We examined the physical and mental health of adult Thai caregivers. Taking into account possible confounders, being a caregiver was associated with lower back pain and psychological distress among males and females and ‘poor or very poor’ self-assessed health only among females. This could partly be explained by gender difference in reporting self-assessed health among middle-aged adults. Previously we found that females were much more likely to perceive and report worse self-assessed health than males
. We conducted a telephone follow-up of 120 caregivers and found that one-third has been caring for 1–2 years and two-thirds have been caring for 3–5 years. Over 60% reported cause of caring was illness. Assistance included mobility, provision of food and medication, as well as help with daily care.
Our study supports other reports on caregivers and their health, but unlike most work on this topic, our results derive from a developing economy in Asia. Generally, the effects of caring in Thailand are quite similar to those reported in rich, developed countries. For example, in the USA, higher levels of stressors among caregivers have been associated with poor self-reported health, more negative health behaviors, and greater use of health care services
. One study in the UK also found caregiving at home to be associated with morbidity, bodily pain, and obesity
. However, one of the main differences in lower income nations was the limited formal social welfare support system for family caregivers. This could further exacerbate the caregiver burden in emerging economies.
Depression experienced by the caregivers may negatively impact the care recipient, which may further limit self-care and functioning abilities, thus necessitating additional assistance
. Emphasis should also be placed on interventions during the transition to and adjustment into caring roles
. A prospective, British population-based study highlighted that transition into and out of unpaid caregiving is associated with increased risk for onset of or delayed recovery from psychological distress
. One report emphasised the importance of effective caregiver support and early health promotion for care recipients, monitoring high risk groups, and timing interventions
. Exercise programs for caregivers could also help if focused on preventing back pain by developing endurance strength
There is a need for a coordinated system that makes easier the complex work of family caregivers by providing the training and support needed. In order for caregivers to maintain their wellbeing, various studies highlight the need for information in areas including finance, law, and health
[39–41]. A qualitative study of informal caregiving provided to elderly stroke survivors in Thailand highlighted caregiver needs for information, assistance, and support
. Relevant Thai studies on family caregivers reported social support to be vitally important for both caregivers and care recipients among impaired Thai older adults
Cultural differences among caregivers should be taken into account. For example, differences were found in level of stress and coping mechanisms among Korean, Korean-American and Caucasian-American caregivers
. Caucasians reported affection while Koreans and Korean Americans reported filial obligation as their motivation for caregiving. In addition, Korean caregivers reported higher extended family support than Caucasian caregivers, while Caucasian caregivers reported higher utilisation of formal support than Korean caregivers. In Thailand, Buddhist concepts are viewed by many as part of daily life, for example, the return of good karma by caring for the loved ones in the family. Our earlier study has found Thai adults strongly affirming their belief in karma and the importance of religion to calm one’s mind
As noted in the results of this study, 874 participants did not report their caregiving status and were excluded from analyses. Could this relatively small group bias the results? Setting the values for the 874 non-responding participants according to three scenarios (1. ‘all non-caregivers’; 2. ‘all part-time caregivers’; 3. ‘all full-time caregivers’) enables new estimates on health associations (e.g., lower back pain). These estimates differ little from the tabulated estimates shown in Tables
4. For example, without the 874 non-responding participants, the back pain estimates for males were AORs 1.36 and 1.67; with the 874 non-responding participants set to ‘all non-caregivers’ AORs became 1.38 and 1.71, set to ‘all part-time caregivers’ AORs became 1.38 and 1.72, set to ‘full-time caregivers’ AORs became 1.39 and 1.66. We conclude that the bias was minimal and did not change the epidemiological results.
The strength of this study is its large national scale with its wide array of socio-demographic, health-risk behaviours and measures of health available. Caution should be applied when interpreting the findings: our study is based on a group of long-distance adult students aspiring to improve their modest socioeconomic circumstances. The causes of adverse physical and mental health in our study may be different than those among caregivers in the general population. Further in-depth study on the nature and type of caregiving among Thai adults will provide insights into the long term social and health outcomes of caregiving and the support they require