Insights

Mental health, substance use, and suicidal ideation among unpaid caregivers of adults in the United States during the COVID-19 pandemic: Relationships to age, race/ethnicity, employment, and caregiver intensity

Mark É Czeisler, Alexandra Drane, Sarah S Winnay, Emily R Capodilupo, Charles A Czeisler, Shantha MW Rajaratnam, Mark E Howard,
Mental health, substance use, and suicidal ideation among unpaid caregivers of adults in the United States during the COVID-19 pandemic: Relationships to age, race/ethnicity, employment, and caregiver intensity,
Journal of Affective Disorders,
Volume 295,
2021,
Pages 1259-1268,
ISSN 0165-0327,

Caregivers are working at your company or living in your communities. Now. (They are not ‘just’ spouses at home)

• Unpaid caregivers are most likely to be young and employed.
• The majority are essential workers.
• Caregivers are more likely to be from communities that have been broadly, disproportionately impacted by the pandemic
• Unpaid caregivers are more likely to be Black or Hispanic
• Unpaid caregivers are more likely to be living with disability than those who are not caregivers

Caregivers working at your company or living in your communities are struggling. Unimaginably.

• Among all unpaid caregivers,
  • 70% are experiencing a mental health issue right now.
  • 33% have seriously considered suicide in the previous 30 days.
• Among young (24-43) caregivers
  • 45% have seriously considered suicide in the previous 30 days.
• Among Black (non-Hispanic) caregivers
  • 80% are experiencing a mental health issue right now.
  • 46% have seriously considered suicide in the previous 30 days.
• Among Hispanic caregivers
  • 90% are experiencing a mental health issue right now
  • 49% have seriously considered suicide in the previous 30 days.
• Among caregivers with the High Intensity (as measured by the Caregiver Intensity Index)
  • 91% are experiencing a mental health issue right now.
  • 54% have seriously considered suicide in the previous 30 days.

In this study, having a sense of purpose was the most protective buffer against adverse mental health impacts.

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic

Mark É. Czeisler1,2,3; Elizabeth A. Rohan, PhD4; Stephanie Melillo, MPH4; Jennifer L. Matjasko, PhD4; Lara DePadilla, PhD4; Chirag G. Patel, DC4; Matthew D. Weaver, PhD1,3,5; Alexandra Drane6; Sarah S. Winnay6; Emily R. Capodilupo6,7; Rebecca Robbins, PhD3,5; Joshua F. Wiley, PhD1; Elise R. Facer-Childs, PhD1; Laura K. Barger, PhD1,3,5; Charles A. Czeisler, PhD, MD1,3,5; Mark E. Howard, PhD1,2,8*; Shantha M.W. Rajaratnam, PhD1,2,3,5*

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic — United States, December 2020 and February–⁠March 2021. MMWR Morb Mortal Wkly Rep 2021;70:879–887. DOI:

• 70% of parents and/or caregivers reported adverse mental health symptom
• 55% reported anxiety or depression
• 54% reported COVID-19-induced stress and trauma
• 32% reported passive or serious suicidal thoughts

As assessed by the ARCHANGELS Caregiver Intensity IndexTM, drivers of Caregiver Intensity increased odds of adverse mental health symptoms:

• Caregiving related family disagreements (3x odds)
• Resentment about caregiving responsibilities (3x odds)
• Feeling underprepared as a caregiver (2x odds)
• Not having as much personal freedom as desired (2x odds)
• Having had to cut down on expenses due to caregiving (2x odds)

Among those caring for people under 18 and over 18 (sandwich caregivers):

• 52% reported serious suicidal thoughts or 12 times the rate of nonparents/noncaregivers
• 58% reported passive suicidal thoughts, or six times the rate of nonparents/noncaregivers

Ongoing Data Collection

ARCHANGELS is constantly surveying the caregiver experience using our proprietary tool, the Caregiver Intensity IndexTM, both in our own research and in research collaborations. Here’s what we’ve learned:

• 66% of us say yes when asked, "are you worrying about, taking care of, or looking out for a friend, neighbor or family member.”
• 56% of unpaid caregivers have clinically significant anxiety or depression.
• One in three caregivers have suicidal ideation – 10x the rate of non-caregivers where even 1x is too much.
• Unpaid caregivers are increasing substance use at 5x the rate of non-caregivers.

But it doesn’t have to be this way…

• Just knowing someone is in your corner decreases the risk of depression by 40%, and the risk of anxiety by 30%.
• Knowing respite services exist EVEN IF THEY AREN’T USED reduces stress by 70%.
• Employed caregivers with Medium or High Intensity have LESS depression, anxiety, or stress than non-employed caregivers with those same levels of Intensity.
• Among working caregivers with High Caregiver Intensity risk, feeling a strong degree of support from one's employer reduces the likelihood of depression, anxiety or high stress by 19%.