Supporting U.S. Caregivers’ Mental Health: Analysis of Trends and Correlates Pre-COVID and COVID-Onward From the Health Information National Trends Survey, 2018-2022

PurposeTo compare correlates of mental distress among non-professional caregivers vs non-caregivers and evaluate trends in non-professional caregivers' mental distress pre-vs COVID-onward.DesignCross-sectional study.SettingWe used nationally representative data from multiple cycles of the Health Information National Trends Survey (HINTS) from 2018 to 2022.Subjects15 318 participants age 18 and older were included, comprising non-professional caregivers (<i>n</i> = 1387) and non-caregivers (<i>n</i> = 13 931). Professional caregivers and caregivers of child (ren) were excluded from this study.MeasuresThe outcome (mental distress) was categorized based on the Patient Health Questionnaire-4 (PHQ-4) score. Caregivers were identified as those indicating that they provide care or make health care decisions for someone in a non-professional way.AnalysisWe analyzed the association between caregiving status and mental distress pre-COVID and COVID-onward and examined correlates of caregivers' mental distress pre-COVID and COVID-onward through logistic regression models.ResultsCaregivers reported a higher mean PHQ-4 score than non-caregivers overall (<i>|t</i>| = 4.81, <i>P</i> < .001). Caregiving status was significantly associated with mental distress pre-COVID (OR = 1.47; 95% CI = 1.13-1.92; <i>P</i> < .01) and COVID-onward (OR = 1.51; 95% CI = 1.01-2.26; <i>P</i> < .05). Being in fair or poor health status was associated with a higher likelihood of mental distress pre-COVID (OR = 2.58, 95% CI = 1.31-5.09, <i>P</i> < .01), while having a college education or higher was associated with a lower likelihood of mental distress COVID-onward (OR = 0.46, 95% CI = 0.21-0.99, <i>P</i> < .05).ConclusionCaregiving continues to present significant risks for mental distress. The COVID-19 pandemic may continue to present risks to caregivers' mental well-being, requiring policies and programs to improve caregiver mental health.