The hidden toll: psychological and physical consequences of providing informal care to adults in China.

Abstract

Rapid population ageing and insufficient formal care have led over 80% of Chinese older adults to rely on informal care. Yet, research on caregivers' health costs in developing countries remains scarce and inconclusive. This study aims to assess the relationship between informal caregiving and caregivers' multidimensional health and identify the vulnerable groups. Utilizing data from the Harmonized CHARLS, which includes 16 287 participants from 28 Chinese provinces, we assessed psychological health via the CES-D10 scale and physical health by chronic disease count. Ordinary least squares evaluated the association between informal caregiving and psychological health, and Zero-inflated Poisson regression examined the relationship with physical health. We also applied propensity score matching and placebo tests to mitigate potential endogeneity. Our findings reveal that informal caregivers have significantly higher CES-D10 scores [b = 0.859, SE = 0.339, P = 0.011, confidence interval (CI) (0.194, 1.525)] and a greater likelihood of chronic diseases [odds ratio (OR) = 1.213, SE = 0.039, P < 0.001, CI (1.117, 1.269)] compared with non-caregivers. The negative health effects are especially pronounced among women, rural hukou holders, and the employed. Our study argues that policies should prioritize the health deterioration of informal caregivers over their cost-effectiveness, particularly among vulnerable groups. It calls for adequate support for informal caregivers, including gender-sensitive subsidies for female caregivers, improved primary healthcare for rural caregivers, and flexible working arrangements for employed caregivers to reduce their burdens.