The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains[Instrumental variables and the search for identification: From supply and demand to natural experiments]

ObjectivesWe estimate the causal impact of intensive caregiving, defined as providing at least 80 h of care per month, and work on the mental health of caregivers while considering possible sources of endogeneity in these relationships.MethodsWe use 2 linked data sources from the United States by matching caregivers in the National Study of Caregiving with corresponding care recipients in the National Health and Aging Trends Study for years 2011–2017. We address possible sources of endogeneity in the relationships between caregiving, work, and mental health by using instrumental variables methodology, instrumenting for both caregiving and work behavior. We examine 2 measures used to screen for depression (PHQ-2, psychodiagnostic test) and anxiety (GAD-2, generalized anxiety disorders screening instrument), a composite measure that combines these measures (PHQ-4), and positive well-being variables to ascertain possible gains from caregiving.ResultsProviding at least 80 h of care per month to a parent compared to less intensive caregiving increases the PHQ-4 scale for anxiety and depression disorders. This is driven by the screening score for anxiety and not psychodiagnostic test scores for depression. Relationship quality decreases substantially for intensive caregivers, and intensive caregiving leads to less satisfaction that the care recipient is well-cared for. We do not find offsetting mental health gains for intensive caregivers compared to nonintensive caregivers. Work does not independently affect the mental health of caregivers.DiscussionCaregiver interventions that reduce objective demands or support intensive caregivers could reduce or prevent well-being losses and improve the caregiver’s relationship with the recipient.