Health leaders are being urged to make policy changes to safeguard the mental health of unpaid carers as new evidence reveals the negative effects of taking on the role – including those who do so at a young age. The research is featured in a new Parliamentary report which also highlights an ‘urgent need’ for cross-government action to improve the life chances of younger carers. In this blog, Rebecca Lacey and colleagues from a research project on informal caregiving describe evidence which highlights the need for reform.
We have known for some time that unpaid carers suffer worse mental and physical health than their peers – but how quickly is health affected after becoming a carer? How long do these effects last? And does this vary according to age, gender or the amount of care that carers provide?
Our new research highlights a need for carers to be supported, and quickly, to avoid a decline in their own health and wellbeing – and it suggests younger caregivers should not be overlooked.
The questions are pressing ones: as the UK population has aged and the cost of living has risen, unpaid care has become increasingly important. Across the globe there is a similar pattern, with the United Nations estimating that these carers meet between three quarters and nine tenths of care needs.
We looked at the experiences of more than 17,000 caregivers using data from the UK Household Longitudinal Study, which has been following a representative sample of UK households since 2009. Our study focused on those who became caregivers between 2009 and 2020 and was the first to look at health changes around that transition in adults as young as 16.
Respondents answered questions from the General Health Questionnaire (GHQ-12), which measures psychological distress, and the 12-item Short Form Survey (SF-12) which measures physical and mental functioning. We looked at their responses in the eight years before and after they became caregivers, and we compared them with similar respondents who had not become carers.
We looked at four life stages: early adulthood (16-29), early mid-adulthood (30-49), later mid-adulthood (50-64) and later mid-adulthood (65+). We found there were more women than men who became carers in every group, but we did not find a connection between gender and the impact of caring on health. Nor did we find any negative effect on physical health from becoming a carer – though the physical health of carers was poorer than that of non-carers even before the transition.
However, we did find the amount of care given was paramount– those carers providing more than 20 hours’ care per week suffered greater psychological distress than those providing less, and in those aged over 30 the effect persisted for several years. The location in which the care was delivered mattered, too, with those caring for someone they were living with being more at risk of distress than those caring elsewhere.
Age mattered, too: compared to non-caregivers, carers aged under 65 years had greater increases in psychological distress when becoming carers than the over-65s did. Carers aged 30-49 and 50-64 had the largest decrease in mental health function.
The changes are modest, but they unequivocally warrant the need for early identification and intervention to protect the declining mental health of people when becoming caregivers. And we must not forget the young: it’s more unusual to become a carer at a young age, and young adults may simultaneously be completing education, finding jobs, forming partnerships or becoming parents, but our study also finds that the mental health of younger carers is affected when they become carers. Furthermore, most younger carers are looking after their own parents, so coming to terms with role reversal may also be a factor for them.
Our research is featured in the landmark report of an inquiry into the life chances of young and young adult carers by the All-Party Parliamentary Group (APPG) for Young Carers and Young Adult Carers, which underlines the need for urgent action. The inquiry noted our finding that mental health deteriorates shortly after becoming a young adult carer, and that this effect includes younger carers. It inquiry found there were around 15,000 children caring for more than 50 hours a week, and it heard from the Carers’ Trust that 44 per cent of young and young adult carers ‘always’ or ‘usually’ felt stressed because of their caring role, while 27 per cent said they felt they had enough sleep ‘never’ or ‘not often.’
Our research, along with the APPG’s report, underlines an urgent need for policymakers to grasp these issues and to facilitate change in the health sector. Health practitioners need to recognise that both caregivers and the people they care for need their support. They need to have conversations about the physical and mental health of both caregivers and care recipients. This is crucial to help break the cycle of care, especially as we know that caregivers are currently more likely to require care themselves in the future.
We know there are at least 376,000 young adults providing unpaid care in the United Kingdom. They deserve the same life opportunities as their peers, and our study confirms that mental health is a key factor in determining whether they get them.
Mental and physical health changes around transitions into unpaid caregiving: a longitudinal, propensity score analysis, by Rebecca E Lacey, Baowen Xue, Georgio Di Gessa, Wentian Lu and Anne McMunn, is published in The Lancet Public Health. Dr Lacey is lead author and Reader in Social and Lifecourse Epidemiology in the Population Health Research Institute at St George’s, University of London, and her co-authors are affiliated with the Research Department of Epidemiology and Public Health at University College London.
The study was supported by funding from the UK Economic and Social Research Council (ES/W001454/1).