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Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability.
Int J Equity Health. 2019 12 31; 19(1):3.IJ

Abstract

BACKGROUND

Socioeconomic 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.

METHODS

Cross-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.

RESULTS

We 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.

CONCLUSIONS

Our 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.

Authors+Show Affiliations

Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland. Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland. Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.Senior Professorship 'Work Stress Research', Faculty of Medicine, University of Düsseldorf, Life-Science-Center, Merowingerplatz 1A, 40225, Düsseldorf, Germany.Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland. christine.fekete@paraplegie.ch. Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland. christine.fekete@paraplegie.ch.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31892324

Citation

Tough, Hannah, et al. "Social Inequalities in the Burden of Care: a Dyadic Analysis in the Caregiving Partners of Persons With a Physical Disability." International Journal for Equity in Health, vol. 19, no. 1, 2019, p. 3.
Tough H, Brinkhof MWG, Siegrist J, et al. Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability. Int J Equity Health. 2019;19(1):3.
Tough, H., Brinkhof, M. W. G., Siegrist, J., & Fekete, C. (2019). Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability. International Journal for Equity in Health, 19(1), 3. https://doi.org/10.1186/s12939-019-1112-1
Tough H, et al. Social Inequalities in the Burden of Care: a Dyadic Analysis in the Caregiving Partners of Persons With a Physical Disability. Int J Equity Health. 2019 12 31;19(1):3. PubMed PMID: 31892324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability. AU - Tough,Hannah, AU - Brinkhof,Martin W G, AU - Siegrist,Johannes, AU - Fekete,Christine, AU - ,, Y1 - 2019/12/31/ PY - 2019/05/21/received PY - 2019/12/13/accepted PY - 2020/1/2/entrez PY - 2020/1/2/pubmed PY - 2020/4/2/medline KW - Caregiver burden KW - Dyadic analysis KW - Inequalities KW - Mediation KW - Socio-economic position KW - Spinal cord injury KW - Stress process model of caregiving SP - 3 EP - 3 JF - International journal for equity in health JO - Int J Equity Health VL - 19 IS - 1 N2 - BACKGROUND: Socioeconomic 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. METHODS: Cross-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. RESULTS: We 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. CONCLUSIONS: Our 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. SN - 1475-9276 UR - https://www.unboundmedicine.com/medline/citation/31892324/Social_inequalities_in_the_burden_of_care:_a_dyadic_analysis_in_the_caregiving_partners_of_persons_with_a_physical_disability_ L2 - https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1112-1 DB - PRIME DP - Unbound Medicine ER -