Association Between Marital Status and Depressive Symptoms Among Family Caregivers in Japan: The Moderating Roles of...

This study examined the main effect of marital status on depressive symptoms and the interactions of marital status with subjective economic status and social support among Japanese family caregivers.

A cross-sectional web-based survey was conducted among 1,260 primary family caregivers aged 20 years or older, who provided care to their biological mother or father aged 65 or older and certified as requiring long-term care under Japan's long-term care insurance system. Depressive symptoms were assessed using the Japanese version of the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear regression analyses were conducted to assess the association between marital status and depressive symptoms, including interaction terms for subjective economic status and social support. Additionally, stratified analyses were conducted by sex and age group to explore potential heterogeneity.

Among the participants, 38.8% were unmarried. Unmarried caregivers initially exhibited significantly higher depressive symptoms; however, after adjusting for covariates, they demonstrated significantly lower depressive symptoms than married caregivers (B: -1.87; 95% CI: -3.44, -0.31). Interaction analyses indicated that depressive symptoms were significantly higher among unmarried caregivers who experienced greater economic hardship or lacked instrumental support (B: 1.28; 95% CI: 0.08, 2.48; B: -5.26; 95% CI: -9.48, -1.03, respectively). Stratified analyses suggested that these interactions were more evident among female caregivers and those aged < 60 years.

Although unmarried caregivers experience lower depressive symptoms overall, those experiencing economic hardship and lacking instrumental support exhibited elevated depressive symptoms. These associations may be more pronounced in specific subgroups, particularly by sex and age. These findings highlight the importance of targeted financial and caregiving support for vulnerable caregivers.