Aging
The effects of family caregiving and cash transfers on probable depression among older adults in the Survey of Health, Ageing and Retirement in Europe (SHARE): simulation using parametric g-formula Sherry Hou* Sherry Hou Jee Won Park M. Maria Glymour Arijit Nandi
When the intensity of caregiving exceeds the capacity of the caregivers, caregivers may experience poorer mental health outcomes. Traditional regression methods cannot account for time-varying confounding or simulate effects of hypothetical interventions. Our goal was to estimate the effect of caregiving on probable depression and how cash transfers, as a hypothetical intervention, could modify that relationship.
Using 7 waves (2004-2012) of SHARE, a cohort study of adults age 50+, we used parametric g-formula to estimate the prevalence of depression (defined as 4+ symptoms on the EURO-D depression scale) under the following simulated scenarios: if all participants, at all waves, were to provide daily, less-than-daily, or no caregiving, with and without a cash transfer of 12,000 €/year in household income. We accounted for time-fixed (gender, number of children, country, and education) and time-varying (age, employment, marital status, income, physical limitations, psychiatric drugs, and receiving help) covariates, and 95% confidence intervals were bootstrapped.
Among 36,359 participants, the average follow-up time was 2.9 waves or 4.8 years. If everyone provided daily caregiving consecutively for one, two, or three waves after baseline, the depression prevalence would be 4.8% [2.5%, 7.3%], 3.1% [0.4%, 6.4%], and 2.8% [-3.5%, 9.3%] higher than if everyone were noncaregivers. If everyone were daily caregivers receiving cash transfer of 12,000 €/year, the depression prevalence would be 0.2% [>-0.1%, 0.6%], 0.3% [-0.8%, <0.1%], and 0.3% [-1.1%, 0.4%] lower than daily caregivers without cash transfer.
Our results found that daily caregiving increased the prevalence of depression. Additional income did not mitigate the effect of daily caregiving on depression. While the g-formula simulation offered insight to how hypothetical cash transfer may affect caregiver mental health, future research using quasi-experimental methods is needed for more robust causal analysis.