Depression and Emotional Difficulty in Informal Caregivers by Employment Status: An Analysis based on data of the National Study of Caregiving (NSOC)

Abstract

Background: 81% of more than 43 million informal caregivers (CG) in the U.S. are in working age, of whom more than two third are employed. Some studies found that CG are more likely to work fewer hours, leave the labor market, or have higher work productivity losses than non-caregivers. Although the results are quite consistent regarding the association between informal care and depression, the effect of employment status on CGs’ mental health is less clear. Objectives: First, this study aims to examine whether employment status is associated with depression or emotional difficulty in informal CG in working age, and second, to descriptively compare predictors of depression/emotional difficulty in different employment status groups. Methods: This cross-sectional study analyzed CG aged 18 to 64 from the NSOC III (N=1,292/1,306). Binary logistic regression analyses were performed. The Stress Process Model functioned as the theoretical framework for the modeling process and the selection of independent variables. Interactions were included if they were significant. Results: Around 40% of CG in working age have emotional difficulty and 12% have depression. Unemployment is associated with depression (OR=2.22, 95% CI [1.51-3.27]) but not with emotional difficulty. In both employment groups, worse physical health, relational deprivation, and overload predict depression. For employed CG, having children under 18 is protective, whereas for unemployed CG, living with a partner is protective, but co-residence is associated with a higher risk of depression. In both employment groups, constriction of social life, financial difficulty, relational deprivation, and overload are associated with emotional difficulty. Black race, being a friend/nonrelative, and co-residence is protective against emotional difficulty in employed CG. In unemployed CG, female sex is associated with a higher risk of emotional difficulty. Conclusion: This study supports the protective effect of employment on mental health but cannot make a sufficient explanatory contribution. Future studies should illuminate causal relationships by analyzing trajectories of the stress process with a special focus on employment status or identifying early indicators of depression to offer support services to relevant target groups.