In this post, Becca Lacey, Reader at St George’s, University of London, shares research from the Eurocare team on how mental and physical health change around becoming an unpaid carer in the UK.
Why care about carers?
We have known for quite a long time that unpaid carers report poorer mental and physical health compared to their peers who are not caring – at least on a population level. Unpaid carers might provide help to a relative or friend because of poor health, addiction or disability. Carers are increasingly plugging the gaps in health and social care services and have been termed the “invisible army”. In fact, the United Nations estimated that as much as 75-90% of all care needs globally are met by unpaid carers. It is therefore critical that we better understand how we can support the health of carers to prevent a perpetuating cycle of care need and ultimately a public health crisis.
Why was this study needed?
Prior to our study, there had been a few other studies which had looked more at how health changes before and after becoming a carer. However, these had all focused on adults aged 45+ and therefore not included younger carers, including those in earlier stages of adulthood. Also, many of the prior studies had not considered whether the health changes that becoming a carer brings might differ for men and women, or by caring intensity (the number of hours per week of care provided and whether the carer is living with the person they are looking after). We set out to plug these evidence gaps.
Methods and data
By using data from the UK Household Longitudinal Study (UKHLS), which follows the same representative sample of adults aged 16+ since 2009, we were able to map how carers health changed around becoming a carer for the first time and how this compared to similar people who did not become carers. These types of longitudinal data allow us to assess how quickly mental and physical health is affected when becoming a carer. We can also look at whether any changes in health persist over time and if so, for how long.
One thing that is unique about UKHLS is that it asked all household members aged 16+ about whether they were providing care or not. This meant that we could look at how becoming a carer in early adulthood compared to at other stages of adulthood.
In terms of health, we were able to look at how becoming a carer affects psychological distress (symptoms of depression and anxiety) plus mental and physical health functioning.
What did we find?
16.5% of young adults aged 16-29 became a carer during this lifestage. This is in comparison to 27% of people aged 30-49, 37% of those aged 50-64 and 34% of those aged 65+. We found that carers reported an increase in psychological distress and a reduction in mental health functioning immediately around becoming a carer for the first time. This was the case for carers of all ages. For carers aged 30-49 the decline in mental health persisted for several years.
Interestingly, we found no differences between men and women. However, it’s important to note that more women become carers than men, and women tend to provide more intense care.
What really mattered for mental health was taking on high intensity care. That is, becoming a carer and providing more than 20 hours of care per week. We found this to be the case for all age groups except those aged 16-29 years where there were fewer people taking on such intense levels of care. We also found that caring for someone who lives with the carer was associated with increases in psychological distress and lower levels of mental health functioning.
We did not see any declines in physical health upon becoming a carer. However, there was some indication that people who became a carer had slightly poorer physical health beforehand.
What do our findings mean?
Our findings point to the importance of early identification. If carers are identified quickly then support can be given faster and hopefully any effects on mental health could be reduced. Early identification via health and other services might be a way of achieving this. This a situation where GPs and hospital discharge teams are probably best placed. The focus of discussions is often solely on the patient/care recipient with no focus on the health of the carer.
We also showed that it is important to remember younger carers, i.e. those in early adulthood. There is less awareness and discussion of the fact that young adults can be carers too; care is often seen as something that older people do and this is not necessarily the case. It is therefore important that we recognise that younger people can also be carers. In the UK there is growing awareness of younger carers, but our findings show that even with this increased recognition their mental health is still being negatively affected.
It is essential that we support the mental health of carers to prevent a cycle of care need and a public health and social care crisis.
What’s next?
The Eurocare team are now investigating whether there are additional inequalities in the change in mental health upon becoming a carer for different ethnic minority groups and different levels of financial means. We know from some of our previous work that people from Pakistani and Bangladeshi ethnicities are more likely to be carers but we don’t yet know whether their health is more affected by becoming a carer. Similarly, we might expect families with lower incomes to have to pick up more unpaid care instead of paying for private care. But again, we don’t if becoming a carer impacts more on their health compared to people who have higher incomes.
We are also now working on a study which focuses squarely on young carers – the group missing in the study discussed in this blog. Again using UKHLS we are looking at how the health and wellbeing of young carers aged 10-24 changes when they become a carer.
About the author
Becca Lacey is a Reader in Social and Lifecourse Epidemiology in the Population Health Research Institute at St George’s, University of London. Her research focuses on the impact of caring in adolescence and young adulthood on peoples’ longer-term health, work and social participation outcomes.