Ervin Jennifer, Taouk Yamna, Fleitas Alfonzo Ludmila, Peasgood Tessa, King Tania
Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
EClinicalMedicine. 2022 Nov 1;53:101711. doi: 10.1016/j.eclinm.2022.101711. eCollection 2022 Nov.
Informal unpaid caregivers provide most of the world's care needs, experiencing numerous health and wealth penalties as a result. As the COVID-19 pandemic has highlighted, informal care is highly gendered. Longitudinal evidence is needed to assess the causal effect of caregiving on mental health. This review addresses a gap by summarising and appraising the longitudinal evidence examining the association between unpaid caregiving and mental health among working age adults in high-income Organisation for Economic Co-operation and Development (OECD) countries and examining gender differences.
Six databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science, Econlit) from Jan 1, 2000 to April 1, 2022. Population-based, peer-reviewed quantitative studies using any observational design were included. Population of interest was working age adults. Exposure was any unpaid caregiving, and studies must have had a non-caregiving comparator for inclusion. Mental health outcomes (depression, anxiety, psychological distress/wellbeing) were measurable by validated self-report tools or professional diagnosis. Screening, data extraction and quality assessment (ROBINS-E) were conducted by two reviewers. The study was prospectively registered with PROSPERO (CRD42022312401).
Of the 4536 records screened; 13 eligible studies (133,426 participants) were included. Overall quality of evidence was moderate. Significant between-study heterogeneity precluded meta-analysis, so albatross and effect-direction plots complement the narrative synthesis. Results indicate a negative association between informal unpaid care and mental health in adults of working age. Importantly, all included studies were longitudinal in design. Where studies were stratified by gender, caregiving had a consistently negative impact on the mental health of women. Few studies examined men but revealed a negative effect where an association was found.
Our review highlights the need to mitigate the mental health risks of caregiving in working age adults. Whilst men need to be included in further scholarship, reducing the disproportionate caregiving load on women is a crucial requirement for policy development.
Melbourne School of Population and Global Health, Targeted Research Support Grant.
非正式无薪照料者满足了世界上大部分的照料需求，因此承受着诸多健康和财富方面的不利影响。正如新冠疫情所凸显的，非正式照料存在高度的性别差异。需要纵向证据来评估照料对心理健康的因果效应。本综述通过总结和评估纵向证据来填补这一空白，这些证据考察了高收入经济合作与发展组织（经合组织）国家工作年龄成年人中无薪照料与心理健康之间的关联，并研究了性别差异。
检索了六个数据库（Medline、PsycInfo、EMBASE、Scopus、Web of Science、Econlit），时间跨度为2000年1月1日至2022年4月1日。纳入采用任何观察性设计的基于人群的、经同行评审的定量研究。研究对象为工作年龄成年人。暴露因素为任何无薪照料，且研究必须有非照料对照以纳入研究。心理健康结果（抑郁、焦虑、心理困扰/幸福感）可通过经过验证的自我报告工具或专业诊断进行测量。由两名评审员进行筛选、数据提取和质量评估（ROBINS-E）。该研究已在PROSPERO（CRD42022312401）上进行前瞻性注册。
在筛选的4536条记录中，纳入了13项符合条件的研究（133,426名参与者）。证据的总体质量为中等。研究间存在显著异质性，无法进行荟萃分析，因此采用信天翁图和效应方向图来辅助叙述性综合分析。结果表明，工作年龄成年人的非正式无薪照料与心理健康之间存在负相关。重要的是，所有纳入研究均为纵向设计。在按性别分层的研究中，照料对女性心理健康始终有负面影响。很少有研究考察男性，但发现存在关联时显示有负面影响。
我们的综述强调了减轻工作年龄成年人照料带来的心理健康风险的必要性。虽然需要在进一步的学术研究中纳入男性，但减少女性不成比例过重的照料负担是政策制定的关键要求。
墨尔本人口与全球健康学院，定向研究支持基金。
