1. Caregiving, Bereavement and Mental Health in Families
Using administrative data to better understand population mental health
Dr Aideen Maguire
Lecturer Centre for Public Health, QUB

2. NIMS Project 86: Mortality and caregiving
Dr Aideen Maguire, Dr Dermot O'Reilly, Dr David Wright, Dr Foteini Tseliou and Dr Michael Rosato
NILS Project 61: The Grief Study
Dr Mark McCann, Dr Aideen Maguire, Dr John Moriarty and Dr Dermot O'Reilly
NIMS Project 87: Mental Health and Mortality in Families
Dr Aideen Maguire, Dr Dermot O’Reilly, Dr Michael Rosato, Dr Tania Bosqui, Dr Foteini Tseliou and Dr David Wright

3. Household & Family Indicators
Question 23
2011 Census
“Do you have an emotional, psychological or mental health condition (such as depression or schizophrenia)”.
Question 25
2011 Census
“Do you look after or give any help or support to others because of illness, old age…etc. – not part of your paid employment”
NILS - NIMS
Prescribing Database
Deaths
Household & Family Indicators

4. NIMS Project 86: Mortality and caregiving
Questions:
What is the effect of informal caregiving on mental health & mortality?
Does this vary given the health condition of the care recipient?

5. Caregiver (number of hours per week)
Likelihood of health condition given carer burden by gender Figures represent odds ratios (95%confidence intervals)
Health status
 Caregiver (number of hours per week)
None
Less than 20
20-49 hours
50 and over
Men
Mental health problem
1.00
0.81 (0.77, 0.85)
0.85 (0.79, 0.92)
1.09 (1.03, 1.15)
Mobility and dexterity
0.63 (0.61, 0.66)
0.85 (0.81, 0.90)
1.01 (0.97, 1.05)
Long-term Pain
0.87 (0.84, 0.90)
1.00 (0.95, 1.06)
1.25 (1.20, 1.29)
Shortness of breath
0.86 (0.83, 0.90)
1.00 (0.94, 1.07)
1.14 (1.09, 1.19)
Women
0.73 (0.71, 0.76)
0.91 (0.86, 0.96)
1.20 (1.16, 1.25)
0.55 (0.53, 0.56)
0.74 (0.70, 0.77)
0.90 (0.87, 0.92)
0.75 (0.73, 0.77)
0.94 (0.90, 0.98)
1.11 (1.07, 1.14)
0.82 (0.80, 0.85)
0.92 (0.87, 0.97)
1.11 (1.07, 1.15)

6. Death data from Registrar General’s Office up end 2013
2011 Census returns For entire Northern Ireland population
Care-giver
Care-recipient
Identifies as informal care-giver in census and lives with someone with a long-term health condition
Identifies as having a long-term health condition (at least 1 of a list of 10 conditions) and lives with an
informal care-giver
Assume care-giver is caring for the co-resident ill family member
Categorise care-recipients based on health status
Investigate likelihood of
poor mental health and mortality risk of care-giver based on health of care recipient

7. Cohort: 58,547 carer/care-recipient dyads Carers were 18yrs+ & sole care-giver in household (61% female, mean age 49.2yrs)
Likelihood care-giver death (adj sex, age, gender, marital status, SES, area deprivation & physical health)
0.92 (0.79,1.06)
1.07 (0.87,1.31)
0.83 (0.73,0.95)
0.82 (0.72,0.95)
1.24 (1.05,1.46)*
0.96 (0.82,1.13)
1.13 (0.85,1.50)
1.10 (0.88,1.37)
1.12 (0.94,1.39)
0.97 (0.85,1.10)
Likelihood care-giver poor MH (adj. sex, age, gender, marital status, SES, area deprivation & physical health)
1.27 (1.17,1.36)*
1.12 (0.99,1.29)
1.15 (1.07,1.24)*
1.08 (1.01,1.16)*
1.51 (1.37,1.67)*
0.98 (0.89,1.08)
1.26 (1.14,1.39)*
1.22 (1.10,1.36)*
2.02 (1.87,2.18)*
1.14 (1.06,1.23)*
Health complaint
of care recipient
Shortness Breath (25.1%)
Blind (6.6%)
Chronic Pain (41.2%)
Mobility/Dexterity (54.6%)
Confusion/Memory loss (9.7%)
Deafness (16.0%)
Learning Difficulty (9.2%)
Communication Difficulty (8.1%)
Psychological/Emotional (19.5%)
Other Chronic Illness (65.9%)

8. Living & Caring for those with Dementia Symptoms (Q23 confusion/memory loss)
Likelihood poor mental health in dementia patients' co-residents based on caregiving
Co-resident status
Unadjusted
Adjusted age & gender
Fully Adjusted*
Not a carer
Light care (<20hrs)
Heavy care (>20 hrs)
1.00
0.45 (0.32,0.61)
0.56 (0.46,0.67)
0.41 (0.30,0.56)
0.60 (0.50,0.72)
0.78 (0.57, 1.08)
0.97 (0.81, 1.15)
Likelihood mortality in dementia patients' co-residents based on caregiving
Co-resident status
Unadjusted
Adjusted age & gender
Fully Adjusted*
Not a carer
Light care (<20hrs)
Heavy care (>20 hrs)
1.00
0.45 (0.32,0.61)
0.56 (0.46,0.67)
0.41 (0.30,0.56)
0.60 (0.50,0.72)
0.78 (0.57, 1.08)
0.97 (0.81, 1.15)
*adjusted for age, gender, marital status, ethnicity, HH size, baseline health (LLTI), deprivation and urbanicity

9. NILS Project 61: The Grief Study
Questions:
What is the effect of bereavement on mental health (as measured by receipt of antidepressant and/or anxiolytic medication)?
Does this vary given the reason for bereavement?

10. NILS Project 61: The Grief Study
Dies during study follow-up
NILS member
Census data
Prescription Medication data

11. Likelihood of receiving antidepressant medication in January 2009 given bereavement experience between OR (95% CI)
Adjusted *
Bereavement Status
Not Bereaved
1.00
Bereaved Illness
1.18 (1.09, 1.28)
Bereaved Sudden
1.57 (1.18, 2.10)
Bereaved Suicide
1.80 (1.32, 2.48)
Worse outcomes for carers
Worse outcomes for the less educated (except when bereaved by suicide)

12. Likelihood of Antidepressant Medication post bereavement based on bereavement type

13. NIMS Project 87: Mental Health and Mortality in Families
Questions:
What is the burden of mental ill health in families?
Does parental mental health affect mental health and suicide risk in offspring?

14. Self-reported mental ill-health (Q23)
4.5% of individuals report poor MH in Q23 of census (psychological condition)
13.0% of households have someone reporting poor Mental Health (n=89,557 households)
over 1 in 8 households affected by mental ill health

15. ANALYSIS STILL ONGOING
Does parental mental health affect mental health and suicide risk in offspring?
ANALYSIS STILL ONGOING
(WATCH THIS SPACE)

16. Acknowledgements
“The help provided by the staff of the Northern Ireland Longitudinal Study/Northern Ireland Mortality Study (NILS/NIMS) and the NILS Research Support Unit is acknowledged. The NILS/NIMS is funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and NISRA. The NILS-RSU is funded by the ESRC and the Northern Ireland Government. The authors alone are responsible for the interpretation of the data and any views or opinions presented are solely those of the author and do not necessarily represent those of NISRA/NILS.”