摘要：0bjectives. This study examined the association between caregiving for disabled or ill family members, estimated to occur in more than 22 million US households, and change in mental health. Methods. We assessed 4-year change in mental health among 37 742 Nurses’ Health Study participants with the Medical Outcomes Study Short-Form 36. Results. Women who provided 36 or more weekly hours of care to a disabled spouse were almost 6 times more likely than noncaregivers to experience depressive or anxious symptoms (multivariate odds ratio [OR] = 5.6; 95% confidence interval [CI] = 3.8, 8.3). Caring for a disabled or ill parent (≥ 36 weekly hours) was associated with a less dramatic elevation in depressive or anxious symptoms (multivariate OR = 2.0; 95% CI = 0.9, 4.3). Conclusions. In this population, caregiving was associated with increased risk of depressive or anxious symptoms. In 1990, more than 31 million people in the United States were aged 65 years or older. The US elderly population is expected to exceed 75 million by 2040, at which point 1 in 5 Americans will be aged 65 years or older. 1 The aging of the population, and the accompanying prevalence of chronic disease and disability, is already exerting a profound effect on familial roles and responsibilities. Caregiving for disabled or ill family members is estimated to occur in more than 22 million US households. 2 Relatives and friends are the sole source of assistance for 70% of the Americans who require long-term care. 3 It is expected that more than 60% of all women will provide this type of informal care to a disabled or an ill family member at some point during their lives. 4, 5 In 1980, Zarit and colleagues 6 identified caregiving as a source of burden or role strain, and several studies followed to show that caregivers experience elevated rates of depressive symptoms. 7– 13 Researchers have linked informal care provision to adverse health effects such as sleep disturbance, 14 increased blood pressure, 15 increased insulin levels, 16 altered endocrine function, 17 impaired vaccine response, 18 and poorer adherence to therapeutic regimens. 19 Schulz and Beach 20 published results from a longitudinal study in which caregivers who reported role strain also experienced a 63% elevation in mortality risk. The current study, conducted in a large community-based cohort, complements the existing literature by offering longitudinal data on caregiving and mental health. The primary purpose of this study was to examine, with data from 1992 and 1996, the relation between care for a disabled or ill spouse and onset of depressive or anxious symptoms. Secondarily, we investigated the association between care for a disabled or an ill parent and onset of depressive or anxious symptoms. The study was conducted in a cohort of women who were free from high levels of depressive or anxious symptoms at baseline in 1992.
