title: Caregiving and mental health among workers: Longitudinal evidence from a large cohort of adults in Thailand.
abstract: BACKGROUND
  As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults.
  
  
  METHODS
  Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19-30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates.
  
  
  RESULTS
  Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009-2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02-1.96] and 1.64 [1.16-2.33], respectively).
  
  
  CONCLUSIONS
  Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health.
authors.affiliation: National Centre for Epidemiology and Population Health and Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia; Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia.
authors.forename: Vasoontara
authors.initials: V
authors.lastname: Yiengprugsawan
authors.affiliation: Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia.
authors.forename: Liana
authors.initials: L
authors.lastname: Leach
authors.affiliation: Monash Injury Research Institute, Monash University, Melbourne, Australia.
authors.forename: Janneke
authors.initials: J
authors.lastname: Berecki-Gisolf
authors.affiliation: Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia.
authors.forename: Hal
authors.initials: H
authors.lastname: Kendig
authors.affiliation: National Centre for Epidemiology and Population Health and Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Harley
authors.affiliation: National Centre for Epidemiology and Population Health and Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia; School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand.
authors.forename: Sam-Ang
authors.initials: SA
authors.lastname: Seubsman
authors.affiliation: National Centre for Epidemiology and Population Health and Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Sleigh
keywords: Caregivers; Carers; Cohort study; Longitudinal data; Mental health; Thailand; Work and health