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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

01-12-2020 | Care | Research

Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability

Authors: Hannah Tough, Martin W. G. Brinkhof, Johannes Siegrist, Christine Fekete, for the SwiSCI Study Group

Published in: International Journal for Equity in Health | Issue 1/2020

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Abstract

Background

Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. However, the basic assumption that low SEP is associated with greater caregiver burden has so far lacked empirical support. The objective of this study was to investigate social inequalities in the caregiver burden among caregiving partners of persons with a physical disability, i.e., spinal cord injury (SCI), applying a dyadic approach. More specifically, we investigated 1) the association of the caregivers’ SEP with caregiver burden (‘actor effect’); 2) the association of the care-receivers’ SEP with caregiver burden (‘partner effect’), and 3) potential mediators of the association between SEP and caregiver burden.

Methods

Cross-sectional survey data from 118 couples of persons with SCI and their partners living in Switzerland was used. We firstly employed logistic regression to investigate the actor and partner effects of SEP on objective (hours of caregiving) and subjective caregiver burden (Zarit Burden Interview). We additionally used structural equation modelling to explore whether unfulfilled support needs, psychosocial resources and the care-receivers health status mediated the association between SEP and caregiver burden. SEP was operationalized by household income, education, subjective social position, financial strain and home ownership.

Results

We observed a consistent trend towards higher objective and subjective burden in lower SEP groups. Caregivers with higher subjective social positon and home ownership indicated lower subjective burden, and caregivers with higher education and absence of financial strain reported lower objective burden. Further evidence suggested a partner effect of SEP on caregiver burden, whereby objective caregiver burden was reduced in couples where the care-receiver had a higher educational level. The negative association between SEP and subjective burden was partially mediated by the unfulfilled support needs and deprived psychological resources of the caregiver, and the poor health status of the care-receiver. Similar mediation effects were not supported for objective burden.

Conclusions

Our study, in the context of SCI, provides support for the contextual role of SEP in the Stress Process Model of caregiving. To reduce subjective caregiver burden, policy programs may target the strengthening of psychosocial resources, or the improvement of access to support services for caregivers with low SEP.
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Metadata
Title
Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability
Authors
Hannah Tough
Martin W. G. Brinkhof
Johannes Siegrist
Christine Fekete
for the SwiSCI Study Group
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-1112-1

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