Variation in the Spillover Effects of Illness on Parents, Spouses, and Children of the Chronically Ill

Published in: Applied Health Economics and Health Policy, v. 12, no. 2, Apr. 2014, p. 117-124

Posted on RAND.org on April 01, 2014

by Tara Lavelle, Eve Wittenberg, Kara Lamarand, Lisa A Prosser

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Research Question

  1. How is health-related quality of life affected for individuals who have a child, parent, or spouse with Alzheimer's disease/dementia, arthritis, cancer, or depression?

BACKGROUND: Given the broad scope of the spillover effects of illness, it is important to characterize the variability in these outcomes to identify relationship types in which secondary impacts of illness are particularly important to include in health economic evaluations. PURPOSE: To examine heterogeneity in spillover effects of chronic conditions on family members by type of familial relationship with patient. METHODS: Adults (aged ≥18 years) and adolescents (aged 13–17 years) who had a parent, spouse, or child in their household with a chronic condition (Alzheimer's disease/dementia, arthritis, cancer, or depression) were recruited from a US national panel to participate in an on-line survey. Respondents were asked to rate the spillover effect of their family member's illness on their own health on a 0–100 scale, with lower scores indicating greater spillover. Regression analysis was used to evaluate the association between rating scale scores and relationship with an ill family member (ill parent, child, or spouse) for each illness separately, controlling for caregiving responsibility and the health status of the ill family member. RESULTS: 1,267 adults and 102 adolescents met inclusion criteria. In adjusted analyses, having a sick child was significantly (p < 0.05) associated with lower rating scale scores compared with having a spouse with the same condition (cancer: −24.2; depression −9.7). Having a non-elderly or elderly adult parent with a condition, compared with a spouse, was significantly associated with lower rating scale scores for arthritis (−3.8) and depression (−5.3), but not for Alzheimer's disease/dementia or cancer. CONCLUSIONS: The impact of illness on family members, measured with a rating scale, varies by relationship type for certain illnesses. Having a child with cancer, a parent with arthritis, or either with depression, is significantly associated with greater spillover, compared with having a spouse with one of these conditions.

Key Findings

  • Having a family member with a chronic condition has spillover effects on one's own health-related quality of life.
  • The magnitude of the effect varies both by health condition and relationship with the ill family member. It appears that the greatest quality of life impact for family members can be seen in parents of ill children, particularly parents of children with cancer.

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