does it hurt to care? caregiving, work-family conflict...

Does It Hurt to Care? Caregiving, Work-Family Conflict, and Midlife Well-Being

Nadine F. Marks

Journal of Marriage and the Family, Volume 60, Issue 4 (Nov., 1998), 951-966.

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NADINE F. MARKS University of Wisconsin-Madison

Does it Hurt to Care? Caregiving,

Work-Family Conflict, and Midlife Well-Being

This study examined the effects of caregiving for disabled children, spouses, parents, and other kin and nonkin on multiple positive and negative dimensions of psychological well-being and development using data from a population sample of employed, middle-aged men and women respondents in the Wisconsin Longitudinal Study 1992-1993 (n = 5,782). A life course role-identity theoretical framework was employed to hypothesize that con- tenzporary social organization leads to conflicting demands across the role identities of employee and caregiver and that this conflict is an important factor in accounting for the negative effects of caregiving on well-being. Multivariate regression analyses confirmed these hypotheses and further revealed that i f differences in work and family conflict between caregivers and noncaregivers were eliminated, the caregiving role would more often lead to positive effects on well-being.

Understanding the consequences of assuming the role of caregiver to a disabled family member or friend is becoming an increasingly important pri- vate and public issue. Population estimates of caregiving now make it clear that the caregiving role is not a rare event in the life course (N. Marks, 1996;

Child and Family Studies, School of Human Ecology, Univer- sity of Wisconsin, 1430 Linden Drive, Madison, WI 53706 ([email protected]).

Key Words: caregiving, ntidlife, psycizological well-being, work-family conflict.

Stone, Cafferata, & Sangl, 1987). The prevalence of caregiving for the frail and the disabled peaks for adults in midlife when about one in five women and men provide some degree of care. This fact has led to recent scholarly interest in tracking the well- being of middle-aged women and men who often are faced with demanding multiple-role responsibilities related to family, employment, and cornmu- nity (Brody, 1981, 1985, 1990). The prevalence of caregiving responsibility for elders is also expected to increase as the United States and the world become an increasingly aging and aged society (Coward, Horne, & Dwyer, 1992). Demographic trends toward longer lives, smaller families, higher rates of divorce, lower rates of marriage and remar- riage, and higher rates of women's employment have led to predictions that caregiving for frail and disabled family members will fall on relatively fewer shoulders in the years ahead and that the risk of becoming a caregiver at some time or at multiple times over the life course is likely to increase (Coward et al., 1992; N. Marks, 1996; Moen, Rob- ison, & Fields, 1994).

Caregiving research to date suggests that providing care for the frail and disabled leads to increased distress and burden (Schulz, Visintainer, & Williamson, 1990). There is also some evidence that caring for disabled family members is associated with poorer personal health (N. Marks, 1996; Schulz et al., 1990). However, most studies of caregiving are based on nonrepresentative samples that often include only women caregivers and lack a comparison group of noncaregivers. Research on the consequences of caregiving has focused pre-

Journal of Marriage and the Family 60 (November 1998): 951-966

952 Joiirnal of Marriage and the Family

dominantly on documenting the negative effects of caregiving; potential benefits related to the caregiving role are yet to be well investigated (Kramer, 1997).

A sizable proportion of caregivers today are faced with blending the often contradictory behavioral expectations that accompany the roles of employee and the caregiver (N. Marks, 1996; Stone et al., 1987). Previous studies of employed caregivers have noted reports of considerable con- cerns about work-family conflict among caregivers (Scharlach & Boyd, 1989; Stone et al., 1987). Yet there is only limited evidence thus far (e.g., Gerstel & Gallagher, 1993) that addresses how many of the negative consequences of caregiving among employed persons are a result of taking on the caregiving role, itself, and how many can be accounted for by role overload.

This study addresses this issue. Guided by a life course role-identity perspective, this investi- gation first examines associations between con- trasting types of caregiving for disabled persons (i.e., care of a disabled child, care of a spouse, care of a parent, and other care) and multiple dimensions of well-being using data from a large sample of employed men and women in midlife. Then it considers evidence related to how much work-family conflict accounts for the negative effects of caregiving on midlife well-being. Addi- tionally, I evaluate gender differences in the effects of caregiving on well-being and in the effects of caregiving on reported work-family conflict.

A Life Course Role-Identity Perspective on Caregiving

Most recent caregiving research has employed a theoretical perspective that deals with family- systems stress and coping. Using this conceptual framework, caregiving is theoretically postulated to be a family crisis or stressor with which a family must cope (Hill, 1949; McCubbin & McCubbin, 1993; McCubbin & Patterson, 1983; Pearlin, Mullan, Semple, & Skaff, 1990).

This study employed an alternative theoretical approach to understanding caregiving and its consequences-a life course role-identity perspective. This theoretical orientation suggests that caregiving be viewed as a role in the life course that one is likely to enter and exit once or several times during adulthood (Moen, Robison, & Fields,

1994). The caregiving role is not prejudged a "crisis" or "stressor." Following principles of the life course perspective (Elder, 1992), to understand the likely consequences to well-being of the caregiving role, it is useful to consider the developmental tim- ing of transitions to the caregiver role, the intersec- tion of other roles in relation to the caregiver role, and the changing historical context for enactment of the caregiver role (Moen et al., 1994).

Role-identity theory, as it has been outlined in structural symbolic interactionism (Stryker, 1980), complements the life course perspective. (See another statement of synthesis and complementarity in Wells & Stryker, 1988.) Role-identity theory suggests that when a person assumes any social role, he or she internalizes the socially constructed behavioral expectations associated with that social position (at that historical time) as a role identity. A person's combination of role identities at any given time is the basis for the person's "self." Role-identity theory predicts that the more compe- tently and easily a person is able to fulfill all the internalized, normative, behavioral expectations related to all of his or her social roles, the more likely it is that he or she will exhibit high self- esteem and well-being (Stryker, 1980; Wells & Stryker, 1988).

Although some role combinations can lead to beneficial effects on well-being (e.g., S. Marks, 1977; Moen, Dempster-McClain, & Williams, 1989, 1992), the enactment of multiple roles also has the potential for introducing conflicting behavioral expectations leading to role overload or role conflict. For example, if a person's internalized expectation for the role of caregiver is that he or she be available to take a frail mother to the hospital on a weekday morning for a required critical test at the same time he or she is ex~ected to be available for a required office staff meeting, conflict between work and family roles is likely to result. Addition- ally, as a result of such role conflict (i.e., problematic role-identity enactment), role-identity theory predicts a decline in self-related well-being.

The Multidimensionality of Well-Being

Considerable research on the structure of psychological well-being indicates that positive and negative dimensions of well-being are related but do not form a bipolar continuum (Bradburn, 1969; Bryant & Veroff, 1982; Ryff, 1989; Ryff & Keyes, 1995). Therefore, because positive dimensions of well- being and negative dimensions of well-being are somewhat independent, the same stimuli may lead

Does It Hurt to Care? 953

to an increase in both negative and positive aspects of well-being. For example, although becoming a parent may lead to an increase in worry and distress, most parents also report that caring for children adds meaning and pleasure to life (Umberson & Gove, 1989). Similarly, being a caregiver for a disabled member of the family may be distressing, but at the same time, caregiving may offer an opportunity to experience increased purpose in life and personal growth (Kramer, 1997).

Ryff and her colleagues (Ryff, 1989; Ryff; 1995; Ryff & Essex, 1991; Ryff & Keyes, 1995) have used adult development theory to guide the creation and validation of new measures of six dis- tinct positive dimensions of adult psychological well-being and development: autonomy, environmental mastery, purpose in life, personal growth, personal relations with others, and self-acceptance. Use of these measures now provides an expanded opportunity to explore the consequences of caregiving on positive psychological wellness, as well as psychological distress.

giving, take on more responsibility for intense personal care, and elicit less additional support from others than do men (Horowitz, 1985). Women also are socialized to place a higher salience on role identities related to interpersonal relationships than men are (Chodorow, 1978; Gilligan, 1982; Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Kessler & McLeod, 1984; Miller, 1990). This gendered social- ization may make women more vulnerable to distress associated with the conflict that arises from trying to cany out activities associated with identifying as a caregiver in conjunction with identifying as an employee.

The relationship of caregiver to care recipient also has emerged as another important moderator of the association between caregiving and well- being. For example, spousal caregivers appear to be more strongly impacted by caregiving than filial caregivers (Biegel et al., 1991; George & Gwyther, 1986; Young & Kahana, 1989). However, coresi- dence and its typical association with additional caregiver burden may help account for this difference.

The Well-Being Consequences of Caregiving

A voluminous multidisciplinary literature has studied family caregiving and its consequences for caregivers during the last few decades. (See Biegel, Sales, & Schulz, 1991; Chappell, 1990; Given & Given, 1991; Horowitz, 1985, for useful reviews.) Overall, a sizable body of research now suggests that caregiving is associated with considerable burden, depression, and, in some cases, poor health (Anthony-Bergstone, Zarit, & Gatz, 1988; Brody, & Saperstein, 1989; George & Gwyther, 1986; Lawton, Strawbridge, Wallhagen, Shema, & Kap- lan, 1997; Schulz et al., 1990). Most of this literature, however, is based on data from nonrepresentative samples that typically do not include a noncaregiver reference group, often exclude men, and generally do not take into account demographic factors (e.g., household income) that may influence results (Schulz et al., 1990).

How gender moderates the effects of caregiving has also been a prominent topic of interest in caregiving research. Overall, most studies suggest that women experience more burden and distress than men as caregivers. (See Miller & Cafasso, 1992; Montgomery, 1992; Stoller, 1992, for reviews.) The behavioral expectations associated with the caregiver role appear to be gendered. Women typically assume a higher level of involvement in care-

Blending the Caregiving Role and the Employee Role

A life course perspective on role identity suggests that the consequences of any role identity for well-being are likely to depend, in part, on how readily that role identity blends with an individ- ual's other role identities. Among midlife adults, caregiving often is done in combination with the potentially conflicting demands of paid employment (N. Marks, 1996; Seccombe, 1992; Stone et al., 1987). Employee-identity expectations and caregiver-identity expectations need not be at odds. However, if, guided by life course theory (which emphasizes the importance of taking a historical-contextual perspective on developmental processes), we consider the contemporary social organization of work in the U.S., we find that conditions of employment are still largely a historical holdover from a period when it was expected that most employees would be breadwin- ning husbands with homemaker wives handling family responsibilities. Therefore, most contemporary work environments are not organized to facilitate employees' fulfillment of family responsibilities (Glass & Estes, 1997). Given our current cultural context, we might expect that assuming the caregiving role for an employee would be associated with an exacerbation of work-family conflict.

954 Journal of Marriage and the Family

If contemporary caregiving does contribute to greater work-family conflict among caregivers and if work-family conflict is also associated with poorer well-being, then we might hypothesize that one mediator of the negative effects of caregiving is work-family conflict. A large proportion of caregivers for disabled and frail family members and friends is, in fact, employed (N. Marks, 1996; Stone et al., 1987). Caregivers report a number of ways in which caregiving and work roles interfere with each other (Gottlieb, Kelloway, & Fraboni, 1994; Scharlach & Boyd, 1989; Stone et al., 1987). However, there is only limited evidence of whether caregivers truly have more negative work- to-family spillover and more negative family-to- work spillover than those who are not caregivers and whether this helps account for the negative effects of caregiving on well-being.

Gerstel and Gallagher (1993) studied 179 married women and 94 of their husbands from a North- eastern city. They found that, among these respondents, providing help to a larger number of kin was associated with greater psychological distress and that work-family conflict accounted for a portion of this effect among employed respondents. Further, their results also suggested that gender did not affect this. However, this analysis must be consid- ered cautiously. It included husbands and wives from the same couples; therefore, men and women were not independent cases in these analyses.

Spitze, Logan, Joseph, and Lee's (1994) study using data from a representative sample of midlife men and women (aged 40-65, n = 763) in their 1988 survey of upstate New York residents consid- ered the issue of multiple roles. Their goal was to examine how different roles (spouse, parent of a minor coresident child, parent of an adult coresident child, helper to parents, helper to adult children) and their interactions with each other affected psychological well-being (burden, distress, life satis- faction). The results of their analyses suggested that the number of hours of help provided to parents was not associated with a difference in well-being among women. Among men, more help to parents was associated with more distress. Combining employment with help to parents somewhat buffered the association of help to parents with distress for men-suggesting that adding the employee role to the caregiver role did not tend to lead to problematic conflict for men. There was no significant interaction effect for this combination of roles for women, and this also suggested that combining employment with helping a parent was not a major problem for women's well-being.

Note, however, that the contrast in Spitze et al.'s study (1994) is work role and caregiver role versus caregiver role only. Considering the potential for isolation in the caregiver role, this finding might be expected. This is different from a consideration of the work role and the caregiver role versus only the work role (the focus of my study). Additionally, although Spitze et al.'s study represents an important contribution to the literature, caution must be used in generalizing its results to all caregivers because the measure of caregiving was based on hours of help provided. No constraint was made on the parent's condition that led to such help. (That is, there is not a specification that disability led to the help. Providing help might have occurred in a reciprocal exchange of help between two generations of healthy adults.) Also, only help to parents and adult children (also likely to be healthy) was con- sidered. This study did not consider caregiving for a disabled child, spouse, or other kin and nonkin.

In sum, this research addresses several gaps in the caregiving literature. It utilizes a large sample that included both caregiving and noncaregiving women and men. It provides contrasts among caregivers to disabled children, caregivers to spouses, caregivers to parents in the household, caregivers to parents out of the household, caregivers to other kin and nonkin, and noncaregivers. It examines an expansive array of positive and negative dimensions of well-being. It evaluates differences in work-to-family negative spillover and family-to- work negative spillover between caregivers and those who are not caregivers. It systematically examines whether work-family conflict helps account for the negative effects of caregiving on well-being among employed, midlife adults.

Guided by life course role-identity theory and the existing empirical literature, this study investi- gates the following hypotheses:

Hypothesis 1: Because the contemporary social organization of work and its definition of behavioral expectations that constitute work-role identities typically do not take into account the behavioral expectations of a caregiver-role identity, employed persons who have a caregiving role will report more work-stress spillover to family and family- stress spillover to work (i.e., work-family conflict) than employed persons who are not caregivers.


Hypothesis 2: Because the caregiver role for women includes more expectations of per- forming intensive tasks of personal care, more primacy of interpersonal relationships, and more empathic sensitivity, gender will moderate the effect of caregiving on work- family conflict such that employed women will report more work-family conflict associated with the caregiver role than employed men.

Hypothesis 3: Due to the demands of caregiving, employed persons who are in a caregiver role will evidence poorer well-being (i.e., more psychological distress, more hostility, less autonomy, less positive relations with others, less purpose in life, less self- acceptance, less environmental mastery, less personal growth, and poorer self-assessed health) than employed persons who are not caregivers.

Hypothesis 4: Because the caregiving role is gendered and the role expectation for women includes more responsibility for intense tasks of personal care than for men and because women continue to be socialized to attach greater salience to identities related to interpersonal relationships, gender will moderate the effect of caregiving, i.e., the well- being effects of caregiving will be more deleterious for women than for men.

Hypothesis 5: Differences in work-family conflict between caregivers and those who are not caregivers will help account for the negative effects of caregiving on midlife well-being.

Data

Data from the Wisconsin Longitudinal Study (WLS) were used for these analyses. The WLS is a long-term study of a random sample of 10,317 men and women who graduated from Wisconsin high schools in 1957. Survey data were collected from the original respondents or their parents in 1957, 1964, and 1975. In 1992-1993, when most respondents were 53 or 54 years old, 10,031 (97%) of the original sample of men and women were located. Computer-assisted telephone inter- views (averaging about 1 hour long) were con-

ducted by trained interviewers employed by the Letters and Science Survey Laboratory at the Uni- versity of Wisconsin-Madison. About 90% of still living respondents (n = 8,493) completed the interview. Twenty-page mailback surveys were received from 81% of telephone respondents (n = 6,875). Data from these cluestionnaires in 1992-1 993 included extensive information about health, psychological distress. positive psychological well-being, and work-family stress spillover. Although this is a longitudinal study, all the data for these analyses were obtained from respondents who completed the 1992-1993 mailback survey. The response rate is about 73% of the living respondents from the original 1957 sample. (For additional details, see Hauser et al., 1994.) The analytic sample used for this study is the subsample of respondents who mailed back questionnaires and who were employed full-time or part-time- about 80% of the women (n = 2,926) and 94% of the men (n = 2,856).

Almost all respondents are non-Hispanic White because of the composition of Wisconsin's population in 1957 and the fact that minority residents during that era were less likely to complete high school. Because the WLS respondents are all high school graduates, they represent a somewhat advantaged population group. (The overall rate of high school completion in Wisconsin in 1957 was approximately 75%.) However, they are still relatively representative of the approximately 66% of the U.S. population now in their mid-50s who are non-Hispanic White and high school graduates (Kominski & Adams, 1992).

Measures

Caregiving. Caregiving for disabled family members and friends was measured with responses to the telephone question: "Sometimes because of a physical or mental condition, illness, or disability. people have trouble taking care of themselves and require the assistance of friends or relatives. Dur- ing the last 12 months, have you, yourself, given personal care for a period of 1 month or more to a family member or friend because of a physical or mental condition, illness, or disability?" If respondents answered "yes," they were asked: "To whom did you give the most personal care'!" Interviewers also asked a series of additional follow-up ques- tions about where the care took place and the extent of care.

Table 1 details the distribution of caregiving across men and women and the results o f t tests of

Journal of Marriage and the Family

Caregiving Type Men Women Total

(n = 2856) (n = 2926) (n = 5782)

Caregiver in home Caregiver out of home Caregiver (total)

Disabled child care in home Disabled child care out of home Disabled child care (total) Spousal care in home Spousal care out of home Spousal care (total) Parent care in homea Parent care out of home" Parent care (total)" Other care in homeb Other care out of homeb Other care ( t ~ t a l ) ~

Note: Some totals do not add up due to rounding error. Tarent care includes care for stepparents and parents-in-law. care includes care for other relatives and other

nonkin. *Significant difference ( p < .05) in proportions by gender.

bivariate-level gender differences. The caregiver (total) row indicates that about 9% of employed men and about 15% of employed women reported giving care for 1 month or more during the previous 12 months. In analyses (not shown), I com- pared the caregiving rates for the employed-only sample and the full sample in the WLS and found they were almost identical.

One in eight persons is a nontrivial proportion of the population to report this degree of participation in providing personal care. However, to put this cross-sectional estimate in a life course context, another estimate of lifetime prevalence of caregiving of this type was computed by pooling the respondents who answered "yes" to the 1-year incidence question and those who answered "yes" to a follow- up question. ("Have you ever given care for a period of 1 month or more to a family member or friend who, because of a long-term physical or mental condition, illness or disability, was not able to take care of himself or herself?') The resulting estimates indicated that the lifetime incidence of

home. Caregiving for other persons (e.g., grandpar- ents, siblings, aunts, uncles, friends) was next in prevalence. yet this type of care is usually not included in studies of caregivers. Care for others usually took place outside the home. Caregiving for spouses and children was almost always done in the home. Therefore, I constructed the following mutually exclusive categories of types of caregiving: disabled child care, spousal care, parent care (in household), parent care (out of household), and other care.

Outcomes. Psychological distress was measured with an adapted version of the 20-item Center for Epidemiological Studies Depression (CES-D) index (Radloff, 1977). Respondents were asked to rate how many days in the last week (0-7) they ex- perienced each of 20 symptoms (e.g., feel sad, feel depressed, feel bothered by things that usually don't bother you). Cronbach's alpha for this scale is .88. Table 2 provides descriptives for all additional variables.

such intense caregiving at about age 53 among Hostility was measured with a three-item index these employed adults was about one in three over- that asked respondents to indicate how many days all (32%); about one in four (24%) for men, and in the last week they felt irritable or likely to fight about two in five (39%) for women. Caregiving or argue, felt like telling someone off, and felt rates were significantly higher for women than for angry or hostile for several hours at a time. Cron- men in every case except disabled child care and bach's alpha for this index is .77. other care in the home. A standard one-item measure of self-rated

The breakdown of caregiving by type of care global health was examined. Respondents were recipient provided in Table 1 indicates that caregiv- asked: "How would you rate your health?" Five ing for parents was most prevalent-and that this response categories were provided, ranging from care took place both in the home and out of the velypoor (1) to excellent (5).

Does It Hurt to Care?

TABLE 2. DESCKIPTIVES FOK ANALYTIC VARIABLES

Variable

Men Women M M Cronbach's Alpha

(SD) (SD) (Number of Items)

Outcomes Psychological distress and health

Psychological distress (CES-D) 18.0 20.3% .88 (12.9) (15.2) (20)

Hostility 1.7 1.8 .77 (2.5) (2.7) (3)

Global health 4.17 4.21* NA (.6) (.6) (1)

Psychological well-being and development Autonomy 32.1% 31.2 .69

(4.9) (5.7) (7) Positive relations with others 33.0 35.3% .78

(5.4) (5.2) (7) Purpose in life 34.1 34.4% .78

(5.2) (5.7) (7) Self-acceptance 33.3 33.5 .79

(5.6) (6.2) (7) Environmental mastery 33.8 34.0* .72

(4.8) (5.1) (7) Personal growth 32.8 34.0* .76

(5.4) (5.5) (7) Mediators

Work and family conflict Family-stress spillover to work 8.8 9.0% .72

(2.7) (2.9) (4) Work-stress spillover to family 8.1* 7.6 .59

(2.4) (2.5) (3) Demographic controls

Married 87.1%* 78.3% Child < 19 years in household 20.5%* 10.8% Education (years) 14.1* 13.5

(2.5) (2.1) Household income 99592* 61011

(264758) (59830) Missing data on household income .21 .38*

*Mean for this gender group is significantly larger than the mean for the other @ < .05).

Positive psychological wellness was measured using six self-administered scales developed and validated by Ryff (1989; Ryff & Keyes, 1995). Each scale included seven items that asked respondents to "decide the extent to which each statement describes you." Respondents were given a 6-point response scale, ranging from disagree strongly to agree strongly (e.g., for autonomy: "My decisions are not usually influenced by what everyone else is doing"; for positive relations with others: "I know I can trust my friends, and they know they can trust me"; for purpose in life: "I enjoy making plans for the future and working to make them a reality"; for self-acceptance: "The past has had its ups and downs, but in general, I wouldn't want to change it"; for environmental mastery: "I am quite good at managing the many responsibilities of my daily life"; for personal growth: "I think it is important to have new expe-

riences that challenge how I think about myself and the world). Internal consistency (Cronbach's alpha) for each scale is acceptable: self-acceptance (.79), environmental mastery (.72), positive relations with others (.78), purpose in life (.78), autonomy (.69), and personal growth (.76).

~Vfediators. Two indices of work-family conflict were examined as potential mediators of the association between caregiving and well-being. Four items assessed spillover of family stress to work (e.g., "Family worries or problems distract me from my work"; Cronbach's alpha = ,721. Three items assessed spillover of work stress to family (e.g., "My job reduces the amount of time I can spend with the family"; Cronbach's alpha = .59). Items for both indices were self-rated from 1 (strongly disagree) to 5 (strongly agree).

958 Journal of Marriage and tlze Family

Demographic controls. A number of additional demographic factors associated with well-being (Ross, Mirowsky, & Goldsteen, 1990) also were controlled in all analyses: marital status, presence of a child (biological, adopted, or stepchild) under age 19 in the household, years of completed education. and household income (earnings and other income summed across all members of the household).

Analytic sequence. Ordinary least squares multiple regression models were estimated to examine the associations between caregiving and well-being, as well as between caregiving and work-family stress spillover. Gender interaction variables for each type of caregiving (e.g., gender x disabled child care) were created and included in initial analyses to examine differences between men and women in the effects of caregiving, as well as work-family stress spillover, on well-being. Because some gender interactions were found in combined-gender analyses, additional analyses of women and men separately were undertaken, and the results from these latter analyses are reported here (with significant gender interactions from combined-gender models also noted).

Caregiving and Work-Family Conflict

To evaluate Hypothesis 1 regarding the association of caregiving with work-family conflict and Hy- pothesis 2 regarding gender differences in the degree to which the caregiver role leads to work-

family conflict, I began by examining models that regressed the two measures of work-family spillover on types of caregiving, along with the additional demographic controls. The results of these models are reported in Table 3.

The estimates for the predictors of work-stress spillover to family among employed women suggested that the care of a disabled parent in the household during the last year and possibly care of a disabled child, care of a spouse, and care of a parent out of the household were associated with more work-stress spillover than employment with- out an added caregiving role. Among men, spousal care was significantly related to work-stress spillover, and a trend effect also emerged for care of a parent out of the household. Overall. these results provided partial support for Hypothesis 1. No significant gender interaction effects were found in combined gender analyses. Therefore, Hypothesis 2, that women caregivers would experience exacer- bated work-stress spillover to family due to caregiving, was not supported for this outcome.

In the case of family-stress spillover to work, there was even clearer evidence of support for Hypothesis 1. For women, in every case except other care. there was a robust association between being a caregiver and reporting more family-stress spillover. For men, this strong relationship extended to all types of caregiving. Again, only one significant gender interaction effect was observed in combined-gender models, suggesting that family- stress spillover to work is even more accentuated for men than for women who undertake the role of spousal caregiver. This result was clearly contrary to Hypothesis 2.

TABLE 3. UNSTANDARDIZED OLS REGRESSION ESTIMATES OF EFFECTS OF CAREGIVING TYPES ON WOKK AND FAMILY CONFLICT

Work-Stress Family-Stress Spillover to Family Spillover to Work

Predictor Women Men Women Men

No care for disabled - - - -

Disabled child care .62' .34 1.84*** 2.44*** Spousal care .47+b 1.06**b .89**a 1,93***a Parent care (home) .69* .59 1.89*** 1.71*** Parent care (out of horne) .32+ .43 87*** .57* Other care .10 .16 .33 .53*

Constant 6.88** 6.73** 7.98*** 7.90***

Note: Models also controlled for marital status, parental status, education, and household income. % significant gender difference 0, 5 .05) was noted in a combined gender model. b A significant gender difference (p 5

. lo ) was noted in a combined gender model. .?p 5 . lo. * p 5 .05. **p 5 .Ol. ***I> 5 ,001 (one-tailed test).


Caregiving, Work-Family Conflict, and Midlife Well-Being

To examine the associations between caregiving and well-being, p re l iminq models were estimated, regressing all of the well-being outcomes on gender, the types of caregiver roles, gender x type of caregiver role interactions, and demographic controls. The results provided evidence of a number of gender interaction effects. Therefore, all the models for women and men were exanlined separately. The results of these analyses are reported as Model 1 in Tables 4 and 5. Superscript notation indicates significant gender interactions. For each outcome, a second model was estimated, adding the measures for family-stress spillover and work-stress spillover to the equation. (See Model 2 in Tables 4-5.)

In the first model predicting psychological distress, being a caregiver for a disabled child, spouse, or a parent in or out of the home was associated with more distress for working women. This supports Hypothesis 3. In the second model when work-family stress spillover was controlled, the negative effects of parental care in or out of the

home were reduced to nonsignificance, and the effects for care of a spouse and care of a disabled child were considerably reduced. supporting Hy- pothesis 5. For men, only caregiving to a spouse was associated with more psychological distress. Contrary to Hypothesis 3, providing care to persons outside the immediate family (other care) actually was associated with less distress. Further, when family and work-stress spillover was held constant across men caregivers and noncaregivers, the negative effect of spousal care was reduced by half. and the beneficial effects associated other care even increased, supporting Hypothesis 5. Note (as evidence of mediation) that both family-stress spillover and work-stress spillover showed evidence of having independent and negative robust effects on psychological distress and on every additional well-being outcome examined here.

Only one gender interaction was found in the combined gender analysis predicting psychological distress. Women caring for a disabled child were significantly more distressed than men caring for a disabled child. This finding provided only limited support for Hypothesis 4.

TABLE 4. UNSTANDARDIZED OLS REGRESSION ESTIMATES OF EFFECTS OF CAREGIVING TYPES AND

WORK-FAMILY CONFLICT ON PSYCHOLOGICAL DISTRESS, HOSTILITY, AND HEALTH

Predictor

Psychological Distress Hostility Health

Model 1 Model 2 Model 1 Model 2 Model 1 Model 2

Wotnen No care for disabled Disabled child care Spousal care Parent care (in home) Parent care (out of home) Other care Family stress spillover Work stress spillover

Constant

K -

Men No care for disabled Disabled child care Spousal care Parent care (in home) Parent care (out of home) Other care Family stress sptllover Work 5tress spillover

Constant

R2

Note: Models also controlled for education and household income. "A significant gender difference 0, < .05) was noted in a combined gender model. bA significant gender difference ( p <

. lo) was noted in a combined gender model. lp < . lo. *p 5 .05. **p < .01. ***p < .001 (one-tailed test).

Journal of Marriage and the Family

TABLE 5. UNSTANDARDIZED OLS REGRESSION ESTIMATES OF EFFECTS OF CAREGIVING TYPES AND

WORK-FAMILY CONFLICT ON PSYCHOLOGICAL WELL-BEING AND DEVELOPMENT

Positive Autonomy Relations

Predictor Model 1 Model 2 Model 1 Model 2

Women No care for disabled Disabled child care Spousal care Parent care (home) Parent care (out of home) Other care Family stress spillover Work stress spillover

Constant

R2

Men No care for disabled Disabled child care Spousal care Parent care (home) Parent care (out of home) Other care Family stress spillover Work stress spillover

Constant 30.41*** 34.65*** 32.211:** 38.67***

R2 .01 .07 .O1 .12

Note: Models also controlled for education and household income. "A significant gender difference 0, < .05) was noted in a combined gender model. bA significant gender difference O, 5

. lo ) was noted in a combined gender model. +p 1 .lo. *p 1 .05. **p 5 .01. ***p 1.001 (one-tailed test). Table 5 continues on next page.

Women providing care to other kin and nonkin reported more hostility than women who were not providing care. A trend effect also suggested that women providing care for a disabled child may experience more hostility. When work-family conflict was controlled in Model 2, the effect for other care was considerably reduced, and the trend effect for care of a disabled child was no longer present.

Men who provided spousal care reported more hostility than men who did not provide care. Men providing out-of-home care to parents also showed evidence at a trend level of more hostility (Model 1). Controlling for work-family conflict (Model 2) reduced by about a quarter the negative effect for spousal care and eliminated the negative trend effect for nonresidential parent care. This lends more support for Hypothesis 5.

Only one significant gender interaction was observed in predicting hostility. Spousal care was associated with more hostility for men than for women. This result is contrary to Hypothesis 4.

In the case of health, for working women, caring for a disabled child and caring for a spouse were associated with poorer reported health

(Model 1; support for Hypothesis 3). But when family and work-stress spillover were controlled, the negative effect of caring for a disabled child was considerably reduced, and the negative effect of caring for a spouse was eliminated. Among employed men, the health of caregivers was not different than that of noncaregivers. Controlling for work-family conflict revealed that there may be a suppressed tendency for men who are caring for a spouse to report somewhat better health than men who are not.

Only one significant gender interaction was observed in the case of health. The effect for men's spousal caregiving was significantly less deleterious for self-reported health than the effect of women's spousal caregiving. This supports Hypothesis 4.

Table 5 shows the results of analyses of the effects of caregiving on the six Ryff measures of positive psychological wellness and development. Contrary to what Hypothesis 3 predicted, there were no differences between caregivers and noncaregivers in reports of autonomy. Neither were there gender differences in the effects of caregiving on autonomy, contrary to Hypothesis 4. When

Does It Hurt to Care?

TABLE 5-CONTINUED

Purpose Self- Environmental Personal in Life Acceptance Mastery Growth

Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2

work-family conflict factors were added to Model 2, trend effects emerged, suggesting possibly suppressed positive associations between autonomy and caregiving for a parent out of the household and other care among women and spousal care among men. This supports Hypothesis 5.

There was evidence that women who provided care to persons other than members of their nuclear family actually rated themselves higher on positive relations with others than women who did not provide this kind of care. Additionally, contrary to Hy- pothesis 3, when differences in family and work conflict were controlled in Model 2, suppressed positive associations between parental care (both in the household and out of the household) and positive relations with others were revealed.

Men giving other care also reported more positive relations with others, although a trend effect suggested that men providing spousal care might assess their quality of positive relations with others less highly than men who were not caregivers (Model 1). Again, when factors of work-family conflict were controlled (Model 2), suppressed positive effects of caring for a disabled child and

caring for a residential parent emerged, and the positive effect of other care increased, revealing more support for Hypothesis 5.

For women, caring for a disabled child was associated with less purpose in life (Model 1; limited support for Hypothesis 3). However, when work- family stress spillover was controlled (Model 2), this negative effect was eliminated, and suppressed positive associations between residential parent care and (at a trend level) other care were evident (support for Hypothesis 5).

Men giving care to others reported more purpose in life, contrary to Hypothesis 3. However, men providing spousal care reported less purpose in life than noncaregiving men, supporting Hypoth- esis 3. Yet when differences in work-family conflict were accounted for, the negative effect of spousal care was eliminated, the positive effect of other care increased, and a trend effect indicating a suppressed beneficial effect of parent care in the household emerged, supporting Hypothesis 5.

Women providing care for a disabled child reported less self-acceptance than women who did not provide such care. These results support Hy-

962 Journal of M~zrri~zge and the F~zrnily

pothesis 3. This negative effect was observed only for women and not for men, adding support for Hypothesis 4. When work-family conflict factors were controlled in Model 2, the negative effect of caring for a disabled child was eliminated, and trend effects suggesting suppressed positive effects of residential parent care and other care among men again became evident. These results provide more support for Hypothesis 5.

Women who took on the roles of caring for a disabled child and caring for a parent reported less environmental mastery. This lends support to Hypothesis 3. Consistent with the pattern observed for other outcomes, when work-family conflict was controlled, all of the significant negative effects among women disappeared. The negative effect associated with spousal care by men also exhibited a similar pattern of mediation.

Finally, caring for a disabled child was associated (at a trend level) with a lower rating of personal growth for women, but controlling for work- family conflict eliminated this negative trend effect and allowed beneficial suppressed effects for care of a nonresidential parent and other care to become evident. The role of caregiver to persons other than members of the immediate family was positively associated with reports of personal growth for men, contrary to Hypothesis 3. When Model 2 also controlled differences in work-family conflict, this positive effect increased, and an additional positive association of spousal care with personal growth was revealed.

The results of this complex analysis of midlife caregiving and well-being suggest a number of intriguing conclusions. First, it is notable that about one in eight employed, midlife adults indicated that they had given personal care for 1 month or more to a disabled or frail relative or friend during the last year and that, overall, one in three by age 53-54 had provided this type of care at some point in the past. We may need to get beyond the myth that at any point in time the majority of rmdlife adults are sandwiched between intense caregiving to very young children and older parents (Loomis & Booth 1995; Rosenthal, Martin-Matthews, & Matthews, 1996; Spitz & Logan, 1990). However, we should not replace this myth with an unwarranted under- estimation of the incidence of various types of caregiving during middle adulthood or with reduced attention to the variety of competing role demands and their consequences that midlife caregivers typi-

cally face. The rates of caregiving reported here suggest that the caregiver role, indeed, is an important life course role (along with the roles of marital partner, employee, and parent) to consider when evaluating the influence of adult roles on well-being and development for men and women.

Second, a global assessment of the caregiving role as deleterious for well-being was not substan- tiated here. The third hypothesis that caregiving would be uniformly associated with negative effects on well-being was only partially supported. The results of Model 1 estimated across all nine outcomes, which included 45 caregiver-role-by- outcome associations (all of which would have been expected to be significant and negative, given the "stressor" view of caregiving), yielded only 11 cases in which women caregivers evidenced clearly worse well-being than women who were not caregivers. Consistent with previous literature that has emphasized psychological distress associated with caregiving, I found that caregiving was associated with more psychological distress for women who were caring for a disabled child, spouse, or parent in or out of the household. Other care was also associated with more hostility for women. Care for a disabled child and spousal care were associated with poorer health for women.

Yet few negative effects of caregiving on positive dimensions of psychological wellness were found. Women caregivers for a disabled child evidenced less purpose in life, less self-acceptance, and less environmental mastery. Caring for a parent out of the household also was associated with poorer ratings of environmental mastery for women. In all other cases, caregiving women were no different in psychological wellness and health than women who were not caregivers.

Among men, only spousal care was associated with negative effects on well-being. Men who provided care to spouses reported more psychological distress, more hostility, less purpose in life, and less environmental mastery than men who did not provide care. However, in the majority of cases, the caregiver role was not associated with well-being that was different from the well-being of noncaregivers. In fact, contrary to the third hypothesis of negative effects due to caregiving, a few positive effects of the caregiver role for men emerged in the initial evaluation of associations between caregiving and well-being (Model 1). Assuming the caregiver role for someone other than an immediate family member was associated with less psychological distress, more positive relations with others, more purpose in life, and more personal growth for men.


It is likely that providing other care is more vol- untary and less intense than providing care to a disabled child, spouse, or parent. This may account for some of these more positive associations. It is also possible that some reverse causality may be taking place here-men with better well-being may be more likely to take on the role of caregiver for a kinsperson or friend than men with poorer well-being. Interpretation must remain speculative because this type of caregiving has seldom been studied. Nonetheless, in the future when the pool of immediate family members available for care dwindles and when caregiving may need to be shared more frequently in a network (Cantor, 1979, 1991; Penrod, Kane, Kane, & Finch, 1995), caregiving for other kin and nonkin may be expected to increase. Therefore, it is promising to consider that, rather than being a detriment to men's well- being, assuming this type of caregiver role may actually offer a buffer from distress and an opportunity to feel better about relations with others, purpose, and personal growth.

Do women caregivers suffer more serious consequences than men caregivers, as predicted by Hypothesis 4 ? The results of this analysis suggest that overall the answer to this question is no. Only four significant (p < .05) gender interactions were noted here. Women caregivers for a disabled child reported more psychological distress and less self- acceptance than men caregivers for a disabled child. Women's levels of psychological distress did not benefit from caring for other members of their family and friends as much as men's did. Contrary to the hypothesis of more negative effects for women than for men, men who provided spousal care reported significantly more hostility than women providing spousal care.

Is the caregiver role associated with more work-family conflict than not being a caregiver, as predicted by Hypothesis l ? These results suggest that the answer to this question is yes, especially for perceived family-stress spillover to work but also for work-stress spillover to family.

Is the caregiver role associated with even more work-fanlily conflict for women caregivers than for men caregivers, as suggested by Hypothesis 2? No, in the majority of cases the caregiver role does not appear to be associated with more work-family conflict for women than for men. In fact, the only clear gender difference was contrary to hypothesis. Men who were spousal caregivers reported more work-family conflict than women who were spousal caregivers.

Do work-family conflict differences between caregivers and noncaregivers help account for the negative effects of caregiving, as predicted by Hy- pothesis 5? Yes, when work-family conflict is held constant across caregivers and noncaregivers, in only five cases do significant negative associations remain: more distress for both women and men caregiving for a spouse, more hostility for men caring for a spouse, more distress and poorer health for women caring for a disabled child. Still, even in these cases, the negative effects of caregiving are attenuated by controlling differences in work-fanlily conflict.

In every other case, the negative effects of caregiving are eliminated once an adjustment is made for work-family conflict. Remarkably, when levels of work-family conflict are held constant across caregiving and noncaregiving employed adults, some unexpected and beneficial suppressed effects of caregiving on well-being become evident. Specifically, among women, more positive relations with others and more purpose in life are reported by those who care for parents in the home. More positive relations with others and more personal growth are reported by women who care for parents out of the home, in contrast to women who do not provide such care. More personal growth is reported by women and men who provide care for other members of the family and friends than is reported by their noncaregiving peers. Among men, after adjusting for work-family conflict, providing care for a disabled child is associated with more positive relations with others. Additionally, for men, providing spousal care is associated with more personal growth and providing care for a parent in the household is associated with more positive relations with others. Finally, Inen who provide care for a friend or kinsperson outside the nuclear family report less psychological distress, more positive relations with others, more purpose in life, and more personal growth than men who do not provide any caregiving to others.

This study, like other cross-sectional investiga- tions, cannot be definitive in its inferences of causality. In some cases it is plausible that differences in well-being have influenced selection into the caregiver role. This is less likely in the cases of caring for a disabled child and caring for a spouse, situations in which there is no choice about assuming the role of caregiver. Also, in most cases of care for a parent, choice is limited. Reverse causality is more likely in some cases of providing care to other members of the family or friends.

964 Journal of Marriage and the Family

Further, although this study did specify that personal care must have been provided to a disabled family member or friend for 1 month or more in the past year (a relatively stringent definition of caregiving), it did not delineate differences in the intensity of the caregiver role, which have been shown to contribute to differences in work-family conflict (Gottlieb et al., 1994). Neither was an indi- cator of primary caregiver or secondary caregiver available to factor into this analysis.

Because this study utilized a relatively well- educated, non-Hispanic White, regionally based, age-specific, and birth-cohort-specific sample, it is important to replicate these findings in samples of less-educated adults, other ethnic groups, other age groups, different birth cohorts, and different locales before generalizing too broadly from these results. A life course perspective, indeed, suggests that the midlife developmental period that this study's respondents represent and their particular historical, cultural, and regional niche might influence the profile of findings. The caregiving experiences of persons of a different age (older or younger) might be different.

Nonetheless, these results suggest that it does not always hurt to care. Certainly, caregiving for immediate family members is associated with more psychological distress for employed midlife women. Additionally, caring for a disabled child is associated with less physical and psychological wellness for women. However, if steps were taken to make work-family conflict less problematic for employed caregiving women, women caregivers would evidence considerably less distress than they currently do, and some additional psychological benefits of the caregiver role would emerge more clearly.

Similarly, employed midlife men who are providing care for a disabled spouse are at risk for poorer psychological well-being. However, if the increased work-family conflict currently associated with caregiving for these men were eliminated, the negative effects of spousal care would be considerably attenuated, and the positive effect that providing spousal care has on the experience of personal growth would become more evident.

A life course role-identity perspective suggests that social change and social interventions have the potential to modify the pattern of results presented here. Addressing ways to ameliorate work-family conflict among caregiving men and women is critical for reducing the drawbacks of caregiving and for increasing the benefits. Undoubtedly, more research is required to determine exactly what types

of social policies might contribute to the ameliora- tion of the work-family conflict associated with caregiving. Some obvious examples of changes in the organization of work and social welfare that might help include more flexible time schedules, more availability of quality part-time work, sick leave and family leave allowed for family care, more information pertinent to caregiving, and additional day programs and services for disabled older persons and other family members (Glass & Estes, 1997; Neal, Chapman, Ingersoll-Dayton, & Emlen, 1993; Seccombe, 1992). Restructuring social insti- tutions, particularly workplaces and caregiver support services, to socially reconstruct and remake (Stryker, 1980) the behavioral expectations of the employee role identity to become more congruent with the behavioral expectations of the caregiver role identity is critical to ensuring and enhancing adult well-being and development.

Support for this research was provided by the John D. and Catherine T. MacArthur Foundation Research Net- work on Successful Midlife Development and a FIRST Grant Award from the National Institute on Aging (AG12731). The Wisconsin Longitudinal Study has been supported principally by the National Institute on Aging (AG9775), with additional support from the Na- tional Science Foundation (SES-9023082), the John D. and Catherine T. MacArthur Foundation, the Spencer Foundation, and the Graduate School of the University of Wisconsin-Madison.

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