The weight of “I do”: spousal caregiving and the shadow of depressive symptoms across five cohort studies

OBJECTIVES: This study examined the longitudinal associations between spousal caregiving dimensions (status, type, and transitions) and depressive symptoms among middle-aged and older adults across North America, Europe, and East Asia to inform interventions and policies. METHODS: We analyzed harmonized data from 5 international aging cohorts (HRS, ELSA, SHARE, KLOSA, and CHARLS; N = 53,728 observations) collected during 2010-2020. Spousal caregiving was assessed by status (caregiver/non-caregiver), type (ADL care, IADL care, or non-caregiver), and transitions (initiated care, sustained care, ended care, or remained non-caregiver). Generalized linear mixed models estimated associations between spousal caregiving and depressive symptoms while controlling for covariates. RESULTS: Spousal caregivers reported significantly higher prevalence of depressive symptoms than non-caregivers in 4 of 5 cohorts: ELSA (odds ratio [OR] = 1.49, 95% confidence intervals [95% CI]: 1.19-1.87), KLOSA (OR = 1.33, 95% CI: 1.03-1.73), SHARE (OR = 1.29, 95% CI: 1.15-1.44), and CHARLS (OR = 1.26, 95% CI: 1.14-1.39). The pooled analysis yielded an OR of 1.25 (95% CI: 1.17-1.33). Compared to non-caregivers, depressive symptoms were higher for ADL caregivers (pooled OR = 1.45, 95% CI: 1.34-1.56). Both sustained care (pooled OR = 1.26, 95% CI: 1.12-1.42) and initiated care (pooled OR = 1.23, 95% CI: 1.12-1.36) showed significant associations with depressive symptoms compared to remaining non-caregivers. DISCUSSION: This cross-national examination indicates that spousal caregiving is widely associated with increased depressive symptoms. The consistent patterns across diverse cultural contexts underscore the need for targeted support services for spousal caregivers globally, particularly those providing intensive and prolonged care.