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To the Editor: Drs Schulz and Beach¹ demonstrate significant variability in mortality among elderly caregivers. Those reporting physical or emotional strain as a consequence of caring for a disabled spouse experienced a 63% increase in mortality over 4 years, compared with noncaregivers. Conversely, caregivers reporting no strain had a small and statistically nonsignificant mortality increase, whereas those whose disabled spouses made no care demands showed an intermediate (also statistically nonsignificant) increase. The authors' conclusion that these associations are caused by chronic psychological stress, however, extends beyond their data.

Psychological constructs such as stress also are affected by physical health and financial status.² For individuals whose financial resources are already limited, caring for a disabled spouse is likely to result in increased material disadvantage in addition to more apparent "caregiving strain." Which of these has the greater effect on mortality rates is unclear. Confounding by financial stress is unlikely to have . . . [Full Text of this Article]

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