Risk of depression in family caregivers: unintended consequence of COVID-19

  1. Stephen Gallagher
  2. Mark A. Wetherell

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Abstract

Coronavirus disease 2019 (COVID-19) is likely to exacerbate the symptoms of poor mental health in family caregivers.

Aims

To investigate whether rates of depressive symptomatology increased in caregivers during COVID-19 and whether the unintended consequences of health protective measures, i.e., social isolation, exacerbated this risk. Another aim was to see if caregivers accessed any online/phone psychological support during COVID.

Method

Data (1349 caregivers; 6178 non-caregivers) was extracted from Understanding Society, a UK population-level data-set. The General Health Questionnaire cut-off scores identified those who are likely to have depression.

Results

After adjustment for confounding caregivers had a higher risk of having depressive symptoms compared with non-caregivers, odds ratio (OR) = 1.22 (95% CI 1.05–1.40, P = 0.008) evidenced by higher levels of depression pre-COVID-19 (16.7% caregivers v. 12.1% non-caregivers) and during the COVID-19 pandemic (21.6% caregivers v. 17.9% non-caregivers), respectively. Further, higher levels of loneliness increased the risk of depression symptoms almost four-fold in caregivers, OR = 3.85 (95% 95% CI 3.08–4.85, P < 0.001), whereas accessing therapy attenuated the risk of depression (43%). A total of 60% of caregivers with depression symptoms reported not accessing any therapeutic support (for example online or face to face) during the COVID-19 pandemic.

Conclusions

COVID-19 has had a negative impact on family caregivers’ mental health with loneliness a significant contributor to depressive symptomatology. However, despite these detriments in mental health, the majority of caregivers do not access any online or phone psychiatric support. Finally, psychiatric services and healthcare professionals should aim to focus on reducing feelings of loneliness to support at-risk caregivers.

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  1. Version published to 10.1192/bjo.2020.99
  2. ScreenIT

    SciScore for 10.1101/2020.06.15.20131532: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: 11 All participants gave informed consent and ethics were obtained by the University of Essex, UK from National Research Ethics Service (NRES) Oxfordshire REC A (08/H0604/124).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: This study has several strengths, notably a longitudinal design and the use of a validated tool for the assessment of depression in population research. In response to recent calls, it also assesses an at risk group and identifies potential contributory factors linked to depression. However, these findings should be considered in light of some limitations. First, we do not have the details of the type of care-recipients’ illness/disability type which may confer an additional risk and differences in the caregiver experience and associated care burden (e.g. Alzheimers and Cancer). Second, there may be other unmeasured variables that may also explain risk of depression (e.g. worry and anxiety), and as can be seen in Figure 2, some 40% of caregivers were not categorised as depressed but were availing of treatments, and as such may have had another mental health condition. Third, while caregiving was predictive of depression at both time-points, we cannot infer causality. Increased psychiatric symptomatology and rates of common mental disorder in caregivers could also reflect shared biological vulnerabilities with their care-recipient relatives. While plausible, there is convincing evidence that it is the caregiver role itself that drives increases in psychological morbidity such as depression, 5 Finally, depression status was derived through a self-report scale rather than psychiatric interview. Nonetheless, we used a widely used scale, which has intrinsic value as a...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.06.15.20131532v1 on medRxiv