Association of Caregiving Receipt With Mental Health Utilization in a National Cohort of Older Adults

• Published in: The American journal of geriatric psychiatry 2024-12, Vol.32 (12), p.1387-1398
• Main Authors: Wyman, Mary F., Jacobs, Josephine, Stalter, Lily, Venkatesh, Manasa, Voils, Corrine I., Trivedi, Ranak B., Gleason, Carey E., Byers, Amy L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Caregivers - psychology; Caregivers - statistics & numerical data; Caregiving; Cross-Sectional Studies; Dementia; Depression - epidemiology; Female; Humans; Male; Mental Health Services - statistics & numerical data; Mental health utilization; Middle Aged; Older adults; Patient Acceptance of Health Care - statistics & numerical data; United States; United States Department of Veterans Affairs - statistics & numerical data; Veterans - psychology; Veterans - statistics & numerical data
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2024.06.010

•What is the primary question addressed by this study? Using a unique combination of comprehensive survey data and Veterans Affairs health care records encompassing 12 years, we used mixed effects logistic regression models to examine the association between receiving any in-home caregiving assistance and likelihood of mental health utilization in a sample of community-dwelling older veterans.•What is the main finding of this study? After accounting for demographics, caregiver availability, health factors, and socioeconomic status, caregiving receipt was associated with two-fold odds of MH utilization, compared to receiving no assistance. Being classified as having dementia and reporting less severe depressive symptoms potentiated the relationship between caregiving receipt and using mental health care.•What is the meaning of the finding? We found that for this group of community-dwelling older adults, having a caregiver is associated with increased odds of using mental health care, suggesting that caregivers may represent an underutilized resource to reduce age-related disparities in mental health access. There exist significant age disparities in mental health (MH) utilization, such that older adults, including older veterans, are much less likely to use MH services. In-home caregivers represent a novel, yet understudied, pathway to increase appropriate utilization. We sought to examine the association between receiving caregiving assistance and MH utilization and test moderation effects of cognitive status and depression severity in a sample of older veterans. Cross-sectional, mixed effects logistic regression with moderation analyses was used with a unique data resource combining survey data from the 2000–2012 U.S. Health and Retirement Study with Veterans Affairs (VA) healthcare administrative records. The analytic sample included N=1,957 Community-dwelling veterans (mean age 68.2 [9.7]), primarily male (96.5%) and non-Hispanic white (77.0%). Measures included MH utilization extracted from VA records or self-report; CESD-8 for depressive symptoms; and the Langa-Weir cognitive status classification using the modified TICS. After accounting for demographics, spousal caregiver availability, health factors, and socioeconomic status, caregiving receipt was associated with two-fold odds of MH utilization, compared to receiving no assistance (8,839 person-year observations; OR = 2.02; 95% CI 1.54–2.65) and remained similar following VA policy changes to enha