Associations between young informal caring and mental health: a prospective observational study using augmented inverse probability weighting

Deterioration of health-related quality of life: the hidden health burden of informal caregiving

Informal caregiving is physically and mentally demanding and may lead to poor health and impaired well-being. We aim to check the effects of informal caregiving on health-related quality of life (HRQoL). We utilised longitudinal data from the most recent sixteen waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We measured HRQoL through the physical component summary (PCS), the mental component summary (MCS), the short-form six-dimension (SF-6D) utility index, and the eight dimensions of the SF-36 health survey. The primary exposure variable is informal caregiving. The variable was categorised into not a caregiver, lighter (< 5 hours [h]/week), moderate (5-19 h/week), and intensive (≥ 20 h/week) caregiving based on the hours of providing informal care per week. We have found that informal caregiving negatively affects HRQoL. We found that moderate (β = -0.0035, standard error [SE] = 0.0012) and intensive caregiving (β = -0.0074, SE = 0.0020) reduced SF-6D utility value. We also found that lighter (β = -0.29, SE = 0.07), moderate (β = -0.55, SE = 0.12), and intensive (β = -1.53, SE = 0.19) caregiving lowered MCS scores. Moreover, our results revealed that lighter, moderate and intensive caregiving decreases the scores of mental health-related dimensions (e.g., role emotional, social functioning, and mental health) of the SF-36 health survey. Our study findings have significant policy implications for improving the HRQoL and well-being of caregivers. To effectively support the health and well-being of informal carers, it is crucial to implement strategies that address their diverse needs, including supporting work-life balance, providing financial assistance and social security measures, ensuring access to community-based services, providing access to relevant information and training, and offering respite care options.

A Longitudinal Analysis Comparing the Mental Health of Children By Level of Young Carer Status

INTRODUCTION

Young carers research has predominantly focused on the experiences of children who often provide substantial levels of care for family members, and the impacts of this caring on their lives. While quantitative studies of prevalence have increased, there have been increasing calls for cross-sectional and longitudinal studies of young carers relative to children without caring responsibilities, to strengthen and challenge the existing evidence on impact.

METHODS/MATERIALS

The study utilized the Longitudinal Study of Young People in England: Next Steps (LSYPE), a cohort study of over 12,500 children aged 13 in 2004. The data set enabled the cross-sectional and longitudinal study of young carers mental health relative to those without caring responsibilities. A descriptive analysis produced separate prevalence estimates for the whole young carer spectrum and those with more substantial responsibilities, and assessed caring impact on individual mental health aspects. This was a precursor to the structural equation modelling (SEM) of their overall mental health.

RESULTS

The findings highlighted the marginal or positive impacts of short-term caring responsibilities, but also how mental health deteriorated over time. Both the short-term benefits and long-term deterioration of mental health was of a higher magnitude for those with more substantial responsibilities.

CONCLUSION

The analysis of the larger young carer spectrum highlighted a diversity of positive and negative outcomes. While this was partly due to the size of the caring roles, duration of time in the carer role was a key factor in problematic caring roles.

Young Carers in Early Childhood-How Are Young Carers Represented in Broader Literature and What Factors Influence Dominant Representations of Young Carers in Early Childhood in the UK?

Contextualization of young carers in early childhood is complex. Biopsychosocial impacts of young caregiving are receiving growing interest, yet the voice and experience of society's youngest carers (0-5 years) remain absent from the literature. This scoping review explores representation of young carers in their early years (0-5 years), presented as part of a broader program of PhD research undertaken by the lead author. Aiming to influence systematic change in the way young carers are perceived and supported in society, further research is recommended. This will serve to better inform whole family support strategies in the context of young carer policy and practice. This review has been undertaken following JBI guidance for scoping reviews. A comprehensive literature search included publications dated 2014-2024 in Scopus, PubMed, PsycINFO, Eric, Web of Science, and Carers Trust and NSPCC websites. The overall search yielded no studies which met the inclusion criteria. Results were discussed with knowledge users, and content experts with lived experience of caring in early childhood, at all stages of the review process. The absence of relevant research highlights a significant gap in knowledge regarding the way in which the lived experiences of young carers in early childhood are represented and understood.

Longitudinal associations between informal caring, social network, and psychological distress among adolescents and young adults: modelling within-person effects

BACKGROUND

Informal caring is associated with mental health deterioration among young people and impacts their help-seeking ability. Social network can provide social support and mitigate the impact of informal care. However, young carers may avoid identification and withdraw from social networks. Evidence regarding the reciprocal associations between caring, social network, and mental health is scarce. We aimed to investigate the directionality and specificity of the associations among the three factors in young people.

METHODS

This study used three consecutive assessment data (2021-2023; T0-T2) from the Japan COVID-19 and Society Internet Survey. We included 5539 young persons aged ≤ 25 years and 25,445 adults aged 26-59 years. Social network was measured using the Lubben Social Network Scale. Psychological distress was evaluated using the Kessler Psychological Distress Scale. Caring status was retrospectively reported at T2. We employed a random intercept cross-lagged model to detect within-person prospective associations between informal caring, social network, and psychological distress.

RESULTS

Young persons showed significant directional relationships from increased social network and psychological distress at T0 to increased likelihood of caring at T1 (standardised coefficient: 0.131 and 0.176, respectively; 95% confidence interval, 0.015-0.247 and 0.071-0.282, respectively). Adults aged 26-59 years showed a reverse relationship from caring to increased psychological distress both from T0 to T1 (0.061, 0.009-0.112) and from T1 to T2 (0.042, 0.000-0.084).

CONCLUSIONS

Increased psychological distress and social network preceded the onset of informal caring among young persons. Incorporating psychological distress assessment may benefit the early identification of and support for young carers. The long-term interplay between social networking and informal caring needs further clarification.

Promoting Mental Health and Well-Being Among Adolescent Young Carers in Europe: A Cross-National Randomized Controlled Trial Study

BACKGROUND/OBJECTIVES

This cross-national study focuses on adolescents who provide care and support to family members or significant others. Current evidence regarding their mental health and solutions to strengthen it is limited and mostly available in a few countries. The aim of this study is to evaluate the results of a primary prevention intervention for improving the mental health and well-being of adolescent young carers (AYCs) aged 15-17 years in six European countries. The intervention was based on a psychoeducational program and tools adapted from the Discoverer, Noticer, Advisor, and Values (DNA-V) model.

METHODS

We designed a randomized controlled trial with 217 AYCs participating in the study, either in the intervention or control group. Quantitative and qualitative data were collected via questionnaires at baseline, post-intervention, and a 3-month follow up.

RESULTS

The results were mixed, as positive improvements in primary (i.e., psychological well-being and skills) and secondary (school/training/work functioning) outcomes were shown by the experimental group but, in most cases, they were not statistically significant. The qualitative data supported positive claims about the intervention and its appropriateness for AYCs.

CONCLUSIONS

The study implementation during the peak of the COVID-19 pandemic forced the consortium to adapt the design and may have influenced the results. More long-term studies are needed to assess similar mental health programs with this hard-to-reach target group.

Impact of informal caregiving on depressive symptoms among a national cohort of men

BACKGROUND

There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men.

METHODS

We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations.

RESULTS

In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses.

CONCLUSION

These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.

Youth Caregivers of Adults in the United States: Prevalence and the Association Between Caregiving and Education

A growing proportion of individuals adopt family caregiving roles. Family caregivers are the primary providers of long-term care in the United States yet limited federal policy supports exist, despite the known negative impacts of caregiving. There is also limited information about the prevalence of youth/young adult caregivers and the impacts of caregiving at formative ages in the United States. Our objective is to estimate the prevalence of youth caregivers and examine the association of caregiving with educational investments. We use the American Time Use Survey (2013-2019) to identify and describe youth caregivers (aged 15-18) and young adult caregivers (aged 19-22) and compare them with non-caregiving peers. We estimate that there are approximately 1,623,000 youth caregivers and 1,986,000 young adult caregivers, corresponding to 9.2% and 12.7% of these age groups, respectively. However, there is a wide range in the estimated prevalence per year, from approximately 364,000 to 2.8 million youth caregivers and from 353,000 to 2.2 million young adult caregivers, depending on caregiver definition. Unlike adult caregivers, we find that young men and women were nearly equally likely to provide care. We also find that non-White individuals are disproportionately represented as youth caregivers. Compared with non-caregiving peers, both youth and young adult caregivers are less likely to be enrolled in school and, among those enrolled in school, spend significantly less time on educational activities. Considering the association of caregiving among youth/young adults and education, policies supporting youth and young adult caregivers are critical.

The mental health impact of school bullying among young carers in Australia: a causal mediation analysis

Informal care can exert adverse effects on the mental health of young people. Bullying victimisation is an important determinant of mental disorders. Young carers are at elevated risk of bullying. We quantify the mental health effects of informal care among Australian adolescents and the extent to which these effects are transmitted through school bullying. We used data from the Longitudinal Study of Australian Children. Participants were classified as non-carers, light carers (caring for < 10 h/week) and moderate-to-heavy carers (caring for 10 + h/week). Mental health was measured using the Kessler Psychological Distress Scale (K10). Using a counterfactual approach to mediation analysis, total effects (TE) of informal care on mental health were decomposed into natural direct effects (NDE-mental health effects not transmitted through school bullying) and natural indirect effects (NIE-mental health effects transmitted through school bullying). The TE of informal caring was 0.71 (95%CI - 0.03, 1.49) for light carers and 1.72 (95%CI 0.45, 3.02) for moderate-to-heavy carers. While school bullying explained 27% of the TE among moderate-to-heavy carers (NIE: 0.46; 95%CI 0.12, 0.91) there was weak evidence of mediation for light carers. Our findings indicate that the mental health effects of moderate-to-heavy caregiving can be reduced by school bullying interventions.

Gender and care: Does gender modify the mental health impact of adolescent care?

Young carers are people aged 25 years or less who deliver unpaid informal care to a family or a friend living with a physical or mental illness, a disability, problems related to alcohol/substance use or an elderly relative. Young caring has negative impacts on the mental health of adolescents. Gender patterns underpinning this association have not been explored. We examined gender differences in the mental health effect of informal care among Australian adolescents. We used data from the Longitudinal Study of Australian Children (LSAC). Participants were categorised as non-carers or young carers at 14/15 years old. Although we acknowledge that gender is non-binary, information about gender identity was not collected in LSAC during adolescence. We used the study child's sex as reported at age 14/15 years to categorise adolescents as boys or girls. Mental health was measured using the Kessler Psychological Distress scale (K10) at ages 18/19. We conducted multivariable linear regression models and assessed effect modification by fitting an interaction term between gender and informal care. Informal care was associated with poorer mental health among boys (β: 0.97, 95%CI: -0.01, 1.95), and girls (β: 1.66, 95%CI: 0.63, 2.69). Overall, in comparison to boy non-carers, girl carers had the highest level of distress (β: 4.47; 95%CI: 3.44, 5.51), yielding high predicted scores of K10. While the mental health effects of young care were stronger for girls, there was limited evidence of effect modification as the difference in mental health disparities due to informal care between girls and boys was small (β: 0.69) with high uncertainty levels (95%CI: -0.72, 2.11). Psychological distress scores were higher for girls than boys in both caring categories. Support strategies should focus on identifying and supporting boy and girl carers to reduce the adverse mental health impact of young informal care.

Informal Caregiving in Adolescents from 10 to 16 Years Old: A Longitudinal Study Using Data from the Tokyo Teen Cohort

There is growing evidence of the impact of informal caregiving on adolescent mental health, and its role is often hidden unintentionally or intentionally, which may hamper early identification and support for young informal caregivers. However, the quantitative evidence regarding household factors relating to informal caregiving has mostly been based on cross-sectional findings. This study examines the longitudinal associations between household characteristics and the duration of informal caregiving in adolescents from 10 to 16 years of age. Child-household respondent pairs (n = 2331) from the Tokyo Teen Cohort in Japan were followed every 2 years from 10 to 16 years of age. Informal caregiving was assessed repeatedly based on the household respondent's survey responses. Persistent caregiving was defined as daily caregiving at two or more waves. There were 2.2% of children who gave daily care at two or more waves. Cross-sectional associations with daily informal caregiving at each wave were found with girls, low household income, and cohabiting with grandparents. A significant association with persistent caregiving was found only in cohabiting with grandparents at 10 years of age after adjusting for sex, number of siblings, single parent, and household income. Our longitudinal examination highlighted cohabiting with grandparents as a preceding factor for persistent caregiving. Identification and support for young informal caregivers should be integrated into social care service systems for older adults. The mechanism of persistent caregiving requires clarification.

Use of Parental Disability Trajectories to Identify Adolescents Who are Young Carers

Being a young carer can have significant impacts on the lives of children and adolescents. Identifying young carers is difficult, making the provision of support challenging for service providers. This sample contained 4464 Australian children/adolescents across 11 years (49% female, aged 6/7 years at baseline, and 16/17 years at final wave). Group-based trajectory modeling was applied to examine parental disability trajectories across 5 waves of data collection. Associations between estimated trajectories and unpaid/informal caring at age 16/17 years were then assessed. Three trajectory groups were identified: consistently-low (80%), low-increasing-high (10%) and moderate-high (10%) levels of parental disability. There was strong evidence that caring was elevated in the low-increasing-high group compared to the consistently-low group, and moderate evidence of elevation in the moderate-high group. By identifying adolescents with increased odds of becoming young carers, this study shows that parental disability may be an important way for service providers to identify and support young carers.

Mental health of young informal carers: a systematic review

PURPOSE

This systematic review aims to assess and evaluate quantitative evidence on the association between informal caregiving and mental health in young people.

METHODS

This review was registered in PROSPERO (CRD42021251666). We conducted our search in the following four databases: Medline (PubMed and OVID), EMBASE, PsycInfo and Web of Science. The last search was performed on the 17th of March of 2021. Quantitative studies that focused on carers aged 25 years or less and compared the mental health status of carers and non-carers were eligible for inclusion. Two reviewers independently assessed articles for eligibility and performed the quality assessment using the Risk of Bias tool in Non-Randomised Studies of Exposures (ROBINS-E).

RESULTS

We identified a total of ten eligible articles. Mental health outcomes included depression, anxiety and other mental or emotional problems. Nine out of the ten studies showed that being a young carer was consistently associated with poor mental health. However, the overall quality of evidence was low, and longitudinal data were limited to three articles. The primary sources of bias were confounding and outcome measurement.

CONCLUSION

Young carers experience poorer mental health outcomes than their non-caring peers. However, we identified an overall lack of quantitative evidence of high methodological rigour. To establish if young caring leads to poor mental health, future research should focus on addressing the identified methodological limitations and understanding the mechanisms explaining these associations. Addressing these gaps can better inform the allocation of appropriate support and resources to optimise the mental health of young carers.