2012 American Orthopsychiatric Association DOI: 10.1111/j.1939-0025.2012.01175.x
American Journal of Orthopsychiatry 2012, Vol. 82, No. 4, 542–549
Emerging Adults’ Perspectives on Their Relationships With Mothers With Mental Illness: Implications for Caregiving Kristen M. Abraham
Catherine H. Stein
VA Center for Clinical Management Research
Bowling Green State University
Guided by a life course perspective, the current study examined whether emerging adults with and without mothers with affective disorders viewed their relationships with their mothers differently, and whether aspects of the emerging adult-mother relationship were associated with reports of caregiving for mothers. Reports from emerging adults with mothers with affective disorders (n = 46) were compared to reports from emerging adults with mothers without mental illness (n = 64). Results indicated that emerging adults with mothers with affective disorders reported significantly lower levels of affection, felt obligation, reciprocity, and future caregiving intentions, and significantly higher levels of role reversal in their relationships with their mothers. Reported current caregiving levels did not differ between emerging adults with and without mothers with affective disorders. Hierarchical multiple regression analyses generally indicated higher levels of felt obligation were associated with higher levels of caregiving, regardless of maternal mental health status. Results and future research directions are discussed from a life course perspective.
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increased rates of psychiatric diagnoses by emerging adulthood (Beardslee, Versage, & Gladstone, 1998; Klein, Lewinsohn, Rohde, Seeley, & Olino, 2005). Far less is known about other aspects of these emerging adults’ lives. Empirical investigations have not yet examined the amount of care that these individuals provide to their parents or how these emerging adults view their relationships with their parents, more generally. A life course perspective is thought to be useful in studying family members’ caregiving for people with mental illness, because a life course perspective acknowledges that family members’ lives are linked across time (Stein & Wemmerus, 2001) and that life trajectories of individual family members may impact their provision of caregiving (Cook et al., 1997). A life course perspective suggests that family members’ interactions and behaviors are collectively influenced by societal norms, social roles, and the unique context of a given family (Antonucci, Jackson, & Biggs, 2007; Price, McKenry, & Murphy, 2000). Guided by a life course perspective, the present research considers participants in their social role as potential caregivers for their mothers with affective disorders and as people in the life stage of emerging adulthood. Accordingly, the first aim of the present exploratory study was to assess emerging adults’ reports of parental caregiving and their perceptions of their relationships with their mothers with affective disorders as compared to emerging adults without mothers with mental illness. A second aim of the present research was to explore whether aspects of the emerging adult–mother relationship are associated with parental caregiving.
espite advances in mental health care, family members assume much responsibility for the practical assistance and emotional support of individuals coping with mental illness (Lefley, 1996). Most research on caregiving for a family member with mental illness reflects the perspective of parents (Kaufman, 1998) or well siblings (Greenberg, Kim, & Greenley, 1997) who care for an adult child or sibling with schizophrenia. However, affective disorders are among the leading causes of disability worldwide (World Health Organization, 2011), and families are known to provide care to loved ones with depressive (van Wijngaarden et al., 2009) and bipolar disorders (Steele, Maruyama, & Galynker, 2010). Scholars suggest that adult children may be sources of care for their parents with serious mental illnesses (Cook, Cohler, Pickett, & Beeler, 1997), yet little is known about caregiving provided to parents with mental illness by their emerging adult children. Prior research on children of parents with affective disorders has typically documented the risks they face, including
The writing of this article was supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs. The research is based, in part, on the first author’s dissertation that was supported by a Dissertation Fellowship awarded by the Department of Psychology and Graduate College at Bowling Green State University. Correspondence concerning this article should be addressed to Kristen Abraham, VA CCMR/VA National SMITREC, University of Michigan North Campus Research Complex, 2800 Plymouth Road, Building 14, Ann Arbor, MI 48109-2800. Electronic mail may be sent to
[email protected]. 542
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Caregiving for a Family Member With Mental Illness The few published studies on adult children’s caregiving for parents with mental illness are qualitative or descriptive and generally include samples of adult children whose parents have diagnostically heterogeneous serious mental illnesses, including psychotic and affective disorders. These studies provide preliminary evidence that emerging adults do, indeed, act as caregivers for their parents. For example, adolescent and adult children report caring for their parent with schizophrenia and assuming homemaking activities at the expense of their own employment, student activities, or free time (Caton, Cournos, Felix, & Wyatt, 1998). In retrospective accounts, adult children of parents with mental illness recalled providing care and acting in a parental role toward their parent or younger siblings (Dunn, 1993; Foster, 2010; Williams, 1998). Marsh and Dickens (1997) also identified themes of role reversal in qualitative accounts, as adult children recalled assuming parental responsibilities at the expense of their own needs, and some described difficulty separating from their families to pursue normative life course tasks like moving away to attend college. Although few studies speak directly to factors that impact emerging adults’ current provision of care for their parents with mental illness, research suggests that interpersonal relationship characteristics are associated with well siblings’ provision of care for their brothers and sisters with mental illness. Specifically, higher levels of affection for a sibling with mental illness and a higher degree of perceived reciprocity in the sibling–sibling relationship (Jewell & Stein, 2002; Smith, Greenberg, & Selzer, 2007) are associated with higher levels of well siblings’ caregiving. It is unknown whether similar relationship factors play a role in emerging adults’ caregiving decisions for their parents with mental illness.
Emerging Adult–Parent Relationships Relationship characteristics relevant to the typical emerging adult–parent relationship have been identified in developmental theory and research. During emerging adulthood, typically defined as the developmental period from age 18 to 25, adults become ‘‘near equals’’ to their parents, and the adult–parent relationship is characterized by individuation and connectedness (Arnett, 2006; Youniss & Smollar, 1985), as well as reciprocity (Wintre, Yaffe, & Crowley, 1995; Youniss, 1980). Parent gender is an important consideration in life course research as emerging adults report more affectionate, intimate, and comfortable relationships with their mothers than their fathers (Buhl, 2008; LeCroy, 1988; Miller & Subblefield, 1993). Felt obligation is a construct that captures the individuation and connectedness common to adult child–parent relationships and is considered a mechanism by which emerging, young, and middle-aged adult children remain linked with their parents (Stein, 1992, 2009). Felt obligation is defined as a set of concrete ‘‘negotiated commitments’’ adult children feel compelled to apply in their relationship with their parents (Stein, 1992) and is higher toward mothers than fathers (Stein, 1992, 2009; Stein et al., 1998). Although affection, reciprocity, and felt obligation are identified as relevant aspects of the emerging adult–parent
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relationship, little research has assessed the emerging adult– parent relationship when a parent has an affective disorder. To date, one empirical study (Abraham & Stein, 2010) examined felt obligation among a small sample of emerging adults whose parents had various mental illnesses, including affective disorders. Emerging adults with one parent with mental illness (n = 53) did not report different levels of felt obligation than emerging adults with nondistressed parents (n = 41). Thus, felt obligation appears relevant to the study of emerging adult–parent relationship when parents have a mental illness. Unfortunately, there is a striking lack of empirical studies that have examined ongoing relationships between emerging adults and parents with affective disorders. An extensive review of the literature yielded a single retrospective study of 129 adolescents and young adult children with parents diagnosed with bipolar disorder (Reichart et al., 2007). In retrospective accounts, study participants who had a parent with bipolar disorder generally considered their interactions with both parents during their upbringing more positively than adolescent and emerging adults in the general population. Clearly, more research is needed to understand rewards and challenges that young adults face in their relationships with parents coping with affective disorders.
The Adult Child–Parent Relationship and Parental Caregiving Although recent studies of parental caregiving examined emerging adult children’s caregiving for parents with medical conditions (Mancini, Simeoni, Cle´ment, Viens, & Auquier, 2006; Piemonte, 2010), studies of parental caregiving typically focus on middle-aged adults’ provision of care for their aging parents (Shifren, 2009). However, Stein et al. (1998) found that parental caregiving is also provided by both young and middleaged adults in nondistressed families, and that aspects of the adult child–parent relationship predicted caregiving. Specifically, higher levels of felt obligation and affection predicted more parental caregiving by both young and middle-aged adults, indicating that these aspects of the adult child–parent relationship are salient to the study of parental caregiving. To date, little empirical research has assessed parental caregiving among emerging adults, and the roles of felt obligation, affection, and other relationship factors in emerging adults’ parental caregiving are unknown.
The Present Study The present exploratory study compared self-reports from emerging adults with mothers with affective disorders to selfreports from emerging adults whose mothers do not have mental illness regarding caregiving for their mothers and the emerging adult–mother relationship. Specifically, emerging adults’ reports of current provision of caregiving, intentions to provide future caregiving, affection, reciprocity, felt obligation, and role reversal with regard to their mothers were examined as a function of whether or not mothers had an affective disorder. The present study also explored whether aspects of the emerging adult–mother relationship (affection, reciprocity, role reversal, and felt obligation) were associated with emerging adults’
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caregiving and future caregiving intentions for mothers with and without affective disorders.
Method Participants and Procedure Emerging adults with mothers with affective disorders were recruited from higher education institutions in the Midwestern United States. The study announcement invited participation in an online survey from people aged 18–30 who have a mother diagnosed with a serious mental illness. Participants without a mother with mental illness were recruited in a similar manner from higher education institutions through a study announcement that specified participation required having a mother without mental illness. Participation incentives were partial course credit (if available) and entry in a raffle for gift cards. Participants provided informed consent and completed a selfreport questionnaire in an online format. For emerging adults reporting a mother with an affective disorder, the questionnaire contained additional items about their mothers’ mental illness. The study was approved by the appropriate institutional review boards. A total of 211 emerging adults completed the online survey. For the present study, exclusionary criteria included having a deceased father (n = 3), reporting paternal substance abuse or mental illness (n = 92), or reporting a mother with a mental illness other than an affective disorder (n = 6). The resulting 110 respondents were included in the present study. Forty-six of the 110 participants reported a mother with an affective disorder (42%). Most participants were women (n = 91; 83%), Caucasian (n = 101; 92%), and had never been married (n = 105; 96%). Participants reported a mean age of 19.78 years (SD = 2.28) and about half were college freshman (n = 58; 53%). With regard to family circumstances, 61% (n = 67) of participants reported married parents, and 84% (n = 92) reported no maternal substance abuse. Table 1 contains descriptive information regarding maternal mental illness among the 46 participants who reported a mother with an affective disorder. Participants reporting a mother with an affective disorder were less likely to be college freshman, v2 (1, N = 110) = 7.89, p < .01, and more likely to be men, v2 (1, N = 11) = 4.30, p < .05, have divorced or separated parents, v2 (1, N = 110) = 10.09, p = .001, and report maternal substance abuse, v2 (1, N = 110) = 5.46, p < .05, than participants reporting mothers without mental illness.
Measures Maternal mental illness. Maternal mental illness was assessed by the single-item question: ‘‘Has your mother been diagnosed with a mental illness?’’ This method of assessing parental mental illness was adapted from a single-item method of assessing parental alcoholism (Cuijpers & Smit, 2001) and has been previously used to assess parental mental illness (Abraham & Stein, 2010). Participants who responded ‘‘yes’’ to this item were prompted to provide additional information regarding their mother’s mental illness. Questions to elicit information
Table 1. Emerging Adults’ Reports of Descriptive Information About Maternal Mental Illness Variable Diagnosis (frequency (%)) Depression Bipolar Disorder Diagnostician (frequency (%)) Mental health professional Family doctor ‘‘I don’t know’’ Suicide attempt (frequency (%))a Yes No Timing of diagnosis (frequency (%)) Before young adult born After young adult born ’’I don’t know’’ Age of young adult at time of diagnosis (M (SD))b Psychiatric hospitalizations (M (SD))a None (frequency (%)) 1–5 (frequency (%)) More than 5 (frequency (%)) Prescribed medication (frequency (%)) Yes No
28 (61) 18 (39) 17 (37) 6 (13) 23 (50) 5 (11) 39 (85) 7 (15) 25 (54) 14 (30) 10.24 (5.17) 1.00 (1.93) 26 (57) 17 (37) 1 (2) 41 (89) 5 (11)
Note. n = 46. a Two participants did not report this information (n = 44). b Includes only participants who reported their mothers were diagnosed after their birth (n = 25).
regarding maternal mental illness were adapted from Alexander (2003). Maternal substance abuse. Maternal substance use was assessed by two questions: (a) Has your mother ever had a problem with drinking? (b) Has your mother ever had a problem with drugs? If participants answered ‘‘yes’’ to either or both questions, substance abuse was assumed. A single-item measure designed to assess parental alcoholism from emerging adults’ reports yields results comparable to longer methods of assessing parental alcoholism from emerging adults’ reports (Cuijpers & Smit, 2001). This method was adapted for the present study. Relationship reciprocity. The mother subscale of Wintre et al.’s (1995) Perception of Parental Reciprocity Scale assessed emerging adults’ perceived communication reciprocity in their relationships with their mothers. This self-report measure contains 17 items on which participants rate their agreement from 0 (Strongly Disagree) to 5 (Strongly Agree). Internal consistency in the present study (a = .94) was good. Affection. Emerging adults’ affection for their mothers was assessed by a modified version of the Positive Affect Index (Bengtson & Schrader, 1982). The original measure contains 10 items that participants rate on a scale ranging from 1 (Not at All) to 6 (Extremely). In the present study, five items tapping participants’ feelings toward their mothers were used, as emerging adults’ feelings of affection, rather than reciprocal feelings
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of affection, were the construct of interest. A similarly modified version of the Positive Affect Index has been used (Amato, 1994). In the present study, the internal consistency was a = .93. Felt obligation. Felt Obligation Measure (Stein, 1992) assessed participants’ obligation toward mothers. This 34-item self-report measure taps both connectedness and separateness characteristics of adult children’s relationships with their parents. Participants report how often, on a scale from 1 (Rarely) to 5 (Very Often), they feel they ‘‘need to’’ or ‘‘should’’ act in certain ways toward their mother. Present study internal reliability for the measure was good (a = .94). Parent–child role reversal. The 21-item Relationship with Parents Scale (Alexander, 2003) was used to assess emerging adults’ perceptions of role reversal in their childhood relationship with their mothers. Participants rated agreement on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree). Items tap participants’ retrospective accounts of their mothers using guilt to elicit nurturing from them, demanding their attention or company, and their perception of their mothers’ competence as a parent. Alexander (2003) provides evidence of convergent validity, adequate test–retest reliability (r = .82 for men; r = .88 for women), and good internal consistency for this measure (a = .86) in a sample of 990 young adults. The internal consistency in the present study was higher (a = .93). Current caregiving. Current level of care participants provide to their mothers was assessed with Jewell’s (1999) 10item Current Caregiving Scale. Participants reported the frequency with which they assisted their mothers with various tasks in the past year on a scale from 1 (None) to 4 (Frequently). Items tap emotional support, assistance with basic needs, and psychiatric symptom management (from Horwitz, 1993; Horwitz, Tessler, Fisher, & Gamache, 1992), and perceived helping in areas of coordinating services and family contact. Good internal reliability was reported (a = .87, Jewell, 1999; a = .95, Jewell & Stein, 2002) in studies of well siblings of people with mental illness. In the present study, one item was modified for participants without mothers with mental illness, so that its content was not reflective of mental health issues. Present study internal reliability was adequate (full sample a = .85; mom with
affective disorder subsample a = .86; mom without mental illness subsample a = .85). Future caregiving intentions. Participants’ intentions to provide future care to their mothers were assessed with the five-item Intention to Caregive Scale, which measures caregiving intentions of family members of people with mental illness (Jewell & Stein, 2002). Response options were provided on a Likerttype scale, 1 (Strongly Disagree) to 5 (Strongly Agree). Participants responded based on intentions (rather than expectations) to provide future care. Linguistic modification of original instructions was made to emphasize deliberate willingness to provide care. One item was modified so as not to reflect mental health-related concepts for participants reporting a mother without mental illness. In Jewell and Stein’s (2002) study, the measure demonstrated good internal reliability (a = .82) and a moderate correlation with the Current Caregiving Scale. Internal reliability in the present study was good (full sample a = .85; mom with affective disorder subsample a = .82; mom without mental illness subsample a = .86).
Results Between-Group Differences in the Emerging Adult–Mother Relationship and Caregiving Two one-way multivariate analyses of variance (MANOVAs) were conducted to assess between-group differences in perceptions of the emerging adult–mother relationship and reported caregiving, respectively. In both analyses, maternal mental health status (mother with affective disorder, mother without mental illness) was the independent variable. There was a multivariate effect for maternal mental health status in both analyses (Table 2). In terms of relationship characteristics, emerging adults with mothers with affective disorders reported significantly lower average levels of affection, felt obligation, and reciprocity and significantly higher levels of role reversal than emerging adults without mothers with mental illness. With regard to caregiving, emerging adults with mothers with affective disorders, as compared to participants without mothers with mental illness, reported significantly fewer intentions to provide future care to their mothers. Current caregiving did not differ based on maternal mental health status.
Table 2. Multivariate Analyses of Variance: Emerging Adult–Mother Relationship and Caregiving by Maternal Mental Health Status
Measure Emerging adult–mother relationship Affection Felt obligation Role reversal Reciprocity Caregiving Current caregiving Future caregiving intentions
Mother with affective disorder n = 46 Mean (SE)
Mother without mental illness n = 64 Mean (SE)
4.07 (0.16) 3.40 (0.10) 2.75 (0.11) 2.66 (0.16)
5.17 (0.14) 3.75 (0.09) 2.09 (0.10) 3.63 (0.13)
2.69 (0.09) 3.57 (0.12)
2.57 (0.08) 3.99 (0.10)
Multivariate (Wilks’ lambda) and univariate tests F(4, 105) F(1,108) F(1,108) F(1,108) F(1,108) F(2, 107) F(1,108) F(1,108)
= = = = = = = =
9.81, p < .001, Partial g2 = .27 27.06, p < .0001, Partial g2 = .20 6.79, p = .01, Partial g2 = .06 19.54, p < .0001, Partial g2 = .15 22.68, p < .0001, Partial g2 = .17 7.07, p = .001, Partial g2 = .12 1.04, p > .05, Partial g2 = .01 7.42, p < .01, Partial g2 = .06
Note. Per Cohen (1988), effect size magnitude for g2 is as follows: g2 = .01 (small), g2 = .09 (medium), g2 = .25 (large).
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Contributions of the Emerging Adult–Mother Relationship to Caregiving Hierarchical multiple regression analyses were conducted to assess the contributions of the relationship factors to emerging adults’ reported current caregiving and future caregiving intentions. Two regression analyses were conducted separately in each of the two subsamples (participants with a mother with an affective disorder; participants with a mother without mental illness) to independently assess factors relevant to caregiving within each subsample. Hierarchical order of entry for the variables was the same for all analyses. Step 1 contained emerging adults’ demographic variables of age and gender. In Step 2, family circumstance variables of maternal substance abuse status and parents’ marital status were entered. In Step 3, scores on affection, felt obligation, reciprocity, and role reversal were entered. Criterion variables were current caregiving and future caregiving intentions. In the subsample of emerging adults with mothers with affective disorders, the full models predicting current caregiving, F(8, 37) = 2.02, p = .05, R2 = .32, Adj. R2 = .18, and future caregiving intentions, F(8, 37) = 2.59, p < .05, R2 = .36, Adj. R2 = .22, were statistically significant. In both full models, aspects of the emerging adult–mother relationship (Step 3) accounted for a significant amount of variance in both current caregiving (DR2 = .24, p = .02) and future caregiving intentions (DR2 = .32, p < .01), and felt obligation was the only significant predictor of caregiving—higher levels of felt obligation were associated with more current caregiving and future caregiving intentions (b = .41, p < .05; b = .60, p = .01, respectively). For emerging adults without mothers with mental illness, neither the full model predicting current caregiving, F(8, 55) = 1.84, p > .05, nor the full model predicting intentions to provide future care, F(8, 55) = 1.47, p > .05, was significant.
Testing the Moderation Effect of Maternal Mental Health Status on the Relationship Between Felt Obligation and Caregiving Although not hypothesized, felt obligation significantly predicted current caregiving and future caregiving intentions among emerging adults whose mothers have affective disorders, but not among emerging adults whose mothers do not have mental illness. To statistically assess this apparent moderation effect, two additional hierarchical regression analyses were conducted with all participants’ data in the same models. Step 1 contained demographic variables and relationship covariates. The felt obligation variable was centered and added to Step 2 with maternal mental health status to account for potential main effects. Step 3 contained an interaction term (i.e., centered Felt obligation · Maternal mental health status) to test the moderation effect (Aiken & West, 1991). Table 3 contains the sequential and full models. Full models predicting current caregiving, F(10, 99) = 3.06, p < .01, R2 = .24, Adj. R2 = .16, and future caregiving intentions, F(10, 99) = 3.30, p = .001, R2 = .25, Adj. R2 = .17, were statistically significant. The moderation effect was not significant in the current caregiving model and approached significance in the future caregiving intentions model (Step 3: DR2 = .02, p = .08). However, for both current caregiving and
future caregiving intentions, the more parsimonious models containing only Steps 1 and 2 were significant, and higher levels of felt obligation were significantly associated with higher levels of current caregiving and future caregiving intentions, regardless of maternal mental health status. Additionally, higher levels of role reversal were associated with more current caregiving.
Discussion The present study examined emerging adults’ perceptions of their relationship with their mothers and their reports of caregiving for mothers on the basis of maternal mental health status. Emerging adults with mothers with affective disorders reported less affection, felt obligation, and reciprocity and more experiences of role reversal in their relationships with their mothers. Aspects of the emerging adult–mother relationship have not previously been empirically examined among emerging adults who have mothers with mental illness; however, present findings contravene previous findings that adolescent and emerging adults from families affected by parental bipolar disorder retrospectively rate their parents more favorably (Reichart et al., 2007). Present study findings are consistent with the qualitative literature base, which describes role reversal and obligation as parts of the complex and challenging relationships that adult children have with their parents with mental illness (Dunn, 1993; Williams, 1998). The present finding of higher levels of felt obligation toward mothers without mental illness differs from a prior quantitative study (Abraham & Stein, 2010) in which levels of felt obligation did not differ as a function of parental mental illness. The present study was conducted in a larger sample and found a small-to-medium effect size for maternal mental illness on felt obligation. Additional replication is needed to better estimate the true population effect size. In the present study, current caregiving provided to mothers did not differ as a function of maternal mental health status. However, emerging adults with mothers with affective disorders reported fewer intentions to provide future care as compared to their peers. Similar levels of current caregiving may reflect emerging adults’ phase of life, as being a college student may be a more salient social role than that of caregiver, even for participants whose mothers have affective disorders. Family members’ life course stages and transitions may influence the caregiving they provide to loved ones with mental illness (Cook et al., 1997). Emerging adulthood is a self-focused phase in which individuals ‘‘explore a variety of possible life directions’’ (Arnett, 2000, p. 469, 2006). Parent–emerging adult relationships are typically characterized by mutual exchanges and independence (Arnett, 2006; Youniss & Smollar, 1985). Virtually no prior theory or research has identified parental caregiving as common among college students, possibly because it is not a typical aspect of the emerging adult–parent relationship. Lower levels of future intentions to provide care among emerging adults with mothers with affective disorders could suggest that, relative to their peers, they anticipate more challenges pursing normative life course transitions while providing care to their mothers. Well siblings expect to confront challenges providing future care to siblings with mental illness because of concerns about commitments to their own families, work, or school (Hatfield & Lefley, 2005). Contemplating forthcoming
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Table 3. Hierarchical Regression Moderation Models Predicting Current and Future Caregiving Current caregiving Variable Model with Step 1 Age Gender Maternal substance abuse Parents marital status Positive affect index Role reversal Reciprocity Model with Steps 1 and 2 Age Gender Maternal substance abuse Parents marital status Positive affect index Role reversal Reciprocity Maternal affective disorder Felt obligationa Model with Steps 1, 2, and 3 Age Gender Maternal substance abuse Parents marital status Positive affect index Role reversal Reciprocity Maternal affective disorder Felt obligationa Interaction: Maternal affective disorder · Felt obligationa
B
SE B
b
)0.03 )0.01 0.09 )0.12 )0.04 0.24 0.14
0.03 0.15 0.17 0.13 0.09 0.08 0.09
).10 ).01 .06 ).10 ).07 .33** .27
)0.02 0.00 0.13 )0.09 )0.10 0.24 0.09 0.02 0.29
0.03 0.15 0.17 0.13 0.09 0.07 0.09 0.13 0.10
).06 .00 .08 ).07 ).19 .31** .18 .02 .34**
)0.02 )0.01 0.13 )0.11 )0.10 0.22 0.10 0.02 0.21
0.03 0.15 0.17 0.13 0.09 0.08 0.09 0.13 0.12
).06 .00 .08 ).09 ).20 .30** .18 .02 .24
0.20
0.16
.15
Future caregiving intentions
DR
2
.16*
.07*
.01
2
Adj. R
b
B
SE B
)0.02 0.13 0.06 )0.04 0.23 0.09 0.04
0.04 0.21 0.24 0.18 0.13 0.11 0.13
).05 .06 .03 ).02 .34† .09 .06
0.00 0.08 0.09 )0.02 0.10 0.11 )0.04 )0.28 0.41
0.03 0.20 0.23 0.18 0.13 0.10 0.12 0.18 0.14
.00 .04 .04 ).01 .15 .11 ).05 ).17 .35**
0.00 0.08 0.10 )0.06 0.10 0.10 )0.03 )0.27 0.25
0.03 0.20 0.23 0.18 0.13 0.10 0.12 0.17 0.17
).01 .04 .05 ).03 .14 .10 ).04 ).16 .21
0.38
0.21
.10*
.15**
.16**
DR2
Adj. R2
.14*
.08*
.09**
.16**
.02†
.17***
.22†
Note. N = 110. a Felt obligation variable was centered. *p < .05. **p < .01. ***p < .001. †p < .08.
developmental milestones like marriage, children, and employment is common in emerging adulthood (Arnett, 2006), and emerging adults may be focused on these life course transitions rather than caregiving for their mothers with affective disorders. Additionally, the present study findings suggest maternal mental health status may moderate the association between felt obligation and caregiving. When data were analyzed separately using subsample, higher levels of felt obligation were associated with higher levels of caregiving among emerging adults with mothers with mental illness; but among emerging adults without mothers with mental illness, felt obligation was not related to caregiving. However, when all participants’ data were analyzed in the same models, the moderation effects did not reach significance and were small in magnitude. Notably, the more parsimonious models indicated that higher levels of felt obligation were associated with more current caregiving and future caregiving intentions, regardless of maternal mental health status. This is consistent with prior research on felt obligation and caregiving in community samples (Stein et al., 1998). Future studies with larger samples will clarify whether emerging adults who have a mother with mental illness require a higher level of felt obligation to motivate
a similar level of caregiving behavior than their peers without mothers with mental illness. Additionally, when all participants’ data were examined together, role reversal emerged as a significant predictor of current caregiving, regardless of maternal mental health status. Caring for one’s mother in childhood or adolescence was associated with providing more care in emerging adulthood. The contribution of prior parental caregiving to current provision of care should be addressed in future research.
Limitations Present study limitations include a relatively small, homogeneous sample of Caucasian college undergraduates. Experiences of emerging adults with mothers with mental illnesses other than affective disorders, notably schizophrenia, were not represented. Emerging adults who have mothers with mental illness and attend college may have had more opportunities to separate from their mothers and pursue their own futures. Moreover, emerging adults’ relationship and caregiving experiences may differ based on their educational opportunities and maternal psychiatric diagnosis. It is unclear the degree to which present
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findings are generalizable, and research with larger, more representative samples is critically needed. Although prior studies (Abraham & Stein, 2010; Williams & Corrigan, 1992) used similar methodology to identify maternal mental illness, emerging adults’ knowledge of their mothers’ diagnostic information may be inaccurate. Clearly, verification from mothers themselves or psychiatric records will strengthen future studies. Of course, the cross-sectional nature of this research makes it impossible to infer causality among the relationship and caregiving variables. Prospective research is needed to ascertain how aspects of parent-child relationships may impact parental caregiving across the life course.
Implications for Future Research Limitations notwithstanding, this exploratory study is a preliminary step toward a better understanding of adult child– mother relationships and parental caregiving among emerging adults. The present study is among the first to empirically assess emerging adults’ relationships with mothers with affective disorders and found emerging adults with mothers with affective disorders generally reported lower quality of relationships with their mothers than their peers. Continued empirical research is needed to better understand the relationship between emerging adults and mothers with mental illness, how this relationship may evolve over the life course, and how this relationship affects adult children’s parental caregiving. Continued research on care provided by emerging adult children to their parents with mental illness is important because family members often assume caregiving responsibilities for people with mental illness (Lefley, 1996). The present study focused exclusively on assessing whether aspects of the emerging adult– mother relationship were associated with caregiving. Caregiving provided to mothers by other family members or friends was not assessed, may influence the amount of care emerging adults provide, and should be addressed in future investigations. More broadly, future research should identify in what circumstances emerging adults provide care to parents. The present study focused on caregiving provided by emerging adults to mothers with and without affective disorders. Assessment of caregiving among community samples and among emerging adults coping with various parental disabilities will lead to a more comprehensive understanding of what constitutes a typical level of parental caregiving for emerging adults. Moreover, researchers should assess the psychosocial impact of emerging adults’ provision of care, particularly with regard to how caregiving impacts adult children’s life course trajectories, including the adoption of social roles (e.g., employee, spouse, parent). Keywords: children of mentally ill parents; caregivers; emerging adult–parent relationship; parent–child role reversal; affective disorders; maternal mental illness
References Abraham, K. M., & Stein, C. H. (2010). Staying connected: Young adults’ felt obligation toward parents with and without mental illness. Journal of Family Psychology, 24, 125–134.
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