# The emotional cost of containment: a cross-sectional analysis of treatment effects among informal carers in South Asia during the COVID-19 pandemic

## TL;DR

This study explores how pandemic containment measures in South Asia affected the emotional well-being of informal caregivers and suggests ways to support them in future crises.

## Contribution

The study identifies specific emotional costs of pandemic policies on caregivers in South Asia and proposes culturally embedded support strategies.

## Key findings

- Social confinement and restricted visitation rights caused persistent emotional costs for caregivers.
- Emotional costs were highest when caregiving intensity increased or decreased unexpectedly from pre-pandemic levels.
- Counseling and emotional support services can help reduce caregiver distress during crises.

## Abstract

The COVID-19 pandemic led to government-imposed mobility restrictions, social distancing, and lockdowns, altering the caregiving environment worldwide. In South Asia, it is unknown what aspects of these changes posed significant emotional costs to informal carers, or how such costs can be mitigated in future pandemics.

To identify environmental change aspects (dimensions) that posed distinct emotional costs for South Asian carers. To quantify the costs and classify them as persistent, transient, hidden, or insignificant. To propose ways of mitigating carer distress during future pandemics.

The data came from the Coping with Loneliness, Isolation, and COVID-19 Caregiver survey. Carers (n=454) in Bangladesh (N=123), India (N=116), and Pakistan (N=215) self-reported their experiences before/during the pandemic. The dimensions were extracted from 11 change indicators. A dimension’s emotional costs were its effects on (1) the change in burden frequency relative to pre-pandemic conditions and (2) the during-pandemic burden frequency.

Five factors emerged: social confinement, reduced/missing information on the recipient, loss of connection, restricted visitation rights, and protective clothing. Social confinement (loss of connection) increased both changes in burden frequency and during-pandemic burden frequency, indicating a persistent emotional cost to carers. Restricted visitation rights affected only pandemic burden frequency, indicating a hidden emotional impact.

Social confinement (loss of connection, restricted visitation rights) was emotionally costly because it forced an increase (decrease) in care intensity relative to pre-pandemic levels. Through enhanced counseling and emotional support services, South Asian public health systems can alleviate carers’ private suffering during normal times and future crises.

Main findings: During the COVID-19 pandemic, government containment policies changed the caregiving environment, posing emotional costs to South Asian carers.Added knowledge: The highest emotional costs resulted from undesirable increases and decreases in caregiving intensity relative to the carer’s normal pre-pandemic level.Global health impact for policy and action: Carer support strategies embedded in local cultural norms, socioeconomic realities, and healthcare systems can enhance the sustainability of informal care in normal times and during crises.

Main findings: During the COVID-19 pandemic, government containment policies changed the caregiving environment, posing emotional costs to South Asian carers.

Added knowledge: The highest emotional costs resulted from undesirable increases and decreases in caregiving intensity relative to the carer’s normal pre-pandemic level.

Global health impact for policy and action: Carer support strategies embedded in local cultural norms, socioeconomic realities, and healthcare systems can enhance the sustainability of informal care in normal times and during crises.