Emotional demands and the risks of depression among homecare workers in the USA

Purpose: Homecare workers' diversity of emotional demands and their relation to mental health problems have not yet been fully explored. The purpose of this study is to investigate the types of emotional demands on homecare workers and the association of these demands with depression. Method: Data were collected from two surveys of a random sample of 1,599 homecare workers (June 2003-September 2003 and December 2003-February 2004). Depression was assessed using a 20-item RCES-D screening scale. Results: Homecare workers appeared to have a variety of emotional demands: unfair treatment, client's family abuse, unmet care needs, client health, and emotional suppression. In general, homecare workers were more likely to be exposed to their client health and emotional suppression (mean scores = 1.46-3.07) than to be exposed to unmet care needs, unfair treatment, and client's family abuse (mean scores = 1.02-1.38). After adjusting for potential confounders, four emotional-demand factors (excluding the client health factor) were significantly associated with a high risk of subthreshold depression at Wave 1. In particular, the factor "unmet care needs" was an essential predictor of 6-month subthreshold depression at Wave 2. Conclusion: This study illustrated the diversity of emotional demands among homecare workers and their association with depression. Our mixed findings regarding the cross-sectional and longitudinal analyses suggested that further research should refine the measurement of emotional demands and their relationship with mental health among homecare workers.