Do Rural Caregivers' Mental Health Quality of Life Differ from Non-Rural Caregivers?

Background and Purpose

Of the 43.5 million Americans who provided informal, unpaid caregiving to an adult or child in the previous year, 16% lived in a rural area. Rural caregiving offers a novel lens for social work researchers to consider racial and economic inequality: demographic changes (aging, depopulation, racial diversification), unemployment, and access to health care services. Evidence on the rural caregivers’ mental health and well-being has been mixed and lacks generalizability. Rural residents increasingly include people of color, and caregiving roles differ by culture, race, and ethnicity, yet little data exists on rural caregivers of color across multiple states.

Methods

We used cross-sectional data from the BRFSS in 46 states between 2015-2017 that included the optional caregiving module. We used a continuous variable of the number of days where the respondent reported that their mental health was not good and also a dichotomized variable of >= 14 days of poor mental health. BRFSS calculates whether the respondent was in a Metropolitan Service Area (MSA); we categorized responses to rural (outside the MSA) and non-rural (urban and suburban).

We used survey adjusted and weighted analyses of the descriptive results, comparing BRFSS respondents by their rural location and caregiving status with survey adjusted chi-square tests for categorical/binary variables and ANOVA for continuous variables. We estimated differences in mental health quality of life (MHQOL) with linear and logistic regression models and tested for differences between groups with interaction terms (caregiving x rural; caregiving x rural x race).

Results

Rural caregivers were more likely caring for a grandparent or spouse/partner, and less likely to be caring for a child than non-rural caregivers. They were more likely caregiving for someone with a chronic health conditions, such as arthritis, cardiovascular disease, chronic respiratory disease, and diabetes, than non-rural caregivers. Notably, rural caregivers were more likely than non-rural caregivers to report needing no additional supports, and less likely to report needing counseling and service referrals or respite care.

While caregivers had worse MHQOL than non-caregivers, this pattern did not vary significantly between rural and non-rural individuals. As such,  there was not evidence that rural caregivers’ mental health was worse than non-rural caregivers. Similarly, these patterns did not vary by race/ethnicity.

Conclusions and Implications

All caregivers have worse MHQOL than non-caregivers, though this pattern did not vary by rural location. Further, recognizing the impact of racism and oppression on marginalized groups, our findings about rural caregivers of color were surprising. Notably, rural caregivers did not report needing additional services. The reasons for this may be related to factors not captured in these secondary data. One implication salient for social work research and practice is that strategies to support MHQOL of rural caregivers may require different intervention points than non-rural caregivers, particularly to focus on chronic disease specific caregiving demands. Additional data and practice evidence is needed to better understand the needs and service use patterns of caregivers, especially caregivers of color, in rural locations.