Research Spotlights: December 2023

Caregiving as a chronic stressor detrimental to mental health – or not?

Contrary to the common belief that caregiving is always stressful and harms mental health, recent studies are shedding light on its potential health benefits. A recent study funded by NIA explored how family health issues may influence the connection between caregiving and mental well-being. Focusing on adult children providing care to aging mothers, the research aimed to 1) clarify whether previous studies linking caregiving to depression might be misleading and 2) explore if caregiving for aging mothers could have mental health benefits.

Using data from the US Health and Retirement Study (HRS), the researcher analyzed responses of adult children aged 50 and older with a living mother, who participated in the HRS from 2002 to 2018 (n = 4812; 18,442 person-wave observations). The average age of the respondents was 57 years, 53% identified as female, and they reported 1.4 depression symptoms on average at baseline. Respondents’ mothers were approximately 82 years old at baseline. With a series of within-between random effects models, the researcher attempted to elucidate how health issues in aging mothers (like disability and dementia) and changes in caregiving situations influenced the mental health of adult children.

Surprisingly, findings showed that changes in caregiving situations were not linked to depressive symptoms in adult children once the impact of the mother's health issues were controlled. Additionally, results indicated that caregiving behavior helped protect adult children from the negative effects of their mother's disability on their mental health. The researcher includes recommendations for future study designs that would provide a more complete picture of family caregiving.

Study limitations include selective attrition, lack of generalization to caregiving of aging fathers as well as to caregiving outside the U.S., and measurement error due to social desirability bias and recall bias.

This study adds to the growing body of research challenging the frameworks underlying the chronic stress paradigm and, specifically, the idea that caregiving is always a chronic stressor harming mental health. It aligns with earlier calls for a more balanced understanding of caregiving in policy reports and research literature. Recognizing the potential positive effects of caregiving is crucial for supporting families and developing more informed policies.

Han SH. Revisiting the caregiver stress process: Does family caregiving really lead to worse mental health outcomes? Adv Life Course Res. 2023 Dec;58:100579. Doi: 10.1016/j.alcr.2023.100579. Epub 2023 Oct 26. PMID: 38054877.

Adoption and scaling up of overdose education and naloxone distribution through a “hub with many spokes” model.

As part of the HEALing Communities Study clinical trial, researchers supported by NIDA set out to demonstrate the feasibility of a “hub with many spokes” model for scaling up channels of delivery for proven medical intervention to prevent overdose deaths in representative communities most effected by the opioid pandemic.

To meet this objective, researchers analyzed data regarding infrastructure characteristics to discuss the effectiveness of scaling up Overdose Education and Naloxone Distribution (OEND) programming in eight Kentucky counties that matched criteria for the Communities That Heal (CTH) intervention: a sum of ≥ 150 opioid-related overdose fatalities, a rate of ≥ 25 opioid-related overdose fatalities per 100,000 in 2016, and 30% rural. The CTH intervention consists of evidence-based practices (EBPs) within the Opioid-overdose Reduction Continuum of Care Approach (ORCCA); OEND is one of three EBP options with the CTH.

Eight counties in Kentucky were randomized to receive the OEND programming from January 2020 to June 2022. The “hub” consisted of a centralized, university-based naloxone dispensing unit, and the “many spokes” consisted of partner organizations, organized according to priorities set by community coalitions for implementation sectors and venues. There was no control group of organizations. Funds for designing the OEND model and for purchasing naloxone for the 8 communities were allocated from the HEALing Communities Study (HCS-KY) grant, supplemented by funds from the Kentucky Opioid Response Effort’s SAMHSA funding through state stakeholders, in keeping with Kentucky’s regulatory environment.

Over the course of the intervention, 209 organizations in the eight Kentucky counties were contacted, of which 177 (84.7%) responded and engaged in the preparation phase and 145 (69.4%) completed onboarding into the HCS-KY OEND program. A total of 40,822 units of naloxone were distributed during the implementation phase (mean = 281.5, SD = 806.2). Mean county distribution rate was 8396.5 units per 100,000 residents, and the mean number of units distributed per county was 5102.8. At the end of the intervention, 127 partner organizations (87.6%) attended meetings to transition to state-funded naloxone programming.

This study has some limitations. Findings represent OEND implementation in eight counties within a single state. Additionally, the intervention prioritized scaling up of OEND versus limiting the amount of facilitation provided, meaning that results cannot support a measure of optimal facilitation support. Nevertheless, study findings indicate that the “hub with many spokes” model is effective in scaling up an evidence-based intervention focused on education and naloxone distribution.

Knudsen HK, Freeman PR, Oyler DR, Oser CB, Walsh SL. Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a "hub with many spokes" model. Addict Sci Clin Pract. 2023 Nov 30;18(1):72. doi: 10.1186/s13722-023-00426-6. PMID: 38031180; PMCID: PMC10688494.