标题：Changes Over Time in the Health of Caregivers of Children With Health Problems: Growth-Curve Findings From a 10-Year Canadian Population-Based Study
摘要：Objectives. We used Canadian population-based data to examine changes in the health of caregivers of children with complex health problems compared with caregivers of healthy children over a 10-year time period. Methods. The National Longitudinal Survey of Children and Youth collected data biennially from 9401 children and their caregivers in 6 waves from 1994–1995 to 2004–2005. We conducted growth-curve analyses of these data to model self-reported general health and depressive symptoms for 4 groups of caregivers: caregivers of healthy children, and caregivers of children with 1, 2, or at least 3 of 4 conceptually distinct indicators of child health problems. We modeled covariates for children (age, gender, only-child status) and caregivers (age, gender, education, income, marital status). Results. After we controlled for covariates, caregiver health outcomes worsened incrementally with increasing complexity of child health problems. Change in self-reported general health and depressive symptoms over the 10-year period was consistent across all groups of caregivers. Conclusions. Poorer health among caregivers of children with health problems can persist for many years and is associated with complexity of child health problems. Attention to parental health should form a component of health care services for children with health problems. Caring for any child is a demanding task, but parents of children with chronic physical or psychological health problems can face significantly greater caregiving challenges, including greater time demands, 1 , 2 higher medical and other related costs, 3 – 5 child care challenges, 6 – 8 lower incomes, 7 , 9 , 10 and employment constraints. 8 , 9 Coupled with these challenges are societal changes (smaller family units, more single-parent families 11 ) and trends in health care (innovations that increase life expectancy of children with severe disabilities, 12 family-centered models of health care, 13 , 14 increased emphasis on value for money spent on health care 15 , 16 ) that may inadvertently increase the burden on caregivers of children with chronic health problems. Evidence is now accumulating that these challenges have implications for caregiver health. 1 , 2 , 5 , 9 , 17 – 20 For example, we recently showed that caregivers of children with health problems had more than twice the odds of having chronic health problems, activity limitations, and depressive symptoms compared with the population of caregivers of healthy children. 21 Our broad definition of child “health problems” included approximately 26% of Canadian families, but we still found strong caregiver health effects, suggesting that the health of caregivers of children with health problems is an important public health issue. Previous work examining the relationship between the caregiving situation and caregiver health has provided many cross-sectional snapshots of caregiver health, but relatively few controlled studies have examined whether these relationships change over time. Longitudinal studies that do exist have yielded strikingly diverse, if not contradictory, results. Initial findings among elderly caregivers of people with Alzheimer's disease 22 – 24 and among caregivers of children 25 , 26 have suggested that caregivers might experience worsening health over time as wear and tear accumulates, but these findings have been challenged by studies showing that both the physical and the psychological health of these caregivers remains relatively stable over the study periods (typically < 2 years). 2 , 22 , 27 , 28 In other circumstances, caregiver health can improve over time. Mothers of children with cancer reported lower anxiety scores 20 months after the diagnosis than they did at the time of diagnosis. 29 , 30 Similarly, levels of distress were initially elevated in mothers and fathers of children diagnosed with diabetes, but their symptoms resolved over a 12-month period. 31 Other studies have demonstrated positive aspects of parenting—including decreases in anxiety, depression, and mortality—that may be tied to feelings of empowerment when the caregiver is able to provide effective help. 32 – 36 Several methodological issues may have contributed to this variability in results. Studies have typically focused on relatively small samples that are limited in their power to demonstrate change. Many studies did not include control groups, making it impossible to examine relative changes in health. Existing longitudinal studies have often involved elderly caregivers or have only included children with specific health problems, producing results that may not generalize well to caregivers of children with a broader range of health problems. Most studies have also typically been limited to relatively short time frames (< 2 years; but see Brehaut et al., 9 Seltzer et al., 26 and Brown et al. 36 ), and therefore may not be sensitive to processes that manifest over longer periods of time. We examined a large-scale Canadian sample of children and caregivers to determine changes in the health of caregivers of children with health problems. By employing data from a population-based national study, we were able to conduct more sensitive analyses on a broader sample than has existed in the literature to date. We examined the extent to which the complexity of the child health problem affects caregiver health compared with a healthy comparison group. We examined the scope of caregiver health effects across a wide spectrum of childhood illness rather than limiting our study to a single clinical area. And because the data source offers 6 cycles of repeated measurements of caregiver health over the course of 10 years, we had an unprecedented opportunity to examine whether these effects change over a longer period of time.
