Revisiting the caregiver stress process: Does family caregiving really lead to worse mental health outcomes?

Abstract

While the act of caregiving is often characterized as a stressful experience detrimental to mental health, recent studies are challenging this view by reporting robust health and well-being benefits linked to family caregiving. The current study attempted to provide an explanation of this apparent paradox by focusing on the role played by family health problems in the association between being a caregiver and mental health. Framed within the life course perspective and focusing on caregiving provided to aging mothers, the current study aimed 1) to demonstrate how the linkage between caregiving and depression reported in earlier studies may be misleading and 2) to further investigate whether caregiving to an aging mother may lead to any mental health benefits. Using longitudinal data drawn from the nationally representative US Health and Retirement Study, I follow adult children 50 and older who had a living mother during the observation period (N = 4812; 18,442 person-wave observations). A series of within-between random effects models were estimated to explicate how health conditions of aging mothers (i.e., disability and dementia) and caregiving transitions of adult children were associated with changes in depressive symptoms of adult children. Findings demonstrated that caregiving transitions were unrelated to depressive symptoms among adult children once the model controlled for the confounding effects of having their mother experience disability and dementia. Further, caregiving behavior was found to buffer the direct detrimental effect of maternal disability on adult children's depressive symptoms. This study adds to the growing body of research that cautions against characterizing caregiving as a chronic stressor detrimental to mental health and further echoes earlier calls for a more balanced portrayal of caregiving in policy reports and research literature.

Keywords: Caregiver role; Chronic stress paradigm; Constrained agency; Health and Retirement Study; Linked lives; Stress process model.

Figure 1.

An illustrative representation of health trajectories of individuals in the same family system. Figure 1A demonstrates family effect, where health deterioration (accompanied by disability and dementia) and the ensuing loss of independence of Family Member A (light gray line) is followed by worsening depression of Family Member B (black line). Note that the family effect is theorized to occur independently of Family Member B’s caregiver status. Figure 1B represents potential caregiving effects (denoted with dashed lines), where the act of caregiving is theorized to either alleviate or worsen the family effect.

Figure 2.

Graphical representation of within-person estimates from Model 1 (left; see Table 2) and Model 4 (right; see Table 3). Earlier studies often compared individuals who provided help and assistance to family members with health limitations to their non-caregiving counterparts whose family members were likely in good health (an approach similar to taking a comparison between A1 and A2 or between B1 and B2), often leading to the conclusion that caregiving behavior worsens mental health for the caregiver. However, when the effect of caregiving is properly estimated in the context of having a family member with care needs caused by serious health conditions (assessed as moderate disability in the figure; comparisons between B1* and B2), potential mental health benefits associated with caregiving may be observed.