Our study adds to the growing body of literature examining both the positive and negative aspects of caregiving and it is one of the first large studies of caregiving in middle-income Asia. We used both the international standard measure of psychological distress (Kessler-6) and a national measure, the Thai Mental Health Indicator (TMHI). There was a clear gradient of part-time and full-time caregivers experiencing more psychological distress.
We noted the seeming contradiction that when compared to non-caregivers, the caregivers reported higher psychological distress but higher positive mental health
(i.e., self-esteem and content with life), higher positive mental capacity
(i.e., coping with crises), and higher positive mental quality
(i.e., helping others). The high distress could be explained by the daily activities which could put pressure on caregivers physically and psychologically (Brown 2007
; Savage et al. 2004
; Treasure 2004
; Vitaliano et al. 2003
). However, taking on the task of caregiving can also be positive for mental health when helping others and managing crises. These findings also confirm other studies on the positive role of caregiving on self-esteem and sense of life satisfaction (Kuuppelomaki et al. 2004
; Ribeiro et al. 2008
On multivariate analysis of caregiving and psychological distress, we found significant associations with a dose-response effect: full-time caregivers were worse off than part-time caregivers who in turn were more distressed than non-caregivers. This is especially so among males. We also noted that lack of social contacts (colleagues and friends) significantly contributed to this psychological distress. We could not assess the association for family members as ‘high contact’ could be confused with the caregiving task itself.
Our findings provide evidence on age and sex differences in both psychological distress and mental health of caregivers. Previous literature has also reported that women positioned themselves as natural caregivers and they did not find caregiving as rewarding as male caregivers (Ekwall et al. 2007
). Our results are supportive of this conclusion. Our results also confirmed previous literature on the association between lower psychological distress and advancing age; a longitudinal analysis in the USA spanning more than 20 years showed that adults reported fewer negative emotions as they grew older (Charles et al. 2001
). Hence younger caregivers are more likely to be at risk of adverse mental health.
Our findings provide strong evidence that lack of social contacts with friends and colleagues contributes to psychological distress. Other Thai studies found social support is important for both caregivers and care recipients and can reduce depression among impaired Thai older adults (Suttajit et al. 2010
; Thanakwang 2009
). In addition, social support could help to provide respite care and leisure time enabling the caring role to be sustained (Stevens et al. 2004
; van Exel et al. 2008
). These points reveal the important but complex role that social networks can play in assisting caregivers and enhancing access social support should be further examined.
The importance of religion and spiritual wellbeing among caregivers has been examined internationally (Hebert et al. 2006
; Leblanc et al. 2004
; Yeh et al. 2009
). In Thailand, Buddhist concepts are viewed by many as part of daily life and this also applies to Thai caregivers. A qualitative study in Thailand has supported the Buddhist view highlighting caregivers’ suffering, acceptance and compassion (Sethabouppha et al. 2005
). Thai cohort members overall have strongly affirmed the importance of karma and religion in their daily lives (Yiengprugsawan et al. 2010
The strength of this study is its large national scale and its wide array of socio-demographic and health covariates. One of the limitations of this current analysis is the cross-sectional data which does not permit causal interpretation; however subsequent cohort follow-up will permit longitudinal analyses. In addition, we note that the questionnaire was self-administered; however, cohort members were university educated which should facilitate the understanding of the questions. Further in-depth study on the nature, intensity, and burden of caregiving among Thai cohort members will provide insights into the long term outcomes which could provide vital information on the social and health support required for caregivers.
This study underlines the importance and prevalence of caregivers in Thailand, the strong possibility of mental health benefits, some risks of associated psychological distress, and the positive role of keeping social contacts. One of the main differences to be expected in lower income nations than that previously observed in higher income nations that formal social welfare support measures for caregivers are yet to be implemented. This study highlights the alarming need for such support. Early identification of vulnerable caregivers is required to target effective health promotion.