Introduction
Methods
Study design and source population
Data collection and procedures
Informal caregiving
Presence of suicidal thoughts
Risk factors for suicidal thoughts
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Sociodemographics included: age; gender; educational level (primary, basic vocational or lower secondary education, higher education); employment status (in paid employment, not in paid employment), living with a partner (yes, no); and, parental status (cohabiting with child(ren) yes/no).
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Caregiving-related characteristics included: the type of relationship with the care recipient (partner, first-degree family [e.g. parents, siblings or children], other family [e.g. in-laws] or friend); number of care recipients (one, more than one); cohabiting with the care recipient (yes, no); reasons for care (physical problems, mental problems, ageing, dementia); type of care (domestic chores, personal care/nursing, emotional support/supervision, practical care); time spent giving care (0–7 h per week, 8 or more hours per week); and, duration of care (less than 1 year, 1 year or more).
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Other characteristics included:
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◦ Perceived social support from three sources (partner, family or friends, neighbours) was measured with two questions on instrumental and emotional support from each source. These referred to the extent respondents could rely on them for help if they had a problem and could open up to them if they needed to talk about worries. The four response categories ranged from one (not at all) to four (a lot). Perceived social support was calculated as the mean score from at least two sources—because not all respondents had a partner at the time of interview.
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◦ Chronic physical disorders were identified with a standard checklist of 17 chronic physical disorders, treated or monitored by a medical doctor in the 12 months prior to T1, including: asthma; chronic obstructive pulmonary disease; chronic bronchitis; emphysema; severe heart disease; heart attack; hypertension; stroke; stomach or intestinal ulcers; severe intestinal disorders; diabetes; thyroid disorder; chronic back pain; arthritis; migraine; impaired vision or hearing; or, any other chronic physical disorder [22].
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◦ Mood disorders (major depression, dysthymia and bipolar disorder) and Anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia and generalized anxiety disorder) in the last 12 months were identified with the CIDI 3.0 [23]. Clinical calibration studies in various countries found that the CIDI 3.0 assesses common mental disorders with generally good validity in comparison with blinded clinical reappraisal interviews [20].
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◦ The presence of ten negative life events (e.g. death of a relative or friend, divorce) in the 12 months prior to T1 were measured, based on the Brugha Life Events scale [24].
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◦ Role functioning was assessed in the past 4 weeks for the physical, mental and social domains from the Medical Outcomes Study Short Form Health Survey (SF-36) [25]. All three functioning scales ranged from 0 (low functioning/ ill health) to 100 (high functioning), and were dichotomized into high functioning (score 100) versus impaired functioning (score < 100).
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Statistical analysis
Results
Sample characteristics
Total
n = 1582
| Suicidal thoughts
n = 36
| No suicidal thoughts
n = 1546
| Model adjusted for age and gender | |||
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n (%) | n (%) | n (%) | OR | 95% CI | p | |
Sociodemographics
| ||||||
Age, mean (SD) | 50.2 (11.5) | 49.2 (10.0) | 50.2 (11.5) | 0.99 | 0.97; 1.02 | 0.61 |
Female gender | 1022 (64.6) | 25 (69.4) | 997 (64.5) | 1.24 | 0.60; 2.54 | 0.56 |
Lower educational levela | 469 (29.6) | 15 (41.7) | 454 (29.4) | 1.79 | 0.90; 3.57 | 0.10 |
No paid employment | 501 (31.7) | 17 (47.2) | 484 (31.3) | 2.34 | 1.14; 4.80 | 0.02 |
Living without a partner | 400 (25.3) | 16 (44.4) | 384 (24.8) | 2.39 | 1.22; 4.66 | 0.01 |
Cohabitation with child(ren) | 688 (43.5) | 16 (44.4) | 672 (43.5) | 0.96 | 0.47; 1.95 | 0.91 |
Caregiving characteristics
| ||||||
Relationship with care recipient | ||||||
Partner | 191 (12.1) | 6 (16.7) | 185 (12.0) | 1.54 | 0.63; 3.77 | 0.35 |
First-degree family | 903 (57.1) | 20 (55.6) | 883 (57.1) | 0.93 | 0.48; 1.82 | 0.84 |
Other family | 453 (28.6) | 10 (27.8) | 443 (28.7) | 0.94 | 0.45; 1.98 | 0.88 |
Friend | 255 (16.1) | 4 (11.1) | 251 (16.2) | 0.63 | 0.22; 1.79 | 0.38 |
More than one care recipient | 615 (38.9) | 17 (47.2) | 598 (38.7) | 1.41 | 0.72; 2.73 | 0.32 |
Living with care recipient | 266 (16.8) | 9 (25.0) | 257 (16.6) | 1.69 | 0.79; 3.64 | 0.18 |
Providing care for 8 or more hours per week | 507 (32.0) | 11 (30.6) | 496 (32.1) | 0.93 | 0.45; 1.92 | 0.84 |
Providing care for longer than one year | 777 (49.1) | 21 (58.3) | 756 (48.9) | 1.52 | 0.77; 3.01 | 0.23 |
Reason for care | ||||||
Physical problems | 938 (59.3) | 21 (58.3) | 917 (59.3) | 0.96 | 0.49; 1.87 | 0.90 |
Mental problems | 472 (29.8) | 16 (44.4) | 456 (29.5) | 1.88 | 0.96; 3.66 | 0.07 |
Ageing | 511 (32.3) | 8 (22.2) | 503 (32.5) | 0.61 | 0.27; 1.35 | 0.22 |
Dementia | 212 (13.4) | 5 (13.9) | 207 (13.4) | 1.06 | 0.41; 2.79 | 0.90 |
Type of care | ||||||
Domestic work | 915 (57.8) | 22 (61.1) | 893 (57.8) | 1.12 | 0.56; 2.21 | 0.75 |
Personal care or nursing | 419 (26.5) | 13 (36.1) | 406 (26.3) | 1.56 | 0.78; 3.12 | 0.21 |
Emotional support | 1419 (89.7) | 34 (94.4) | 1385 (89.6) | 1.97 | 0.47; 8.30 | 0.36 |
Practical care | 1232 (77.9) | 28 (77.8) | 1204 (77.9) | 1.02 | 0.46; 2.27 | 0.96 |
Other characteristics
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Social support total score, mean (SD) | 3.4 (0.6) | 3.1 (0.8) | 3.4 (0.59) | 0.50 | 0.31; 0.80 | < 0.01 |
Chronic physical disorder in last 12 months | 753 (47.6) | 27 (75.0) | 726 (47.0) | 3.75 | 1.72; 8.17 | < 0.01 |
Mood disorder in last 12 months | 72 (4.6) | 12 (33.3) | 60 (3.9) | 12.32 | 5.80; 26.14 | < 0.001 |
Anxiety disorder in last 12 months | 100 (6.3) | 9 (25.0) | 91 (5.9) | 5.23 | 2.35; 11.65 | < 0.001 |
Negative life event in last 12 months | 878 (55.5) | 24 (66.7) | 854 (55.2) | 1.59 | 0.79; 3.21 | 0.19 |
Impaired social role functioning (< 100) | 601 (38.0) | 26 (72.2) | 575 (37.2) | 4.34 | 2.07; 9.10 | < 0.001 |
Impaired physical role functioning (< 100) | 215 (13.6) | 15 (41.7) | 400 (25.9) | 4.73 | 2.39; 9.36 | < 0.001 |
Impaired emotional role functioning (< 100) | 420 (26.5) | 20 (55.6) | 200 (12.9) | 3.58 | 1.83; 7.01 | < 0.001 |
Suicidal thoughts
Risk factors for suicidal thoughts
Total
n = 3036
| Suicidal thoughts
n = 86
| No suicidal thoughts
n = 2950
| Model adjusted for age and gender | |||
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n (%) | n (%) | n (%) | OR | 95% CI | p | |
Sociodemographics
| ||||||
Age, mean (SD) | 46.7 (12.6) | 46.1 (11.0) | 46.7 (12.6) | 1.00 | 0.98; 1.01 | 0.70 |
Female gender | 1537 (50.6) | 43 (50.0) | 1494 (50.6) | 0.97 | 0.63; 1.49 | 0.90 |
Lower educational levela | 910 (30.0) | 38 (44.2) | 872 (29.6) | 2.04 | 1.30; 3.20 | < 0.01 |
No paid employment | 741 (24.4) | 35 (40.7) | 706 (23.9) | 2.76 | 1.70; 4.48 | < 0.001 |
Living without a partner | 907 (29.9) | 43 (50.0) | 864 (29.3) | 2.41 | 1.57; 3.71 | < 0.001 |
Cohabitation with child(ren) | 1367 (45.0) | 37 (43.0) | 1330 (45.1) | 0.90 | 0.57; 1.40 | 0.63 |
Other characteristics
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Social support total score, mean (SD) | 3.4 (0.6) | 2.9 (0.9) | 3.4 (0.6) | 0.33 | 0.25; 0.44 | < 0.001 |
Chronic physical disorder in last 12 months | 1200 (39.5) | 53 (61.6) | 1147 (38.9) | 2.93 | 1.84; 4.67 | < 0.001 |
Mood disorder in last 12 months | 152 (5.0) | 36 (41.9) | 116 (3.9) | 18.32 | 11.39; 29.46 | < 0.001 |
Anxiety disorder in last 12 months | 164 (5.4) | 17 (19.8) | 147 (5.0) | 4.78 | 2.72; 8.38 | < 0.001 |
Negative life event in last 12 months | 1218 (40.1) | 49 (57.0) | 1169 (39.6) | 2.03 | 1.32; 3.13 | 0.001 |
Impaired social role functioning (< 100) | 983 (32.4) | 59 (68.6) | 924 (31.3) | 4.93 | 3.09; 7.85 | < 0.001 |
Impaired physical role functioning (< 100) | 624 (20.6) | 40 (46.5) | 584 (19.8) | 3.68 | 2.37; 5.71 | < 0.001 |
Impaired emotional role functioning (< 100) | 309 (10.2) | 37 (43.0) | 272 (9.2) | 7.67 | 4.90; 12.03 | < 0.001 |