Association between caregiver stress, caregiver burden, and health outcomes in a large population based sample

Objective: To test the hypothesis that caregiving stress and/or caregiving burden, is associated with cardiovascular and mental health outcomes for caregivers. Methods: This was a secondary analysis of a prospective study of 2,688 Nova Scotians enrolled in the Nova Scotia Health Study (NSHS95) in 1995 and followed until 2005. Caregiving was defined as helping a person with an illness or physical/mental disability. Caregiving stress (emotional strain), caregiving burden (amount of care provided), general health measures, as well as depression, anxiety, and hostility measures were gathered during a home interview. Incident coronary heart disease (CHD) hospitalizations were determined from the provincial health care administrative databases. Results: The prevalence of caregiving in this population was 8%. Caregiver stress contributed significantly to the prediction of CHD incidence in a Cox regression model; this association remained after controlling for age and Framingham score (HR= 1.08, 1.02-1.13CI, p=.004). Caregiver stress also significantly predicted higher depression scores (b=.45, .39-.67 CI, p<.0001), higher anxiety (b=.33, .22-.58 CI, p<.0001), and greater hostility (b=.22, .10-.40 CI, p=.002) in regression models. Caregiver burden did not significantly predict health outcomes in any model. Conclusion: Caregivers who reported higher levels of stress were significantly more likely to be hospitalized for CHD and experience poorer mental health compared to those with lower levels of caregiver stress; there was no relation between caregiver burden and outcomes. These findings suggest that it may not be the amount of caregiving that has negative health effects, but how one copes with caregiving responsibilities that predicts health status.