{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T03:53:54Z","timestamp":1788062034585,"version":"build-2784847793"},"reference-count":60,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["(PI12\/00498 and PI16\/00207)"],"award-info":[{"award-number":["(PI12\/00498 and PI16\/00207)"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["(PI12\/00498 and PI16\/00207)"],"award-info":[{"award-number":["(PI12\/00498 and PI16\/00207)"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005886","name":"Ministerio de Econom\u00eda, Fomento y Turismo","doi-asserted-by":"publisher","award":["(ECO2017-83771-C3-1-R)"],"award-info":[{"award-number":["(ECO2017-83771-C3-1-R)"]}],"id":[{"id":"10.13039\/501100005886","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: The aim of this study was (i) to analyze problems faced by informal caregivers in three areas of their life: health, work and finances, and family and social relationships, (ii) to investigate the main determinants of these problems, and (iii) to explore differences between men and women. (2) Methods: The study population consisted of people aged \u226518 years living in a family home who were providing unpaid care to a dependent person in the same or another home and who were registered as caregivers with the Primary Health Care District of Granada or the Provincial Council of Gipuzkoa. Several logistic regression models were built to analyze the likelihood of caregivers experiencing health, work-related, or social problems as a result of their caregiving responsibilities. (3) Results: Informal female caregivers were more likely to experience problems attributed to caregiving than their male counterparts, particularly in the areas of health and work. Additional factors associated with an increased likelihood of problems were low perceived social support, performance of ungratifying tasks, and fewer years as a caregiver. (4) Conclusions: Informal caregivers in Spain face significant problems as a result of their caregiving duties, and the impact on men and women is different. Policies and interventions to mitigate the negative effects of unpaid caregiving should incorporate differential strategies to meet the specific needs of male and female caregivers in different caregiving contexts.<\/jats:p>","DOI":"10.3390\/ijerph18147332","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T10:42:17Z","timestamp":1625740937000},"page":"7332","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Health, Work, and Social Problems in Spanish Informal Caregivers: Does Gender Matter? (The CUIDAR-SE Study)"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7224-2189","authenticated-orcid":false,"given":"Luz Mar\u00eda","family":"Pe\u00f1a-Longobardo","sequence":"first","affiliation":[{"name":"Departamento de An\u00e1lisis Econ\u00f3mico y Seminario de Investigaci\u00f3n en Econom\u00eda y Salud (SIES), Universidad de Castilla-La Mancha, 45071 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Del","family":"R\u00edo-Lozano","sequence":"additional","affiliation":[{"name":"Escuela Andaluza de Salud P\u00fablica (EASP), 18080 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada ibs. Granada, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8997-0307","authenticated-orcid":false,"given":"Juan","family":"Oliva-Moreno","sequence":"additional","affiliation":[{"name":"Departamento de An\u00e1lisis Econ\u00f3mico y Seminario de Investigaci\u00f3n en Econom\u00eda y Salud (SIES), Universidad de Castilla-La Mancha, 45071 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Larra\u00f1aga-Padilla","sequence":"additional","affiliation":[{"name":"Departamento de Salud del Gobierno Vasco, Delegaci\u00f3n de Salud de Gipuzkoa, 20010 San Sebasti\u00e1n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3108-4633","authenticated-orcid":false,"given":"Mar\u00eda del Mar","family":"Garc\u00eda-Calvente","sequence":"additional","affiliation":[{"name":"Escuela Andaluza de Salud P\u00fablica (EASP), 18080 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada ibs. 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Community Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1192\/bjp.bp.112.125369","article-title":"Mental and physical illness in caregivers: Results from an English national survey sample","volume":"205","author":"Smith","year":"2014","journal-title":"Br. J. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1157\/13061998","article-title":"El impacto de cuidar en la salud y la calidad de vida de las mujeres","volume":"18","year":"2004","journal-title":"Gac. Sanit."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1157\/13126925","article-title":"Impacto del cuidado informal en la salud y la calidad de vida de las personas cuidadoras: An\u00e1lisis de las desigualdades de g\u00e9nero","volume":"22","author":"Bacigalupe","year":"2008","journal-title":"Gac. Sanit."},{"key":"ref_7","first-page":"126","article-title":"Correlates of Physical Health of Informal Caregivers: A Meta-Analysis","volume":"62","author":"Pinquart","year":"2007","journal-title":"B Psychol. Sci. Soc. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1037\/0033-2909.129.6.946","article-title":"Is caregiving hazardous to one\u2019s physical health? A meta-analysis","volume":"129","author":"Vitaliano","year":"2003","journal-title":"Psychol. Bull."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bittman, M., and Folbre, N. (2004). Making the Invisible Visible: The Life and Time(s) of Informal Caregivers. Family Time: The Social Organisation of Care, Routledge.","DOI":"10.4324\/9780203411650"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Madrid, M.N., del R\u00edo-Lozano, M., Fern\u00e1ndez-Pe\u00f1a, R., Elizalde, B., and Garc\u00eda-Calvente, M.M. (2020). Redes personales de apoyo y cuidado informal: \u00bfDiferencias por sexo y territorio? (estudio CUIDAR-SE II). Gac. Sanit.","DOI":"10.1016\/j.gaceta.2020.05.011"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1037\/0882-7974.18.2.250","article-title":"Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis","volume":"18","author":"Pinquart","year":"2003","journal-title":"Psychol. Aging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s11136-009-9482-2","article-title":"Family caregiving and emotional strain: Associations with quality of life in a large national sample of middle-aged and older adults","volume":"18","author":"Roth","year":"2009","journal-title":"Qual. Life Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/01.NAJ.0000336406.45248.4c","article-title":"Physical and mental health effects of family caregiving","volume":"108","author":"Schulz","year":"2008","journal-title":"Am. J. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.jhealeco.2007.10.004","article-title":"Your next of kin or your own career? Caring and working among the 50+ of Europe","volume":"27","author":"Bolin","year":"2008","journal-title":"J. Health Econ."},{"key":"ref_15","unstructured":"Fast, J., Dosman, D., Lero, D., and Lucas, S. (2013). The Intersection of Caregiving and Employment across the Life Course, University of Alberta. Final Report."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/1748-8583.12048","article-title":"Combining work and informal care: The importance of caring organisations","volume":"25","author":"Plaisier","year":"2015","journal-title":"Hum. Resour. Manag. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1017\/S0144686X08008180","article-title":"Effect of caring for an older person on women\u2019s lifetime participation in work","volume":"29","author":"Masuy","year":"2009","journal-title":"Ageing Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1111\/j.1468-0009.2007.00504.x","article-title":"Labor market work and home care\u2019s unpaid caregivers: A systematic review of labor force participation rates, predictors of labor market withdrawal, and hours of work","volume":"85","author":"Lilly","year":"2007","journal-title":"Milbank Q."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Heitmueller, A., and Michaud, P.C. (2006). Informal Care and Employment in England: Evidence from the British Household Panel Survey, IZA. Discussion Paper No. 2010.","DOI":"10.2139\/ssrn.890291"},{"key":"ref_20","unstructured":"Garc\u00eda-Calvente, M.M., and del R\u00edo-Lozano, M. (2010). An\u00e1lisis del Impacto de Cuidar Sobre la Salud de Mujeres y Hombres, Escuela Andaluza de Salud P\u00fablica. Informe de Resultados EDAD 2008; Documento Mimeografiado."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1093\/eurpub\/ckw229","article-title":"Informal care in Europe: Findings from the European Social Survey (2014) special module on the social determinants of health","volume":"27","author":"Verbakel","year":"2017","journal-title":"Eur. J. Public Health"},{"key":"ref_22","unstructured":"European Institute for Gender Equality (EIGE) (2021). Gender Inequalities in Care and Consequences for the Labour Market. Beijing Platform for Action, Publications Office of the European Union."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lee, Y., Xu, L., Kim, B.J., and Chen, L. (2019). Leisure activity, gender and depressive symptoms among dementia caregivers: Findings from the REACH II. Aging Ment. Health, 1\u20138.","DOI":"10.1080\/13607863.2019.1660853"},{"key":"ref_24","unstructured":"Esparza, C. (2011). Discapacidad y Dependencia en Espa\u00f1a, IMSERSO and CSIC. Informes Portal Mayores, n\u00b0 108."},{"key":"ref_25","unstructured":"Abell\u00e1n, A., Ayala, A., P\u00e9rez, J., and Pujol, R. (2021, May 01). Los Nuevos Cuidadores. Available online: https:\/\/observatoriosociallacaixa.org\/-\/los-nuevos-cuidadores."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3384\/ijal.1652-8670.17356","article-title":"Men and older persons also care, but how much? Assessing amounts of caregiving in Spain and Sweden","volume":"12","author":"Jegermalm","year":"2018","journal-title":"Int. J. Ageing Later Life"},{"key":"ref_27","unstructured":"(2021, May 01). Ley 39\/2006, de 14 de Diciembre, de Promoci\u00f3n de la Autonom\u00eda Personal y Atenci\u00f3n a las Personas en Situaci\u00f3n de Dependencia (Promotion of Personal Autonomy and Care for Dependent People Act). Available online: https:\/\/www.boe.es\/eli\/es\/l\/2006\/12\/14\/39\/con."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.healthpol.2016.08.012","article-title":"The Spanish long-term care system in transition: Ten years since the 2006 Dependency Act","volume":"120","year":"2016","journal-title":"Health Policy"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Oliva-Moreno, J., Pe\u00f1a-Longobardo, L.M., Garc\u00eda-Moch\u00f3n, L., Del R\u00edo-Lozano, M., Mosquera-Metcalfe, I., and Garc\u00eda-Calvente, M.M. (2019). The economic value of time of informal care and its determinants (The CUIDARSE Study). PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0217016"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1007\/s11136-017-1678-2","article-title":"Health-related quality of life in Spanish informal caregivers: Gender differences and support received","volume":"26","year":"2017","journal-title":"Qual. Life Res."},{"key":"ref_31","first-page":"153","article-title":"Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11","volume":"18","year":"1996","journal-title":"Aten. Primaria"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Moch\u00f3n, L., Pe\u00f1a-Longobardo, L.M., del R\u00edo-Lozano, M., Oliva-Moreno, J., Larra\u00f1aga-Padilla, I., and Garc\u00eda-Calvente, M.M. (2019). Determinants of burden and satisfaction in informal caregivers: Two sides of the same coin? The CUIDAR-SE study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16224378"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/jama.2014.304","article-title":"Caregiver burden: A clinical review","volume":"311","author":"Adelman","year":"2014","journal-title":"JAMA"},{"key":"ref_34","first-page":"e10","article-title":"Burden and Gender inequalities around Informal Care","volume":"38","year":"2020","journal-title":"Investig. Educ. Enferm."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1177\/1049732313507144","article-title":"Gender identity in informal care: Impact on health in Spanish caregivers","volume":"23","year":"2013","journal-title":"Qual. Health Res."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Matud, M.P., Garc\u00eda, M.C., and Fortes, D. (2019). Relevance of Gender and Social Support in Self-Rated Health and Life Satisfaction in Elderly Spanish People. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16152725"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/00001199-200204000-00006","article-title":"Predictors of Caregiver and Family Functioning Following Traumatic Brain Injury: Social Support Moderates Caregiver Distress","volume":"17","author":"Ergh","year":"2002","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mohanty, I., Niyonsenga, T., Cochrane, T., and Rickwood, D. (2020). A multilevel mixed effects analysis of informal carers health in Australia: The role of community participation, social support and trust at small area level. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09874-0"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1002\/gps.561","article-title":"Positive aspects of caregiving: Rounding out the caregiver experience","volume":"17","author":"Cohen","year":"2002","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Madrid, M.N., del R\u00edo-Lozano, M., Fernandez-Pe\u00f1a, R., Jim\u00e9nez-Pernett, J., Garc\u00eda-Moch\u00f3n, L., Lupia\u00f1ez-Castillo, A., and Garc\u00eda-Calvente, M.M. (2018). Gender Differences in Social Support Received by Informal Caregivers: A Personal Network Analysis Approach. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16010091"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/jan.13172","article-title":"Gender and socio-economic inequalities in health and living conditions among co-resident informal caregivers: A nationwide survey in Spain","volume":"73","author":"Abajo","year":"2017","journal-title":"J. Adv. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1017\/S0144686X15001543","article-title":"Changes in life satisfaction when losing one\u2019s spouse: Individual differences in anticipation, reaction, adaptation and longevity in the German Socio-economic Panel Study (SOEP)","volume":"37","author":"Infurna","year":"2017","journal-title":"Ageing Soc."},{"key":"ref_43","first-page":"341","article-title":"Economic analysis and the psychology of utility: Applications to compensation policy","volume":"81","author":"Kahneman","year":"1991","journal-title":"Am. Econ. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.jebo.2004.03.003","article-title":"A puzzle for adaptive theory","volume":"56","author":"Easterlin","year":"2005","journal-title":"J. Econ. Behav. Organ."},{"key":"ref_45","unstructured":"Gilligan, C. (1985). La Moral y la Teor\u00eda, Fondo de Cultura Econ\u00f3mica. Psicolog\u00eda del Desarrollo Femenino."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/geroni\/igz026","article-title":"The Effectiveness of Psychoeducational and Financial Intervention to Support Caregivers of Individuals with Alzheimer\u2019s Disease in Poland","volume":"3","author":"Leszko","year":"2019","journal-title":"Innov. Aging"},{"key":"ref_47","unstructured":"(2021, May 03). C\u00edrculo Empresarial de Atenci\u00f3n a las Personas (CEAPS). Available online: https:\/\/www.acra.cat\/informe-el-caos-de-la-atenci\u00f3n-a-la-dependencia-una-perspectiva-desde-la-gesti\u00f3n-_464277.pdf."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1017\/S0144686X18001708","article-title":"Does long-term care coverage shape the impact of informal care-giving on quality of life? A difference-in-difference approach","volume":"40","author":"Grundy","year":"2020","journal-title":"Ageing Soc."},{"key":"ref_49","first-page":"S121","article-title":"The Moderating Influence of Service Use on Negative Caregiving Consequences","volume":"5","author":"Bass","year":"1996","journal-title":"B Psychol. Sci. Soc. Sci."},{"key":"ref_50","unstructured":"(2021, May 02). Instituto Nacional de Estad\u00edstica. Available online: https:\/\/www.ine.es\/."},{"key":"ref_51","first-page":"e2246","article-title":"The study of health in men from a gender perspective: Where we come from, where are we going","volume":"16","author":"Mateos","year":"2020","journal-title":"Salud Colect."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/inr.12000","article-title":"Spouses\u2019 experience of caregiving for cancer patients: A literature review","volume":"60","author":"Li","year":"2013","journal-title":"Int. Nurs. Rev."},{"key":"ref_53","unstructured":"Ram\u00edrez-Navarro, J.M., Revilla-Castro, A., Fuentes-Jim\u00e9nez, M., and G\u00f3mez-Castro, E. (2021). XXI Dictamen del Observatorio Estatal de la Dependencia, Asociaci\u00f3n de Directoras y Gerentes de Servicios Sociales de Espa\u00f1a. Available online: https:\/\/directoressociales.com\/wp-content\/uploads\/2021\/03\/XXI-DICTAMEN-DEL-OBSERVATORIO-DE-LA-DEPENDENCIA.pdf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/0020731416662611","article-title":"Gender Policies and Gender Inequalities in Health in Europe: Results of the SOPHIE Project","volume":"47","author":"Artazcoz","year":"2017","journal-title":"Int. J. Health Serv."},{"key":"ref_55","first-page":"124","article-title":"The Impacts of COVID-19 on Unpaid Carers of Adults with Long-Term Care Needs and Measures to Address These Impacts: A Rapid Review of the Available Evidence up to November 2020","volume":"2021","year":"2021","journal-title":"J. Long Term Care"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/S0140-6736(20)30526-2","article-title":"COVID-19: The gendered impacts of the outbreak","volume":"395","author":"Wenham","year":"2020","journal-title":"Lancet"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.gaceta.2020.04.007","article-title":"COVID-19 en clave de g\u00e9nero","volume":"34","year":"2020","journal-title":"Gac. Sanit."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Del R\u00edo-Lozano, M., and Garc\u00eda-Calvente, M.M. (2020). Grupo de alumnado del Diploma de Especializaci\u00f3n en G\u00e9nero y Salud de la Escuela Andaluza de Salud P\u00fablica-Universidad de Granada. Cuidados y abordaje de la pandemia de COVID-19 con enfoque de g\u00e9nero. Gac. Sanit.","DOI":"10.1016\/j.gaceta.2020.05.006"},{"key":"ref_59","unstructured":"Lorenz-Dant, K. (2021, May 04). International examples of measures to support unpaid carers during the COVID-19 pandemic Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available online: https:\/\/ltccovid.org\/2020\/05\/20\/new-report-international-examples-of-measures-to-support-unpaid-carers-during-the-covid-19-pandemic\/."},{"key":"ref_60","unstructured":"ONU Mujeres (2021, May 04). Las Mujeres y el COVID-19: Cinco Acciones que los Gobiernos Pueden Adoptar sin Demoras. Available online: https:\/\/www. unwomen.org\/es\/news\/stories\/2020\/3\/news-women-and-covid-19-governments-actions-by-ded-bhatia."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/14\/7332\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:28:00Z","timestamp":1760164080000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/14\/7332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,8]]},"references-count":60,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["ijerph18147332"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18147332","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,8]]}}}