Elsevier

Social Science & Medicine

Volume 173, January 2017, Pages 72-80
Social Science & Medicine

Health effects of informal caregiving across Europe: A longitudinal approach

https://doi.org/10.1016/j.socscimed.2016.11.036Get rights and content

Highlights

  • We examine informal caregivers' health across Europe using longitudinal methods.

  • Different caregiving settings are studied in a country comparison.

  • Health consequences differ between caregiving inside and outside the household.

  • Health effects of caregiving vary between and within different welfare state types.

Abstract

Due to an expected increase of people in need of care, sound knowledge about health effects of informal care provision is becoming more and more important. Theoretically, there might be positive as well as negative health effects due to caregiving to relatives. Moreover, we suppose that such health effects differ by national context – since care is differently organized in Europe – and depend on the social setting in which the care relationship takes place. Using data from the Survey of Health, Ageing and Retirement (SHARE, waves 1, 2, 3, and 5) and from the English Longitudinal Study of Ageing (ELSA, waves 2–5) we examined the connection between informal caregiving and self-perceived as well as mental health in a country comparative perspective. Taking advantage of the longitudinal structure of the data, pooled ordinary least squares (OLS) and fixed-effects models (FEM) were estimated. Our results show distinct differences in the relationship between reported health and the provision of informal care depending on whether individuals give care to someone inside or outside the household. Caregivers inside the household reported worse health, caregivers from outside the household reported better health than non-caregivers. We find that this correlation is largely due to selection into caregiving: people in worse health took up care inside while people in better health took up care outside the household. However, in most countries people who started caregiving inside the household experienced a decline in their mental health. This suggests that caregiving inside the household results in psychological stress irrespective of the type of welfare state. The results regarding self-perceived health and caregiving outside the household are less distinct. All in all our results show that health consequences of caregiving vary not only between different welfare regimes but also between countries of similar welfare state types.

Introduction

In ageing societies the number of people in need of care is expected to increase (Colombo et al., 2011) – although the extent is unknown yet (Crimmins and Beltrán-Sánchez, 2011). At present, the share of people receiving long-term care varies notably across Europe (Colombo et al., 2011). For all countries, at least in relative terms, the availability of potential caregivers decreases because of demographic as well as socio-structural changes, such as lower fertility, increased mobility, and rising labor market participation of women (Brandt et al., 2016, Colombo et al., 2011). In many European countries informal care is important for the overall care provision, but the (legal and structural) duty to provide care for older relatives differs (Genet et al., 2013). Not least with families having to “step back in” (reverse substitution, Johansson et al., 2003) and provide informal support in times of welfare state retrenchment, the wellbeing of informal caregivers gains importance. To establish environments that keep caregivers in good health and thus reduce individual costs of caregiving, evidence on negative health effects of caregiving is needed. An international comparison may help to detect “caregiver supportive environments”.

The pathways through which caregiving might affect physical and mental wellbeing are manifold. Caregivers may experience a decline in their wellbeing due to the physical and time demanding caregiving task (Zarit et al., 1980). Indeed, empirical studies suggest that caregiving impairs mental health (Hiel et al., 2015). However, adverse health effects might depend on the emotional closeness between those involved (Litwin et al., 2014) and on the motive for care provision. Different caregiving intentions have been reported for spouses and children resulting in different health effects (Broese van Groenou et al., 2013). Finally, contextual factors like socio-demographics or social support can moderate the caregiving burden (Pearlin et al., 1990, Tolkacheva et al., 2011). Not least, it is important to consider the country context, as the extent of caregiving tasks and thus the burden of caregiving depends on the institutional setting (Brandt, 2013). Previous research using a broad differentiation of welfare state regimes suggests that women in Southern welfare states suffer more from caregiving than those in Northern ones (Brenna and Di Novi, 2016). Yet, not all studies use longitudinal data and methods, which is necessary to take selection into caregiving into account (Vlachantoni et al., 2013).

The literature suggests that health outcomes of caregiving vary across different contexts. Taking this into account we do not just estimate an average effect of caregiving over all countries and all types of caregiving situations but allow adverse consequences of caregiving to differ between countries and place of care provision (inside and outside the household). As we use data from the Survey of Health Ageing and Retirement (SHARE, waves 1, 2, 4 and 5) and the English Longitudinal Study of Ageing (ELSA, waves 2–5) our analysis is the first of this kind covering eleven countries which represent various welfare regimes over time.

The remainder of this paper is structured as follows: We first discuss how caregiving (in specific contexts) can influence health and present previous findings in the field. Both theoretical arguments and empirical evidence lead to our expectation, that caregiving in certain welfare state and household contexts is more incriminatory for individual health (section 2). In the following we present our data and methods (section 3) and results (section 4), which we discuss in the final section (section 5).

Section snippets

Caregiving and health in context: theoretical reasoning, empirical evidence and hypotheses

According to the “Informal Care Model” (Broese van Groenou and de Boer, 2016: 273) the care decision depends on the care recipient's needs, attitudes and beliefs towards caregiving as well as on perceived difficulties. But also the relationship between those involved, the family and social network as well as the community are important factors. Furthermore the caregiving decision is framed by policy decisions and changes within society (Broese van Groenou and de Boer, 2016).

Data and methods

Our data covers people from the ten countries that participated in all available waves of SHARE and people from England who participated in the ELSA panel, thus comprising a broad variation in welfare state contexts over time. We did not use wave 3 of SHARE as this was a retrospective survey and in ELSA we could not use wave 1 as it did not distinguish between help given inside or outside the household. Both are surveys that contain information e.g. about the socio-economic status and health of

Empirical findings

About 9% of the individuals in the sample (N = 82,524) ever gave care to somebody inside and about 16% provided support for someone outside the household. In SHARE 35% and in ELSA 45% of those who gave care inside the household in a wave gave care in the following wave, too, and 6.2% (respectively 2.5% in ELSA) of those not giving care in a certain wave took up care in the following wave. The transitions into and out of caregiving for caregiving outside the household were very similar but on a

Discussion

In times of rapid demographic change the number of people in need of care is expected to increase. Research focusing on the main source of care supply – informal caregivers – and evidence based policy making in their favor becomes ever more important. An important step on the way to “caregiver supportive environments” is to detect mechanisms underlying the relationship between caregiving and health in different contexts. Previous research focused either on caregiving in specific social settings

Acknowledgments

We are grateful for comments by two anonymous referees. We also thank the participants at conferences in Rostock, Los Angeles and Esch-sur-Alzette for their suggestions. This paper uses data from SHARE (wave 1, 2, 4 and 5, release 5-0-0) and ELSA (wave 2 -5). The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP:

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