Should I care for my mum or for my kid? Sandwich generation and depression burden in Italy

Brenna E., 2021 – Health Policy

The phenomenon of aging, which characterizes most Western countries, encompasses an increasing need for care by the older share of the population. Elderly care can be provided formally, by qualified and paid personnel, or informally, by friends, family, and neighbors.

In Italy, over the last decades, elderly care has been mostly provided by family members, especially adult children, and typically daughters. However, as the first baby boomers approach their eighty, concern arises about the long-term care needs of this generation, which is more numerous than the previous cohorts and generated fewer children at an older age. Therefore, the parents/children’s ratio will decrease at the denominator, with fewer adult children caring for their parents and more likely to be contemporarily pressed by the double responsibility to their older relatives and their own kids/grandkids: the so-called “sandwich caregivers”.

In a recent article, “Should I care for my mum or for my kid? Sandwich generation and depression burden in Italy”, published in Health Policy, Elenka Brenna focuses on the generation of individuals aged 35 to 59, which is representative of the sandwich generation, to study the impact, if any, of caring on mental health. Providing informal care to elderly parents can be burdensome in terms of family allocative choices: the time spent in caring for a relative is withdrawn, voluntarily or out of necessity, from other activities, namely work, kids’ care, homecare, or leisure time. If the caring commitment requires many weekly hours and lasts over time, this can lead to job losses and/or negative consequences on the physical and mental health of the caregivers.

The study aims to investigate whether caregivers have a higher probability of being depressed compared to non-caregivers, with a focus on gender differences and parenthood responsibilities. Data are drawn from the European Health Interview Survey for the Italian population, in 2015. Individuals between 35 and 59 years old, representative of the “sandwich generation”, were identified as “caregivers” and “non-caregivers”. For both categories, observable characteristics were selected (age, sex, income, education level, health status, etc.) to describe both the propensity for informal care and the probability of being depressed. Using Propensity Score Matching, the author identifies each caregiver’s “statistical twin”, i.e., an individual showing the same observable characteristics but the status of the caregiver. Once verified that there are no significant differences in the observable variables, any differences in the outcome variable, which detects the presence of depression, can be attributed to the caregiver’s status.

The model was first implemented on the whole sample, checking for any gender differences, and subsequently, it was run on a restricted sample of individuals who live with children under the age of 16, to verify any effects on the sandwich generation. Available empirical evidence suggests that sandwich caregivers, especially women, are more likely to experience stress and burnout due to the time constraints in managing working and family tasks.

Results from different subsamples confirm findings in the literature and provide interesting viewpoints. Specifically, women caregivers providing their older relatives with informal care are less likely to suffer from mental distress compared to non-carers (for men the result is not significant). However, if the sample is restricted to caregivers living with dependent children, the result is reversed: sandwich caregivers (male and female) show a greater propensity to depression than their statistical twins. By splitting the sample by gender, the result increases in magnitude and significance for women only, while it is not significant for men, corroborating the gender effect on care responsibilities.

What does the study tell us? Women caring for an elderly family member, without having other care responsibilities (towards dependent children/grandchildren) can benefit from caregiving. This finding supports recent literature that shows satisfaction and well-being in caring for a fragile relative. However, stress and strain emerge when children up to fifteen are included among care recipients too; this reversed result contributes to the evidence on sandwich generation. Burnout problems arise when the care-load is overwhelming; a woman torn by a double responsibility to both ends of the generational ladder, very likely experiences a feeling of inadequacy that may result in mental health distress.

Faced with a continuously evolving society, characterized by a growing share of working women, an increase in single-parent families, and a rapid population aging, the Italian care model based on family ties is no longer sustainable. Lower socioeconomic classes are those most at risk, especially in terms of economic sustainability; women forced to give up paid work to care for their relatives are unlikely to re-enter the job market, with negative consequences on their financial autonomy.

Policy implications involve different welfare areas: greater flexibility at work (more leaves, hours adaptable to family needs, possibility of working remotely), more funds for nursery schools, especially those managed by employers, transfers to the poorest people to hire formal carers and avoid job quitting during the years of intensive family needs (children at pre-scholar age, parents approaching the end of life). As for health policies: investments in long-term care, especially home care, and greater use of telemedicine; enhancement of the role of the general practitioner with the support of new entities connected through a network (diagnostic clinics, pharmacies, health homes, etc.), as a sustainable approach to ease the burden of care on family members.

Go to the published article