Personal Income Progression of Informal Family Caregivers of Children and Young Adults With Mental Disorders

Abstract

Informal family care for a child with a mental disorder may negatively impact work capacity and decrease income. We compare prolonged sex-specific personal income progression between informal family caregivers of children/young adults with and without mental disorders. We evaluate mediation via cumulated unemployment. This observational matched cohort study included register data on Danish residents between 2000 and 2018, analyzing personal income each year during a 10-year follow-up period (T1-T10) following incidence of children/young adults with mental disorders (T0). Case caregivers were matched 1:5 to control caregivers of children without mental disorders by age, sex, education, child's age, sex, and baseline (2000-2017) and follow-up calendar years (2001-2018). We analyzed sex-stratified income ratios between case and control caregivers using generalized estimating equations log-linear regression models. Both unadjusted and adjusted analyses were performed. Adjusted associations controlled for age, sex, and socio-demographic factors. Mediation was assessed by comparing ratio estimates of models with and without accounting for cumulated weeks of unemployment. We analyzed 2,339,240 case caregiver and 11,696,200 control caregiver observations based on 204,607 unique case (age: mean = 43.2, SD = 7.3) and 1,371,097 control caregiver (age: mean = 43.0, SD = 7.6) individuals. At T5, unadjusted analysis showed a lower income among case caregivers, females (Income Ratio = 0.956, 95% CI = 0.952-0.959) and males (Ratio = 0.933, 95% CI = 0.929-0.937), relative to controls (Ratios = 1.000). Adjusting for confounders attenuated the associations, although the income differences remained statistically robust (females: Ratio = 0.969, 95% CI = 0.965-0.972; males: Ratio = 0.962, 95% CI = 0.957-0.966). Accounting for cumulated weeks of unemployment reduced income-ratio estimates marginally, suggesting poor mediation. The present results underscore family costs of informal caregivers of children/young adults with mental disorders, who experience weaker personal income progression than caregivers of other children. Trial Registration: ClinicalTrials.gov identifier: NCT06441461.