Difference in the physical and mental health of informal caregivers pre- and post-COVID-19 National Emergency Declaration in the United States

Emery Lady Ngamasana; Meagan Zarwell; Lori Eberly; Laura H Gunn

doi:10.1016/j.ssmph.2024.101609

Difference in the physical and mental health of informal caregivers pre- and post-COVID-19 National Emergency Declaration in the United States

SSM Popul Health. 2024 Jan 17:25:101609. doi: 10.1016/j.ssmph.2024.101609. eCollection 2024 Mar.

Authors

Emery Lady Ngamasana¹, Meagan Zarwell¹, Lori Eberly¹, Laura H Gunn^{1

2

3}

Affiliations

¹ Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
² School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA.
³ Department of Primary Care and Public Health, Imperial College London, London, UK.

Abstract

Background: The burden of informal caregiving represents a chronic stressor for the informal caregivers (ICs). The study investigates differences in the physical and mental health of ICs and that of non-informal caregivers before and during COVID-19.

Methods: We used data from the 2019/2020 Behavioral Risk Factor Surveillance System (BRFSS) to investigate differences in the rates of days of poor physical and mental health among ICs compared to non-informal caregivers before and after the COVID-19 National Emergency Declaration (NED). A propensity score model simulated a pseudo experimental design, comparing ICs ("treated") with non-informal caregivers ("control"). A difference-in-difference regression model estimated the incidence rate ratios for days of poor physical and mental health as a function of IC status and time of care provision.

Results: A total of 44,583 respondents were identified with valid responses on informal caregiving status and key sociodemographic characteristics. Of those, 6.24% (n = 3073) were ICs, matched against 15,365 non-informal caregivers. In the matched sample (n = 18,848), the incidence rate for days of poor physical health among ICs was 17% (p = 0.003) higher compared to non-informal caregivers. The incidence rate for days of poor physical health was 23% (p < 0.001) lower in the post-NED compared to the pre-NED periods. The incidence rate for days of poor mental health was 44% (p < 0.001) higher among ICs compared to non-informal caregivers and 22% higher among respondents who took the survey post-NED compared to those who answered during the pre-NED period. No statistically significant differences were found between the two groups in their incidence rates for days of poor physical and mental health from the pre-to the post-NED period.

Conclusion: These findings suggest a need to balance between the benefits conferred by public health restrictions versus the mental health burden that may result among certain groups, including ICs, who experience higher negative mental health outcomes.

Keywords: COVID-19 National Emergency Declaration; Informal caregiver; Physical and mental health; Societal disruptions; Theory of caregiver stress.