Determinants of the mental wellbeing of unpaid carers in Wales: a cross-sectional study

Abstract

BackgroundCaring duties fall disproportionally on particular demographic groups (eg, women and individuals aged 45 years or older) and can have adverse effects on their mental wellbeing. Effects on carers tend to worsen as the extent of care increases but how sociodemographic factors can strengthen or weaken the association is unclear. We aimed to assess the association between socioeconomic position and caring intensity on the mental wellbeing of unpaid carers. MethodsIn this cross-sectional study, we analysed data from unpaid carers (aged ≥16 years) using the 2016–17 National Survey for Wales (NSW). Mental wellbeing was measured using the Warwick–Edinburgh Mental Wellbeing Score (WEMWBS). NSW collected information on carers' demographics, caring intensity (caring hours per week) alongside with socioeconomic position (economic status, education, and income deprivation). Ordinary least square regression was used to examine how demographic factors modify the association between caring intensity and average mental wellbeing. We used quantile regression to examine how socioeconomic position contributes to specific percentile points of WEMWBS, with a focus on the pattern from low (15th percentile) to high (85th percentile) mental wellbeing. FindingsWe identified 2144 unpaid carers (40·3% men and 59·7% women) for analysis. Increasing caring intensity negatively correlated with mental wellbeing (high vs low intensity, estimated WEMWBS 49 vs 51, p=0·011) and the correlation exacerbated in carers who were female (48 vs 50, p=0·028), age 65 years or older (49 vs 54, p=0·0001), and providing care while working (46 vs 49, p=0·014). Carers who were economically inactive (50 vs 52, p=0·0012) and with low level of education (ie, NFQ level 3 or below) (50 vs 52, p=0·0004) were more likely to experience poor mental wellbeing. A decreasing trend was observed in the differences between economically active and inactive carers' mental wellbeing from poor to good mental wellbeing percentiles (p=0·011). A similar pattern was observed in education (p=0·042), but not income deprivation. InterpretationCaring intensity is associated with mental wellbeing, but the effects vary by demographics. Future public health policy and intervention development should consider carers who are disproportionally affected by caring responsibilities and clarify whether the aim is to prevent poor mental wellbeing or promote mental wellbeing. FundingPublic Health Wales.