Abstract
In the last decades, both the lengthening of life expectancy and an accentuated decline in birth rates have reduced the consistency of the younger generational cohorts. Due to an ageing population, the burden of caregiving is expected to intensify in the next quarter of the century in Europe, especially for mature women. This paper investigates the impact of the provision of constant care for older parents on the mental health of adult daughters, between the ages of 50 and 75, living in different European countries. Data is drawn from the Survey of Health, Ageing and Retirement in Europe. Information on mental health status is provided by Euro-D depression scale, a measure of depression standardized across European countries. We focus on differences in the effects according to the North–South gradient: we test whether the relationship between informal caregiving and mental health differs across European macro-regions. Our results, robust under different specifications of the propensity score model, reveal a clear North–South gradient: the provision of informal care has a negative and significant impact on daughters’ mental health in the Mediterranean countries only, where the amount of resources allocated to the Long Term Care is minimal and the local system of health and social services for the elderly lacks the necessary structures to meet the increasing demand for eldercare.
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Notes
The target population of SHARE is defined both in terms of households and in terms of individuals. The interviewers observed families with at least one person and the individuals born before 1954 who speak the official language of the country and who, during the time of the survey, do not live abroad or in an institution like a prison, as well as their spouse/partner, independently of age.
We have included this age cut-off, according to the extant literature, since parents who need constant assistance generally have children aged 50 or over and equally, children who are over 75 are less likely to still have parents to care for, or may be too old themselves to provide care (see also Grundy and Henretta 2006; Rubin and White-Means 2009; Coe and Van Houtven 2009).
Literature suggests different ways of classifying European countries according to the reported characteristics. Consistently with the data availability, we adopted a care regime cluster approach that falls midway between the traditional Esping-Anderson approach (1990) and the countries classification carried out by Bettio and Plantenga (2004). Our clustering approach was also adopted by Crespo and Mira (2010) who used SHARE data.
Data for Italy and Greece LTC expenditure were missing since they are not included in the OECD data we used (see Fig. 1). .
In Sweden for example the children’s legal obligation to care for their parents has been abolished. The municipality is solely responsible for elderly assistance (EOP 2010).
The issue of informal caregivers’ training is very important and well debated. Southern countries in particular lack these kind of services, with the consequence that, without receiving any preparation on this topic, the carers often feel inadequate in coping with the elderly personal care.
The "parent-sample" provides comprehensive information reported by the elderly parents themselves, among which their access to different sources of care, in addition to informal care provided by their daughter (see also p. 14).
Prince et al.(1999) found that reporting four or more symptoms on the EURO-D scale is the optimal cut-off point in predicting clinical depression. Dewey and Prince (2005) suggested to set a threshold at a score of 4 and defined clinically significant depression as a EURO-D score equal or greater than 4. Therefore, we used 4 symptoms as a threshold – i.e. dichotomising the EURO-D scale. We carried out a sensitivity analysis re-running the model using the whole EURO-D scale to examine whether informal care affects the total number of depressive symptoms. This construction did not significantly affect the results: the ATT still results significant for the Southern European macro area only. Providing any type of care to older parents has a positive and significant effect of 0.18 on the total number of depressive symptoms. For the sake of brevity, the results of the sensitivity analysis are not included but they are available on request.
In order to construct the occupational prestige scale we employed the STATA command “iskotrei” which transforms ISCO-88 codes into Treiman's SIOPS scale (Standard International Occupational Prestige Scale) (Ganzeboom and Treiman 1996).
Coe and Van Houtven (2009) claimed: “a certain threshold of health may be needed before becoming a caregiver, making it very important to control for initial health to understand the effects of informal care on health over time”.
Using a lagged dependent variable in a cross-sectional data is an alternative way of addressing the unobserved characteristics. The main assumption in a lagged dependent variable approach is that the majority of the same unobserved characteristics affects both current and previous (i.e. lagged) dependent variables. Thus, including a lagged dependent variable in a cross-sectional regression model, makes it easier to account for the unobserved factors that cause the current differences in the dependent variable, which is not feasible in a pure cross-sectional data analysis (see Wooldridge 2000).
The estimation was carried out using the PSMATCH2 program for STATA developed by Leuven and Sianesi (2003).
All observed controls used in the propensity score matching analysis satisfy the balancing property again (see Table 6).
Respondents fill in the drop-off questionnaire only once. Individuals who weren’t interviewed in wave 1 were asked to answer the drop-off questionnaire in wave 2. Our sample includes, however, women who were interviewed for the first time in wave 1 and again in wave 2. Hence, the indicator of attitudes towards parent’s care refers to wave 1. We assumed that the attitude towards care did not change between wave 1 and 2.
We performed additional robustness checks displayed in Online Appendix.
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Acknowledgments
An earlier draft of this paper was presented at the annual meeting of the Italian Health Economics Association (AIES), Trento, Italy, at the International Health Economics Association (iHEA) annual conference, Milan, Italy, at the European Federation of Retired and Older Persons (FERPA) Annual Conference, Bruxelles, Belgium, at XII Workshop of Public Economics at Regional and Local Level (PEARL), Alessandria, Italy, and at seminars at the University of Lugano, Marche Polytechnic University, Ca’ Foscari University of Venice. The authors thank the conference and seminar participants for their detailed and helpful comments. The authors also thank Andrea Albarea, Silvia Balia, Vincenzo Carrieri, Alberto Cassone, Claudio Lucifora, Fabrizio Mazzonna, Giacomo Pasini, Elisabetta Trevisan, Francesca Zantomio for useful suggestions. Financial support provided by Fondazione FarmaFactoring (Milan) for this research project is gratefully acknowledged. The authors also wish to thank the editors and two anonymous referees for helpful comments. The usual disclaimer applies.
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Brenna, E., Di Novi, C. Is caring for older parents detrimental to women’s mental health? The role of the European North–South gradient. Rev Econ Household 14, 745–778 (2016). https://doi.org/10.1007/s11150-015-9296-7
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DOI: https://doi.org/10.1007/s11150-015-9296-7