Aging
Effect of family caregiving on depression outcome among older European adults Sherry Hou* Sherry Hou Arijit Nandi Jee Won Park
The majority of caring for older adults is done by family members. While the conventional wisdom is that caregiving is deleterious for the caregivers’ health, most studies rely on observational data and traditional regression methods, which fail to account for time-varying confounding, limiting causal inference. This analysis uses inverse probability weighting (IPW) to appropriately account for time-varying confounding in caregiving-depression relationship.
Using 7 waves (2004-2019) of the Survey of Health, Ageing and Retirement in Europe, a longitudinal survey, we estimated the effect of caregiving on depression caseness (having 4+ symptoms) comparing daily and less-than-daily caregivers to non-caregivers. We accounted for potential measured confounding and censoring by time-fixed covariates (gender, number of children, country, and education) and time-varying covariates (age, employment, marital status, income, physical limitations, psychiatric drugs, receiving help, previous caregiving, and previous depression) using IPTW and IPCW. The product of the two weights was applied to a marginal structural model to obtain the causal estimand on the prevalence difference scale. Confidence intervals were derived from bootstrapping.
Among 36,346 participants and 67,800 person-waves, compared to no caregiving in the last year, daily caregiving was associated with an 8.3 percentage point (95% CI: 6.1%, 10.5%) increase in the prevalence of depression caseness, after accounting for time-fixed and time-varying covariates. Less-than-daily caregiving was not associated with depression caseness (PD=0.8 percentage point, 95% CI=-0.9%, 2.4%).
Our results support previous findings that high levels of caregiving may increase the prevalence of depressive symptoms, while lower levels of caregiving do not. Accurate documentation of the relationship between caregiving and health outcomes is foundational in creating evidence-based policies to support healthy aging.
