Abstract
Aim
Although research on the prevalence and psychological difficulties of young carers has increased, little is known about how their difficulties differ according to the type of disability or illness of the care recipient. This study examined the association between the type of disability of care recipients and psychological difficulties among Japanese junior and senior high school students.
Methods
A total of 860 students participated in a self‐administered survey that included the Young Carers Scale–Japanese version (YCS‐J), the Multidimensional Assessment of Caring Activities Checklist for Young Carers (MACA‐YC18), and the Strengths and Difficulties Questionnaire (SDQ). Multiple regression analyses were conducted to identify which types of family members were cared for and which disability or disease categories were associated with perceived difficulties. Post hoc analyses were performed to examine patterns in MACA‑YC18 and SDQ scores among young carers supporting family members with mental health problems.
Results
The prevalence of young carers was 8.8% (n = 76). Multiple regression analysis revealed that having a care recipient with a mental health problem was a significant predictor of higher total difficult scores on the SDQ (adjusted R2 = 0.014, F[11, 844] = 2.119, p = 0.017). Young carers supporting family members with mental health problems were significantly more involved in personal care, assessed by the MACA‐YC18, and exhibited significantly higher emotional symptoms and total difficulties scores on the SDQ than non‐young carers.
Conclusion
These findings highlight the need for targeted support for young carers—particularly those caring for family members with mental health problems—within schools and the broader community.
Keywords: care recipient disability, family caregivers, mental health problems, psychological difficulties, young carers
INTRODUCTION
Young carers (YCs) are children and adolescents under the age of 18 who undertake responsibilities typically assumed by adults, such as caring for family members with care needs and performing household tasks. 1 , 2 The United Kingdom has been at the forefront of recognizing and supporting YCs. The concept of “carer” originally emerged to highlight the burden experienced by family members caring for individuals with illness or disability. From a child rights perspective that emphasizes the right to education and age‐appropriate activities, young people who assume such responsibilities are identified as YCs because they bear caregiving burdens that would otherwise fall to adults or society. Legal frameworks and school‐based support systems for YCs have been established. 2 , 3 , 4
Epidemiological studies have indicated that YCs are present across countries, although the prevalence estimates vary. A 2018 survey conducted by the British Broadcasting Corporation (BBC) and the University of Nottingham found that approximately 22% of respondents met the definition of YCs, with around 7% providing high levels of care. 5 Data from the UK Household Longitudinal Study (2009–2021) further suggest that approximately 9% of individuals aged 16–29 years are engaged in caregiving with stable rates over time. 6 In the United States, a national survey reported that 3.2% of households with children aged 8–18 years included a child caregiver, 7 whereas studies from other European countries have estimated prevalence rates of 4.5%–7.9%. 8 , 9 We developed and validated a Japanese version of the Young Carers Scale (YCS‐J) in collaboration with the original authors of the BBC–University of Nottingham Survey. 10 Using this instrument, the prevalence of YCs was estimated at 7.4% in a sample of 5000 junior and senior high school students.
Accumulating evidence indicates that YCs are at increased risk of poorer mental health outcomes. 11 , 12 , 13 , 14 , 15 In our previous cross‐sectional study in Japan, YCs showed higher levels of prosocial behavior and greater emotional symptoms than non‐YCs. 10 Longitudinal data from the UK Millennium Cohort further suggest that YCs have experienced greater psychological distress and lower well‐being during the COVID‐19 pandemic. 16 Similarly, findings from the Tokyo Teen Cohort indicated that persistent caregiving is associated with an increased risk of adverse mental health outcomes in later adolescence. 17
Although previous quantitative studies have often compared YCs with non‑YCs, YCs are unlikely to constitute a homogeneous group. A realist synthesis of research on YCs’ mental health and psychosocial wellbeing suggests that the impact of caring may vary depending on children's caregiving responsibilities, the support available to them, the development of a carer identity, and broader family circumstances. 18 These findings indicate that caregiving experiences may differ not only in the amount of care provided but also in relation to the caregiver–recipient relationship and the nature of the recipient's illness or disability. For example, caring for a family member with mental health problems may involve emotional support, monitoring, and concerns that are difficult to disclose or share with others. 19
Despite this growing body of research, important gaps remain. To date, no quantitative studies have systematically examined whether caregiver burden and psychological difficulties vary according to the type of care recipient or the nature of their illness or disability. To address this gap, this study investigated the association between the type of care recipient's condition and psychological difficulties among Japanese junior and senior high school students.
METHODS
Participants
A total of 860 students from three private junior high schools (n = 629) and one private senior high school (n = 231) in Tokyo and its suburbs participated in this study (Table 1). The participants were aged 12–18 years. The gender distribution was as follows: male, 621; female, 218; other, 6; preferred not to disclose, 14; and missing responses, N = 1.
Table 1.
Descriptive statistics of the study participants (N = 860).
| Grades, N (%) | ||
| 7th | 218 | (25.3) |
| 8th | 196 | (22.8) |
| 9th | 215 | (25.0) |
| 10th | 79 | (9.2) |
| 11th | 70 | (8.1) |
| 12th | 82 | (9.5) |
| Gender, N (%) | ||
| Male | 621 | (72.2) |
| Female | 218 | (25.3) |
| Other | 6 | (0.7) |
| Prefer not to disclose | 14 | (1.6) |
| Blank | 1 | (0.1) |
| Young carers (YCs), N (%) | 76 | (8.8) |
| YCs with MACA‐YC > = 14 (at least a high amount of caring activitya) | 25 | (2.9) |
| YCs with MACA‐YC > = 18 (a very high amount of caring activitya) | 11 | (1.3) |
| Family's relationship with YCsb, c | ||
| Mother | 38 | (50.0) |
| Father | 11 | (14.5) |
| Siblings | 23 | (30.3) |
| Grandparents | 24 | (31.6) |
| Others | 4 | (5.3) |
| Family's type of disability/diseasesb, c | ||
| Physical disability | 13 | (17.1) |
| Intellectual disability | 11 | (14.5) |
| Mental health problem | 14 | (18.4) |
| Alcohol abuse | 1 | (1.3) |
| Drug abuse | 0 | (0.0) |
| Chronic physical diseases | 23 | (30.3) |
| Others | 8 | (10.5) |
| Prefer not to disclose | 16 | (21.1) |
Abbreviation: MACA‐YC, Multidimensional Assessment of Caring Activities Checklist for Young Carers.
The criteria were based on Joseph et al. 5
Percentages are calculated using YCs (n = 76) as the denominator.
Respondents could select more than one option; therefore, percentages do not sum to 100%.
The Young Carers Scale–Japanese version (YCS‐J)
The YCS‐J was developed based on a questionnaire used in the 2018 BBC/University of Nottingham Survey 5 and includes questions #1‐ 5. The reliability and validity were tested in our previous study. 10 Question #1 (Q1) asked whether there was someone in the respondent's home who had an illness or disability. If the respondent answered yes to Q1, Q2 then asked whether he or she helped look after that person and did things at home to support them. The YCs were operationally defined as those who answered yes to both Q1 and Q2.
Q3 asked about the relationship between the family member being cared for and the respondent (mother, father, siblings, grandparents, or others). Q4 asked what type of disability or disease the family member needed care for (physical disability, intellectual disability, mental health problems, alcohol abuse, drug abuse, chronic physical diseases, others, or prefer not to disclose).
Q5 corresponded to a modified version of the Multidimensional Assessment of Caring Activities Checklist for Young Carers (MACA‐YC18) 20 (Japanese version is available at 10 ). The MACA‐YC18 asks what types and amounts of caring activities are provided by adolescents. The 18 items were divided into six domains: domestic chores; household management; and financial/practical, personal, emotional, and sibling care (Table 2).
Table 2.
Item questions for the Japanese version of the MACA‐YC18. a
| Item # | Domain | Question |
|---|---|---|
| 1 | Domestic chore | Clean your own bedroom |
| 2 | Clean other rooms | |
| 3 | Wash up dishes or put away dishes in a dishwasher | |
| 4 | Household management | Change wardrobes seasonally, or replace light bulbs or batteries in the house |
| 5 | Take responsibility for shopping for food | |
| 6 | Help with lifting or carrying heavy things | |
| 7 | Financial/practical | Help with financial matters such as dealing with bills, banking money, or collecting benefits |
| 8 | Work part time to bring money in | |
| 9 | Interpret, sign, or use another communication system to help someone in the house. | |
| 10 | Personal care | Help someone in the house to dress or undress |
| 11 | Help someone in the house to have a wash | |
| 12 | Help someone in the house to have a bath or shower | |
| 13 | Emotional care | Keep someone in the house company, e.g., sitting with them, reading to them, and talking to them |
| 14 | Keep an eye on someone in the house to make sure they are alright | |
| 15 | Take someone in the house out, e.g., for a walk or to see friends or relatives | |
| 16 | Sibling care | Take brothers or sisters to school |
| 17 | Look after brothers or sisters whilst another adult is nearby | |
| 18 | Look after brothers or sisters on your own |
Abbreviation: MACA‐YC, Multidimensional Assessment of Caring Activities Checklist for Young Carers.
Corresponding to Question #5 in the Young Carers Survey, Japanese version (YCS‐J).
SDQ
The Strength and Difficulty Questionnaire (SDQ) 21 was administered, and the total difficulties score as well as subdomain scores were calculated (emotional symptoms, conduct problems, attention hyperactivity, peer relationship problem and prosocial behavior).
Statistical analysis
IBM SPSS Statistics V30 (IBM, Inc.) was used for all statistical analyses.
Comparisons of MACA‐YC18 domain and total scores between YCs and non‐YCs
The Mann–Whitney U test was performed. Because it was reasonably predicted that YCs would be associated with higher domain and total scores, Bonferroni corrections for multiple comparisons were not applied.
Comparisons of SDQ factor and total difficulties scores between YCs and non‐YCs
The Mann–Whitney U test was performed. Since our previous study showed that prosocial behavior, emotional symptoms, and attention/hyperactivity on the SDQ were significantly higher in YCs than in non‐YCs, it was reasonably predicted that YCs would be associated with higher scores in these domains and total scores in the current study. Therefore, the Bonferroni correction was not applied to multiple comparisons.
Multiple regression analysis and post hoc exploratory analyses
To identify which types of family members cared for and which types of disability/diseases would have an influence on the YCs perceived difficulties, we conducted univariate analyses followed by multiple regression analysis using the types of family members cared for (mother, father, siblings, grandparents, others) and types of disability/diseases (physical disability, intellectual disability, mental health problems, alcohol abuse, drug abuse, chronic physical diseases, others, prefer not to disclose) as the independent variables. Drug abuse was not observed in any participant. In addition, because only one participant was classified as having alcohol abuse, this category was not suitable for statistical analysis. Therefore, alcohol abuse was combined into the Others category for the regression analysis. The total difficulties score of the SDQ was the dependent variable. We conducted post hoc exploratory analyses in the subgroups whose attributes were statistically significant in the multivariable regression to examine whether MACA‑YC18 and SDQ scores differed from those of non‑YCs.
Ethical procedure
The ethics committee of the Faculty of Medicine, University of Tokyo, approved the study (Approval Number: 2019326NI‐(4)). Data were obtained from questionnaire responses administered as part of a study to develop materials for enhancing psychological resilience in this age group. Participants provided consent to participate in the study by responding to the questionnaires. None of the participants received any compensation.
RESULTS
The rate of the presence of YCs
The rate of operationally defined YCs (respondents who answered yes to both Q1 and Q2) was 8.8% (n = 76/860). Of the 860 respondents, 25 (2.9%) had at least a high amount of caring activity with a MACA‐YC18 score of 14 or above 5 and 11 YCs (1.3%) had a very high amount of caring activity with a MACA‐YC18 score of 18 or above (Table 1).
Family's relationship with YCs and their type of disability/disease
Among the 76 YCs, the three most frequent care recipients were mothers (n = 38, 50.0%), grandparents (n = 24, 31.6%), and siblings (n = 23, 30.3%) (Table 1). The three most frequent disability or disease categories were chronic physical diseases (n = 23, 30.3%), ‘prefer not to disclose’ (n = 16, 21.1%), and mental health problems (n = 14, 18.4%) (Table 1). Respondents could select more than one option; therefore, percentages do not sum to 100%.
Differences in MACA‐YC18 between YCs and non‐YCs
All MACA‐YC18 domain scores except sibling care, as well as the total score, were significantly higher in YCs than in non‐YCs (Table 3).
Table 3.
Comparison of MACA‐YC18 scores and SDQ scores between YCs and non‐YCs.
| YCs | Non‐YCs | Group comparison | ||||||
|---|---|---|---|---|---|---|---|---|
| N = 76 | N = 784a | Mann–Whitney U test | ||||||
| Range | Mean | SD | Mean | SD | U | p value | r value | |
| MACA domain scores | ||||||||
| Domestic chore | 0‐6 | 2.99 | 1.56 | 2.53 | 1.41 | 25,245.5 | 0.024 | 0.077 |
| Household management | 0‐6 | 3.16 | 1.53 | 2.42 | 1.47 | 21,534.5 | <0.001 | 0.139 |
| Financial/practical | 0‐6 | 0.89 | 1.25 | 0.50 | 0.95 | 24,038.0 | <0.001 | 0.117 |
| Personal care | 0‐6 | 0.80 | 1.52 | 0.33 | 0.93 | 24,311.5 | <0.001 | 0.141 |
| Emotional care | 0‐6 | 2.30 | 1.81 | 1.43 | 1.54 | 21,421.0 | <0.001 | 0.143 |
| Sibling care | 0‐6 | 1.25 | 2.00 | 0.72 | 1.38 | 26,583.0 | 0.054 | 0.066 |
| MACA total score | 0‐36 | 11.39 | 6.82 | 7.93 | 5.00 | 20,192.5 | <0.001 | 0.158 |
| SDQ factors | ||||||||
| Prosocial behavior | 0‐10 | 6.01 | 2.33 | 5.21 | 2.07 | 23,243.0 | 0.001 | 0.109 |
| Emotional symptoms | 0‐10 | 4.43 | 2.81 | 3.65 | 2.70 | 24,891.5 | 0.017 | 0.081 |
| Conduct problems | 0‐10 | 2.05 | 1.54 | 1.94 | 1.46 | 28,472.5 | 0.520 | 0.022 |
| Attention/hyperactivity | 0‐10 | 4.42 | 2.29 | 4.01 | 2.20 | 26,803.0 | 0.144 | 0.050 |
| Peer relationship problems | 0‐10 | 3.32 | 2.11 | 2.44 | 1.75 | 22,196.0 | <0.001 | 0.127 |
| Total difficulties score | 0‐40 | 14.22 | 6.21 | 12.01 | 5.71 | 23,305.5 | 0.002 | 0.105 |
Abbreviations: MACA‐YC, Multidimensional Assessment of Caring Activities Checklist for Young Carers; SDQ, Strength and Difficulty Questionnaire; YC, young carers.
Missing data: sibling care, N = 1; MACA total score, N = 1; conduct problems, N = 1; peer problems, N = 3; total difficulty score, N = 4.
Differences in SDQ between YCs and non‐YCs
Compared with non‐YCs, YCs had significantly higher total difficulties scores, as well as significantly higher scores on the prosocial behavior, emotional symptoms, and peer relationship problems subscales of the SDQ (Table 3).
Multiple regression analysis
In the univariate analyses, caregiving for “mother,” “siblings,” “others,” “mental health problem” and “prefer not to disclose” were associated with psychological difficulties. The multiple regression analysis (adjusted R2 = 0.014; ANOVA, F[11, 844] = 2.119, p = 0.017) indicated that “mental health problems” (unstandardized coefficient B = 5.667 [95% CI: 1.934–9.400], SE = 1.902, standardized coefficient β = 0.124, t = 2.980, p = 0.003, VIF = 1.508) were a significant explanatory factor for SDQ total score. The number of YCs who care for a family member with a mental health problem was 14. We conducted post hoc exploratory analyses focusing on the subgroup in which having a family member with a mental health problem was identified as a statistically significant factor in the multivariable regression.
MACA‐YC18 domain score differences between YCs who cared for family members with mental health problems and non‐YCs
Comparisons of the MACA‐YC18 domain and total scores between YCs caring for family members with mental health problems (N = 14) and non‐YCs were performed using Mann–Whitney U tests. Bonferroni correction was applied, and the statistical significance level was set at p = 0.007 (six MACA‐YC18 domain scores and the total score). The MACA‐YC personal care domain score (U = 3938.5, p = 0.004, r = 0.103) was significantly higher in YCs who cared for family members with mental health problems than in non‐YCs (Table 4). The MACA‐YC emotional care domain score (U = 3409.0, p = 0.011) in YCs who cared for a family member with mental health problems tended to be higher than in non‐YCs, although the difference was not statistically significant after Bonferroni correction.
Table 4.
Multiple regression analysis predicting total difficulty scores (N = 856). a
| Predictors | B | 95% CI for B | SE | β | p value | ||
|---|---|---|---|---|---|---|---|
| Cared family's relationship | |||||||
| Mother | −0.802 | −3.660 | ‐ | 2.056 | 1.456 | −0.029 | 0.582 |
| Father | −0.005 | −4.058 | ‐ | 4.049 | 2.065 | 0.000 | 0.998 |
| Siblings | 1.314 | −2.210 | ‐ | 4.838 | 1.795 | 0.037 | 0.465 |
| Grandparents | −1.340 | −4.608 | ‐ | 1.927 | 1.665 | −0.038 | 0.421 |
| Others | 4.413 | −1.930 | ‐ | 10.756 | 3.232 | 0.052 | 0.172 |
| Type of disability/diseases | ‐ | ||||||
| Physical disability | 0.997 | −2.646 | ‐ | 4.640 | 1.856 | 0.021 | 0.591 |
| Intellectual disability | −2.477 | −7.186 | ‐ | 2.233 | 2.399 | −0.048 | 0.302 |
| Mental health problem | 5.667 | 1.934 | ‐ | 9.400 | 1.902 | 0.124 | 0.003 |
| Chronic physical diseases | 2.016 | −1.280 | ‐ | 4.691 | 1.730 | 0.036 | 0.454 |
| Others | 2.721 | −2.053 | ‐ | 7.239 | 2.434 | 0.041 | 0.312 |
| Prefer not to disclose | 3.112 | −0.653 | ‐ | 6.547 | 1.927 | 0.065 | 0.152 |
Abbreviations: CI, confidence interval; SE, standard error.
R 2 = 0.027, Adjusted R 2 = 0.014.
SDQ factor score differences between YCs who cared for family members with mental health problems and non‐YCs
Comparisons of the SDQ factor scores between YCs caring for family members with mental health problems (N = 14) and non‐YCs were performed using Mann–Whitney U tests. The Bonferroni correction was applied, and the statistical significance level was p = 0.008 (five SDQ factor scores and one SDQ total difficulty score). The SDQ emotional symptom score (U = 3103.5, p = 0.005, r = 0.099) and SDQ total difficulties score (U = 2850.5, p = 0.002, r = 0.109) were significantly higher in YCs who cared for a family member with mental health problems than in non‐YCs (Table 5). The SDQ peer relationship problems score (U = 3506.0, p = 0.019) in YCs who cared for a family member with mental health problems tended to be higher than in non‐YCs, although the difference was not statistically significant after Bonferroni correction.
Table 5.
Comparison of MACA‐YC18 scores and SDQ scores between m‐YCs and non‐YCs.
| m‐YCs | non‐YCs | Group comparison | ||||||
|---|---|---|---|---|---|---|---|---|
| N = 14 | N = 784a | Mann–Whitney U test | ||||||
| Range | Mean | SD | Mean | SD | U | p value | r value | |
| MACA domain scores | ||||||||
| Domestic chore | 0–6 | 3.21 | 1.63 | 2.53 | 1.41 | 4289.5 | 0.151 | 0.051 |
| Household management | 0–6 | 2.93 | 1.59 | 2.42 | 1.47 | 4536.5 | 0.255 | 0.040 |
| Financial/practical | 0–6 | 0.64 | 0.93 | 0.50 | 0.95 | 4798.0 | 0.313 | 0.036 |
| Personal care | 0–6 | 0.93 | 1.39 | 0.33 | 0.93 | 3938.5 | 0.004 | 0.103 |
| Emotional care | 0–6 | 2.71 | 2.02 | 1.43 | 1.54 | 3409.0 | 0.011 | 0.090 |
| Sibling care | 0–6 | 1.21 | 2.23 | 0.72 | 1.38 | 5223.0 | 0.702 | 0.014 |
| MACA total score | 0–36 | 11.64 | 6.88 | 7.93 | 5.00 | 3708.5 | 0.037 | 0.074 |
| SDQ factors | ||||||||
| Prosocial behavior | 0–10 | 6.14 | 1.92 | 5.21 | 2.07 | 4034.5 | 0.085 | 0.061 |
| Emotional symptoms | 0–10 | 5.86 | 2.93 | 3.65 | 2.70 | 3103.5 | 0.005 | 0.099 |
| Conduct problems | 0–10 | 2.21 | 1.85 | 1.94 | 1.46 | 5263.5 | 0.791 | 0.009 |
| Attention/hyperactivity | 0–10 | 5.36 | 2.50 | 4.01 | 2.20 | 3824.0 | 0.049 | 0.070 |
| Peer relationship problems | 0–10 | 3.79 | 2.46 | 2.44 | 1.75 | 3506.0 | 0.019 | 0.083 |
| Total difficulties score | 0–40 | 17.21 | 6.33 | 12.01 | 5.71 | 2850.5 | 0.002 | 0.109 |
Abbreviations: MACA‐YC, Multidimensional Assessment of Caring Activities Checklist for Young Carers; m‐YC, young caregivers caring for families with mental health problems; SDQ, Strength and Difficulty Questionnaire.
Missing data: sibling care, N = 1; MACA total score, N = 1; conduct problems, N = 1; peer problems, N = 3; total difficulty score, N = 4.
DISCUSSION
This study is the first to quantitatively examine whether the degree of psychological difficulties among YCs differs according to the type of illness or disability of the care recipient, using standardized operational criteria to define YCs.
In this study, the prevalence of YCs was 8.8%. Although lower than that reported in the United Kingdom using the same Young Carers Scale (YCS), this estimate is comparable to that of our previous Japanese study using the YCS‐J (7.4%). 10 Half of the YCs were caring for their mother, who, in most cases, had a chronic physical condition or a mental disorder. The second most frequently reported care recipient was a grandparent. Notably, previous findings from the Tokyo Teen Cohort indicated that cohabitation with grandparents is a predictor of persistent caregiving. 22 As expected, YCs engaged in more caregiving and household tasks typically performed by adults than their non‐YC peers.
Psychological difficulties among the YCs were significantly associated with the care of family members with mental health problems. YCs are frequently involved in personal and emotional caregiving. In addition, those who did not disclose the type of the care recipient's condition showed higher SDQ total difficulty scores than non‐YCs, underscoring the challenge of identifying and supporting YCs who are reluctant to seek help. Previous research has shown that adult caregivers for family members with mental illnesses experience greater psychological and emotional strain than those with physical illnesses. 23 This study demonstrated a similar trend among young caregivers.
YCs caring for family members with mental health problems showed elevated emotional symptoms. Consistent with this finding, Bowman Grangel et al. 24 reported that YCs caring for their parents were more likely to experience depression than those caring for other relatives or non‐YCs. These YCs were found to experience a substantial burden of personal care, such as helping someone in the house dress or undress, wash, bathing, or showering. Previous research has shown that YCs face difficulties maintaining friendships because of time constraints resulting from their caregiving responsibilities. 25 It has also been reported that YCs are at a higher risk of being bullied at school because of time constraints and isolation resulting from their caregiving responsibilities. 26 Previous studies have shown that school bullying negatively affects YC's mental health. 27 When considered together with previous research, the findings of this study suggest that the association between YCs’ engagement in personal care tasks and the deepening of YCs’ social isolation warrants further examination through additional longitudinal studies.
However, longitudinal evidence suggests a complex temporal relationship. Data from Japan indicate that psychological distress and peer network characteristics may precede the assumption of caregiving roles, 28 and that YCs have been shown to report lower life satisfaction even before becoming carers. 29 Together with evidence of elevated prosocial behavior among YCs 10 (also observed in the present study), these findings highlight the need to clarify which individual traits and contextual factors predispose adolescents to assume caregiving roles and how these trajectories shape long‐term outcomes.
Adolescence is a developmental period marked by a shift from parent–child dependency toward engagement with peers and the broader social environment. Assuming a caregiving role for parents may have significant implications for psychological development. While such experiences may foster competencies that contribute to well‐being and caregiving‐related career pathways, they also lead to a reversal of parental roles and can result in problems such as overadaptation among YCs. 30 They may also lead to depression, social restrictions, and reduced life opportunities, ultimately resulting in poor outcomes.
This study had several limitations. First, participants were recruited from private junior and senior high schools in Tokyo and surrounding areas, which may limit generalizability. International comparisons based on the Programme for International Student Assessment (PISA) indicate that Japanese adolescents achieve top‐tier academic performance. 31 Moreover, domestic evidence suggests that students in private integrated junior–senior high schools outperform other adolescents on PISA assessments. 32 These observations suggest that private high school students in the Tokyo metropolitan area may be subject to greater academic pressure. Further studies in diverse settings, including international comparisons, are warranted. Secondly, the factors included in the regression analysis were limited. Previous studies have shown that SDQ total difficulties scores are associated with socioeconomic background, 33 an increased likelihood of DSM‑IV behavioral and emotional disorders, 34 bullying and school climate. 35 For example, Adolescents with lower socioeconomic status—such as lower parental education or household income—tend to show elevated SDQ scores. 33 In this study, only the relationship to the care recipient and the type of illness or disability in the family were included as explanatory variables, resulting in a low coefficient of determination (R2 = 0.014). Future analyses should incorporate these factors to improve explanatory power. Finally, the cross‐sectional design precludes conclusions regarding causal relationships. Longitudinal studies have reported mixed findings on the long‐term health effects of adolescent caregiving, 17 , 36 underscoring the need for further investigation.
CONCLUSIONS
This study, which was conducted in a major metropolitan area in Japan, highlights the substantial psychological burden experienced by YCs providing personal care to family members with mental health problems. Although legal frameworks to support YCs were introduced in Japan in 2024, significant challenges remain. In particular, there is a need to identify and address personal care that is sometimes difficult to share, hard for others to approach, and often challenging for YCs to seek help for.
AUTHOR CONTRIBUTIONS
Norihito Oshima, Akiko Kanehara, Ryo Morishima, Yusuke Takahashi, Naohiro Okada, and Kiyoto Kasai conceptualized and designed the study. Sho Kanata, Akito Uno, Ryo Morishima, Yusuke Takahashi, Shunichi Sato, Naohiro Okada, and Kiyoto Kasai acquired the data. Norihito Oshima and Kiyoto Kasai analyzed the data and drafted the manuscript. All authors participated in result interpretation; moreover, they reviewed and approved the final version of the manuscript.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ETHICS APPROVAL STATEMENT
The ethical committee of the Faculty of Medicine, The University of Tokyo, approved the study (Approval Number: 2019326NI‐(4)).
PATIENT CONSENT STATEMENT
Data were obtained from questionnaire responses administered as part of a study to develop educational materials to enhance psychological resilience in this age group. Prior to the administration of the questionnaire, the participants and his/her parents were given a written explanation of the study. The participants expressed their consent to participate in the study by responding to the questionnaires. They were assured of their free will not to consent by not completing the questionnaires. The participants did not receive compensation.
CLINICAL TRIAL REGISTRATION
N/A.
ACKNOWLEDGMENTS
This study was supported by JSPS KAKENHI Grant Numbers JP21K13474 (A. K.), JP23K27525 (K. K.), and JP26K06003 (N. Oshima), AMED under Grant Number JP25oa0439005h0001, and by the International Research Center for Neurointelligence (WPI‐IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS). We would like to thank Editage (www.editage.com) for English language editing.
DATA AVAILABILITY STATEMENT
The availability of the data in this study is not open access due to the provisions of the ethics committee and the extent of the participants’ consent. If readers wish to apply for the use of data, they must contact the corresponding author and consult the Ethics Committee, Faculty of Medicine, The University of Tokyo.
REFERENCES
- 1. Aldridge J, Becker S. Children who care: inside the World of Young Carers. Department of Social Sciences, Loughborough University; 1993.
- 2. Aldridge J. Where are we now? Twenty‐five years of research, policy, and practice on young carers. Crit Soc Policy. 2018;38:155–165. [Google Scholar]
- 3. Leu A, Berger FMP, Heino M, et al. The 2021 cross‐sectional and comparative classification of in‐country awareness and policy responses to young carers. J Youth Studies. 2022;26:619–636. [Google Scholar]
- 4. Sempik J, Becker S. Young adult carers at school: experiences and perceptions of caring and education. London: Carers Trust; 2013. [Google Scholar]
- 5. Joseph S, Kendall C, Toher D, Sempik J, Holland J, Becker S. Young carers in England: Findings from the 2018 BBC survey on the prevalence and nature of caring among young people. Child Care Health Dev. 2019;45:606–612. [DOI] [PubMed] [Google Scholar]
- 6. Di Gessa G, Xue B, Lacey R, McMunn A. Young adult carers in the UK: New evidence from the UK household longitudinal study. Int J Environ Res Public Health. 2022;19:14076. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Hunt G, Levine C, Naiditch L. Young caregivers in the U.S.: findings from a national survey. Bethesda, MD: National Alliance for Caregiving; 2005. [Google Scholar]
- 8. Leu A, Frech M, Wepf H, et al. Counting young carers in Switzerland: a study of prevalence. Child Soc. 2019;33:53–67. [Google Scholar]
- 9. Nagl‐Cupal M, Daniel M, Koller MM, Mayer H. Prevalence and effects of caregiving on children. J Adv Nurs. 2014;70:2314–2325. [DOI] [PubMed] [Google Scholar]
- 10. Kanehara A, Morishima R, Takahashi Y, Koike H, Usui K, Sato S, et al. Young carers in Japan: Reliability and validity testing of the BBC/University of Nottingham young carers survey questionnaire and prevalence estimation in 5,000 adolescents. Psychiatry Clin. Neurosci. Rep. 2022;1:e46. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Bowman Grangel A, McMahon J, Dunne N, O'Donoghue F, Gallagher S. Health outcome and psychosocial determinants in young carers: a systematic review. Lancet Public Health. 2025;10:e625–e639. [DOI] [PubMed] [Google Scholar]
- 12. Fleitas Alfonzo L, Disney G, Singh A, Simons K, King T. The effect of informal caring on mental health among adolescents and young adults in Australia: a population‐based longitudinal study. Lancet Public Health. 2024;9:e26–e34. [DOI] [PubMed] [Google Scholar]
- 13. King T, Singh AS, Disney G. Associations between young informal caring and mental health: a prospective observational study using augmented inverse probability weighting. Lancet Reg Health West Pac. 2021;15:100257. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Lacey R, Xue B, McMunn A. The mental and physical health of young carers: a systematic review. Lancet Public Health. 2022;7:e787–e796. [DOI] [PubMed] [Google Scholar]
- 15. Lacey RE, Xue B, Di Gessa G, Lu W, McMunn A. Mental and physical health changes around transitions into unpaid caregiving in the UK: a longitudinal, propensity score analysis. Lancet Public Health. 2024;9:e16–e25. [DOI] [PubMed] [Google Scholar]
- 16. Nakanishi M, Richards M, Stanyon D, et al. Adolescent carers’ psychological symptoms and mental well‐being during the COVID‐19 pandemic: Longitudinal study using data from the UK Millennium Cohort Study. J Adolesc Health. 2022;70:877–884. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Stanyon D, Nakanishi M, Yamasaki S, et al. Investigating the differential impact of short and long‐term informal caregiving on mental health across adolescence: data from the Tokyo Teen Cohort. J Adolesc Health. 2024;75:642–649. [DOI] [PubMed] [Google Scholar]
- 18. Janes E, Forrester D, Reed H, Melendez‐Torres GJ. Young carers, mental health and psychosocial wellbeing: a realist synthesis. Child Care Health Dev. 2022;48:190–202. [DOI] [PubMed] [Google Scholar]
- 19. Dharampal R, Ani C. The emotional and mental health needs of young carers: what psychiatry can do. BJPsych Bull. 2020;44:112–120. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Joseph S, Becker S, Becker F, Regel S. Assessment of caring and its effects in young people: development of the Multidimensional Assessment of Caring Activities Checklist (MACA‐YC18) and the Positive and Negative Outcomes of Caring Questionnaire (PANOC‐YC20) for young carers. Child Care Health Dev. 2009;35:510–520. [DOI] [PubMed] [Google Scholar]
- 21. Goodman R. The strength and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–586. [DOI] [PubMed] [Google Scholar]
- 22. Nakanishi M, Stanyon D, Richards M, et al. Informal caregiving in adolescents from 10 to 16 years old: a longitudinal study using data from the Tokyo Teen Cohort. Int J Environ Res Public Health. 2023;20:6482. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Settineri S, Rizzo A, Liotta M, Mento C. Caregiver burden and caregiving representations among caregivers of patients with schizophrenia. J Ment Health. 2014;23(5):236–240.24988002 [Google Scholar]
- 24. Bowman Grangel A, McMahon J, Dunne N, Gallagher S. Predictors of depression in young carers: a population based longitudinal study. Int J Adolesc Youth. 2024;29:2292051. [Google Scholar]
- 25. Dearden C, Becker S. Young carers in the UK: the 2004 report. London: Carers UK; 2004. [Google Scholar]
- 26. Lloyd K. Happiness and well‐being of young carers: Extent, nature and correlates of caring among 10–11‐year‐old school children. J Happiness Stud. 2013;14(1):67–80. [Google Scholar]
- 27. Fleitas Alfonzo L, Singh A, Disney G, King T. Gender and care: does gender modify the mental health impact of adolescent care? SSM Population Health. 2023;23:101479. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Nakanishi M, Yamaguchi S, Sakai M, Yoshii H, Yamasaki S, Nishida A, et al. Longitudinal associations between informal caring, social network, and psychological distress among adolescents and young adults: modelling within‐person effects. BMC Public Health. 2025;25:260. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Lacey RE, Letelier A, Xue B, McMunn A. Changes in life satisfaction, self‐esteem, and self‐rated health before, during, and after becoming a young carer in the UK: a longitudinal, propensity score analysis. Lancet Reg Health Europe. 2025;50:101187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Yamada A, Kato N, Kawamata M. Psychosocial characteristics and role reversal among young carers in Japan: implications for support and well‐being. Child Youth Serv Rev. 2023;149:106965. [Google Scholar]
- 31. Organisation for Economic Co‐operation and Development . PISA 2022 results (Volume I). 2023. Available from: https://www.oecd.org/en/publications/pisa-2022-results-volume-i_53f23881-en.html
- 32. Kawaguchi T. Student Achievement in Public and Private Schools. Bulletin of Fukuoka University of Education. Part IV, Education and Psychology. 2013;62:11–19. [Google Scholar]
- 33. Becker A, Rothenberger A, Sohn A, Ravens‐Sieberer U, Klasen F. Six years ahead: a longitudinal analysis regarding course and predictive value of the Strengths and Difficulties Questionnaire (SDQ) in children and adolescents. Eur Child Adolesc Psychiatry. 2015;24:715–725. [DOI] [PubMed] [Google Scholar]
- 34. Nielsen LG, Rimvall MK, Clemmensen L, Munkholm A, Elberling H, Olsen EM, et al. The predictive validity of the Strengths and Difficulties Questionnaire in preschool age to identify mental disorders in preadolescence. PLoS One. 2019;14:e0217707. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35. Donato F, Triassi M, Loperto I, Maccaro A, Mentasti S, Crivillaro F, et al. Symptoms of mental health problems among Italian adolescents in 2017‐2018 school year: a multicenter cross‐sectional study. Environ Health Prev Med. 2021;26:67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36. Xue B, King M, Deindl C, Lacey R, Di Gessa G, McMunn A. Do health and well‐being change around the transition to informal caring in early adulthood? A longitudinal comparison between the United Kingdom and Germany. J Adolesc Health. 2024;74:885–891. [DOI] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
The availability of the data in this study is not open access due to the provisions of the ethics committee and the extent of the participants’ consent. If readers wish to apply for the use of data, they must contact the corresponding author and consult the Ethics Committee, Faculty of Medicine, The University of Tokyo.