The high cost of unpaid care by young people:health and economic impacts of providing unpaid care

Trajectories of depressive symptoms among young people in London, UK, and Tokyo, Japan: a longitudinal cross-cohort study

BACKGROUND

Research suggests gender inequalities in adolescent mental health are context dependent and might be preventable through social and structural change. However, variations in the size of gender inequalities in mental health across diverse cultural contexts could be due to incomparable measurement. We aimed to compare a measurement of mental health among young people in Tokyo, Japan, and London, UK, and test the hypothesis that gender inequalities in depressive symptom trajectories are larger in London than in Tokyo.

METHODS

For this longitudinal cross-cohort study, we extracted responses to the 13-item Short Mood and Feelings Questionnaire (SMFQ) by young people who participated in three consecutive waves of the Tokyo Teen Cohort (TTC) and the London-based Resilience, Ethnicity and Adolescent Mental Health (REACH) cohorts. We used multigroup and longitudinal confirmatory factor analysis to examine measurement invariance of the SMFQ by cohort, gender, and age. Latent growth curve models were used to estimate and compare mean trajectories of SMFQ from ages 11-16 years among boys and girls, overall, and in each cohort.

FINDINGS

7100 young people from TTC and REACH (3587 boys [50·5%] and 3513 girls [49·5%]) were included in the analysis. With the TTC and REACH cohorts combined, we found very strong evidence of differences in SMFQ between boys and girls, with a mean starting level of 0·71 points (95% CI 0·42-0·95) higher and mean rate of change of 0·73 points (95% CI 0·62-0·82) higher in girls versus boys. Among the 4287 participants in REACH (2097 [48·9%] boys and 2190 [51·1%] girls), a difference in SMFQ was evident between boys and girls at age 11-12 years (difference in mean intercepts: 0·75 [95% CI 0·25-1·25]). Among the 2813 participants in TCC (1490 boys [53·0%] and 1323 girls [47·0%]), differences in SMFQ between boys and girls emerged at a later age, between ages 11 years and 14 years, during which SMFQ decreased among boys and increased among girls (mean difference in slopes 0·52 [95% CI 0·40 to 0·65]). The difference in SMFQ between boys and girls widened year-on-year in both cohorts; by age 16 years, the difference in SMFQ between boys and girls in REACH (mean difference in slopes 0·98 [95% CI 0·77 to 1·20]) was around twice as large as in TTC (0·52 [0·40 to 0·65]). The annual rate of increase in SMFQ among girls in REACH (1·1 [95% CI 0·9-1·3]) was around four times greater than among girls in TTC (0·3 [0·2-0·4]). We found little evidence to suggest these differences in gender inequalities were due to incomparable measurement.

INTERPRETATION

Gender inequalities in emotional health among young people are context dependent and might be preventable through social and structural change.

FUNDING

Japanese Society for the Promotion of Science, UK Economic and Social Research Council, and European Research Council.

TRANSLATION

For the Japanese translation of the abstract see Supplementary Materials section.

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.

Investigating the Differential Impact of Short- and Long-Term Informal Caregiving on Mental Health Across Adolescence: Data From the Tokyo Teen Cohort

PURPOSE

Young caregivers experience, on average, poorer mental health outcomes than non-caregiving young people. However, it is unknown to what extent these effects differ with age, or among short-term versus long-term caregivers. Using repeated assessment of young caregiving across multiple waves of a prospective adolescent cohort study, we conducted repeated cross-sectional analyses of caregiver status and contemporaneous depressive symptoms, self-harm, and suicidality in early to middle adolescence.

METHODS

Four waves of questionnaire data from a large, longitudinal population-based cohort study (Tokyo Teen Cohort) were analyzed. Caregiver status was collected from participants aged 10, 12, 14, and 16 years. Mental health outcomes assessed were depressive symptoms, self-harm and suicidal feelings. Logistic regression analyses were conducted assessing effects of a) young caregiver status and b) new, long-term, and ex-caregiver 2-year categorizations on mental health outcomes at 12, 14, and 16 years, both unadjusted and adjusted for potential confounders (sex, low income, single-parent household, and parental distress).

RESULTS

Depressive symptoms were elevated among long-term caregivers at 14 years (unadjusted odds ratio (uOR): 3.11 [1.33-7.27], adjusted odds ratio (aOR): 2.49 [1.03-5.99]). Borderline associations between long-term caregiving and self-harm (uOR: 3.14 [1.06-9.35], aOR: 2.51 [0.82-7.63]) and suicidal feelings (uOR: 2.49 [0.98-6.34], aOR: 2.06 [0.80-5.33]) were detected at 16 years. No associations were found at age 12 years in primary analyses; sensitivity analyses indicated possible increased depressive symptoms.

DISCUSSION

Young caregivers with long-term caregiving roles are at the greatest risk for negative mental health outcomes, with effects concentrated in later adolescence. These findings highlight urgent need for early identification and practical and psychological support for young people shouldering caregiving burdens.

Understanding the unmet support needs of young and young adult carers and their families

Support for children and young people who provide unpaid care is important to help prevent negative impacts of caregiving on their education, employment, mental health, and social relationships. We aimed to address an evidence gap about what services and support are needed from young carers' perspectives. We carried out focus groups or in-depth interviews with 133 carers aged 9-25 in England. Expressed unmet need for services and support could be grouped in three categories: support that would reduce or remove young people's need to provide care, help improve the lives of the people they care for, mitigate against impacts of providing care on their mental health, wellbeing, education, social participation and leisure activities, and, whilst they are still providing care, assist them in their caring role. Action is needed to address these currently unmet needs and implement young carers' and their families' rights to support.

Types and aspects of support that young carers need and value, and barriers and enablers to access: the REBIAS-YC qualitative study

Background

Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. Providing care can negatively impact children and young people's education, employment, health and social participation, with associated costs. Support is needed to prevent and reduce these negative impacts. The study sought to provide new knowledge and address prior research gaps regarding how best to support young carers from their perspective and that of the people they care for.

Objectives

To address the following questions: What types, components or features of services and other support are seen as helpful, valued, and acceptable to young people who look after someone at home and the people they support? Conversely, what is found to be less or unhelpful? What additional support is perceived as needed? What are the barriers experienced by young and young adult carers in seeking and accessing services for themselves or the person they support? What are the barriers and facilitators for practitioners in providing support and services perceived as valued, helpful and needed by young and young adult carers and the people they support?

Design and setting

In-depth qualitative methodology using focus groups, in-depth semistructured interviews and workshops in four localities in England.

Participants

One hundred and thirty-three carers aged 9-25 years with a range of caring and life circumstances and sociodemographic characteristics. Seventeen adult care recipients (parents) with a range of physical and/or mental healthcare and support needs. Nineteen practitioners from schools, colleges, young carers organisations, voluntary sector services, mental health services, the National Health Service, adult social care and local authority adult and children's social care commissioners.

Results

The types and aspects of support that young carers and their families need, and value when received, include: support that reduces or removes their practical and emotional caring responsibilities; support to mitigate the negative impacts of care and help with other life issues; information and advice about services and wider resources and support; someone trusted available to talk to; greater awareness, recognition and understanding; and choice, flexibility, and co-development of plans and solutions. We found a great deal of unmet need for support, and variation in type and quality of support received, including geographically.

Limitations

Potential limitations are that we were not able to engage with, or recruit, young carers from some intended subgroups, meaning some perspectives are missing. Partly because of COVID-19 measures during the study, we mainly recruited through young carers organisations and their family projects, although this was balanced by recruitment through schools and extensive outreach and engagement by the collaborating organisations prior to the project starting.

Conclusions

Action is now needed to consistently and sustainably implement the types of support that young carers and the people they care for say they need and value.

Future work

Future work should include more research from the perspectives of young carers and the people they care for, especially from particularly marginalised groups; and research to understand what works and how to improve implementation of the support needed and valued.

Study registration

This study is registered as Current Controlled Trials ISRCTN13478876. https://doi.org/10.1186/ISRCTN13478876.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129645) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 36. See the NIHR Funding and Awards website for further award information.

The Impact of Positive and Adverse Experiences in Adolescence on Health and Wellbeing Outcomes in Early Adulthood

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

Projected costs of informal care for older people in England

BACKGROUND

Health economics research and economic evaluation have increasingly taken a societal perspective, accounting for the economic impacts of informal care. Projected economic costs of informal care help researchers and policymakers understand better the long-term consequences of policy reforms and health interventions. This study makes projections of the economic costs of informal care for older people in England.

METHODS

Data come from two national surveys: the English Longitudinal Study of Ageing (ELSA, N = 35,425) and the Health Survey for England (N = 17,292). We combine a Markov model with a macrosimulation model to make the projections. We explore a range of assumptions about future demographic and epidemiological trends to capture model uncertainty and take a Bayesian approach to capture parameter uncertainty.

RESULTS

We estimate that the economic costs of informal care were £54.2 billion in 2019, three times larger than the expenditure on formal long-term care. Those costs are projected to rise by 87% by 2039, faster than public expenditure but slower than private expenditure on formal long-term care. These results are sensitive to assumptions about future life expectancy, fertility rates, and progression of disabilities in the population.

CONCLUSIONS

Prevention schemes aiming to promote healthy aging and independence will be important to alleviate the costs of informal care. The government should strengthen support for informal caregivers and care recipients to ensure the adequacy of care, protect the well-being of caregivers, and prevent the costs of informal care from spilling over to other sectors of the economy.

Do Health and Well-Being Change Around the Transition to Informal Caring in Early Adulthood? A Longitudinal Comparison Between the United Kingdom and Germany

PURPOSE

Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17-29 years old) influenced health and life satisfaction in the United Kingdom and Germany.

METHODS

Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009-2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care.

RESULTS

In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany.

DISCUSSION

The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.

Young carers' experiences of services and support: What is helpful and how can support be improved?

Globally, many children and young people provide support to family members who have poor physical or mental health, are disabled, or misuse drugs and alcohol. These young carers are at higher risk of poorer education, employment, health, and social participation outcomes compared to their peers without caring responsibilities. In the UK, awareness of the challenges faced by young carers, and a framework of their legal rights, are relatively well-developed. However, it is unclear how support can most effectively be provided. Taking a qualitative approach we explored experiences and views of young carers (aged 9-25), conducting focus groups or interviews with 133 young carers and 17 parent care recipients. We explored what aspects of services and support are seen as helpful, valued, and acceptable to young people, and what could be improved. A reflexive, thematic analysis was conducted. Valued support came from: young carers groups (including peer support), school-based and mental health support, and support for the care recipient. Helpful aspects of support included someone who listens and understands, and can be trusted not to break confidentiality; involving the young person in information, decision-making and planning (sometimes including regarding the care recipient); and finding and linking to other services. There was a difficult balance for practitioners between being perceived as proactive, persistent or intrusive when offering support to a young carer, but it was important to allow opportunities for young carers, and those they care for, to change their minds about when and whether to access support. Many interactions were perceived as unhelpful or threatening to the family, and there was often not enough of the type of support that was valued. Sharing of positive experiences can be beneficial for both people seeking support and those delivering it; key messages on what is helpful from the perspective of young carers can help support and shape practice approaches.

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

Young carers' perspectives on navigating the healthcare system and co-designing support for their caring roles: a mixed-methods qualitative study

OBJECTIVES

Despite young carers (YCs) providing regular and significant care that exceeds what would normally be associated with an adult caregiver, we need to learn more about their experience interacting with the healthcare system. The primary study aims were to (1) describe YC experiences in interacting with the healthcare system and (2) identify types of support YC recognise as potentially helpful to their caring role.

DESIGN AND SETTING

A mixed-methods qualitative study was conducted between March 2022 and August 2022, comprising two phases of (1) semi-structured interviews and focus groups with YCs living in the community to confirm and expand earlier research findings, and (2) a co-design workshop informed by a generative research approach. We used findings from the interviews and focus groups to inform the brainstorming process for identifying potential solutions.

RESULTS

Eight YCs completed either a focus group or an interview, and four continued the study and participated in the co-design activity with 12 participants. Phase 1 resulted in three overarching themes: (1) navigating the YC role within the healthcare system; (2) being kept out of the loop; and (3) normalising the transition into caregiving. Phase 2 identified two categories: (1) YC-focused supports and (2) raising awareness and building capacity in the healthcare system.

CONCLUSION

Study findings revealed the critical role that YCs play when supporting their families during pivotal interactions in the healthcare system. Like their older caregiver counterparts, YCs struggle to navigate, coordinate and advocate for their family members while juggling their needs as they transition from adolescence to adulthood. This study provides important preliminary insights into YCs encountering professionals, which can be used to design and implement national support structures.

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.

Does providing informal care in young adulthood impact educational attainment and employment in the UK?

Most research on the effects of caring has focused on older spouses or working-age carers providing care for older people, but providing care in early adulthood may have longer-term consequences, given the importance of this life stage for educational and employment transitions. This study aims to investigate the impact of informal care in early adulthood on educational attainment and employment in the UK and to test whether these associations differ by gender or socio-economic circumstances. Data are from young adults (age 16-29 at first interview, n = 27,209) in the UK Household Longitudinal Study wave 1 (2009/11) to wave 10 (2018/2020). Carers are those who provide informal care either inside or outside the household. We also considered six additional aspects of caring, including weekly hours spent caring, number of people cared for, relationship to care recipient, place of care, age at which caring is first observed, and duration of care. Cox regression was used to analyse the association between caring and educational qualifications and employment transitions. We found that young adult carers were less likely to obtain a university degree and enter employment compared to young adults who did not provide care. In terms of care characteristics, weekly hours spent caring were negatively associated with the likelihood of obtaining a university degree qualification and being employed. Providing care after full-time education age negatively influenced employment entry, but having a university degree buffered the negative influence of providing care on entering employment. The influence on unemployment may be stronger for female carers than for male carers. Our results highlight the importance of supporting the needs of young adults who are providing informal care while making key life course transitions.

Recruitment of Adolescent Young Carers to a Psychosocial Support Intervention Study in Six European Countries: Lessons Learned from the ME-WE Project

Young carers provide a substantial amount of care to family members and support to friends, yet their situation has not been actively addressed in research and policy in many European countries or indeed globally. Awareness of their situation by professionals and among children and young carers themselves remains low overall. Thus, young carers remain a largely hidden group within society. This study reports and analyses the recruitment process in a multi-centre intervention study offering psychosocial support to adolescent young carers (AYCs) aged 15-17 years. A cluster-randomised controlled trial was designed, with recruitment taking place in Italy, the Netherlands, Slovenia, Sweden, Switzerland and the United Kingdom exploiting various channels, including partnerships with schools, health and social services and carers organisations. In total, 478 AYCs were recruited and, after screening failures, withdrawals and initial dropouts, 217 were enrolled and started the intervention. Challenges encountered in reaching, recruiting and retaining AYCs included low levels of awareness among AYCs, a low willingness to participate in study activities, uncertainty about the prevalence of AYCs, a limited school capacity to support the recruitment; COVID-19 spreading in 2020-2021 and related restrictions. Based on this experience, recommendations are put forward for how to better engage AYCs in research.

Young Adult Carers in the UK-New Evidence from the UK Household Longitudinal Study

Despite growing interest in young adult carers, little is known about trends in prevalence of caregiving among young adults aged 16-29. Furthermore, few studies have so far investigated demographic, health, and socioeconomic inequalities in the duration of care among young carers as well as demographic differences in caregiving characteristics. Using data from 11 waves of the nationally representative UK Household Longitudinal Study (2009-2021), we first estimated the prevalence of caregiving among 16-29 years-old adults at each wave. Results show that about 9% of those aged 16-29 provided care, and that this prevalence remained stable throughout the 2010s. Then, selecting respondents who participated for three waves of more, we assessed demographic, socioeconomic, and health characteristics associated with duration of care using ordinal regression models. Almost 52% of carers cared at two or more waves. Compared to non-carers, those who cared had more disadvantaged socioeconomic backgrounds, were from ethnic minorities and reported poorer health, particularly if they cared at two or more waves. Finally, focusing on carers, we tested differences by sex, age, and urbanicity in care relationships, intensity, and duration. Overall, women and those aged 25-29 cared for longer hours, for more people, and for more years than men and younger carers respectively. Put together, these findings provide an up-to-date description of young carers in the 2010s in the UK.

The Young Carers' Journey: A Systematic Review and Meta Ethnography

Despite growing international interest, the caregiving body of literature lacks a recent understanding of young carers’ experiences and their contact with the health care system. We conducted a systematic review of qualitative studies to (1) synthesize more recent qualitative evidence on young carers’ experience, and (2) to identify how these young carers interact with the health care system in their caregiving role. Using a meta-ethnographic synthesis, a total of 28 empirical studies met inclusion. Key findings helped inform an overarching framework of the experience of young carers as illustrated by a journey map. The journey map is a visual depiction of the stages these young carers go through when in a caregiving role framed by three themes: (1) encountering caregiving; (2) being a young caregiver, and (3) moving beyond caregiving. The caregiving experience is perceived by young people as challenging and complex, which could be improved with more informational navigation and emotional support. Understanding these experiences provides insight into gaps in health services and potential solutions that align with the stages outlined in the journey map.

Study progress, recreational activities, and loneliness in young adult carers: a national student survey

BACKGROUND

Young adults (18-25 years) with informal care responsibilities have received limited attention in the research literature, and little is known on how caring responsibilities are related to functioning across different life domains. In the present study we examine associations between care responsibilities and study progress, recreational life, and loneliness in young adults in higher education.

METHODS

A national survey was conducted among Norwegian students in higher education (the SHoT2018-study). The response rate was 30.8%. The current sample is a subsample of the respondents, including young adults 18 to 25 years old, comprising 40.205 participants (70.2% women, mean age 22.0 years, SD = 1.7). Participants reported whether they had regular care responsibility for someone with physical or mental illness, disabilities, or substance misuse. They also answered questions on study progress, number of hours studying, physical exercise, involvement in organized volunteer student activities, number of close friends, and feelings of loneliness. Data were analyzed by Chi-square tests and logistic regression analyses, adjusting for age, sex, and chronic illness.

RESULTS

Compared to students without care responsibility, young adult carers (n = 2228, 5.5% of study sample) were more likely to report delayed study progress (OR 1.20, p < .001), higher average number of failed exams (e.g., having failed three times or more, OR 1.31, p = .002), more feelings of loneliness (OR 1.26, p < .001), and slightly fewer friends. Those with limited care responsibility (≤ 1 h daily) were more likely to participate in organized volunteer student activities, whereas students with 2 h or more of caring per day were less likely to participate in leisure student activities. Both study progress and feelings of loneliness were related to care responsibility in a response-dose pattern, with worse outcomes for those with 2 h or more of daily caring responsibility. All comparisons were adjusted for age, sex, and chronic illness.

CONCLUSIONS

Study progress, recreational activities, and loneliness among young adults are associated with informal caring responsibilities. Professionals in the educational system as well as health personnel should be sensitized to the needs of young adult carers and necessary support made available.

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.

Association between work status and depression in informal caregivers: a collaborative modelling approach

Background

Care is regularly provided on an informal basis by family and friends and it is well established that caregivers experience high rates of depression. The majority of research on caregivers tends to focus on older, full-time caregivers, with less attention paid to working caregivers (in paid employment). The aim of this study is to explore the impact of work status on depression in caregivers.

Methods

A sample of individuals from the 2014 European Social Survey dataset, aged 18 and older, who reported being a caregiver, were investigated (n = 11 177). Differences in sociodemographic, mental and physical health and social network variables, between working and non-working caregivers, were investigated. Hierarchical logistic regression models were used to investigate associations between the caregivers’ work status and depression. This study was developed in partnership with a panel of caregivers who contributed to the conceptualization and interpretation of the statistical analysis.

Results

Findings showed that 51% of caregivers reported being in paid employment. Non-working caregivers were more likely to be female, older, widowed, have lower education levels and provide intensive caring hours. They were also more likely to report depressive symptoms than working caregivers after controlling for sociodemographic, social networks and intensity of caring (adjusted odds ratio = 1.77, 95% confidence interval = 1.54–2.03). The panel considered policies to support continued work important as a means of maintaining positive mental health for caregivers.

Conclusions

Supportive policies, such as flexible working and care leave, are recommended to allow caregivers to continue in paid work and better manage their health, caring and working responsibilities.

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

BACKGROUND

Across the world, many young people are supplying unpaid, informal care. There is growing evidence of the impact of this caring role on the lives of young informal carers, however there has been little quantitative analysis of the mental health impacts. This research aimed to estimate the effect of informal caring at age 14/15 years on mental health at age 18/19 years.

METHOD

Data was drawn from Waves 5, 6, 8 (2012-2018) of the Longitudinal Study of Australian Children. Effects of caring on mental health were assessed using augmented inverse probability weighting, with adjustment for potential confounders, and using the Kessler-10 measure of mental health. Caring was assessed with both a binary (any caring vs none), and a three category variable (no caring, less than daily caring, daily caring). Multiple imputation was carried out using chained equations, and analysis was conducted on both complete case (n=2165) and the imputed dataset (n=3341).

OUTCOMES

In complete case models, any caring at age 14/15 years was associated with poorer mental health at age 18/19 years compared to those reporting no caring, with an average treatment effect (ATE) of 1.10 (95%CI 0.37, 1.83). The ATE of daily caring compared to no caring at age 14/15 years of age was 1.94 (95%CI 0.48, 3.39), and caring less than daily (compared to no caring) was associated with a treatment effect of 0.83(95%CI 0.06, 1.61). Associations were robust to several sensitivity analyses.

INTERPRETATION

These results suggest there is a mental health impact of caring in adolescence on mental health four years later. This highlights the need for support for young informal carers, particularly for those providing more intensive caring.

FUNDING

This study was supported by an Australian Research Council Discovery Early Career Award (TK, DE200100607).

Women's wellbeing and the burden of unpaid work

Soraya Seedat and Marta Rondon examine how gender inequities in the time allocated to unpaid work, exacerbated by covid-19, are affecting women’s mental health

Promoting Mental Health and Well-Being among Adolescent Young Carers in Europe: A Randomized Controlled Trial Protocol

It is estimated that 4-8% of youth in Europe carry out substantial care for a family member or significant other. To prevent adverse psychosocial outcomes in young carers (YCs), primary prevention resilience building interventions have been recommended. We describe the study protocol of an international randomized controlled trial (RCT) of an innovative group intervention designed to promote the mental health and well-being of adolescent YCs (AYCs) aged 15-17. The RCT will be conducted in six European countries in the context of the Horizon 2020 European funded research and innovation project "Psychosocial support for promoting mental health and well-being among adolescent young caregivers in Europe" ("ME-WE"). The ME-WE intervention is based on Hayes and Ciarrochi's psychoeducational model for adolescents and will consist of seven 2-h sessions in a group format, aimed to help AYCs build psychological flexibility and live according to their values. The control group will be a waitlist. Primary and secondary outcomes and control variables will be measured at baseline (T0), post-intervention (T1) and 3 months follow-up (T2). The COVID-19 pandemic has made amendments necessary to the original study protocol methodology, which we describe in detail. This study will contribute to building an evidence-based manualized program that educators and health and social care professionals can use to support AYCs in their transition to adulthood. From a research perspective, the outcomes of this study will contribute to evidence-based practices in primary prevention of psychosocial difficulties in AYCs and will gather novel knowledge on the effectiveness of Hayes and Ciarrochi's model for use with middle adolescents with caring responsibilities. The trial has been preregistered (registration number: NCT04114864).

The power of informal cancer caregivers' writings: results from a thematic and narrative analysis

Background

Cancer is a disease that disrupts not only the patient’s life, but that of the entire family as well, from a care, organizational, and emotional perspective. Patients share their experience of illness frequently with their informal caregiver (IC), a partner, son/daughter, friend, volunteer, or any other person in the family or social network who offers to support them during their clinical journey. The purpose of this study was to investigate ICs’ still unknown cancer experiences through the stories of IC participants in a Literary Artistic Competition the Centro di Riferimento Oncologico di Aviano (CRO) IRCSS organized, and understand the themes that emerged from their texts and hence, the power of expressive writing.

Materials and methods

A qualitative study was carried out on literary texts using Mishler’s three levels of narrative analysis: thematic (to detect themes and subthemes); structural (to support the thematic level), and performative (to understand the narratives’ meaning). In addition, the narratives were classified based on Kleinman and Frank’s models. A particular focus was placed on the language of the narratives to identify figures of speech, e.g., metaphors related to cancer.

Results

Seven main themes emerged from the 40 stories’ thematic analysis: perceptions of the disease; biographical breakdown; relationships; transformation of the sick body; IC’s role; encounter with death; and strength of memory. The ICs’ stories also highlighted the strengths and weaknesses of the patient’s clinical pathway. ICs are a resource not only for the patient, who, thanks to them, is assured of continuous assistance but also for the healthcare organization, above all because they serve a relational role as a “bridge” between patients and healthcare workers. ICs have important messages to offer to healthcare organizations. If involved adequately, they can provide a strategic strength in supporting patients and healthcare workers themselves. The in-depth analysis of the themes and subthemes in this study led the authors to hypothesize that expressive writing benefit ICs with respect to the possibility of sharing their experiences with others and giving evidence of their role. Their stories are a testimony that can help those who face a similar experience.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-020-05901-3.