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Applebaum AJ, Sannes TS. The Importance of Honoring Family Caregiver Burden: Challenges in Mental Health Care Delivery. J Clin Psychol Med Settings 2025; 32:193-201. [PMID: 39397232 DOI: 10.1007/s10880-024-10051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 10/15/2024]
Abstract
There is growing recognition of the profound mental health challenges faced by the 53 million U.S. family caregivers, and the need for increased access to psychosocial care for this vulnerable population. Family caregivers are increasingly seeking support from hospital-based counseling centers. This trend-combined with a public policy landscape that promotes the delivery of caregiver-specific supports and services-highlights challenges faced by mental health professionals to provide and bill for psychosocial care to family caregivers. In this paper, we discuss three interrelated challenges that mental health professionals face in providing care to family caregivers and which our field needs to confront as healthcare transfers more responsibilities onto the shoulders of family caregivers: (1) caregiver burden is not recognized as a formal diagnosis; (2) current documentation for caregivers is typically linked to patient encounters; and (3) support for family caregivers occurs within larger systematic barriers to mental health integration. By accurately describing and documenting caregiver burden and advocating for increased parity in mental health coverage, we hope that the field can bridge the gap between emerging research, momentum in policy, and available psychosocial services for this vulnerable population.
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Affiliation(s)
- Allison J Applebaum
- Caregivers Clinic, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4th Floor, New York, NY, 10017, USA.
| | - Timothy S Sannes
- Department of Psychiatry, UMass Memorial Cancer Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Oshio T. Evolution of psychological distress with age and its determinants in later life: evidence from 17-wave social survey data in Japan. BMC Public Health 2024; 24:2377. [PMID: 39223518 PMCID: PMC11367901 DOI: 10.1186/s12889-024-19912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied. METHODS We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0-24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD. RESULTS Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0-47.3%), 13.7% (95% CI: 8.2-19.3%), and 10.5% (95% CI: 8.0-13.0%), respectively; consequently increasing PD between 50 and 75 years. CONCLUSION The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.
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Affiliation(s)
- Takashi Oshio
- Institute of Economic Research, Hitotsubashi University, 2-1 Naka, Kunitachi-shi, Tokyo, 186-8603, Japan.
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Li W, Manuel DG, Isenberg SR, Tanuseputro P. Using Exploratory Structural Equation Modeling to Examine Caregiver Distress and Its Contributors. J Am Med Dir Assoc 2024; 25:817-825.e5. [PMID: 38341185 DOI: 10.1016/j.jamda.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To develop and test the direct and indirect associations between caregiver distress and its many contributing factors and covariates. DESIGN Analysis using data from a national, cross-sectional survey of Canadian caregivers. SETTING AND PARTICIPANTS A total of 6502 respondents of the 2012 General Social Survey-Caregiving and Care-receiving who self-identified as a caregiver. METHODS We used exploratory structural equation modeling to achieve our aims. Based on literature review, we hypothesized a structural model of 5 caregiving factors that contribute to distress: caregiving burden, caregiving network and support, disruptions of family and social life, positive emotional experiences, and caregiving history. Survey items hypothesized to measure each latent factor were modeled using exploratory factor analysis (EFA). After establishing a well-fit EFA model, structural equation modeling was performed to examine the relationships between caregiving factors and caregiver distress while controlling for covariates such as caregiver's and care-recipient's sociodemographic characteristics and kinship. RESULTS EFA established a well-fit model that represented caregiver distress and its 5 contributing factors as hypothesized. Although all 5 had significant effects on caregiver distress, disruptions of family and social life contributed the most (β = 0.462), almost 3 times that of caregiving burden (β = 0.162). Positive emotional experiences also substantially reduced distress (β = -0.310). CONCLUSIONS AND IMPLICATIONS Understanding the multifaceted nature of caregiver distress is crucial for developing effective strategies to support caregivers. In addition to reducing caregiving burden, having flexible resources and policies to minimize disruptions to caregivers' families (eg, flexible work policies; family-oriented education, training, and counseling) and enhance the positive aspects of caregiving may more effectively reduce distress.
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Affiliation(s)
- Wenshan Li
- Ottawa Hospital Research Institute, Clinical Epidemiology, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada.
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Clinical Epidemiology, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES uOttawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
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Nomura K, Kitagawa K, Tsuji M, Iida M, Aoki M, Miyauchi K, Hirayama J, Nagashima K, Takebayashi T, Tsutsumi A. The quantity and quality of scientific evidence about the health of working women in occupational health of Japan: A scoping review. J Occup Health 2023; 65:e12427. [PMID: 37845837 PMCID: PMC10579630 DOI: 10.1002/1348-9585.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE We aim to investigate the quantity and quality of scientific evidence dealing with comprehensive health issues of working women in occupational health. METHODS This scoping review of original articles that investigated comprehensive health issues of working women aged 19-64 years in Japan was published in PubMed (1967-2022) and Igaku Chuo Zasshi (or Ichu-shi, 1982-2022). Using identical broad search terms, we first identified 17 122 English and 6154 Japanese articles. We excluded those with clinically relevant topics, or ethnicity other than Japanese and included 853 English and 855 Japanese articles for review and classified them into nine research areas considered to be critical factors for women in the workforce and five study design groups to investigate the quality of the evidence accumulated. RESULTS Among 853 English-language articles in PubMed, "Mental health" was the most frequent area studied, followed by "Work-related disease" and "Lifestyle-related disease." Among 855 Japanese-language articles from Ichu-shi, "Mental health" was the most frequently studied area followed by "Work and balance," and "Work-related disease." "Infertility, pregnancy, and childbirth" and "Menstruation, menopause, and genital disease" were well studied in Ichu-shi but scarcely published in PubMed. "Harassment and discrimination" were sparsely reported in both databases. As for research designs, many articles in both PubMed and Ichu-shi employed descriptive or cross-sectional study designs. However, a few studies employed cohort/longitudinal or interventional studies. CONCLUSION The results underscored the need for higher-quality study designs with more scientific evidence on working women's health in the field of occupational health.
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Affiliation(s)
- Kyoko Nomura
- Department of Environmental Health Science and Public HealthAkita University Graduate School of MedicineAkitaJapan
| | - Kyoko Kitagawa
- Department of Environmental HealthUniversity of Occupational and Environmental HealthKitakyushuJapan
- Division of Ultrastructural Cell Biology, Department of AnatomyUniversity of MiyazakiMiyazakiJapan
| | - Mayumi Tsuji
- Department of Environmental HealthUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Miho Iida
- Department of Preventive Medicine and Public HealthKeio University School of MedicineTokyoJapan
| | - Mizuki Aoki
- Department of Environmental Health Science and Public HealthAkita University Graduate School of MedicineAkitaJapan
| | - Kasane Miyauchi
- Department of Environmental Health Science and Public HealthAkita University Graduate School of MedicineAkitaJapan
| | - Junko Hirayama
- Department of Environmental Health Science and Public HealthAkita University Graduate School of MedicineAkitaJapan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research CenterKeio University HospitalTokyoJapan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public HealthKeio University School of MedicineTokyoJapan
| | - Akizumi Tsutsumi
- Department of Public HealthKitasato University School of MedicineSagamiharaJapan
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Itagi ABH, Dipankar SP, Krishna Veni D, Yunus GY. Evaluation of Spirometric Measures and Quality of Sleep in Tuberculosis Patients and Their Non-Tuberculosis Family Caregivers. Cureus 2021; 13:e17788. [PMID: 34659999 PMCID: PMC8496126 DOI: 10.7759/cureus.17788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/05/2022] Open
Abstract
Background and Aim Tuberculosis (TB) patients may present with depression and poor sleep as co-morbidities. This presents great challenges including the stigma of increased risk of developing TB while taking care of such patients. This study aims to determine the lung functions, quality of sleep in tuberculosis patients in comparison with non-tuberculosis (non-TB) family caregivers. Methods TB patients and their family caregivers (60 each) visiting the Directly Observed Therapy Short-course (DOTS) clinic at a tertiary care hospital were assessed for spirometric parameters and quality of sleep. Spirometry measurements were performed using a portable, computerized, pre-calibrated, electronic, dry type of machine. Pulmonary function impairment pattern and severity were assessed from spirometry results using a percentage of the predicted values of Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). Descriptive statistics and t-tests were applied using SPSS version 19.0. p≤0.05 was considered significant. Results TB patients had a significantly more (p=0.000) sleep disturbance, daytime dysfunction, and higher mean global Pittsburgh Sleep Quality Index (PSQI) score (9.56±3.97) compared to their non-TB family caregivers (4.36±2.07). The spirometric measures were reduced in TB patients and showed significant differences in actual measures of all parameters except FVC (actual). The % predicted measures of FEV1, FEF 25%-75%, PEFR, and MVV showed significant differences in comparison to their non-TB family caregivers. Conclusions The present study shows that TB patients have a poor quality of sleep and pulmonary functions compared to their non-TB family caregivers. Health care workers need to develop systematic strategies to screen the symptoms of mental disorders in tuberculosis patients and their family caregivers to enable better management of this population.
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Affiliation(s)
| | | | - D Krishna Veni
- Physiology, Nimra Institute of Medical Sciences, Vijayawada, IND
| | - G Y Yunus
- Public Health Dentistry, ESIC Dental College, Kalaburagi, IND
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Association between Having Cancer and Psychological Distress among Family Caregivers Using Three Years of a Nationwide Survey Data in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910479. [PMID: 34639779 PMCID: PMC8508454 DOI: 10.3390/ijerph181910479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/11/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022]
Abstract
We aimed to describe the characteristics of caregivers with cancer compared to those without and analyze the association between having cancer and caregivers' psychological distress in Japan. We used data from the Japanese Comprehensive Survey of Living Conditions in 2010, 2013, and 2016. The participants were 5258 family caregivers aged ≥40 years, caring for only one family member whose information in the dataset was available for all the covariates included in the model. The family caregivers' psychological distress was defined by the Kessler Psychological Distress Scale (K6) score (K6 ≥ 5). We conducted a Poisson regression analysis to examine the association between having cancer and family caregivers' distress. The sample of family caregivers consisted of mostly females (69.3%) and people within the 40-64 years age group (51.8%). As a result, family caregivers with cancer increased across the survey periods; a higher number of participants were unemployed. When adjusted for covariates, including the presence of other diseases, having cancer was significantly associated with distress (risk ratio 1.33, 95% confidence interval 1.05-1.69) among family caregivers. Family caregivers with cancer are expected to increase in the future; it is important to provide them with more support in managing both their treatment and caregiving to cope with their distress.
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Virtanen M, Myllyntausta S, Ervasti J, Oksanen T, Salo P, Pentti J, Kivimäki M, Ropponen A, Halonen JI, Vahtera J, Stenholm S. Shift work, work time control, and informal caregiving as risk factors for sleep disturbances in an ageing municipal workforce. Scand J Work Environ Health 2021; 47:181-190. [PMID: 33237332 PMCID: PMC8126445 DOI: 10.5271/sjweh.3937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives: This study aimed to examine the contribution of shift work, work time control (WTC) and informal caregiving, separately and in combination, to sleep disturbances in ageing employees. Methods: Survey data were obtained from two prospective cohort studies with repeated measurements of working conditions, informal caregiving, and sleep disturbances. We used fixed-effect conditional logistic regression analysis to examine whether within-individual changes in shift work, WTC and informal caregiving were associated with changes in sleep. Secondary analyses included between-individuals comparison using standard logistic regression models. Results from the two cohorts were pooled using meta-analysis. Results: Low WTC and informal caregiving were associated with sleep disturbances in within-individual analyses [odds ratios (OR) ranging between 1.13 (95% confidence interval 1.01–1.27) and 1.48 (95% CI 1.29–1.68)] and in between-individuals analyses [OR 1.14 (95% CI 1.03–1.26) to 1.33 (1.19–1.49)]. Shift work alone was not associated with sleep disturbances, but accumulated exposure to shift work, low WTC and informal caregiving was associated with higher risk of sleep disturbances (OR range 1.21–1.76). For some of the sleep outcomes, informal caregiving was related to a higher risk of sleep disturbances when WTC was low and a lower risk when WTC was high. Conclusions: Informal caregiving and low WTC are associated with risk of sleep disturbances among ageing employees. The findings also suggest that low WTC in combination with informal caregiving may increase the risk of sleep disturbances whereas high WTC may alleviate the adverse impact of informal caregiving on sleep.
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Affiliation(s)
- Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, FI-80101 Joensuu, Finland.
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Hanari K, Sugiyama T, Inoue M, Mayers T, Tamiya N. Caregiving Experience and Other Factors Associated With Having End-Of-Life Discussions: A Cross-Sectional Study of a General Japanese Population. J Pain Symptom Manage 2021; 61:522-530.e5. [PMID: 32827656 DOI: 10.1016/j.jpainsymman.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The factors associated with end-of-life discussion (EOLD) are not well elucidated; an understanding of these factors may help facilitate EOLD. OBJECTIVES To investigate the associations between EOLD and experiences of the death of and/or care for a loved one and other factors. METHODS Data from a nationwide anonymous questionnaire survey of public attitudes toward end-of-life medical care, conducted in December 2017 in Japan, were used. Participants were randomly selected from the general population (age ≥ 20 years), and respondents who completed the questionnaire were analyzed (respondents: n = 836; effective response rate: 13.9%). Respondents were divided into two groups based on their experience of EOLD: those who had engaged in EOLD and those who had not. The main predictors were the experiences of the death of and care for a loved one. Multivariable logistic regression analyses were performed. RESULTS Of the 836 respondents (male: 55.6%, aged 65 and over: 43.5%), 43.7% reported their engagement in EOLD. In the analyses, "having experience of caring for a loved one" was associated with EOLD compared with never having experience (odds ratio 1.88, 95% confidence interval 1.35-2.64). However, having experience of the death of a loved one had no association. CONCLUSION For health-care providers, it may be worth recognizing that the care experience of their patient's caregiver might affect the caregiver's own EOLD in the future.
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Affiliation(s)
- Kyoko Hanari
- Doctoral Programs in Medical Sciences, Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan; Health Services Research & Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan; Faculty of Medicine, Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan; Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Megumi Inoue
- Department of Social Work, George Mason University, Fairfax, Virginia, USA
| | - Thomas Mayers
- Faculty of Medicine, Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan; Faculty of Medicine, Medical English Communications Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan; Faculty of Medicine, Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kalavar JM, Zarit SH, Lecnar C, Magda K. I’m Here, You’re There: In-Absentia Caregiver Stress & Transnational Support of Elderly Mothers by Adult Children. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2020. [DOI: 10.1080/15350770.2020.1787044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Christopher Lecnar
- Penn State University, New Kensington Campus, New Kensington, Pennsylvania, USA
| | - Kirsten Magda
- Georgia Gwinnett College, Lawrenceville, Georgia, USA
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Miyawaki A, Kobayashi Y, Noguchi H, Watanabe T, Takahashi H, Tamiya N. Effect of reduced formal care availability on formal/informal care patterns and caregiver health: a quasi-experimental study using the Japanese long-term care insurance reform. BMC Geriatr 2020; 20:207. [PMID: 32532253 PMCID: PMC7291452 DOI: 10.1186/s12877-020-01588-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is unclear how formal long-term care (LTC) availability affects formal /informal caregiving patterns and caregiver health. We tested the impact of reduced formal LTC availability on formal LTC service use, intensity of informal caregiving, and caregiver health. METHODS Using a representative, repeated cross-sectional sample of Japanese caregivers providing care to co-resident family members from 2001 to 2016, we applied a difference-in-differences approach by observing caregivers before and after the major reform of the public Japanese LTC insurance (LTCI) in 2006. The reform reduced coverage benefits for non-institutionalized older persons with low care needs, but not for those with high care needs. We analyzed 12,764 caregivers aged ≥30 years (mean age 64.3 ± 11.8 years, 73.5% women) and measured indicators of formal LTC use, hours of informal caregiving, and caregiver self-reported health outcomes after propensity score matching to balance caregivers' background characteristics. RESULTS We found the 2006 LTCI reform relatively reduced the use of formal LTC services and relatively increased the percentage of experiencing long hours of informal caregiving (> 3 h per day) among the caregivers for seniors with low care needs compared to those for seniors with high care needs. The effects of the LTCI reform for the caregivers for seniors with low care needs were 2.2 percentage point higher on caregivers' experiencing poor self-rated health (95% confidence interval [CI]: 0.7-3.7; p = 0.01), 2.7 percentage point higher on experiencing symptoms of a depressive state (95%CI: 0.5-4.8; p = 0.03), and 4.7 percentage point higher on experiencing symptoms of musculoskeletal diseases (95%CI, 3.6-5.7; p < 0.001), compared to those for seniors with high care needs. CONCLUSIONS Reduced formal care availability under the Japanese LTCI reform increased hours of informal caregiving corresponding to reduced use of formal LTC and deteriorated multiple dimensions of caregiver health. Our findings may highlight the importance of enhancing the availability of formal LTC services for caregiver health.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan. .,Health Services Development and Research Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 3058577, Japan.
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishiwaseda Shinjuku-ku, Tokyo, 1698050, Japan
| | - Taeko Watanabe
- Health Services Development and Research Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 3058577, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 3058577, Japan
| | - Hideto Takahashi
- National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 3510197, Japan
| | - Nanako Tamiya
- Health Services Development and Research Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 3058577, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki, 3058577, Japan
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Yu Y, Liu ZW, Li TX, Zhou W, Xi SJ, Xiao SY, Tebes JK. A comparison of psychometric properties of two common measures of caregiving burden: the family burden interview schedule (FBIS-24) and the Zarit caregiver burden interview (ZBI-22). Health Qual Life Outcomes 2020; 18:94. [PMID: 32252766 PMCID: PMC7137330 DOI: 10.1186/s12955-020-01335-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/19/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose The Family Burden Interview Schedule (FBIS-24) and the Zarit Caregiver Burden Interview (ZBI-22) are among the most widely used measures for assessing caregiving burden, but their psychometric performances have not been compared in the same study of caregivers of people living with schizophrenia (PLS). This is important because the measures assess overlapping constructs- the FBIS-24 assesses objective burden (e.g., completion of manual tasks) and the ZBI-22 assesses subjective burden (e.g., perceived distress, stigma). This study seeks to fill this gap by comparing the reliability and validity of the FBIS-24 and the ZBI-22 in a Chinese community sample of caregivers of PLS. Methods A Cross-sectional stud was conducted in a community-based mental health service program in Central South part of China. A total of 327 primary family caregivers of PLS completed face-to-face interviews of the FBIS-24, the ZBI-22, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR), and PLS were assessed using the Global Assessment of Function scale (GAF). Results Our findings show that both the FBIS-24 and ZBI-22 have comparable psychometric performance in terms of the internal consistency, convergent validity and known group’s validity. Conclusion Both the FBIS-24 and the ZBI-22 are psychometrically sound measures of caregiving burden but the choice of which measure to use will depend on the research question.
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Affiliation(s)
- Yu Yu
- Hospital Evaluation Office, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, Hunan, 410008, China.,Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
| | - Zi-Wei Liu
- School of Medicine, Hunan Normal University, 371 Tongzhi Road, Changsha, Hunan, 410013, China
| | - Tong-Xin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, China
| | - Wei Zhou
- Hospital Administration Institute, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, Hunan, 410008, China
| | - Shi-Jun Xi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, China
| | - Shui-Yuan Xiao
- Mental Health Center, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, Hunan, 410008, China.
| | - Jacob Kraemer Tebes
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
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12
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Corry M, Neenan K, Brabyn S, Sheaf G, Smith V, Cochrane Consumers and Communication Group. Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses. Cochrane Database Syst Rev 2019; 5:CD012533. [PMID: 31087641 PMCID: PMC6516056 DOI: 10.1002/14651858.cd012533.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location. OBJECTIVES The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population. SEARCH METHODS We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another. DATA COLLECTION AND ANALYSIS Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively. MAIN RESULTS We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison. AUTHORS' CONCLUSIONS Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.
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Affiliation(s)
- Margarita Corry
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
| | - Kathleen Neenan
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
| | - Sally Brabyn
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO10 5DD
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Valerie Smith
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
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Miyawaki A, Tanaka H, Kobayashi Y, Kawachi I. Informal caregiving and mortality―Who is protected and who is not? A prospective cohort study from Japan. Soc Sci Med 2019; 223:24-30. [DOI: 10.1016/j.socscimed.2019.01.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 02/01/2023]
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Kumagai N. Distinct impacts of high intensity caregiving on caregivers' mental health and continuation of caregiving. HEALTH ECONOMICS REVIEW 2017; 7:15. [PMID: 28389976 PMCID: PMC5383799 DOI: 10.1186/s13561-017-0151-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/12/2017] [Indexed: 06/07/2023]
Abstract
Although high-intensity caregiving has been found to be associated with a greater prevalence of mental health problems, little is known about the specifics of this relationship. This study clarified the burden of informal caregivers quantitatively and provided policy implications for long-term care policies in countries with aging populations. Using data collected from a nationwide five-wave panel survey in Japan, I examined two causal relationships: (1) high-intensity caregiving and mental health of informal caregivers, and (2) high-intensity caregiving and continuation of caregiving. Considering the heterogeneity in high-intensity caregiving among informal caregivers, control function model which allows for heterogeneous treatment effects was used.This study uncovered three major findings. First, hours of caregiving was found to influence the continuation of high-intensity caregiving among non-working informal caregivers and irregular employees. Specifically, caregivers who experienced high-intensity caregiving (20-40 h) tended to continue with it to a greater degree than did caregivers who experienced ultra-high-intensity caregiving (40 h or more). Second, 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. The control function model revealed that caregivers engaging in high-intensity caregiving who were moderately mentally healthy in the past tended to have serious mental illness currently. Third, non-working caregivers did not tend to continue high-intensity caregiving for more than three years, regardless of co-residential caregiving. This is because current high-intensity caregiving was not associated with the continuation of caregiving when I included high-intensity caregiving provided during the previous period in the regression. Overall, I noted distinct impacts of high-intensity caregiving on the mental health of informal caregivers and that such caregiving is persistent among non-working caregivers who experienced it for at least a year. Supporting non-working intensive caregivers as a public health issue should be considered a priority.
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Affiliation(s)
- Narimasa Kumagai
- Faculty of Economics, Kindai University, 3-4-1 Kowakae, Higashiosaka, Osaka, 577-8502, Japan.
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15
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Sugiyama T, Tamiya N, Watanabe T, Wakui T, Shibayama T, Moriyama Y, Yamaoka Y, Noguchi H. Association of care recipients' care-need level with family caregiver participation in health check-ups in Japan. Geriatr Gerontol Int 2017; 18:26-32. [PMID: 28776904 DOI: 10.1111/ggi.13131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/11/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
Abstract
AIM The public mandatory long-term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check-ups in Japan. METHODS The present study was a cross-sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients' care-need level and in-home caregiver participation in health check-ups during the last year of the survey for caregivers. RESULTS A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check-up by care-need level were 68.4% (support required 1 and 2), 63.5% (care required 1-3) and 60.3% (care required 4 and 5). Higher care-need level was negatively associated with caregiver participation in health check-ups (support required 1 and 2as reference, care required 1-3: odds ratio 0.82, 95% confidence interval 0.75-0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74-0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self-rating of health as independent variables did not change the result. CONCLUSIONS These results suggest that facilitating health check-up participation for family caregivers of care recipients with higher care-need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2018; 18: 26-32.
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Affiliation(s)
- Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, Center for Global Health and Medicine, Tokyo, Japan.,Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Taeko Watanabe
- Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomoko Wakui
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Yoko Moriyama
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Health and Welfare Services, National Institute of Public Health, Saitama, Japan
| | - Yui Yamaoka
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
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16
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Aloba O, Ajao O, Alimi T, Esan O. Psychometric Properties and Correlates of the Beck Hopelessness Scale in Family Caregivers of Nigerian Patients with Psychiatric Disorders in Southwestern Nigeria. J Neurosci Rural Pract 2017; 7:S18-S25. [PMID: 28163498 PMCID: PMC5244054 DOI: 10.4103/0976-3147.196434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To examine the construct and correlates of hopelessness among family caregivers of Nigerian psychiatric patients. Materials and Methods: This is a cross-sectional, descriptive study involving 264 family caregiver-patients’ dyads recruited from two university teaching hospitals psychiatric clinics in Southwestern Nigeria. Results: Exploratory factor analysis revealed a two-factor 9-item model of the Beck Hopelessness Scale (BHS) among the family caregivers. Confirmatory factor analysis of the model revealed satisfactory indices of fitness (goodness of fit index = 0.97, comparative fit index = 0.96, Chi-square/degree of freedom (CMIN/DF) = 1.60, root mean square error of approximation = 0.048, expected cross-validation index = 0.307, and standardized root mean residual = 0.005). Reliability of the scale was modestly satisfactory (Cronbach's alpha 0.72). Construct validity of scale was supported by significant correlations with the family caregivers’ scores on the Zarit Burden Interview, mini international neuropsychiatric interview suicidality module, General Health Questionnaire-12 (GHQ-12), and Patient Health Questionnaire-9. The greatest variance in the family caregivers’ scores on the BHS was contributed by their scores on the psychological distress scale (GHQ-12). Conclusions: The BHS has adequate psychometric properties among Nigerian psychiatric patients’ family caregivers. There is the need to pay attention to the psychological well-being of the family caregivers of Nigerian psychiatric patients.
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Affiliation(s)
- Olutayo Aloba
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olayinka Ajao
- Department of Psychiatric Nursing, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Taiwo Alimi
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olufemi Esan
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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17
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Corry M, Smith V, Neenan K, Brabyn S. Telephone interventions, delivered by healthcare professionals, for educating and psychosocially supporting informal caregivers of adults with diagnosed illnesses. Hippokratia 2017. [DOI: 10.1002/14651858.cd012533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Margarita Corry
- Trinity College Dublin; School of Nursing and Midwifery; Dublin Ireland
| | - Valerie Smith
- Trinity College Dublin; School of Nursing and Midwifery; Dublin Ireland
| | - Kathleen Neenan
- Trinity College Dublin; School of Nursing and Midwifery; Dublin Ireland
| | - Sally Brabyn
- University of York; Department of Health Sciences; Heslington York UK YO10 5DD
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18
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Oshio T, Kan M. How do social activities mitigate informal caregivers' psychological distress? Evidence from a nine-year panel survey in Japan. Health Qual Life Outcomes 2016; 14:117. [PMID: 27549086 PMCID: PMC4994414 DOI: 10.1186/s12955-016-0521-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well known that informal caregiving negatively affects caregivers' mental health, while social activities improve mental health outcomes among middle-aged and elderly individuals. The goal of the present study was to examine how participation in social activities affected the trajectory of an informal caregiver's psychological distress. METHODS We used the data from a nationwide nine-wave panel survey of the middle-aged individuals (aged 50-59 years at baseline) in Japan conducted in 2005-13 (N = 24,193 individuals;12,352 women and 11,841 men), mainly focusing on the respondents beginning to provide informal caregiving during the survey period. We employed linear mixed-effects models to explain how the trajectory of psychological distress, measured by Kessler 6 (K6) scores, was associated with caregiving commencement and duration, as well as social activity participation. RESULTS Participation in social activities was associated with mitigated K6 scores at caregiving commencement by 66.2 and 58.2 % for women and men, respectively. After caregiving started, participation in social activities reduced the average rise in K6 scores, per year, by 65.6 and 89.6 % for women and men, respectively. We observed similar results when focusing on participation before caregiving commencement to avoid endogeneity problems. CONCLUSION Results suggest that participation in social activities can alleviate caregivers' psychological distress. Policy measures to support social activities are recommended for the health and well-being of current and potential caregivers.
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Affiliation(s)
- Takashi Oshio
- Institute of Economic Research, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8603, Japan.
| | - Mari Kan
- School of Economics, University of Hyogo, 8-2-1 Gakuen-Nishi-machi, Nishi-ku, Kobe, Hyogo, 651-2197, Japan
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