Caught in the middle: sandwich care and mental health - a systematic review — The Association Specialists
  1. Schedule
  2. Oral Presentations - Conversations starters - population health & wellbeing
  3. Caught in the middle: sandwich care and mental health - a systematic review

Caught in the middle: sandwich care and mental health - a systematic review (23589)

Jennifer Ervin 1 , Humaira Maheen 2 , Baowen Xue 3 , Anne McMunn 3 , Rebecca Lacey 4 , Tania King 1
  1. Social Equity Research Centre, RMIT University, Melbourne, VIC, Australia
  2. Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC, Australia
  3. Research Department of Epidemiology and Public Health, University College London, London, UK
  4. Population Health Research Institute, City St George’s, University of London, London, UK

Background

Sandwich care - the simultaneous provision of care for dependent children and older family members - disproportionately falls on women, compounding existing gendered inequalities in unpaid care work. The dual caregiving responsibility can be detrimental to those who provide it: not only is it stressful, leading to challenges in managing finances, time, and energy, but the emotional and physical toll can also impact a sandwich carer's mental and physical well-being. Despite the growing prevalence of sandwich care globally, no systematic review has previously been conducted to quantitatively assess evidence of its association with mental health.

Methods

This systematic review (PROSPERO: CRD420261278737) searched five databases (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from January 1, 2000, to April 1, 2026, using a two-tier search strategy. Population-based, peer-reviewed quantitative studies examining the association between sandwich care and mental health, with a non-sandwich or non-caregiving comparator, were eligible for inclusion. Screening, data extraction, and quality assessment (amended Newcastle-Ottawa Scale) were independently conducted by two reviewers. 

Results

Of 452 records screened, 9 eligible studies (23,057 participants) were included. Overall quality of evidence was mixed. High risk of bias studies were excluded from evidence synthesis. Narrative synthesis was complemented by effect-direction and albatross plots, as between-study heterogeneity precluded meta-analysis. Results indicate that the mental health of sandwich carers is consistently poorer than that of non-sandwich comparators, with the strongest evidence drawn from longitudinal studies using validated instruments, and high-quality evidence demonstrating that effects are most pronounced among those providing intensive care.

Conclusion

This review highlights the particular vulnerability of women, who bear a disproportionate share of sandwich caring responsibilities, and underscores the urgent need for targeted, gender-sensitive policy and support interventions to protect the mental health of those simultaneously caring for children and older family members.