The effect of chronic illness on the psychological health of family members.

BACKGROUND: Chronic illness in a family member can cause emotional distress throughout the family, and may impair the family's ability to support the patient.
OBJECTIVES: We compare the familial impact of mental illness to other common chronic conditions. We examine the impact of a person's chronic illness on the psychological health of all persons in his or her family and identify both individual and family-level risk factors associated with psychological spillovers.
METHODS: Our analysis is based on data from the 1996 Medical Expenditure Panel Survey (MEPS) that, because of its sample design, can be used to model both individual and family health status. Psychological distress is measured using responses to the general mental health question for each family member. The chronic conditions considered include cancer, diabetes, stroke-related disorders, arthritis, asthma, and mental illness (including dementia). We estimate the relationships of interest using a semi-parametric method, the discrete random effects probit model.
RESULTS: Brain-related conditions, including mental illness, impose the most significant risk to the psychological well-being of family members. The effects of the other chronic conditions studied, while not as significant, are notable in that their negative impacts on the psychological health of family members are sometimes larger than their direct psychological impacts on the patient. Economic distress not only directly increases the chance that an individual will experience emotional distress, but it appears it also reduces the family's ability as a whole to cope psychologically with chronic illness. DISCUSSION: Our analysis suffers from problems common to all cross-sectional designs, although the impact of selection bias appeared to be small in sensitivity analysis. While health conditions were based on unverified self-reports, condition categories were broadly defined to reduce the required precision of such reports. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Because psychological distress is fairly contagious in families confronted with chronic illness, effective treatment strategies may need to be targeted to all members of the primary patient's family. Providers should be particularly vigilant for intra-family effects when their patients come from families that lack the financial resources that might protect against the stress of caring for a family member with a chronic illness. IMPLICATIONS FOR HEALTH POLICIES: Results suggest that, of the chronic conditions considered, priority for respite care and supportive services should be given to families in which a member has a brain-related disorder, particularly in families with limited financial resources and inadequate insurance coverage. IMPLICATIONS FOR FURTHER RESEARCH: The use of the discrete random effects probit model identified important interpersonal health effects that could not have been detected with standard analytical methods. The potential clinical relevance of the resulting findings underlies the need for additional data collection efforts that, like the MEPS, consider individuals in a family context.