Impact of Aspects of Caregiving on Caregiver Mental Health: Zero-Inflated Negative Binomial Regression Using Behavioral Risk Factor Surveillance System Data

Background and purpose: Caregivers report significant strain related to caregiving, including various mental health impacts. The stress of caregiving has been theorized to have two distinct effects: the caregiving effect and the family effect. The caregiving effect is directly related to providing care while the family effect is the impact of having a loved one who is ill. A stress and coping framework suggests that primary stressors related to the demands of caregiving, such as intensity and type of care, lead to psychological stress and impact the mental well-being of caregivers (Pearlin et al., 1990; Schultz & Sherwood, 2008). Given the critical role of informal caregivers in the US health system in the context of an aging population, support services are a focus of public policy. This study identifies leverage points in the caregiving experience to maximize the impact of programs and policies aimed at supporting informal caregivers.

Methods: This study used pooled de-identified data from the 2017-2019 Behavioral Risk Factor Surveillance System. We assessed the impact of hours engaged in caregiving, length of caregiving, and caregiving tasks on the number of poor mental health days for 12,244 caregivers in the ten states who administered the standard optional caregiving module during the focal years. Multivariate analysis was completed using a zero-inflated negative binomial regression controlling for age, income, sex, and general health.

Results: The average age of the sample was 56 years old (SD=15.43) and 62% were female. Caregivers had an average of five poor mental health days per month (SD=9.05) with over half (57%) reporting zero poor mental health days. Twenty hours or more of informal caregiving work per week was associated with more poor mental health days (IRR= 1.215, p<.001). Those engaged in household caregiving tasks (OR=.83, p<.01) and those engaged in both household and personal tasks (OR=.88, p<.05) had lower odds of zero mental health days compared to those who did not provide either of these types of care.

Conclusions and implications: High intensity caregiving – defined as providing 20 or more hours of care per week – was associated with more poor mental health days compared to less intensive caregiving but was not significantly related to the likelihood of having zero poor mental health days. This suggests that caregiving was associated with poor mental health days at some level for all caregivers regardless of the amount of time spent providing care. This may offer evidence of a family effect. Our results suggest that caregiver mental health depends on the experience of caregiving within the context of the caregiver’s life, especially in high intensity caregiving which takes significant time. Caregivers need support for balancing other life demands such as childcare, paid time off work, and home help. Services targeting specific tasks may not be the most effective way to support caregivers, however. Financial stipends that allow caregivers to purchase appropriate supports for their individual circumstances may be more efficient.