Transition to bereavement: A prospective longitudinal study of health-related quality of life in informal caregivers of oldest-old individuals

Can Cessation of Caregiving for Parents Relieve Family Caregivers' Psychological Distress? A Longitudinal Study Using 17-wave Nationwide Survey Data in Japan

BACKGROUND

Informal caregiving of older parents adversely affects the mental health of family caregivers. However, the psychological effects of caregiving cessation and the trajectories of these effects have rarely been examined in Japan. This study addresses this gap.

METHODS

Based on a 17-wave nationwide population-based survey in Japan, we analyzed longitudinal data from 8,280 individuals aged 50-59 years in 2005 who started caring for their older parents in 2006 or later and ceased caregiving by 2021. We identified the timings of caregiving onset and cessation and examined the trajectory of psychological distress (PD), defined as a Kessler score ≥5 on the 6-item Kessler scale (range 0-24). Linear mixed models were used to assess the trajectory of PD that evolved after caregiving cessation over the subsequent 3 years.

RESULTS

After adjusting for covariates, the probability of PD decreased by 5.6 percentage points (from 40.8%; 95% confidence interval [CI], 4.1-7.0%) for female caregivers and by 1.9 percentage points (from 31.7%; 95% CI, 0.3-3.5%) for male caregivers at caregiving cessation, remaining stable in subsequent years. For women, higher PD risks related to co-residence with a care recipient diminished quickly upon cessation of caregiving, while the unfavorable impacts of no social activity, extended duration of care, and long-hour daily care persisted in subsequent years. For male caregivers, the impact was generally more limited.

CONCLUSION

These results suggest that changes in mental health following caregiving cessation warrant serious consideration when developing support programs for former family caregivers.

Assessing the impact of grief on quality of life, work productivity, and health outcomes for parents bereaved from SMA: A study protocol

BACKGROUND

U.S. cost-effectiveness recommendations suggest that analyses should include all costs and effects relevant to the decision problem [1]. However, in many diseases, including spinal muscular atrophy (SMA), few studies have evaluated bereaved family outcomes after a child has died, neglecting potential impacts on their health-related quality of life (HRQoL), work productivity, and mental health. Additionally, grief-related outcomes are rarely included in economic evaluations. This manuscript outlines the protocol of a study that will estimate the HRQoL, work functioning, and mental health of bereaved parents of children with SMA type 1 to determine how outcomes vary based on parent's sex and the time since a child's death.

METHODS

This study will involve two phases. In Phase 1, we will conduct a literature review to identify prior research that has measured how parental grief impacts HRQoL, work productivity, and mental health. We will also interview four bereaved parents of children with SMA type 1, stratified by parent sex and time since their child's death, and analyze findings using a thematic analysis. In Phase 2, we will develop a survey draft based on Phase 1 findings. Parents bereaved from SMA type 1 will review our survey draft and we will revise the survey based on their feedback. We will send a cross-sectional survey to approximately 880 parents bereaved from SMA type 1. We will analyze findings from the survey to investigate whether the severity of grief symptoms is correlated with HRQoL, productivity, depression and anxiety symptom severity. We will also evaluate whether the mean scores of grief and each of the outcomes vary significantly when stratified by parent sex and the time since the child's death.

DISCUSSION

Our results will provide preliminary information on how parental grief can impact HRQoL, productivity, and mental health outcomes over time. Increasing the availability of family outcomes data will potentially assist organizations performing health economic evaluations, such as the Institute of Clinical and Economic Review (ICER) in the U.S. This research will also help to inform the development of future economic guidelines on this topic.