Availability of Supportive Services and Amenities and Depression of Caregiving Spouses

Background: Family members are the primary source of care and support for community-dwelling older adults. Among older married couples, a spouse is often the primary caregiver who provides assistance in completing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) to their spouse. Caregiving has been described as a stressful experience, which erodes caregivers’ mental health. Previous studies have reported that caregivers tend to experience higher levels of stress and anxiety, more depressive symptoms, and lower subjective well-being than non-caregivers. Support services and amenities provide critical resources that can ease the burden associated with caregiving. For example, being able to quickly run important errands, such as picking up prescriptions or shopping for food, can leave caregivers with more time for themselves and minimize the stress of being away from their loved ones. This study aims to examine the association of perceived neighborhood social cohesion and neighborhood disorder with depressive symptoms among caregiving spouses.

Methods: We used data from the Health and Retirement Study, a longitudinal study of a nationally representative sample of adults over age 50. We defined a respondent as a caregiver if care recipients reported their spouses as a person who provided help in completing ADLs and IADLs. The 2006-2016 HRS includes 2,230 caregiving spouses. We linked the HRS with the National Neighborhood Data Archive, which contains nationwide measures of the physical and social environment. As supportive services and amenities, we included organizations providing home health care and services for older adults (e.g., senior daycare) as well as pharmacies, supercenters, grocery stores, convenience stores, and dollar stores, which can help caregivers complete daily tasks. We estimated negative binomial regression models to examine whether greater availability of supportive services and amenities (per square mile) is associated with fewer depressive symptoms. We also estimated stratified models to urban-rural differences in the relationship.

Results: More availability of supportive services and amenities was associated with fewer depressive symptoms. For one additional service/amenity, depressive symptoms decreased by 0.001 (95% CI: -0.002, 0.00; p<.01). In the stratified model, one additional services and amenities was associated with 0.0007 (95% CI: -0.002, 0.00; p<.05) and 0.0014 (95% CI: -0.003, 0.00; 0<.05) decrease in depressive symptoms in urban and rural, respectively.

Conclusion and Implications: We found that caregiving spouses living in neighborhoods with greater availability of supportive services and amenities had fewer depressive symptoms. We also found urban-rural differences in the association; rural residents were more benefitted from the resources available in their neighborhood. Based on this finding, increasing access to services and amenities may promote the mental health of caregiving spouses.