Researchers have found that caregiving for a spouse who has a disability — an activity long thought to contribute to depression — may instead benefit a caregiver's mental health in the context of spousal activity limitations, because acts of caregiving may provide an opportunity for physical activity and a sense of purpose.
The findings, published May 26 in Social Science and Medicine, could provide comfort to those who care for their spouses — a population that makes up around 12% of the nearly 48 million Americans who serve as caregivers for adults. People who take care of a loved one with a disability or other health issue may find it stressful and time-consuming. Yet with the aid of longitudinal data from thousands of couples, the new study revealed that, in many cases, these challenges may be overcome by positive feelings, such as the belief that one's assistance is actively improving a partner's living situation and health.
"Caregiving to an extent alleviated the emotional health consequences of having a spouse afflicted with a disability, an adverse experience many individuals go through in later life," explained the authors in the study.
"Everyone, if you are fortunate to live long enough, will have someone in their lives who falls sick or disabled," Sae Hwang Han, an assistant professor at the University of Texas at Austin and the paper's first author, told The Academic Times. "What we are arguing is that the act of providing care and help to your loved one is not the culprit, in terms of the cause for depression and other mental health conditions."
Around half of older adults in the United States either have difficulty performing daily activities or require help with everyday tasks. And as the country's population ages, this rate is likely to rise.
Aside from individuals in nursing homes or supportive-care settings, nearly all older adults with a disability receive help from at least one informal caregiver, such as a friend or family member, to assist with daily activities. Those can include basic self-care tasks, such as maintaining one's hygiene, cooking and moving around one's home. But they may also include activities that are necessary for daily living, such as banking, shopping and ordering prescriptions.
Han and his colleagues used data from 2004 through 2016, collected by the Health and Retirement Study, a nationally representative, longitudinal dataset. They analyzed the mental health trends of 6,475 couples, across 57,844 observations and found evidence that caregiving could relieve depressive symptoms in caregivers when they held a spouse's disability status constant.
It's unsurprising that activity limitations or health issues may lead some individuals to feel a sense of isolation or a loss of self-esteem and independence. And because either member of a relationship can be influenced by the other's mental and physical health, a bout of depression brought on by disability may also be experienced by one's partner.
"If you have a very sick or disabled family member that you really care about, then their health status — by virtue of you really caring about them — can influence your psychological well-being," Han said. "It hurts to have your loved one suffer."
But Han thinks that caregiving may help caregivers respond to that suffering in a productive way, because it can offer a degree of control over an unquestionably difficult situation. The researchers titled their paper "Take a Sad Song and Make it Better" — after the lyrics from a Beatles song — to highlight this somewhat optimistic and almost bittersweet message.
Prior research indicates that the act of caregiving itself, which can at times be labor-intensive and emotionally taxing, may also provide a direct pathway to depression for some partners who assume the caregiving role. But Han thinks many earlier studies have suffered from methodological issues because they compared caregiving individuals and their spouses with healthy people who had no caregiving or disability experience.
"It's similar to, for example, taking a sample of people who take a cough medicine because they have a cold, and comparing them to a healthy control, and concluding that it's the cough medicine that explains the health differences between the two groups," Han said.
He and his co-authors instead used the caregivers themselves as controls. In other words, the researchers assessed participants' mental health during periods in which they were serving as a caregiver for a disabled partner. Then they compared those results with the volunteers' mental health during periods in which they were not caregiving for their disabled loved one.
Previous research had taken almost as a scientific fact that caring for a disabled partner was associated with poor health outcomes, Han said. But recently, researchers began noticing a peculiar trend: Large, population-based studies showed that people who engaged in high-intensity caregiving, characterized by activities such as bathing, toileting and dressing a person with a disability, had much lower mortality rates. This may be because some caregiving tasks require a high degree of cognitive attention and physical activity — factors that have been shown to be beneficial to older individuals' overall health — and because caregiving itself may provide caregivers a sense of purpose.
Han thinks that people with a disability or other debilitating health issues can offer some level of care to their partner — even as their partner provides care to them — as a means of showing mutual love and respect, which may provide additional health benefits. Meanwhile, caregivers can learn to be more open to receiving care themselves.
"We have to teach people to effectively provide and also receive help from [their] loved ones, if [they] are able to do so," Han said. "That can also have health benefits for the person who is providing the care."
The study "Take a sad song and make it better: Spousal activity limitations, caregiving, and depressive symptoms among couples" published May 26 in Social Science and Medicine, was authored by Sae Hwang Han, University of Texas at Austin; Kyungmin Kim, Seoul National University; and Jeffrey A. Burr, University of Massachusetts Boston.