Informal care and psychiatric morbidity

Stressors and common mental disorder in informal carers--an analysis of the English Adult Psychiatric Morbidity Survey 2007

This study investigates potential explanations of the association between caring and common mental disorder, using the English Adult Psychiatric Morbidity Survey 2007. We examined whether carers are more exposed to other stressors additional to caring--such as domestic violence and debt--and if so whether this explains their elevated rates of mental disorder. We analysed differences between carers and non-carers in common mental disorders (CMD), suicidal thoughts, suicidal attempts, recent stressors, social support, and social participation. We used multivariate models to investigate whether differences between carers and non-carers in identifiable stressors and supports explained the association between caring and CMD, as measured by the revised Clinical Interview Schedule. The prevalence of CMD (OR=1.64 95% CI 1.37-1.97), suicidal thoughts in the last week (OR=2.71 95% CI 1.31-5.62) and fatigue (OR=1.33 95% CI 1.14-1.54) was increased in carers. However, caring remained independently associated with CMD (OR=1.58 1.30-1.91) after adjustment for other stressors and social support. Thus caring itself is associated with increased risk of CMD that is not explained by other identified social stressors. Carers should be recognized as being at increased risk of CMD independent of the other life stressors they have to deal with. Interventions aimed at a direct reduction of the stressfulness of caring are indicated. However, carers also reported higher rates of debt problems and domestic violence and perceived social support was slightly lower in carers than in non-carers. So carers are also more likely to experience stressors other than caring and it is likely that they will need support not only aimed at their caring role, but also at other aspects of their lives.

Psychological health in older adult spousal caregivers of older adults

OBJECTIVES

The need for informal caregiving has been rapidly increasing across several countries. Spouses comprise a sizeable segment of informal caregivers and typically represent an older cohort with special health concerns. The objective of this review was to examine psychological health outcomes in older adult spouses caring for older adults.

METHODS

Literature review/synthesis (1999-2009).

RESULTS

Compared to demographically matched married non-caregiving controls, older adult spousal caregivers experienced more cognitive functioning difficulties, strain, distress, stress, loneliness, depression, anxiety and poorer mental health. Caregivers of spouses with cognitive impairments, quite often wives, were especially affected by poor psychological health, as were caregivers who were new to the caregiving role and those who rated caregiving as stressful. Psychological health improved when the caregiving role ceased.

DISCUSSION

Several poor psychological outcomes were found in older adults caring for their spouses; the magnitude of which varied and were more pronounced under certain circumstances. To preserve caregiver health, maintain recipient health and care quality and avoid exceeding system of care capacity, efforts are needed to provide support to older adult spousal caregivers and recipients. Couples may need to be assessed as a unit, taking gender and cultural considerations into account, and additional resources may be required.