Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys.

Caregiving has been associated with adverse health outcomes. However, there is a paucity of multi-country, population-based studies on mental health outcomes of caregivers especially from low- and middle-income countries (LMICs). Thus, we assessed the association of caregiving with depression, sleep problems, and perceived stress in 10 high-, 27 middle-, and 21 low-income countries. Cross-sectional community-based data of the World Health Survey including 258,793 adults aged ≥18 years were analyzed. Multivariable logistic and linear regression analyses were conducted to explore the association of past 12-month caregiving with past 12-month DSM-IV depression, and past 30-day perceived stress [range 0 (low)-100 (high)] and severe/extreme sleep problems. Nearly 20% of the individuals were engaged in caregiving with particularly high rates observed in high-income countries (HICs) (e.g., Finland 43.3%). Across the entire sample, after adjustment for potential confounders, caregivers had a significantly higher likelihood of having depression (OR = 1.54; 95%CI = 1.37-1.73), sleep problems (OR = 1.37; 95%CI = 1.25-1.50), while their mean perceived stress score was 3.15 (95%CI = 2.46-3.84) points higher. These associations tended to be stronger in HICs. A greater number of caregiving activities was associated with a greater likelihood of depression, sleep problems, and perceived stress regardless of country income levels. In conclusion, caregiving has a negative impact on mental health worldwide with possibly greater effects in HICs. Given the growing contribution of caregivers in long-term care, interventions and policies to alleviate the mental health burden of caregivers are urgently needed to maintain sustainable and effective care practices.

[1]  T. Roth,et al.  Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young Adults , 1996, Biological Psychiatry.

[2]  J. Laks,et al.  Caregiving for patients with Alzheimer's disease or dementia and its association with psychiatric and clinical comorbidities and other health outcomes in Brazil , 2016, International journal of geriatric psychiatry.

[3]  Paul Duberstein,et al.  Dementia care: mental health effects, intervention strategies, and clinical implications , 2006, The Lancet Neurology.

[4]  E. Kuipers,et al.  Mental and physical illness in caregivers: results from an English national survey sample , 2014, British Journal of Psychiatry.

[5]  Krishnan Bhaskaran,et al.  The effectiveness of , 2014 .

[6]  U. Sambamoorthi,et al.  Disability Prevalence Among Adults: Estimates for 54 Countries and Progress Towards a Global Estimate , 2013 .

[7]  R. Schulz,et al.  Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. , 1999, JAMA.

[8]  Paul Duberstein,et al.  How effective are interventions with caregivers? An updated meta-analysis. , 2002, The Gerontologist.

[9]  M. Prince Care arrangements for people with dementia in developing countries , 2004, International journal of geriatric psychiatry.

[10]  R. Kessler,et al.  Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys , 2012, Psychological Medicine.

[11]  J. Brodsky,et al.  Key Policy Issues in Long Term Care , 2002 .

[12]  L. Punnett,et al.  The association of major depressive episodes with income inequality and the human development index. , 2008, Social science & medicine.

[13]  S. Subramanian,et al.  The association of asthma and wheezing with major depressive episodes: an analysis of 245 727 women and men from 57 countries. , 2012, International journal of epidemiology.

[14]  Ronda C. Talley,et al.  Framing the public health of caregiving. , 2007, American journal of public health.

[15]  R. Jacobs,et al.  The Quality of Life of Female Informal Caregivers: From Scandinavia to the Mediterranean Sea , 2015 .

[16]  E. Clipp,et al.  Dementia and cancer: a comparison of spouse caregivers. , 1993, The Gerontologist.

[17]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[18]        Global prevalence of dementia: a Delphi consensus study , 2006 .

[19]  V. Rao,et al.  Burden among Parkinson's disease care givers for a community based study from India , 2015, Journal of the Neurological Sciences.

[20]  C. Mathers,et al.  Global prevalence of dementia: a Delphi consensus study , 2005, The Lancet.

[21]  D. Vancampfort,et al.  Exercise as a Treatment for Depression: A Meta-Analysis Adjusting for Publication Bias , 2016, physioscience.

[22]  G. Lamura,et al.  Family carers' experiences using support services in Europe: empirical evidence from the EUROFAMCARE study. , 2008, The Gerontologist.

[23]  Ngianga-Bakwin Kandala,et al.  Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. , 2012, Sleep.

[24]  Martin Pinquart,et al.  Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. , 2003, Psychology and aging.

[25]  A. Carvalho,et al.  Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries , 2017, American journal of epidemiology.

[26]  J. Ayuso-Mateos,et al.  Chronic Conditions and Sleep Problems among Adults Aged 50 years or over in Nine Countries: A Multi-Country Study , 2014, PloS one.

[27]  M. Morris What Research Reveals about Gender, Home Care and Caregiving: Overview and Policy Implications , 2004 .

[28]  S. Lambert,et al.  A Descriptive Systematic Review of Physical Activity Interventions for Caregivers: Effects on Caregivers’ and Care Recipients’ Psychosocial Outcomes, Physical Activity Levels, and Physical Health , 2016, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[29]  Yu-ying Zhou,et al.  Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China , 2017, Journal of clinical nursing.

[30]  Rosalynn Carter Addressing the Caregiving Crisis , 2007, Preventing chronic disease.

[31]  Dean S. Karlan,et al.  Social and economic correlates of depressive symptoms and perceived stress in South African adults , 2008, Journal of Epidemiology & Community Health.

[32]  R. Kessler,et al.  Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH) surveys. , 2013, Revista brasileira de psiquiatria.

[33]  C. Lance,et al.  Risk Factors for Potentially Harmful Informal Caregiver Behavior , 2005, Journal of the American Geriatrics Society.

[34]  S. Chatterji,et al.  Socio-demographic determinants of caregiving in older adults of low- and middle-income countries. , 2013, Age and ageing.

[35]  R. An,et al.  Depression and onset of cardiovascular disease in the US middle-aged and older adults , 2015, Aging & mental health.

[36]  Helen R Marucci-Wellman,et al.  Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States , 2017, PloS one.

[37]  M. Hirst Transitions to informal care in Great Britain during the 1990s , 2002, Journal of epidemiology and community health.

[38]  Jennifer L Martin,et al.  Sleep in caregivers: what we know and what we need to learn. , 2015, Current opinion in psychiatry.

[39]  J. Arango-Lasprilla,et al.  Distress associated with patients' symptoms and depression in a sample of Mexican caregivers of individuals with MS. , 2012, Rehabilitation Psychology.

[40]  Joseph Firth,et al.  An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis , 2017, Psychiatry Research.

[41]  R. Breen,et al.  Total, Direct, and Indirect Effects in Logit and Probit Models , 2013 .

[42]  Assessing and helping carers of older people , 2011, BMJ : British Medical Journal.

[43]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[44]  V. Patel,et al.  The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India , 2008, PloS one.

[45]  L. George,et al.  Predictors of Institutionalization Among Caregivers of Patients With Alzheimer's Disease , 1986, Journal of the American Geriatrics Society.

[46]  W. Sanderson,et al.  The coming acceleration of global population ageing , 2008, Nature.

[47]  Ashutosh Kumar Singh,et al.  Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 , 2016, Lancet.

[48]  A. Koyanagi,et al.  The Association between Sleep Problems and Psychotic Symptoms in the General Population: A Global Perspective. , 2015, Sleep.

[49]  A. Koyanagi,et al.  Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries. , 2016, Schizophrenia bulletin.

[50]  H. Giles,et al.  The dark side of family communication: a communication model of elder abuse and neglect , 2013, International Psychogeriatrics.

[51]  Sube Banerjee,et al.  Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru. , 2010, Revista brasileira de psiquiatria.

[52]  Axel Heitmueller,et al.  The earnings of informal carers: wage differentials and opportunity costs. , 2007, Journal of health economics.

[53]  E. Froelicher,et al.  Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke. , 2012, International journal of nursing practice.