Mental health declines when becoming an unpaid carer

Becoming an unpaid carer for family and friends negatively affects the mental health of people of all ages and genders, finds a new study by researchers at UCL and St George’s, University of London.

The research, published in The Lancet Public Health, used data from more than 17,000 people in the UK Household Longitudinal Study between 2009 and 2020 to investigate mental and physical health changes around the transition to becoming a caregiver for the first time in adults aged 16 and older.

Data was collected on 16,906 people from the General Health Questionnaire (GHQ-12) which measures psychological distress on a range from 0 to 12, with a score of 4 or more being indicative of a mental health problem.

The team also used data from 17,909 people who took the 12-item Short Form Survey (SF-12), which measures physical and mental functioning - with a higher score showing better cognitive function.

The team looked at the mental and physical health of caregivers at three points: eight years before becoming a carer, during caring, and eight years after becoming a carer.

They also considered four life stages - early adulthood (16-29 years), early mid-adulthood (30-49 years), later mid-adulthood (50-64 years), and later life (65+ years).

The team then compared their scores with non-caregivers who were otherwise similar.

Researchers found that becoming a carer was linked to increased psychological distress for carers of every age in the study. Carers aged 16-29, 30-49 and 50-64, had the largest increase in psychological distress when becoming a carer, with a 0.37, 0.39 and 0.39 point increase in GHQ score, respectively.

Cognitive  function also declined when becoming a carer in those aged 30-49 and 50-64, with a 0.54 and 0.46 point reduction in SF-12 score, respectively.

Although these are modest changes, researchers say they highlight the need for action to protect the declining mental health of people when becoming caregivers.

Co-author, Professor Anne McMunn (UCL Epidemiology & Health), said: "It’s less common for people to become a caregiver in early adulthood when there are likely to be many competing social roles such as post-secondary education and relationships, as well as establishing a career.

"Early and mid-adult caregivers were likely to be caring for a parent representing a challenging role reversal. Together these factors could contribute to why psychological distress was higher in these age groups."

The team also found that people who provided a high intensity of care (20+ hours per week) experienced increased psychological stress and decline in mental health. In carers aged 30 and above, poorer mental health persisted for several years after becoming a caregiver, so early identification is key to preventing long-term mental health effects.

Physical health did not change upon becoming a carer, but there was evidence of poorer physical health prior to caregiving compared to non-caregivers.

Lead author, Dr Rebecca Lacey (St George’s, University of London), said: "Younger carers are often overlooked as caring is seen as something the older adults do.

"We urge health leaders to take this evidence seriously and ensure that health practitioners quickly identify carers of their patients, including those who are younger adults, so their health can also be reviewed. This is going to be crucial to break the cycle of care need."

The evidence coincides with the publication of a landmark All-Party Parliamentary Groups (APPG) report on young and young adult carers, which reveals that vast numbers of younger carers are not identified early enough, with an average waiting time of three years until young carers get linked to any support.

As the UK population ages and the cost of living rises, unpaid care of family and friends has become an increasingly important in most countries. The United Nations estimate that unpaid carers meet 75-90% of care needs, and although young adults are often overlooked, they make up at least 376,000 of the carers across the UK.

Previous research has found that the general health of unpaid carers is poorer than non-caregivers. But until now, there has been little research into how people’s mental health changes when they start being a caregiver, and whether this varies by age, gender and the amount of care they provide.

Rohati Chapman, Carers Trust’s Executive Director for Programmes, Policy & Impact, said: "Unpaid carers are making huge sacrifices to look after family members and friends. It is vital their health and wellbeing should not suffer as a result. They must have access to effective mental health provision in their area and to dedicated carer support when and where they need it.

"Our network of local carer organisations is ready to help with this but it is clear that support must be ramped up across the board.

Case study

Jordyn, a young adult carer, said: "I have experienced a deep-rooted feeling of guilt for prioritising my own mental health over caring for my dad.

"I was in hospital for my mental health and all I could think about was who would help my dad? Who would do his medication? Who would make him food? Who would help him get up and down the stairs?

"The harsh truth is that us young carers don’t care for ourselves, and it’s tough but we’re not our own priority. We even go so far as to mask our symptoms and struggles because we don’t want to be the problem for someone else. We break down in silence and go longer without getting help because we have someone else that we are responsible for.

"We carry huge burdens and still go on normally. This needs to change and there has to be better support."

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