Abstract
BackgroundSocioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. However, the basic assumption that low SEP is associated with greater caregiver burden has so far lacked empirical support. The objective of this study was to investigate social inequalities in the caregiver burden among caregiving partners of persons with a physical disability, i.e., spinal cord injury (SCI), applying a dyadic approach. More specifically, we investigated 1) the association of the caregivers’ SEP with caregiver burden (‘actor effect’); 2) the association of the care-receivers’ SEP with caregiver burden (‘partner effect’), and 3) potential mediators of the association between SEP and caregiver burden.MethodsCross-sectional survey data from 118 couples of persons with SCI and their partners living in Switzerland was used. We firstly employed logistic regression to investigate the actor and partner effects of SEP on objective (hours of caregiving) and subjective caregiver burden (Zarit Burden Interview). We additionally used structural equation modelling to explore whether unfulfilled support needs, psychosocial resources and the care-receivers health status mediated the association between SEP and caregiver burden. SEP was operationalized by household income, education, subjective social position, financial strain and home ownership.ResultsWe observed a consistent trend towards higher objective and subjective burden in lower SEP groups. Caregivers with higher subjective social positon and home ownership indicated lower subjective burden, and caregivers with higher education and absence of financial strain reported lower objective burden. Further evidence suggested a partner effect of SEP on caregiver burden, whereby objective caregiver burden was reduced in couples where the care-receiver had a higher educational level. The negative association between SEP and subjective burden was partially mediated by the unfulfilled support needs and deprived psychological resources of the caregiver, and the poor health status of the care-receiver. Similar mediation effects were not supported for objective burden.ConclusionsOur study, in the context of SCI, provides support for the contextual role of SEP in the Stress Process Model of caregiving. To reduce subjective caregiver burden, policy programs may target the strengthening of psychosocial resources, or the improvement of access to support services for caregivers with low SEP.
Highlights
Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving
Pro-WELL participants were recruited from the community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), which was performed between September 2011 and March 2013
Over half of persons with spinal cord injury (SCI) were in paid employment and the majority of couples had formed their relationship after SCI had occurred
Summary
Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. To inform and evaluate the efficacy of such programs, the caregivers’ experience of objective and subjective burden needs to be systematically monitored and documented. While the current literature generally supports the notion that caregivers in lower SEP incur higher objective burden [6,7,8], few studies have explored the impact of SEP on subjective burden [9, 10]. According to the Stress Process Model of caregiving, informal caregivers with lower SEP are expected to be at higher risk of caregiver burden due to their limited access to stress-buffering resources [11]. Psychosocial and behavioral stress-buffering resources may be more accessible to caregivers with higher SEP, potentially enabling these caregivers to better cope with their caring role, and limiting their burden of care
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