measured using the Kessler 6 non-specific distress scale – a 6-item, 5-point scale questionnaire yielding an index of distress ranging from 0 to 24. The intensity of caregiving was defined by the number of hours of informal caregiving provided per week. Caregiver characteristics examined included their work status (regular employees, irregular employees, and non-working caregivers) and whether they live with the older adult for whom they are providing care. The dichotomous proxy variable constructed to represent respite care receipt was receipt of any formal care. 

Summary of Key Results: The study found that caregivers who provide high intensity caregiving (20-40 hours per week) tended to continue with it to a greater degree than did caregivers who provide ultra-high intensity caregiving (40 hours or more per week). High-intensity caregiving was associated with worse mental health among non-working caregivers, but did not have any effect on the mental health of irregular employees. Among non-working caregivers, high intensity caregiving did not tend to last more than three years. Further, receipt of formal care (the study’s proxy measure for respite care) by non-working caregivers was significantly negatively related to mental distress, indicating that respite care was useful to reduce stress among non-working caregivers. 

Study Limitations (as cited by authors): While no limitations to the study were cited by the author it should be noted that the study’s use of a proxy measure for respite care, without descriptors of dose or care type, limits the generalizability of this study’s positive findings of the protective impact of respite care receipt and caregiver mental distress. 

Authors’ Discussion/Conclusions: The author suggests that the strong association between family caregiving and mental distress suggests that supporting family caregivers is an important public health issue and supporting non-working intensive caregivers “should be a priority public health issue.” The author called for further research, including further analyses of Japan’s longitudinal panel surveys, to determine the impact of availability and use of respite care on caregivers’ employment status and mental distress.