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Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys

Published online by Cambridge University Press:  09 August 2012

V. Shahly ,
S. Chatterji ,
M. J. Gruber ,
A. Al-Hamzawi ,
J. Alonso ,
L. H. Andrade ,
M. C. Angermeyer ,
R. Bruffaerts ,
B. Bunting  and
J. M. Caldas-de-Almeida
...Show all authors
V. Shahly
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. Chatterji
Affiliation:
World Health Organization, Geneva, Switzerland
M. J. Gruber
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
A. Al-Hamzawi
Affiliation:
Al-Qadisia University College of Medicine, Diwania Teaching Hospital, Diwania, Iraq
J. Alonso
Affiliation:
Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
L. H. Andrade
Affiliation:
Section of Psychiatric Epidemiology, São Paulo, Brazil
M. C. Angermeyer
Affiliation:
Center for Public Mental Health, Gösing am Wagram, Austria
R. Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
B. Bunting
Affiliation:
University of Ulster, Londonderry, UK
J. M. Caldas-de-Almeida
Affiliation:
Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal
G. de Girolamo
Affiliation:
IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
P. de Jonge
Affiliation:
University Medical Center Groningen, Groningen, The Netherlands
S. Florescu
Affiliation:
National School of Public Health Management and Professional Development, Bucharest, Romania
O. Gureje
Affiliation:
Department of Psychiatry, University of Ibadan, College of Medicine, Ibadan, Nigeria
J. M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
H. R. Hinkov
Affiliation:
National Center for Public Health Protection, Sofia, Bulgaria
C. Hu
Affiliation:
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, People's Republic of China
E. G. Karam
Affiliation:
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
J.-P. Lépine
Affiliation:
Hôpital Lariboisiére Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM U 705, CNRS UMR 7157 University Paris Diderot and Paris Descartes Paris, France
D. Levinson
Affiliation:
Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
M. E. Medina-Mora
Affiliation:
Instituto Nacional de Psiquiatria Ramon de La Fuente Muñiz, Mexico City, Mexico
J. Posada-Villa
Affiliation:
Instituto Colombiano del Sistema Nervioso, Bogota, Colombia
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
J. K. Trivedi
Affiliation:
Department of Psychiatry, C.S.M. Medical University, Lucknow, India
M. C. Viana
Affiliation:
Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. (Email: ncs@hcp.med.harvard.edu)
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Abstract

Background

Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers.

Method

Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition.

Results

Among the 26.9–42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7–42.5% reported burden. Of those, 25.2–29.0% spent time and 13.5–19.4% money, while 24.4–30.6% felt distress and 6.4–21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6–23.6 (169.9–205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings.

Conclusions

Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.

Keywords

Caregiverscross-national studiesepidemiologyfamily burdenmental health
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 4 , April 2013 , pp. 865 - 879
Copyright
Copyright © Cambridge University Press 2012

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