Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys
Open accessAbstract
Background: Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method: Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. Results: Among the 26.9–42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7–42.5% reported burden. Of those, 25.2–29.0% spent time and 13.5–19.4% money, while 24.4–30.6% felt distress and 6.4–21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6–23.6 (169.9–205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. Conclusions: Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.
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Worldwide, a significant proportion of people provide substantial and sustained help and support to friends or family members suffering from a long term illness.
“Worldwide, a significant proportion of people provide substantial and sustained help and support to friends or family members suffering from a long term illness (Shahly et al., 2013).”
From eHealth interventions for family carers of people with long term illness: A promising approach? (2018) · cites this paper as Shahly et al., 2013
Carers' unpaid input is of substantial economic value to society as a whole.
“Moreover, carers' unpaid input is of substantial economic value to society as a whole (Carers Trust, 2014;National Alliance for Caregiving, 2009;Shahly et al., 2013).”
From eHealth interventions for family carers of people with long term illness: A promising approach? (2018) · cites this paper as Shahly et al., 2013
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“Worldwide, a signi fi cant proportion of people provide substantial and sustained help and support to friends or family members su ff ering from a long term illness (Shahly et al., 2013).”
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- Authors
- Shahly, V., Chatterji, S., Gruber, M. J., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Angermeyer, M. C., Bruffaerts, R., Bunting, B., Caldas-de-Almeida, J. M., de Girolamo, G., de Jonge, P., Florescu, S., Gureje, O., Haro, J. M., Hinkov, H. R., Hu, C., Karam, E. G., Lépine, J.-P., Levinson, D., Medina-Mora, M. E., Posada-Villa, J., Sampson, N. A., Trivedi, J. K., Viana, M. C., & Kessler, R. C.
- Affiliations
- Harvard University (US)
- World Health Organization (CH)
- University of Al-Qadisiyah (IQ)
- Universitat Pompeu Fabra (ES)
- KU Leuven (BE)
- University of Ulster (GB)
- National School of Public Health, Management and Professional Development (RO)
- University of Ibadan (NG)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- Bulgarian Academy of Sciences (BG)
- Shenzhen KangNing Hospital (CN)
- Saint George Hospital (LB)
- Centre National de la Recherche Scientifique (FR)
- Israel Ministry of Health (IL)
- Instituto Colombiano del Sistema Nervioso - Clínica Montserrat (CO)
- Universidade Federal do Espírito Santo (BR)
- Corresponding author
- Kessler, R. C.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2012-08-09
- Volume
- 43
- Issue
- 4
- Pages
- 865-879
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4045502
- OpenAlex
- W2135779654
- Cited by
- 90
- References
- 87
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 11 · 2019: 11 · 2018: 8 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 6 · 2013: 6
- FWCI
- 16.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- Robert Wood Johnson Foundation (044708)
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- John W. Alden Trust
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- European Commission (QLG5–1999-01042, SANCO2004123, 2004123)
- Public Health Agency (COM/4411/10, COM/4437/11)
- Fundação de Amparo à Pesquisa do Estado de São Paulo (03/00204-3, 03/00204?)
- Generalitat de Catalunya (01042)
- Bundesministerium für Gesundheit
- National Insurance Institute of Israel
- Universidade de Lisboa
- Regione Piemonte (00/0028)
- Fakultet Medicinskih Nauka, Univerziteta U Kragujevcu
- Servier
- Fundação Champalimaud (R01 MH070884)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization
- Fundação para a Ciência e a Tecnologia
- Instituto de Salud Carlos III (CB06/02/0046, RETICS RD06/0011, RD06/0011, FIS 00/0028, CIBER CB06/02/0046)
- Departament de Salut, Generalitat de Catalunya
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, MH60220, MH070884, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (FIRCA R03TW006481, R03TW006481)
- Cilag
- Topics
- Social Sciences › Sociology and Political Science › Intergenerational Family Dynamics and Caregiving
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Health Sciences › Health Professions › General Health Professions › Aging, Elder Care, and Social Issues
- Keywords
- family caregiving, older caregivers, caregiver burden, cross-national differences, financial burden, time burden, caregiver distress, income level, gender differences, informal care, population aging, World Mental Health Surveys
- MeSH terms
- Adult, Age Factors, Mental Disorders, Child, Chronic Disease, Cross-Cultural Comparison, Epidemiologic Methods, Family, Family Health, Female, Home Nursing, Humans, Male, Middle Aged, Population Dynamics, Socioeconomic Factors, Time Factors, Global Health, World Health Organization, Caregivers, Cost of Illness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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