~ Pergamon 0277-9536(95)00296-0 Soc. Sci. Med. Vol. 42, No. 12, pp. 1691 1701, 1996 Copyright ',{" 1996 Elsevier Science Ltd Printed in Great Britain. All rights reserved 0277-9536/96 $15.00 + 0.00 LIVING WITH THE MENTALLY ILL: EFFECTS ON THE HEALTH AND FUNCTIONING OF OTHER HOUSEHOLD MEMBERS SALLY K. GALLAGHER I* and DAVID MECHANIC 2 ~Department of Sociology, Fairbanks 307+ Oregon State University, Corvallis, OR 97331-3703, U.S.A. and 21nstitute for Health, Health Care Policy and Aging Research+ Rutgers University, P.O. Box 2101, New Brunswick. NJ 08903, U.S.A. Abstract--Based on data from the National Health Interview Surrey Mental Health Supplement+ 1989 INCHS+ 1991), this article compares health outcomes for respondents living with someone who is mentally ill (N = 776) with a randomly selected subsample of respondents not living with someone identified as mentally ill (N = 716). When other predictors of health are controlled, sharing a household with a mentally ill person is associated with poorer self-reported physical health, increased risk of reporting some activity limitation, and increased service utilization--both greater risk of hospitalization or visiting a physician, and a greater number of days hospitalized and number of physician visits among those utilizing these services. The severity and duration of mental illness have little effect across health outcome measures. Impaired health and increased utilization of medical care among persons living with someone who is mentally ill suggest hidden costs to individuals, to families of the mentally ill. and to the service system. Copyright ',{'" 1996 Elsevier Science Ltd Key word~'- mental illness, social functioning, family burden, service utilization INTRODUCTION The consequences of mental illness for non-mentally ill family members has been an important focus of mental health research since the mid-1960s [1, 2]. Early work on the "costs' associated with having a mentally ill relative were largely inferential--assess- ing subjective burden from attitudinal measures towards mental illness in general [3]. More recent studies have refined the concept of family burden to distinguish the negative subjective and objective consequences of living with someone who is acutely mentally or physically ill [4-9]. Yet the concept of family burden has been criticized by researchers who argue it obscures the impact of its discrete components [10], is too broad [11], does not provide an adequate basis for developing public policy [12-14] and ignores the positive effects of providing family care [12, 15, 16]. Health: a neglected component of.family burden This analysis focuses on a largely neglected component of family burden: physical health. Although a substantial body of research examines the affective, social, and economic consequences of caring for the chronically ill, very little previous research examines the physical health consequences associated with sharing a household with someone who is chronically ill. Even fewer studies examine the physical health outcomes associated with living with someone who is mentally ill. Yet, this aspect of family *Author for correspondence. burden has important implications for health care policy and service utilization, as well as the quality of life for families of the mentally ill. Physical health in the stress process The neglect of the physical health outcomes associated with living with the mentally ill is somewhat surprising, since stress has been widely recognized as adversely affecting health. Pearlin and colleagues argue that health is substantially influ- enced by the stress process [17-19]. In this process, the hassles and irritations of daily living [20-23], as well as particularly stressful life events [24, 25], produce increased negative physiological, as well as psychological, outcomes. Recent work argues that burdensome behavior depresses immune function- ing-suggesting that distress affects health indirectly through lowering resistance to disease [21]. Given this link between stress and health, we might expect individuals who share a household with someone who is mentally ill to be at greater risk for increased illness, to experience poorer general physical health, and to be in need of more medical care than those in the general population. PREVIOUS RESEARCH Scattered research suggests that living with someone who is mentally ill may have negative health effects on non-mentally ill household members. Early research by Creer and Wing [26] found that families of schizophrenia patients reported impaired physical 1691