Unsung heroes who put their lives at risk? Informal caring, health and neighbourhood attachment

Background Previous studies have highlighted the effects of informal caring on mental health, but evidence for its wider impact remains scant. We explored associations between informal care and a range of health (and health-related) measures. We also considered previously neglected differences between informal care 'at home' and care elsewhere, along with neighbourhood attachment as a possible modifier of the associations we found. Methods The study involved a large population survey in two Primary Care Trusts. Data were collected by postal survey of 15465 adults; subjects were selected from the local General Practice register. 12.7 per cent of respondents identified themselves as carers. Health measures included psychiatric morbidity, bodily pain, self-assessed health, health-related behaviours, obesity, prescribed drugs and high levels of GP consultation. Results Of nine measures considered, care at home was associated with psychiatric morbidity (OR 1.46, 95 per cent CI 1.25-1.70), bodily pain (OR 1.19, 95 per cent CI 1.02-1.39), and obesity (OR 1.59, 95 per cent CI 1.34-1.89). Care 'away' was associated with smoking (OR 1.26, 95 per cent CI 1.03-1.54), and inversely with both sedentary living (OR 0.70, 95 per cent CI 0.58-0.85) and poor self-assessed health (OR 0.78, 95 per cent CI 0.62-0.99). Health tended to be poorer when carers lacked a sense of neighbourhood attachment. Conclusions Informal carers are likely to face serious health challenges besides anxiety and depression. Caring is associated with several aspects of poor health, which are themselves predictors of premature mortality. Proactive and wide-ranging support is required, the more so in neighbourhoods where carers feel alienated. Research and policy should distinguish carers 'at home' from carers 'away'.