Mental health spillovers of Long-Term Care Insurance on spousal caregivers in China

Objectives Under the context of both demographic transitions and spousal caregivers of disabled individuals facing intensifying care burdens, the effects of Long-Term Care Insurance on spousal caregiver mental health remain under-explored. This study aimed to assess its mental health spillover effects and moderation effects of care needs, policy density and region hierarchy. Methods Using four waves of China Health and Retirement Longitudinal Study data, we employed the staggered difference-in-differences method to evaluate the mental health spillover effects of Long-Term Care Insurance on spousal caregivers of disabled individuals and moderation effects of care needs, policy density and region hierarchy. Results Long-Term Care Insurance implementation significantly reduced depressive symptoms among spousal caregivers of disabled individuals. Region hierarchy rather than care needs or policy density moderated the policy effects, with effects being stronger in higher-hierarchy regions. Conclusions Long-Term Care Insurance implementation generated mental health spillover effects among spousal caregivers of disabled individuals and region hierarchy moderated these effects. Our findings advanced the understanding of how social insurance could support spousal caregivers in rapidly ageing societies, while also highlighting the importance of considering caregiving relationships and region hierarchy in policy design and evaluation.