Background An association between informal caring and increased stress, depression and ill-health has been found previously. Limited data are available on the effect of spousal caring on mental health. This study aimed to determine if informal caring for a spouse was associated with depression or health behaviours in adults aged over 50 in Ireland and whether these effects were influenced by the amount of formal care also received.
Methods We analysed two waves (2009–2011, and 2012–2013) of the Irish Longitudinal Study of Ageing (TILDA), a stratified probability sample prospective cohort of men and women aged over 50, resident in Ireland. A total of 5220 respondents, or 2610 couples, who were married/partnered with both spouses in two waves were included. We used multivariate logistic regression models to determine whether caring for a spouse was associated with depression, adjusting for age, socio-economic variables, disability, and cognition of spouse, social support and health-related behaviours in addition to formal care support. Change scores in depression between waves in spousal carers were calculated with the 20-item Centre for Epidemiological Studies Depression (CES-D) scale, and alcohol problems measured using the CAGE alcohol questionnaire. All analyses were conducted in STATA 12.
Results Overall 2.4% (123 of 5051) of married individuals aged over 50 in Ireland began caring for their spouse since surveyed in 2009–2011, and 0.5% (25) cared for their spouse in both surveys. Beginning to care for a spouse was associated with increased depression in the multivariable model (OR 1.05, 95% CI 1.01–1.09) for women, but not in men. Becoming a spousal carer was also associated with negative health behaviours; carers were more likely to be current smokers (OR 2.06, 95% CI 1.17–3.64) and men to have a problem with alcohol (OR 7.78, 95% CI 3.52–17.2), compared to non-carers. The negative effect of caring on mental health was attenuated by receiving respite care, home help and personal care attendants.
Conclusion Becoming a spousal carer was associated with increased depression in this longitudinal study but this effect was reduced by access to formal care. The impact of caring on depression and behavioural health was differentially moderated by gender, with women having increased depression, and men more likely to have problematic drinking. Further research is needed to clarify mechanisms of resilience and support to increase social inclusion of informal carers and enhance home support through formal care mechanisms to reduce the detrimental health-related risks of care-giving.