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a University of Pennsylvania School of Medicine, Philadelphia
b Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio
c Department of Psychology, Kent State University, Ohio
Correspondence: Tracela M. White, PhD, University of Pennsylvania Department of Psychiatry, Section on Geriatric Psychiatry, 3600 Market Street, Room 759, Philadelphia, PA 19104. E-mail: tmwhite{at}mail.med.upenn.edu.
Vernon L. Greene, PhD
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Abstract |
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Key Words: Caregiver • Race • Depression • Stress • Women
By the year 2050, it is estimated that the number of African Americans aged 65 and over will more than triple and their proportion of the total elderly population will increase from 8% to 10% (
U.S. Bureau of the Census 1996
). Because African American elders frequently rely on their children for assistance with physical and psychological needs (see review by
Wykle and Kaskel 1991), the changing demographics among the aging population have significant implications for the number of African American adult children (especially daughters) who will assume the caregiving role. Yet, research on family care to elderly relatives historically has focused on samples exclusively or predominately composed of White caregivers. As a result, little is known about the caregiving experiences of African American families.
The studies of African American caregivers that have begun to appear indicate that there may be differences in the psychological well-being and experiences of family caregivers by race. The purpose of the present study is to extend knowledge about potential differences in well-being and caregiving experiences between African American and White daughters and daughters-in-law who are providing care for an impaired parent or parent-in-law. The study investigates caregivers' depressive symptomatology, parent care stress and rewards, parent care mastery, and the quality of their relationship with the impaired relative.
Prior research has shown that there is a relationship between providing care for an impaired elderly relative and depressive symptomatology. For instance, caregivers have been found to report significantly higher levels of depressive symptomatology than noncaregivers (
Dura, Stukenberg, and Kiecolt-Glaser 1991;
Haley, Levine, Brown, Berry, and Hughes 1987;
Schulz, Tompkins, and Rau 1988). In addition, much of the research comparing the effects of caregiving on African American and White caregivers' depressive symptomatology has found that African American caregivers report lower symptomatology than White caregivers (
Haley et al. 1995;
Lawton, Rajagopal, Brody, and Kleban 1992;
Miller, Campbell, Farran, Kaufman, and Davis 1995;
Mintzer and Macera 1992). However, a study by
Young and Kahana 1995 suggests that controlling for caregiving context variables—such as the age of the caregiver, impairment of the care recipient, and hours spent providing care—eliminates differences in depressive symptomatology between White and African American caregivers.
Although depression is the most commonly studied outcome in the caregiving literature, considerable research also has examined the impact of providing care on caregivers' subjective stress. Many studies have found that providing care for an aging relative can be stressful (
Lawton, Moss, Kleban, Glicksman, and Rovine 1991;
Townsend, Noelker, Deimling, and Bass 1989;
Zarit, Reever, and Bach-Peterson 1980). Most research that focuses on African American caregivers suggests that levels of caregiving stress may vary by race (
Aranda and Knight 1997). For instance, African American caregivers report, on average, less subjective burden, lower levels of caregiver role strain, and less sense of intrusion on their lives from caregiving responsibilities than White caregivers (
Hinrichsen and Ramirez 1992;
Lawton et al. 1992;
Macera et al. 1992;
Miller et al. 1995;
Mui 1992). Alternatively, three studies found no difference in stress or burden between African American and White caregivers (
Cox 1993;
Morycz, Malloy, Bozich, and Martz 1987;
Wood and Parham 1990).
Fewer studies recognize the potential benefits or rewards of the caregiving role than those that focus on the stresses associated with caregiving (
Stephens and Townsend 1997). Only two studies are known to have investigated the relationship between race and caregiving rewards. One is a study by
Lawton and colleagues 1992, which revealed that African American caregivers expressed greater caregiving satisfaction (e.g., benefits from caregiving) than White caregivers did. The second study (
Picot, Debanne, Namazi, and Wykle 1997) also found that race was significantly related to perceived rewards, with African American caregivers reporting higher levels of rewards than White caregivers.
A growing interest in caregivers' sense of mastery is accruing. Global measures as well as role-specific measures of mastery have been used in the caregiving literature. Global measures of mastery assess individuals' feelings of control over forces affecting their lives generally (
Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch 1995). Role-specific caregiving mastery has been defined as caregivers' beliefs in their ability to influence or control care-related events or to manage these events in a competent or effective manner (
Lawton et al. 1992;
Pearlin, Mullan, Semple, and Skaff 1990). Research utilizing primarily White samples has consistently shown that greater caregiving mastery is significantly related to better psychological well-being of caregivers (
Coppel, Burton, Becker, and Fiore 1985;
Haley, Bartolucci, Levine, and Brown 1987;
Pagel, Becker, and Coppel 1985). Two studies are known to have examined the relationship between race and mastery. One concluded that African American caregivers espouse a greater sense of role-specific mastery in caregiving than White caregivers (
Lawton et al. 1992). The other study found no significant difference in African American and White caregivers' global sense of mastery or in their role-specific caregiving mastery (
Miller et al. 1995).
The quality of family relationships has been a relatively neglected topic in the caregiving literature, although the detrimental influence of negative ties and the beneficial influence of positive ties in the caregiving relationship have become increasingly evident with samples composed exclusively or primarily of White caregivers (
Creasey, Myers, Epperson, and Taylor 1990;
Fiore, Becker, and Coppel 1983;
Townsend and Franks 1995). To our knowledge, no study has investigated the association between caregivers' race and the quality of their relationship with care recipients. However, one study (
Mui 1992) has explored race as a moderator of the association between the quality of the caregiving relationship and caregivers' role strain. In that study, White daughters reported more caregiving role strain when their relationship with the impaired parent was poor, but the quality of the parent–daughter relationship was not a significant predictor of caregiving role strain for African American daughters.
A variety of explanations have been offered to explain why caregiving experiences differ by race. Some authors (e.g.,
Dilworth-Anderson and Anderson 1994;
Haley et al. 1996) suggest that racial and ethnic differences in values and beliefs about aging may account for the observed differences. Differences in role expectations and attitudes about providing care and filial support may also account for variations in caregiving experiences (
Cox 1993;
Haley et al. 1996;
Lawton et al. 1992). Another possible explanation is racial/ethnic differences in religiosity or coping mechanisms that may moderate caregiving experiences (e.g.,
Aranda and Knight 1997;
Picot et al. 1997;
Segall and Wykle 1988).
In addition to contributing to the literature on African American caregivers, the present study extends previous research on race and caregiving in six important ways. First, the sample of caregivers is homogeneous with respect to kin relationship, composed solely of daughters and daughters-in-law (both referred to hereafter as daughters). In prior research, a variety of kin and even non-kin relationships have been included. The present study chose to focus on a homogeneous sample of caregivers because previous research has shown that caregiving outcomes differ between adult children and spouses (
George and Gwyther 1986;
Macera et al. 1992;
Wood and Parham 1990), and such variation may confound differences between race and kin relationship. Second, the research design also required that participants occupy three roles (mother, wife, and employee) in addition to that of primary caregiver. The relationship between multiple roles and caregiving experiences has not been taken into account in previous research on African American and White caregivers. Third, the present study focuses on positive aspects (rewards) as well as negative aspects (stresses) of caregiving. Prior research has devoted much more attention to stresses than rewards. Fourth, the experience of caregivers who provide care for an aging parent or parent-in-law (both referred to hereafter as parent) with various forms of impairment is examined. Most prior research has focused on the experiences of African American and White family members who provide care to relatives with Alzheimer's disease or some other form of dementia (e.g.,
Haley et al. 1996;
Hinrichsen and Ramirez 1992;
Lawton et al. 1992). Therefore, the results of such studies may not be generalizable to family members with other forms of impairment (
Ory, Hoffman, Yee, Tennstedt, and Schulz 1999). Fifth, the present research focuses on a broader range of constructs than prior studies, including two constructs (role-specific caregiving mastery and quality of the relationship with the care recipient) that have received particularly limited attention in previous literature on race and caregiving. For relationship quality, both positive and negative dimensions were assessed, using multiple indicators, whereas prior research (
Mui 1992) used a single bipolar indicator. Lastly, the present analyses employed multivariate techniques that take into account the interrelationships among caregiving experiences. Prior research has typically investigated each construct (e.g., stress) separately.
The present study hypothesized that African American women would report fewer symptoms of depression, less stress related to parent care, more rewards from parent care, a greater sense of mastery in the parent care role, and a more positive relationship with their impaired parent than White women would report. In order to further investigate experiences in the parent care role, parent care centrality (i.e., the importance of the caregiving role to the participant) was also included. Role centrality reflects the degree to which a role functions as a source of identity, meaning, or behavioral guidance (
Gurin, Veroff, and Feld 1960;
Stryker and Serpe 1994;
Thoits 1992). Although centrality has received a fair amount of attention in the literature investigating such social roles as employee and mother, the relationship between role centrality and caregiving to an impaired parent is limited (
Martire, Stephens, and Townsend 1998). No a priori hypothesis was made about parent care centrality because no known research has investigated the relationship between race and caregiver role centrality.
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Methods |
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). To be eligible for the study, women were required to occupy four roles when the study began: primary caregiver to an impaired parent or parent-in-law; wife; mother to at least one child living at home; and employee. In order to participate, women must have occupied each of these four roles for at least 2 months prior to the interview.
Primary caregiver was defined as the person who spends the most time assisting the parent with at least one personal activity of daily living (PADL; e.g., eating) or instrumental activity of daily living (IADL; e.g., transportation) or with supervision. No restriction was placed on the underlying cause of the parent's need for assistance. Each participant had to be providing care to a parent who was living in the community, but who was not sharing a household with the participant. Restriction of the sample to participants who initially did not share a residence with the parent was based on research indicating differences in well-being between adult-child caregivers who live with the impaired parent and those who do not (e.g.,
Deimling, Bass, Townsend, and Noelker 1989).
Additionally, participants in the study had to be married and living with their spouse and had to have at least one child who was 25 years of age or younger (and no child over 25) living at home. The upper age limit of 25 was selected in order to account for an increasing tendency for young adults to remain at home for longer periods of time (
U.S. Bureau of the Census 1992). Finally, participants had to be employed either full time or part time.
Recruitment was conducted in northeastern Ohio and in two Pennsylvania counties bordering Ohio, through newspaper articles, radio and newspaper advertisements, brochures and posters, and notices published in newsletters for businesses and social organizations. Special efforts (e.g., contacts with African American women's organizations, announcements in minority-oriented media) were made to recruit African American women in proportion to their representation (13%) in the recruiting area (
U.S. Bureau of the Census 1992). Potential participants volunteered for the study by calling a toll-free number or returning a postage-paid card to the project office. Women who were eligible to participate in the study were interviewed in-person in their home or other preferred location. Interviews averaged one-and-a-half hours.
Sample
A total of 949 women were screened for eligibility. Of those women, 317 (34%) met the eligibility criteria and were willing to participate. Not providing care to a parent (22%), not being the primary caregiver (15%), and having children over the age of 25 or no children living at home (16%) were the three most common reasons for ineligibility. Because information about race was not obtained for women who were ineligible to participate, no data are available to compare the eligibility rates for African American and White women. The final sample (N = 317) consisted of 261 White women (82%) and 56 African American women (18%).
Measures
Although the larger study collected data about each of the four roles (parent care, mother, wife, and employee), the present study will focus solely on the parent care role. Descriptive data and bivariate correlations for study measures are presented in Table 1 .
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). This scale consists of 20 items that assess how frequently individuals experienced depressive symptoms or feelings during the past week (
= .90 for both African American and White participants). Total scores can range from 0 to 60, higher scores indicating greater symptomatology, and scores of 16 or above indicate a risk for clinically significant levels of depression. The CES–D has been widely used in prior studies on caregiver well-being (see review by
Schulz, O'Brien, Bookwala, and Fleissner 1995). On average, the sample reported a moderate level of depressive symptoms (Table 1 ). Approximately one third (30%) of the total sample scored at or above 16.
Parent Care Stress.
Fifteen items assessed stress in the parent care role in the past two months (
Stephens and Townsend 1997). These items were adapted from previous caregiving stress research (
Albert 1991; Kinney & Stephens, 1989a;
Vitaliano, Russo, Young, Becker, and Maiuro 1991;
Zarit and Zarit 1983). Participants were asked to rate each item (e.g., "Dealing with [your] parent's memory problems") using a response scale ranging from 1 "not at all stressful" to 4 "very much stressful." Participants were instructed to indicate any item that was not applicable. Parent care stress was operationalized by summing the ratings across all 15 items and dividing by the number of items that were endorsed as applicable ( = .81 for African American participants and = .80 for White participants). The potential range for parent care stress is 1 to 4, with higher scores indicating greater stress.
Parent Care Rewards.
A 6-item scale ( = .84 for African American participants and = .81 for White participants) was used to assess rewards in the parent care role in the past 2 months (
Stephens and Townsend 1997). Participants evaluated each item (e.g., "How rewarding has it been doing things to help your [parent]") using response categories from 1 "not at all" to 4 "very much." Scores were calculated in the same manner as parent care stress (i.e., summing the ratings and dividing by the number of items that were endorsed as applicable). The potential range for rewards also is 1 to 4, with higher scores indicating greater rewards.
Parent Care Mastery.
A 7-item scale ( = .62 for African American participants and = .68 for White participants) was used to assess mastery in the parent care role in the past 2 months (
Christensen, Stephens, and Townsend 1998). These items (e.g., "To what extent do you agree or disagree that you are usually certain about what to do in caring for your parent?") were developed based on previous research on global and caregiving mastery, self-efficacy, or control (e.g.,
Bandura 1977;
Lawton, Kleban, Moss, Rovine, and Glicksman 1989;
Pearlin, Lieberman, Menaghan, and Mullan 1981;
Rotter 1966). Participants evaluated each item using response categories from 1 "strongly disagree" to 5 "strongly agree." The scores were summed for a possible range from 7 to 35; higher scores are indicative of greater mastery.
Quality of the Relationship With the Impaired Parent.
Both positive qualities (i.e., emotional support) and negative qualities (i.e., emotional undermining) were assessed (
Martire et al. 1998). Five items measured the frequency with which emotional support was received from the parent (e.g., "How often did your [parent] listen carefully to your concerns?") during the past 2 months ( = .77 for African American participants and = .85 for White participants). These items were based on previous research on positive caregiving interactions (e.g., Kinney & Stephens, 1989a;
Lawton et al. 1989). The response scale ranged from 1 "rarely or none of the time" to 4 "most of the time." Scores were summed for a possible range from 5 to 20; higher scores are indicative of greater emotional support. Emotional undermining from the parent was defined as negative evaluation, negative affect, or conflict (
Vinokur and Vinokur-Kaplan 1990). Six items were used to assess the frequency with which the parent reportedly engaged in emotional undermining (e.g., "How often did your [parent] criticize you?") in the past 2 months ( = .87 for African American participants and = .81 for White participants). These items were based on previous research on negative caregiving interactions (e.g., Kinney & Stephens, 1989a;
Lawton et al. 1989;
Townsend and Franks 1995). Emotional undermining scores (possible range from 6 to 24) were calculated in the same manner as emotional support scores, higher scores indicating greater emotional undermining.
Parent Care Centrality.
This construct was assessed by a single item ("How important to you is being a caregiver to your [parent]?"). Scores could range from 1 "not at all important" to 10 "very important."
Covariates.
Prior to examining the study hypotheses, a total of 34 background characteristics were considered as potential covariates, drawn from four domains: caregivers' optimism, demographic characteristics of caregivers and their families, demographic characteristics and impairment of the care recipient, and characteristics of the caregiving situation. The selection of potential covariates was based on previous research on predictors of caregiver well-being and stress. Optimism was included in order to assess women's role experiences net of their generalized expectancies for positive or negative outcomes in life (
Stephens and Townsend 1997). Optimism was assessed using the Life Orientation Test (LOT;
Scheier and Carver 1992). Higher scores are indicative of greater optimism.
Demographic characteristics of the participants included age (in years), kin relationship (0 = daughters-in-law, 1 = daughters), physical health (a 3-item index ranging from 3 = poorer health to 15 = better health), years of education, years married, hours worked per week, weeks worked in the past year, the participant's income (1 = less than $5,000 to 10 = $80,000 and over), and household income (same categories).
Children's characteristics included the number of children at home, age of the youngest child at home (in years), and an index assessing the number of 11 tasks with which the child(ren) at home required help. The husband's characteristics included age (in years), physical health (1 = poor to 5 = excellent), and years of education.
The characteristics of the parent included age (in years), gender (0 = male, 1 = female), number of sons and daughters, and physical health (1 = poor to 5 = excellent). Measures of the parent's impairment included a rating of an index of the frequency of six memory problems such as forgetting what day it is (6 = low to 24 = high impairment), an additive index of the frequency of five behavioral problems such as becoming angry or aggressive (5 = low to 20 = high impairment), the amount of supervision needed (1 = none of the time to 5 = most of the time), an index of the amount of help required with eight IADLs, such as transportation, meal preparation (8 = low to 24 = high impairment), and an index of the amount of help required with seven PADLs, such as bathing, toileting (7 = low to 21 = high impairment).
Characteristics of the caregiving situation included the number of years participants provided care to a parent, hours the participants assisted the parent on a typical weekday and on a typical weekend day, whether supervision of the parent was provided or arranged by the participant (0 = no, 1 = yes), the number of eight IADLs with which the participant helps, the number of seven PADLs with which the participant helps, and whether the participant receives help with caregiving (0 = no paid or unpaid help to 3 = help from family, friends/neighbors, paid agency).
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Optimism.
On average, the total sample reported experiencing a moderate level of optimism (M = 29.23, SD = 4.92, range = 14–40). There was no difference by race (for African American women, M = 30.00, SD = 4.70, range = 16–40; for White women, M = 29.08, SD = 4.96, range = 14–40).
Demographic Characteristics of Participants and Their Families.
Table 2 shows the demographic characteristics of participants and their families for the total sample as well as significant differences by race. A total of eight differences by race were significant (Table 2 ). On average, the African American women were 6 years younger, F(1,316) = 50.69, p < .01, and they were married about 8 years less, F(1,316) = 43.97, p < .01. African American women worked approximately five more hours per week, F(1,316) = 11.08, p < .01, and the amount of income that they contributed to their households was greater than the amount contributed by White women, F(1,310) = 6.75, p < .01. On average, African American women also differed from White women in that their youngest child at home was about 4 years younger, F (1,316) = 21.04, p < .01, and their children at home required help with approximately two more functional needs, F(1,316) = 11.42, p < .01. Finally, the African American women in the study had husbands who were 4 years younger, F(1,316) = 16.36, p < .01, and slightly less well educated, F(1,316) = 4.37, p < .01 than husbands of the White women.
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Multivariate Analysis
To investigate differences by race in depression, stress, rewards, mastery, emotional support, emotional undermining, and centrality, a one-way between-subjects multivariate analysis of variance (MANOVA) was performed (
Tabachnick and Fidell 1996). MANOVA was chosen because study measures were moderately intercorrelated (Table 1 ). The race of the caregiver (African American or White) was the sole predictor. Prior to MANOVA, Box's M was used to test the assumption of homogeneity of variance–covariance matrices (
Tabachnick and Fidell 1996). This test revealed no significant difference between groups, Box's M = 27.35, F(28,34501) = 0.93, p = .57. Omnibus MANOVA results indicated that the parent care experiences of African American and White women were significantly different, Wilks's Lambda = .94, F(7,309) = 3.02, p < .001, effect size = .06.
In order to determine which outcomes contributed significantly to the difference between groups, Roy-Bargmann stepdown F tests were performed (
Tabachnick and Fidell 1996). To reduce the likelihood of Type I error for the stepdown tests, the probability level was adjusted using a correction procedure recommended by
Stevens 1996: namely, a one-tailed probability level ( = .10), because of the study's directional hypotheses, was divided by the number of hypothesized differences (seven) to yield = .014 as the criterion for the statistical significance of race on each of the stepdown tests. Stepdown F tests require prioritizing the outcomes, then conducting a univariate ANOVA to test between-group differences on the first outcome, followed by an analysis of covariance (ANCOVA) for each subsequent outcome (controlling for all prior outcomes). Thus, these stepdown tests use the correlations between outcomes to control in later analyses for shared variance already accounted for in earlier analyses (
Tabachnick and Fidell 1996). For the present study, outcomes were prioritized according to the number of previous studies pertaining to differences by race, resulting in the following order: depression, stress, rewards, mastery, emotional support, emotional undermining, and centrality.
To ensure that differences attributed to race were not due to other characteristics, the stepdown tests also included background covariates, chosen from the 12 characteristics on which significant race differences were found. A background characteristic was included as a covariate in the stepdown analysis for a particular outcome if it had a significant (p 
.05) bivariate correlation with that outcome. Depressive symptomatology was correlated with the participant's individual income (r = –.16, lower income being related to higher symptomatology) and the husband's education (r = –.11, lower spouse education being related to higher caregiver symptomatology). Greater parent care stress was correlated with the caregiver providing help with a greater number of IADLs (r = .14). Parent care rewards were not significantly correlated with any of the background characteristics. Greater parent care mastery was related to the caregiver's children needing less help (r = –.13). Emotional support from the parent was not significantly related to any of the covariates. Emotional undermining from the parent was correlated with the parent's age (r = –.11, more undermining being associated with younger parents) and the number of hours spent providing care on a typical weekend day (r = –.12, more undermining being associated with fewer hours). Greater parent care centrality was associated with fewer years of marriage (r = –.11) and more hours spent providing care on a typical weekend day (r = .14).
As shown in Table 5 , the stepdown F tests revealed a significant difference by race (p .014) on two of the seven study outcomes. As hypothesized, African American women reported not only a lower level of stress than White women did but also a higher level of rewards in the parent care role. The adjusted means (Table 5 ) and the effect sizes (
Cohen 1988) for stress (f = .15, 
2 = .02) and rewards (f = .17, 2 = .03) indicated that these differences by race were of small magnitude. Albeit small, these differences by race are notable, because they were statistically significant even after controlling for depression and IADL assistance in the case of parent care stress and even after controlling for depression and stress in the case of parent care rewards.
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). A quarter (25%) of the African American caregivers and a third (33%) of the White caregivers scored above this cutoff. Although in the direction predicted by prior research, the difference was not statistically significant, 
2(1) = 1.74, p = .19. Similarly, no significant difference by race was found for parent care mastery, emotional support, or emotional undermining from the parent, or parent care centrality. Each of these measures did show significant relationships with one or more of the other outcomes under consideration, however. Thus, caregiving experiences were substantially interrelated, but only stress and rewards varied by race.
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Discussion |
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;
Lawton et al. 1992;
Macera et al. 1992;
Miller et al. 1995;
Mui 1992). Both the present study and these previous studies found significant differences by race in caregiving stress even after controlling for a variety of background characteristics. Only three prior studies (
Cox 1993;
Morycz et al. 1987;
Wood and Parham 1990) have not found a difference by race. Thus, differences between African American and White caregivers in caregiving stress appear to be robust.
The present study also found that African American women reported a higher level of parent care rewards than White women did. This is consistent with prior studies (
Lawton et al. 1992;
Picot et al. 1997). However, in the present study, the analysis of parent care rewards controlled for depression and parent care stress. These confounding experiences have not been taken into account in previous research. It is also important to note that the higher level of rewards African American women reported receiving from caregiving did not merely reflect a more positive outlook on life generally, because there was no difference by race on optimism.
Differences in values and beliefs about aging, role expectations, and religiosity may account for why African American caregivers report less parent care stress and more parent care rewards than White caregivers do.
Dilworth-Anderson and Anderson 1994 theorize that African American caregivers tend to "normalize" the cognitive and/or behavioral problems of older adults and interpret their symptoms of impairment as an integral part of the aging process. African Americans also express more positive attitudes toward their elders, viewing aging as a source of dignity and something to be respected (
Haley et al. 1996;
Mutran 1985).
Prior research has also shown that African American caregivers are more likely than White caregivers to report that caregiving is an expected experience and that caregiving responsibilities are less of an intrusion on their lives (
Haley et al. 1996;
Lawton et al. 1992). African American families generally accept that family members should care for an aging relative (
Dilworth-Anderson and Anderson 1994;
McAdoo 1993), and being able to fulfill the caregiving role has been found to be a source of rewards for African American caregivers (
Picot 1994). For African American caregivers, prayer and faith may raise their threshold for the stresses of caregiving (
Segall and Wykle 1988;
Wheaton 1985), may act as a buffer when caregiving stresses arise, and may be associated with perceptions of caregiving rewards, such as being blessed by God for their caregiving efforts (
Picot et al. 1997).
Contrary to expectation, there was no significant difference by race for depressive symptomatology in our study, despite African American women reporting less stress and more rewards from parent care than White women reported. The present finding was surprising. With one exception (
Young and Kahana 1995), prior research has consistently shown that African American caregivers report significantly lower depressive symptomatology than White caregivers (
Haley et al. 1995;
Lawton et al. 1992;
Miller et al. 1995;
Mintzer and Macera 1992).
One possible explanation for the discrepancy between the present study and prior studies is the nature of the samples. Most of the previous studies aggregated a variety of family (and sometimes nonfamily) caregivers, whereas the present study focused on a more homogenous sample of caregivers (adult daughters and daughters-in-law). The one study that also used a homogenous sample of caregivers but found a significant difference in depression by race examined spouse caregivers (
Miller et al. 1995).
The care recipient's impairment might also account for the inconsistency in findings. All of the prior studies that found differences in depressive symptomatology sampled caregivers who were assisting care recipients suffering from some form of dementia (
Haley 1997;
Haley et al. 1996;
Hinrichsen and Ramirez 1992;
Lawton et al. 1992;
Miller et al. 1995;
Mintzer and Macera 1992). In contrast, the present study and
Young and Kahana 1995, both of which did not find a significant difference in depressive symptomatology by race, used samples that were not limited to dementia care recipients. The present study focused on care recipients with a broad range of impairment, physical and/or cognitive.
Young and Kahana 1995 focused on caregivers to persons with heart disease. Thus, differences in caregivers' depressive symptomatology by race may only occur with specific forms of impairment such as dementia or when physical and/or cognitive impairment reaches some critical threshold.
Another possible explanation for the discrepancy in findings may be that caregivers' income was a significant predictor of depressive symptomatology in our analyses. This finding is consistent with other literature linking income and depressive symptomatology (e.g.,
Eaton and Kessler 1981). It may be that earlier differences attributed to race may have been confounded with socioeconomic factors.
The present study also found no significant difference by race in parent care mastery, which was consistent with one prior study (
Miller et al. 1995) and inconsistent with another (
Lawton et al. 1992). Differences in operationalization of mastery and in care recipients' impairment are unlikely to account for the inconsistency in findings, given that the studies by
Lawton and colleagues 1992 and
Miller and associates 1995 closely resembled each other in those regards. A more plausible explanation is greater homogeneity of caregivers' kin relationship (i.e., daughters and daughters-in-law in the present study and spouses in
Miller et al. 1995). In contrast,
Lawton and colleagues 1992 aggregated a variety of caregivers (e.g., spouses, adult children, siblings), and the distributions across kinship categories differed by race.
We found no significant difference by race for emotional support or emotional undermining from the parent when controlling for factors that were related to these two measures. The association between caregivers' race and the quality of their relationship with care recipients has received limited attention in previous research. The present study also provided an exploratory analysis of the association between race and parent care centrality. To our knowledge, this is the first investigation of this topic. Parent care rewards and the number of hours spent caregiving on a typical weekend day predicted parent care centrality, but race did not.
Limitations of the Study
There are several noteworthy limitations to the present study. The results may not generalize to other ethnic groups or to women with different sociodemographic characteristics. The median income for White families in the present study was considerably higher than the national median for White married dual-earner couples (
Bennett 1995), and both the African American and White women in the present sample were substantially better educated than women nationally (
Bennett 1995). Also, the results of the present study are cross-sectional. Therefore, we do not know whether differences by race in parent care stress and rewards will persist or whether other caregiving experiences (i.e., depressive symptoms) will continue to be unrelated to race over time. The longitudinal design of our study will enable us to address these questions in future analyses. Measures that could explain why the observed differences by race occurred were not available for the present study. In order to assess caregivers' role expectations, religiosity, and attitudes about aging, it is recommended that future research make an effort to include such measures.
Strengths of the Study
Despite these limitations, the present study contributes to research on caregiving and race in several important ways. Our study controlled for caregivers' kin relationship (daughters and daughters-in-law) as a means to limit potential confounds between race and kin relationship. Although research has shown that caregiving outcomes differ between adult child and spouse caregivers (e.g.,
George and Gwyther 1986), prior studies investigating the caregiving experiences of African Americans and Whites have aggregated a variety of caregivers. Our research design also required participants to occupy three roles (mother, wife, and employee) in addition to that of primary caregiver. The relationship between multiple roles and caregiving experiences has not been taken into account in previous research on African American and White caregivers. The present study was able to control for the effect that other roles may have on the caregiving experience.
Many studies have investigated the experiences of caregivers to relatives with Alzheimer's disease or other forms of dementia (e.g.,
Haley, Clair, and Saulsberry 1992;
Lawton et al. 1992). Results from dementia samples may not be generalizable to individuals who provide care to relatives without cognitive impairment (
Ory et al. 1999). The present study extends previous research by examining the experiences of African American and White caregivers who were providing care for aging parents with various forms of impairment.
Research on caregiving stress and race is limited, but even fewer studies have examined the positive aspects of caregiving by race. Similarly, research on the quality of social relationships has focused more often on social support than on social undermining (
Rook 1991). A considerable strength of the present study is that it examined potential differences by race in both negative and positive aspects of the caregiving experience. Constructs such as parent care mastery and parent care centrality have also received limited attention in prior research investigating caregiving experiences by race. Overall, this research demonstrated the importance of examining a broad range of caregiving experiences in order to detect both similarities and differences between African American and White caregivers.
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Acknowledgments |
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Received for publication September 3, 1999. Accepted for publication May 23, 2000.
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