Mentally Unhealthy Days and Frequent Mental Distress Among Caregivers in North Carolina

BACKGROUND Geographic variation in state services and supports for caregivers warrants a closer examination of factors associated with caregiver distress at the state level. We examined factors associated with mentally unhealthy days and frequent mental distress among caregivers as compared to non-caregivers in North Carolina. METHODS We used data from the North Carolina Behavioral Risk Factor Surveillance System optional caregiving modules (years 2011, 2017, and 2021). Multivariable zero-inflated negative binomial (ZINB) and logistic regression analyses incorporating sampling weights were used to predict the number of mentally unhealthy days (MUDs) out of the past month and the probability of frequent mental distress (FMD), defined as 14 or more MUDs in the past month. We provided socio-demographically adjusted marginal effects comparing caregivers to non-caregivers. We produced estimates using both the total sample and a subset of individuals without reported frequent physical distress (FPD), meaning those with less than 14 physically unhealthy days in the past month. RESULTS Caregivers had an average of 1.3 higher predicted number of mentally unhealthy days (95% CI, 0.8–1.9) and a 4 percentage-point higher probability of having frequent mental distress than non-caregivers (95% CI, 1.6–6.3) after controlling for sociodemographic covariates. Individuals with lower educational attainment and those unemployed had a higher average number of MUDs (P values < .05). LIMITATIONS Primary exposure and outcomes were self-reported measures, and study years were constrained to years that the caregiver module was implemented. CONCLUSIONS Further research is warranted to determine if improvements in long-term care services and supports (LTSS) and access may reduce caregiver distress. Useful strategies to support caregivers have been outlined by the National Strategy to Support Family Caregivers initiative to address caregivers’ unmet needs.