Gender inequalities of caregiver mental health and burden in the three years post COVID-19 (CUIDAR-SE Study)

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Abstract
The COVID-19 pandemic has significantly impacted progress towards the Sustainable Development Goals (SDGs), particularly SDG 3 (ensuring healthy lives and well-being) and SDG 5 (achieving gender equality), especially for caregivers. Increased demand for informal caregiving has disproportionately impacted caregivers, worsening mental health challenges. Intense burden reinforces traditional gender norms and exacerbates health inequities, linking it closely to both SDGs. This study investigates the relationship between intense caregiving burden and mental health among informal caregivers in Spain, emphasizing gender differences and the mitigating role of perceived social support. This three-time repeated-measures analysis, part of the larger longitudinal CUIDAR-SE study, was conducted in two regions of Spain, Granada (Andalusia) and Gipuzkoa (Basque Country). 261 caregivers (165 female and 96 male) were enrolled in 2021 and followed through 2022 and 2023. Mental health was assessed using the General Health Questionnaire-12 (GHQ-12), with independent variables including age, sex, and caregiving factors (intense burden, social support). Descriptive statistics characterized the caregiving situation by sex, followed by logistic regression to explore associations between GHQ-12 scores and burden, adjusted for age and social support, stratified by sex. Results showed that male caregivers, typically older and caring for spouses, received less informal support and more external assistance than younger female caregivers, whose care was more varied. A positive association was found between caregiving burden and mental health issues: odds ratio (OR) 7.1 (95% CI: 3.7–14.3) in 2021, OR 6.2 (95% CI: 2.8–14.6) in 2022, and OR 4.6 (95% CI: 1.9–12.0) in 2023, adjusting for age and social support. This association was stronger among male caregivers, particularly in 2021. Social support showed a protective effect against mental health problems for men in 2022 and both men and women in 2023. This study underscores the mental health impact of caregiving during the pandemic, revealing gender inequities in caregiving tasks, burden, and mental health distress. The findings emphasize the need for gender-sensitive policies, aligned with the SDGs, to support caregivers’ well-being. Strengthening formal care services and promoting shared caregiving responsibilities are essential to reducing caregiver burden and improving mental health outcomes.
Funding Information
  • Instituto de Salud Carlos III (PI19/00446, PI19/00446)
  • European Regional Development Fund (PI19/00446, PI19/00446)

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