Mental health problems affect an estimated one in four of the global population and represent one of the leading causes of disease burden and years lost to disability. Informal caregivers, who are typically close family members, play an important role in optimising patient wellbeing. Carers, however, can also have their own health needs that can negatively affect their quality of life and health service use.
This study aims to evaluate whether there is an increased risk of poorer health status in mental health carers compared to carers of people with physical disorders, and if the type of data contained in GPRD supports the investigation of these type questions. It will also examine whether we can identify social-demographic and clinical markers of poorer health status amongst carers and test whether there are differences between mental and physical health carers.
In a representative, population-based sample of people in primary care, these analyses will demonstrate whether we can identify carer subgroups at higher risk of poorer health and potential earlier markers and support the rationale for providing early targeted carer interventions.
Aims: To explore the feasibility of determining the health status of mental health carers in primary care.
Objectives: We plan to compare differences in the incidence and prevalence of common health disorders between carers of people with physical disorders, carers of those with mental disorders and matched non-carer controls. To assess carer mortality, we will link CPRD with the ONS Death registration, and deprivation data. This would support adjustment for the potential influence of socioeconomic deprivation on the association between carer status and risk of physical or mental disorders.
Study design: A matched prospective cohort study where patients, identified as carers, will be examined and compared with non-carer controls (matched for age, gender, and practice) and within the carer group.
Methods: Cox proportional hazards will be used to assess time to event association between caring status with multiple disorders events incidence and all-cause mortality after adjusting for covariates. A multiple outcomes model will be employed which allows for the development of different outcomes in an unordered fashion.
Primary exposure: Carer status (carer vs no carer), as determined via Read or SNOMED codes terminology. If feasible in CPRD, a secondary exposure variable will be developed to classify carers into carers of people with a physical or mental disorder. An index of carer support will also be calculated as days of care delivered per year by caregivers per 1000 dependent persons, and average number of years of care by each caregiver.
Outcomes: These will be the most common physical and mental health disorders including diabetes, cardiovascular disease, rheumatoid arthritis, cancer, hypertension, depression, anxiety, dementia, insomnia, and pain. Carer mortality will also be measured.
The primary outcomes will include incidence of common physical and mental disorders including diabetes, cardiovascular disease, rheumatoid arthritis, cancer, hypertension, depression, dementia, and anxiety.
Juliana Onwumere - Chief Investigator - King's College London (KCL)
Alex Dregan - Corresponding Applicant - King's College London (KCL)
Mark Ashworth - Collaborator - King's College London (KCL)
ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation