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2019 HSR&D/QUERI National Conference Abstract

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4077 — Behind the Scenes: the hidden life of a caregiver.

Lead/Presenter: Roxana Delgado,  Elizabeth Dole Center of Excellence for Veteran/Caregiver Research
All Authors: Delgado RE (Elizabeth Dole Center of Excellence for Veteran/Caregiver Research), Peacock K Elizabeth Dole Center of Excellence for Veteran/Caregiver Research, San Antonio Wang CP University of Texas Health Science Center San Antonio Parish JJ University of Texas Health Science Center San Antonio Pugh MJ, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City

Objectives:
The caregivers of wounded, ill, or injured Veterans (hereafter, "military caregivers") are a unique population, as many begin caring at a young age, with the expectation that they will provide care for the remainder of their lives. Existing data from the RAND Corporation suggests that caregiving exerts a toll on caregivers' physical and mental health. However, little is known about the extent to which caregivers experience suicidal ideation (SI), and the how caregiving may contribute to that outcome.

Methods:
National survey of military caregivers using a convenience sample of caregivers who responded to an online survey via social media or e-mail from caregiver organizations. Measures: duration of caregiving, conditions for which care is provided, and psychosocial measures including depression (PHQ-9), caregiver wellbeing, loss of self (LOS), perceived stress (PSS). We used latent class analysis (LCA) to identify subgroups of caregiver burden, and examined self-reported SI within LCA subgroups.

Results:
467 military caregivers from across the nation responded to the survey. Most were young adults (Mage = 39, SD = 9.1; 40% under the age of 35); 63% had been in a military caregiver > 5 years, and cared for a variety of physical/behavioral conditions. Symptomology on self-report measures was clinically meaningful (e.g., MPHQ = 11.31; SD = 6.38). LCA revealed three subgroups (SG): SG1: Care for trauma and less mental health; reported lower PSS, PHQ, LOS, and higher wellbeing. SG2: High prevalence of caring for amyotrophic lateral sclerosis, TBI, mental health conditions; reported extremely high LOS, PHQ9, and low wellbeing. SG3: Care for mental health and TBI without high ALS or trauma; reported high LOS, with PHQ9 between SG1 and SG3. Probability of SI was: SG2 45%; SG3 28% and SG1 11%.

Implications:
This study found profound levels of SI after becoming a caregiver, which was strongly associated with a near complete LOS, severe depression, and low wellbeing.

Impacts:
Caregiver health is a population health concern that must be addressed by VA given the increasing reliance on family caregivers to support Veterans health, and the mandate of the MISSION Act to expand the caregiver program beyond its current mandate. Analysis of longitudinal data from this cohort may inform those policy decisions.