Impact of Caregiving Burden on the Mental Health and Role of Self-Care Among Asian and Caucasian Family Caregivers of People with Mental Illness

Persons with mental illness (PMI) often require vital assistance and support from family caregivers (FC). FCs spend a substantial amount of time interacting with care recipients, PMI, and often experience caregiving burdens and intense emotional cycles that contribute to poor mental health. The caregiving burden can be further increased by several factors, such as stigma and structural barriers to seeking help. Asian FCs tend to have a greater caregiving burden due to the tendency toward cohabitation and low mental-health service utilization. However, limited research exists on Asian FCs and their caregiving experience in comparison to their Caucasian counterparts. Additionally, despte the mediating role of self-care practice and social support between the caregiving burden and its consequences is well documented for caregivers of people with dementia and cancer, little is known about this role for FCs of PMIs, regardless of ethnicity. To address these gaps, based on the socio-cultural stress and coping model (Knight & Savegh, 2010), this study explored the following research questions (RQ): 1) To what degree do stigma, structural barriers, caregiving burden, self-care practice, social support, and mental health differ among Asian and Caucasian FCs? 2) To what degree do self-care and social support mediate the impact of caregiving burden on mental health?

A cross-sectional quantitative design was used in this study, in which 160 FCs from three ethnic groups (48 Caucasian, 61 Chinese, and 51 Vietnamese) participated. They completed a survey with standardized measures of variables: burden, measured by the Caregiver Burden Scale; mental health, measured by the 5 items for mental health from the 36-item Short Form Medical Outcome Survey; self-care practice, measured by the Health Promotion Lifestyle Profile; social support, measured by the Perceived Social Support Scale; stigma, measured by the Affiliate Stigma Scale; and structural barriers, measured by the Help-seeking Barriers Scale.

Analysis of variance revealed significant group differences in self-care practice (F[2, 157] = 4.56, p < 0.01) and affiliate stigma (F[2, 157] = 3.12, p < 0.05) as Caucasian FCs showed higher self-care and lower stigma than both Chinese and Vietnamese. There were no group differences in other variables, including burden and mental health outcome (RQ1). Hierarchical multiple regression analysis showed that a lower burden (standardized β = -0.21, p < 0.01), more social support (standardized β = 0.17, p < 0.01), and self-care practices (standardized β = 0.25, p < 0.01) predict better mental health, after controlling for caregivers’ age, ethnicity, and educational levels. The results also showed a partial mediation role of self-care and social support in mental health (RQ2).

This study found that caregiving burden has significant, adverse impacts on FCs’ mental health and that self-care and social support play mediating roles in this relationship. These findings suggest that social workers need to take initiatives to develop intervention programs to enhance self-care practices and social support for FCs when working with PMI. For caregivers to provide the best care for their loved ones with mental illness, more services and supports for caregivers should be incorporated into policy and funding.