The association between caregiving for disabled spouses and depressive symptoms among middle-aged and older adults in China

Abstract

Background: It is widely recognized that individuals with disabilities are at a significantly higher risk of mental health issues. However, the mental health status of their spousal caregivers often tends to be overlooked. Objective: To investigate the association between caring for a disabled spouse and depressive symptoms among middle-aged and older adults, and to assess whether this association differs by caregiver gender. Methods: Cross-sectional data were drawn from the 2020 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms in respondents were measured by the CESD-10. Associations were estimated using generalized estimating equations (GEE) with a logit link to account for intra-household correlation. Models adjusted for sociodemographic and health-related confounders. We conducted gender-stratified analyses, tested the interaction between gender and caregiving, performed an analysis restricted to caregivers (n = 1,357), and examined the relation between the number/types of recipient disabilities and caregiver depressive symptoms. Results: In multivariable GEE models, spousal caregiving was associated with higher odds of depressive symptoms (OR = 1.278, 95% CI 1.127 to 1.449, P < 0.001). Stratified analyses indicated a stronger association among female caregivers (OR = 1.459, 95% CI 1.204 to 1.768, P < 0.001) than male caregivers (OR = 1.207, 95% CI 1.013 to 1.438, P = 0.036); however, the gender × caregiving interaction was not statistically significant (P = 0.271). Within the caregiver subsample, female caregivers had markedly higher odds of depressive symptoms compared with male caregivers (OR = 1.824, 95% CI 1.355 to 2.455). Moreover, a greater number or severity of recipient disabilities was associated with incrementally higher depressive risk among caregivers, suggesting a dose–response relationship. Conclusions: Spousal caregiving was associated with elevated odds of depressive symptoms, with larger effect estimates among women. Limitations include cross-sectional design, self-reported measures, and potential residual confounding. Prospective studies are needed to assess temporality and causal pathways; the results support enhanced monitoring and development of targeted supports for spousal caregivers, with consideration of sex differences and recipient disability burden.