Cannuscio Carolyn C, Colditz Graham A, Rimm Eric B, Berkman Lisa F, Jones Camara P, Kawachi Ichiro
Merck Research Laboratories, Department of Epidemiology, Blue Bell, PA 19422, USA.
Soc Sci Med. 2004 Apr;58(7):1247-56. doi: 10.1016/S0277-9536(03)00317-4.
The purpose of this study of mid-life and older women was to assess the relation between informal care provision and depressive symptoms, taking into account concurrent demands on women's time (including multiple caregiving roles and employment outside the home) as well as participants' access to potentially supportive social ties. This cross-sectional study included women ages 46-71, free from major disease, who provided complete health and social information in the 1992 Nurses' Health Study follow-up survey (n = 61,383). In logistic regression models predicting depressive symptoms, we examined the interaction between employment outside the home and informal care provision for a disabled or ill spouse or parent. We also investigated level of social ties, measured with the Berkman-Syme Social Network Index, as a potential modifier of the association between informal care provision and depressive symptoms. In all analyses, higher weekly time commitment to informal care for a spouse or parent was associated with increased risk of depressive symptoms. This relationship persisted whether women were not employed outside the home, were employed full-time, or were employed part-time. Higher weekly time commitment to informal care provision was associated with increased risk of depressive symptoms whether women were socially integrated or socially isolated. However, both informal care provision and social ties were potent independent correlates of depressive symptoms. Therefore, women who reported high spousal care time commitment and few social ties experienced a dramatic elevation in depressive symptoms, compared to women with no spousal care responsibilities and many social ties (OR for depressive symptoms=11.8; 95% CI 4.8, 28.9). We observed the same pattern among socially isolated women who cared for their parent(s) many hours per week, but the association was not as strong (OR for depressive symptoms=6.5; 95% CI 3.4, 12.7). In this cross-sectional study, employment status did not seem to confer additional mental health risk or benefit to informal caregivers, while access to extensive social ties was associated with more favorable caregiver health outcomes.
这项针对中年及老年女性的研究旨在评估非正式护理提供与抑郁症状之间的关系，同时考虑到女性时间的并发需求（包括多种护理角色和外出工作）以及参与者获得潜在支持性社会关系的情况。这项横断面研究纳入了46至71岁、无重大疾病、在1992年护士健康研究随访调查中提供了完整健康和社会信息的女性（n = 61,383）。在预测抑郁症状的逻辑回归模型中，我们研究了外出工作与为残疾或患病配偶或父母提供非正式护理之间的相互作用。我们还调查了用伯克曼-赛姆社会网络指数衡量的社会关系水平，作为非正式护理提供与抑郁症状之间关联的潜在调节因素。在所有分析中，每周为配偶或父母提供非正式护理的时间投入增加与抑郁症状风险增加相关。无论女性是未外出工作、全职工作还是兼职工作，这种关系都持续存在。无论女性是社会融入型还是社会孤立型，每周为非正式护理提供的时间投入增加都与抑郁症状风险增加相关。然而，非正式护理提供和社会关系都是抑郁症状的有力独立相关因素。因此，与没有配偶护理责任且有许多社会关系的女性相比，报告配偶护理时间投入高且社会关系少的女性抑郁症状显著升高（抑郁症状的比值比=11.8；95%置信区间4.8, 28.9）。我们在每周照顾父母数小时的社会孤立女性中也观察到了相同的模式，但这种关联没有那么强（抑郁症状的比值比=6.5；95%置信区间3.4, 12.7）。在这项横断面研究中，就业状况似乎并未给非正式护理者带来额外的心理健康风险或益处，而获得广泛的社会关系与更有利的护理者健康结果相关。
