| 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.
Our analysis is based on data from the 1996 Medical Expenditure Panel
Survey that, because of its sample design, can be used to model both
individual and family health status. The chronic conditions considered
include cancer, diabetes, stroke-related disorders, arthritis, asthma,
and mental illness (including dementia). Brain-related conditions,
including mental illness, are associated with the greatest risk to
the psychological well-being of family members. The effects of the
other chronic conditions studied, while less significant, are notable
in that they are associated with greater risk to the psychological
health of family members than to the patient with the chronic illness.
Economic factors appear to mediate these relationships at both the
individual and family level.
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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.
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