Health inequalities and informal care: prospective, population-based study

Researchers: Michael Hirst

Funder: Department of Health's Inequalities in Health Research Initiative

Duration: October 2001 to January 2004

The research

This project increased knowledge of the extent to which the provision of informal care sustains and increases health inequalities over time. Health differences between carers and non-carers, and between different groups of carers, were related to the incidence, timing, duration and intensity of caring episodes by:

examining health inequalities before, during and after providing care.
investigating the cumulative impact of caregiving on health inequalities in carers and former carers.
quantifying the association between caregiving and the onset and maintenance of psychological distress.
charting trends in carers’ health inequalities during the 1990s.

A further aim was to investigate the association between health inequalities and carers’ GP consultations over time.

The research was based on the first nine waves of the British Household Panel Survey, an annual follow-up survey of almost 10,000 adults in a nationally representative sample of private households. Around 3,500 new (incident) carers and a similar number of former carers were identified during the study period; over 1,000 respondents have provided care between three and five years, a typical caring episode. Health-related outcome measures include the GHQ and the SF-36.

Statistical modelling and longitudinal techniques were used, including repeated measurement analysis, binary and multinomial logistic regression.

Policy relevance

The study is relevant to the Strategy for Carers, National Service Frameworks, Health Improvement Programmes and partnerships between primary and social care. It will inform policy, service developments and good practice in three arenas:

supporting informal carers to care and maintain their own health and well-being.
improving carers’ mental health and reducing health inequalities.
developing primary care-based recognition of carers’ health needs.

By measuring the impact of caregiving on health inequalities over time, the research:

estimated the health risks for carers, focusing on their psychological well-being.
identified those carers who are most at risk of poor health and develop population estimates for a typical health authority and primary care trust.
discovered when stress-related symptoms, anxiety and depression are most likely to arise during a caring episode and beyond.
estimated the impact of caring-related health inequalities on the use of primary care and provide benchmark estimates to base service development.
described and interpreted trends in carers’ health inequalities during the 1990s and anticipate the future impact of recent changes in patterns of caregiving.
established national baseline data which could be used to monitor recent initiatives on maintaining carers’ health and reducing health inequalities.

Publications

2005

Carer distress: a prospective, population-based study, 2005
Hirst, M., Social Science and Medicine, 61, 3, 697-708.

Distress relief, 2005
Hirst, M., Care and Health Magazine, 108, 5-11 April, 26-27.

Estimating the prevalence of unpaid adult care over time, 2005
Hirst, M., Research, Policy and Planning, 23, 1, 1-16.

Promoting carers' health, 2005
Hirst, M. in Proceedings of the Conference on Carers' Health: Working for a positive future, Holyrood Communications.

2004

Health Inequalities and Informal Care, 2004
Hirst, M. , Social Policy Research Unit.

Hearts & Minds: The health effects of caring, 2004
Hirst, M., Research summary, Carers Scotland.

2003

Caring-related inequalities in psychological distress in Britain during the 1990s, 2003
Hirst, M., Journal of Public Health Medicine, 25, 4, 336-343.

If you require further information about the project, please contact Michael Hirst