{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:20:03Z","timestamp":1780510803223,"version":"3.54.1"},"reference-count":80,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Health Promot"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare correlates of mental distress among non-professional caregivers vs non-caregivers and evaluate trends in non-professional caregivers\u2019 mental distress pre-vs COVID-onward.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We used nationally representative data from multiple cycles of the Health Information National Trends Survey (HINTS) from 2018 to 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects<\/jats:title>\n                    <jats:p>\n                      15\u2009318 participants age 18 and older were included, comprising non-professional caregivers (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1387) and non-caregivers (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 13\u2009931). Professional caregivers and caregivers of child (ren) were excluded from this study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>The outcome (mental distress) was categorized based on the Patient Health Questionnaire-4 (PHQ-4) score. Caregivers were identified as those indicating that they provide care or make health care decisions for someone in a non-professional way.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Analysis<\/jats:title>\n                    <jats:p>We analyzed the association between caregiving status and mental distress pre-COVID and COVID-onward and examined correlates of caregivers\u2019 mental distress pre-COVID and COVID-onward through logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Caregivers reported a higher mean PHQ-4 score than non-caregivers overall (\n                      <jats:italic toggle=\"yes\">|t<\/jats:italic>\n                      | = 4.81,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Caregiving status was significantly associated with mental distress pre-COVID (OR = 1.47; 95% CI = 1.13-1.92;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01) and COVID-onward (OR = 1.51; 95% CI = 1.01-2.26;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). Being in fair or poor health status was associated with a higher likelihood of mental distress pre-COVID (OR = 2.58, 95% CI = 1.31-5.09,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01), while having a college education or higher was associated with a lower likelihood of mental distress COVID-onward (OR = 0.46, 95% CI = 0.21-0.99,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Caregiving continues to present significant risks for mental distress. The COVID-19 pandemic may continue to present risks to caregivers\u2019 mental well-being, requiring policies and programs to improve caregiver mental health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08901171251403993","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T10:42:11Z","timestamp":1763980931000},"page":"673-685","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Supporting U.S. Caregivers\u2019 Mental Health: Analysis of Trends and Correlates Pre-COVID and COVID-Onward From the Health Information National Trends Survey, 2018-2022"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1952-5241","authenticated-orcid":false,"given":"Jingxin","family":"Yao","sequence":"first","affiliation":[{"name":"University of Illinois Urbana-Champaign"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiayu S.","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Illinois Urbana-Champaign"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Zhou","sequence":"additional","affiliation":[{"name":"Wayne State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1457-7850","authenticated-orcid":false,"given":"Minakshi","family":"Raj","sequence":"additional","affiliation":[{"name":"University of Illinois Urbana-Champaign"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gny137"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15690"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.26419\/ppi.00373.001"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2009.04.006"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2018.1531375"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0000000000000493"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0000000000001050"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbac031"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2015.1088510"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.17226\/23606"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16726"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/10547738211014211"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gny175"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/23337214211025124"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/10775587211062405"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10433-021-00611-z"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.04.006"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/diseases9040070"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbac002"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.590343"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2020.99"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2024.101609"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.08.130"},{"key":"e_1_3_4_25_2","volume-title":"Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers Act Advisory Council","author":"Administration for Community Living","unstructured":"Administration for Community Living. 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