title: How do social activities mitigate informal caregivers' psychological distress? Evidence from a nine-year panel survey in Japan.
abstract: BACKGROUND
  It is well known that informal caregiving negatively affects caregivers' mental health, while social activities improve mental health outcomes among middle-aged and elderly individuals. The goal of the present study was to examine how participation in social activities affected the trajectory of an informal caregiver's psychological distress.
  
  
  METHODS
  We used the data from a nationwide nine-wave panel survey of the middle-aged individuals (aged 50-59 years at baseline) in Japan conducted in 2005-13 (N = 24,193 individuals;12,352 women and 11,841 men), mainly focusing on the respondents beginning to provide informal caregiving during the survey period. We employed linear mixed-effects models to explain how the trajectory of psychological distress, measured by Kessler 6 (K6) scores, was associated with caregiving commencement and duration, as well as social activity participation.
  
  
  RESULTS
  Participation in social activities was associated with mitigated K6 scores at caregiving commencement by 66.2 and 58.2 % for women and men, respectively. After caregiving started, participation in social activities reduced the average rise in K6 scores, per year, by 65.6 and 89.6 % for women and men, respectively. We observed similar results when focusing on participation before caregiving commencement to avoid endogeneity problems.
  
  
  CONCLUSIONS
  Results suggest that participation in social activities can alleviate caregivers' psychological distress. Policy measures to support social activities are recommended for the health and well-being of current and potential caregivers.
authors.affiliation: Institute of Economic Research, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8603, Japan. oshio@ier.hit-u.ac.jp.
authors.forename: Takashi
authors.identifier: http://orcid.org/0000-0001-8142-5585
authors.initials: T
authors.lastname: Oshio
authors.affiliation: School of Economics, University of Hyogo, 8-2-1 Gakuen-Nishi-machi, Nishi-ku, Kobe, Hyogo, 651-2197, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kan
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D007564:Japan; D007899:Leisure Activities; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012919:Social Behavior; D012944:Social Support; D013315:Stress, Psychological / Q000517:prevention & control*; D011795:Surveys and Questionnaires
keywords: Informal caregiver; Mixed-effects models; Psychological distress; Social activities