Unmet needs and depression among spousal caregivers: the mediating role of marital satisfaction

Abstract

Objectives

Previous research has identified that unmet needs are associated with adverse mental health outcomes in older adults. However, the unmet needs of older adults’ spousal caregivers are unknown. The present study examined the association between unmet needs and depression among spousal caregivers, and whether marital satisfaction mediated this association.

Methods

We included 1,856 participants who provided care to their spouses with difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) from the 2018 China Health and Retirement Longitudinal Survey. Unmet needs of spousal caregivers were assessed as the total number of ADL/IADL tasks with which respondents had unmet needs. Path models were conducted to evaluate the associations between unmet needs, marital satisfaction, and depression. Subgroup analyses by sex were conducted to examine the sex differences regarding the associations.

Results

Spousal caregivers with more unmet ADL/IADL needs reported higher levels of depression (p < 0.001). Additionally, for wife caregivers, unmet ADL/IADL needs were associated with lower marital satisfaction, and lower marital satisfaction was associated with higher degrees of depression, indicating that marital satisfaction partially mediated the association between unmet needs and depression (p < 0.01). However, marital satisfaction did not mediate the association between unmet needs and depression among husband caregivers.

Conclusions

The mediating effect of marital satisfaction on the association between unmet needs and depression only existed in wife caregivers. Social services should be provided to meet the needs of caregivers with ADL/IADL difficulties, and interventions should be implemented to promote the marital satisfaction of wife caregivers.

Keywords:

• Unmet needs
• depression
• marital satisfaction
• spousal caregiver

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

The CHARLS was approved by the Institutional Review Board at Peking University. All participants provided informed consent.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (grant code: 71704006 and 72004236) and the Research Grants Council of Hong Kong (No. 17605119).