IDEAS home Printed from https://ideas.repec.org/p/pav/demwpp/demwp0231.html
   My bibliography  Save this paper

From Care Gaps to Mental Health Strain

Author

Listed:
  • Joan Costa-Font

    (London School of Economics and Political Science)

  • Cinzia Di Novi

    (University of Pavia)

  • Cristina Elisa Orso

    (University of Insubria)

Abstract

We study the later-life spillover effects of adult unmet care needs on mental health and health care utilization of older-age Europeans. We draw on longitudinal data from a longitudinal sample of Europeans before, during, and after COVID-19. We exploit an instrumental variable design alongside a causal mediation analysis to examine the effect of unmet care needs on mental health. We show that unmet care needs after the COVID-19 pandemic gave rise to an increased cognitive decline and depressive symptoms and that this effect is mediated by exposure to loneliness during the pandemic among those with unmet care needs.

Suggested Citation

  • Joan Costa-Font & Cinzia Di Novi & Cristina Elisa Orso, 2025. "From Care Gaps to Mental Health Strain," DEM Working Papers Series 231, University of Pavia, Department of Economics and Management.
    • Handle: RePEc:pav:demwpp:demwp0231
    as

    Download full text from publisher

    File URL: https://economiaemanagement.dip.unipv.it/sites/dip10/files/2025-10/DEMWP0231.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Yang, Yulin & Huang, Rui & Grol-Prokopczyk, Hanna & Torres, Jacqueline M., 2022. "Social network change after new-onset pain among middle-aged and older European adults," Social Science & Medicine, Elsevier, vol. 310(C).
    2. Momtaz, Yadollah Abolfathi & Hamid, Tengku Aizan & Ibrahim, Rahimah, 2012. "Unmet needs among disabled elderly Malaysians," Social Science & Medicine, Elsevier, vol. 75(5), pages 859-863.
    3. Costa-Font, Joan & Vilaplana-Prieto, Cristina, 2022. "Mental health effects of caregivers respite: Subsidies or Supports?," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    4. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    5. Bergeot, Julien & Jusot, Florence, 2024. "How did unmet care needs during the pandemic affect health outcomes of older European individuals?," Economics & Human Biology, Elsevier, vol. 52(C).
    6. Casabianca, Elizabeth & Kovacic, Matija, 2024. "Historical roots of loneliness and its impact on second-generation immigrants’ health," Journal of Economic Behavior & Organization, Elsevier, vol. 224(C), pages 407-437.
    7. Vikesh Amin & Jere R. Behrman & Jason M. Fletcher & Carlos A. Flores & Alfonso Flores-Lagunes & Hans-Peter Kohler, 2022. "Does Schooling Improve Cognitive Abilities at Older Ages: Causal Evidence from Nonparametric Bounds," PIER Working Paper Archive 22-016, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania.
    8. Bonsang, Eric & Adam, Stéphane & Perelman, Sergio, 2012. "Does retirement affect cognitive functioning?," Journal of Health Economics, Elsevier, vol. 31(3), pages 490-501.
    9. Brenda Gannon & Bérengère Davin, 2010. "Use of formal and informal care services among older people in Ireland and France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 499-511, October.
    10. Joan Costa‐Font & Edward C. Norton & Luigi Siciliani & Vincenzo Carrieri & Cinzia Di Novi & Cristina Elisa Orso, 2017. "Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe," Fiscal Studies, Institute for Fiscal Studies, vol. 38, pages 445-468, September.
    11. Smith, Samantha & Connolly, Sheelah, 2020. "Re-thinking unmet need for health care: introducing a dynamic perspective," Health Economics, Policy and Law, Cambridge University Press, vol. 15(4), pages 440-457, October.
    12. Mariana Calderón-Jaramillo & Pilar Zueras, 2023. "Cared and uncared populations: understanding unmet care needs of older adults (65+) across different social care systems in Europe," European Journal of Ageing, Springer, vol. 20(1), pages 1-14, December.
    13. repec:hal:journl:hal-04871667 is not listed on IDEAS
    14. Bu, Feifei & Steptoe, Andrew & Fancourt, Daisy, 2020. "Loneliness during a strict lockdown: Trajectories and predictors during the COVID-19 pandemic in 38,217 United Kingdom adults," Social Science & Medicine, Elsevier, vol. 265(C).
    15. Nicole Schneeweis & Vegard Skirbekk & Rudolf Winter-Ebmer, 2014. "Does Education Improve Cognitive Performance Four Decades After School Completion?," Demography, Springer;Population Association of America (PAA), vol. 51(2), pages 619-643, April.
    16. Laura Alejandra Rico-Uribe & Francisco Félix Caballero & Natalia Martín-María & María Cabello & José Luis Ayuso-Mateos & Marta Miret, 2018. "Association of loneliness with all-cause mortality: A meta-analysis," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-21, January.
    17. Christian Dippel & Andreas Ferrara & Stephan Heblich, 2020. "Causal mediation analysis in instrumental-variables regressions," Stata Journal, StataCorp LLC, vol. 20(3), pages 613-626, September.
    18. Di Novi, Cinzia & Martini, Gianmaria & Sturaro, Caterina, 2023. "The impact of informal and formal care disruption on older adults’ psychological distress during the COVID-19 pandemic in UK," Economics & Human Biology, Elsevier, vol. 49(C).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Plamen Nikolov & Steve Yeh, 2021. "Reaping the Rewards Later: How Education Improves Old-Age Cognition in South Africa," Papers 2109.02177, arXiv.org, revised Oct 2021.
    2. Di Novi, Cinzia & Martini, Gianmaria & Sturaro, Caterina, 2023. "The impact of informal and formal care disruption on older adults’ psychological distress during the COVID-19 pandemic in UK," Economics & Human Biology, Elsevier, vol. 49(C).
    3. Plamen Nikolov & Steve Yeh, 2021. "Reaping the Rewards Later: How Education Improves Old-Age Cognition in South Africa," Working Papers 2021-045, Human Capital and Economic Opportunity Working Group.
    4. Vegard Skirbekk & Valeria Bordone & Daniela Weber, 2014. "A cross-country comparison of math achievement at teen age and cognitive performance 40 years later," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 31(4), pages 105-118.
    5. Freise, Diana & Schmitz, Hendrik & Westphal, Matthias, 2022. "Late-career unemployment and cognitive abilities," Journal of Health Economics, Elsevier, vol. 86(C).
    6. Osea Giuntella & Wei Han & Fabrizio Mazzonna, 2017. "Circadian Rhythms, Sleep, and Cognitive Skills: Evidence From an Unsleeping Giant," Demography, Springer;Population Association of America (PAA), vol. 54(5), pages 1715-1742, October.
    7. Arabadzhyan, Anastasia & Jacob, Nikita & Kasteridis, Panagiotis & Mason, Anne & Rice, Nigel, 2025. "COVID-19 and domiciliary care utilisation: Evidence from the English Longitudinal Study of Ageing," The Journal of the Economics of Ageing, Elsevier, vol. 31(C).
    8. Irene Mosca & Robert E. Wright, 2018. "Effect of Retirement on Cognition: Evidence From the Irish Marriage Bar," Demography, Springer;Population Association of America (PAA), vol. 55(4), pages 1317-1341, August.
    9. Zhonghua Wang & Xue Yang & Mingsheng Chen, 2022. "Inequality and Associated Factors in Utilization of Long-Term Care Among Chinese Older People: Evidence from the Chinese Longitudinal Healthy Longevity Survey," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 160(2), pages 467-486, April.
    10. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 435-451, April.
    11. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Eligibility or use? Disentangling the sources of horizontal inequity in home care receipt in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1161-1179, October.
    12. Shu Cai, 2022. "Does social participation improve cognitive abilities of the elderly?," Journal of Population Economics, Springer;European Society for Population Economics, vol. 35(2), pages 591-619, April.
    13. Zhang, Jingwen & Zhang, Yanan & Bennett, Matthew R., 2025. "Spousal characteristics and unmet care needs: A longitudinal national study of adults aged 50 and over in England," Social Science & Medicine, Elsevier, vol. 365(C).
    14. Schiele, Valentin & Schmitz, Hendrik, 2023. "Understanding cognitive decline in older ages: The role of health shocks," European Economic Review, Elsevier, vol. 151(C).
    15. Vidiella-Martin, Joaquim & Hernández-Pizarro, Helena M. & García-Gómez, Pilar & López-Casasnovas, Guillem, 2024. "Unravelling hidden inequities in a universal public long-term care system," The Journal of the Economics of Ageing, Elsevier, vol. 29(C).
    16. Brugiavini, Agar & Di Novi, Cinzia & Orso, Cristina Elisa, 2022. "Visiting parents in times of COVID-19: The impact of parent-adult child contacts on the psychological health of the elderly," Economics & Human Biology, Elsevier, vol. 46(C).
    17. Albuquerque, Paula C., 2022. "Met or unmet need for long-term care: Formal and informal care in southern Europe," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    18. Viktoria Szenkurök & Daniela Weber & Marcel Bilger, 2025. "Informal and formal long-term care utilization and unmet needs in Europe: examining socioeconomic disparities and the role of social policies for older adults," International Journal of Health Economics and Management, Springer, vol. 25(1), pages 87-106, March.
    19. Zhu, Yumei & Österle, August, 2017. "Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status," Social Science & Medicine, Elsevier, vol. 191(C), pages 30-37.
    20. Paul Berbée & Sebastian Till Braun & Richard Franke, 2025. "Reversing fortunes of German regions, 1926–2019: Boon and bane of early industrialization?," Journal of Economic Growth, Springer, vol. 30(2), pages 307-337, June.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pav:demwpp:demwp0231. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Alice Albonico The email address of this maintainer does not seem to be valid anymore. Please ask Alice Albonico to update the entry or send us the correct address (email available below). General contact details of provider: https://edirc.repec.org/data/dppavit.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.