Journal of Social and Personal

Relationships
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Family conflict from the perspective of adult child caregivers: The influence
of gender
Minyoung Kwak, Berit Ingersoll-Dayton and Jeungkun Kim
Journal of Social and Personal Relationships 2012 29: 470 originally published online 9
January 2012
DOI: 10.1177/0265407511431188

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Article
JSPR
Journal of Social and

Family conflict from the Personal Relationships

29(4) 470487
The Author(s) 2012
perspective of adult child Reprints and permissions:
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caregivers: The influence DOI: 10.1177/0265407511431188
spr.sagepub.com

of gender

Minyoung Kwak1, Berit Ingersoll-Dayton1, and

Jeungkun Kim2

Abstract
This study examines how care recipient impairment and family conflict affect adult
children caregivers stress. A particular focus is on how the gender of the adult child
moderates the relationships among care recipient impairment, family conflict, and care-
giver stress. Based on a nationally representative sample of 861 adult child caregivers,
structural equation modeling indicates that family conflict mediates the relationship
between care recipient impairment and caregiver stress. In addition, gender plays a key
moderator role; that is, the relationship between care recipient impairment and family
conflict is stronger for caregiving sons than for caregiving daughters. Overall, however,
adult sons and daughters experience the stress process similarly.

Keywords
caregiver stress, elders impairment, family dissonance, gender differences, parental care

The family system is important to caregivers wellbeing. Existing studies suggest that
family relations can be a source of support by providing help for primary caregivers and
sharing some portion of care responsibilities (Davey & Szinovacz, 2007). However,
when families do not support primary caregivers or care recipients appropriately, or
when they disagree with primary caregivers over decisions related to providing care, the

1
University of Michigan, USA
2
Samsung Economic Research Institute (SERI), South Korea

Corresponding author:
Minyoung Kwak, 1080 S. University, School of Social Work Building, Ann Arbor, MI 48109, USA
Email: mykwak@umich.edu

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Kwak et al. 471

family can become a source of stress for caregivers (Ingersoll-Dayton, Neal, Ha &
Hammer, 2003; Lashewicz & Keating, 2009; Strawbridge & Wallhagen, 1991). Several
studies have demonstrated that family disagreements and conflicts exacerbate caregiver
strain and negatively impact caregivers health (Scharlach, Li & Dalvi, 2006; Semple,
1992). A small body of literature has indicated that the occurrence of family conflict var-
ies according to the caregivers relationship to a care recipient and by the caregivers
gender. For example, adult child caregivers experience more family conflict than do
care-giving spouses (Semple, 1992; Strawbridge & Wallhagen, 1991; Weitzman, Chee
& Levkoff, 1999). Furthermore, women are more likely to experience family conflict
in the course of their caregiving than are men (Semple, 1992). The focus of this paper
is on family conflict over caregiving and its impact on adult child caregivers stress.
There are a number of reasons why adult child caregivers experience more family
conflict than do spousal caregivers. One is that adult children regard their caregiving
responsibilities for their parents as something beyond their primary responsibilities of
caring for their own children or spouse (Raschick & Ingersoll-Dayton, 2004). In addi-
tion, spousal caregivers may accept their caregiving role more easily than adult child
caregivers since that role is normatively expected of them (Allen, Goldscheider, &
Ciambrone, 1999; Raschick & Ingersoll-Dayton, 2004). Finally, adult children are more
likely to expect help in caring for parents, especially from their own siblings and spouses
(Merrill, 1996; Strawbridge & Wallhagen, 1991), which may lead to more family
conflict.
When focusing on family conflict over caregiving, it is also important to take into
account the role played by gender. Previous research found that daughters more fre-
quently provided routine assistance with personal care and assumed more responsi-
bilities overall in caregiving than did sons (Horowitz, 1985; Stoller, Forster & Duniho,
1992). Moreover, daughters are less likely to receive support from their spouses than are
sons (Henz, 2009; Horowitz, 1985). Because daughters tend to take on more caregiving
responsibilities than do sons, they may be the ones who are in a position to seek assis-
tance when they need help from families more than the sons. The daughters may ask
other family members, especially siblings, to become more involved in caregiving and
may have to negotiate with them in terms of the distribution of caregiving work
(Hequembourg & Brallier, 2005). These requests for assistance and the necessity of
negotiating the delegation of caregiving responsibilities may result in disagreements and
dissonance among family members.
In sum, when adult children provide care to a frail parent, they are at risk for experi-
encing disagreement and conflict with other family members. In an attempt to further
explore these issues, we examine a model that investigates the relationships among care
recipient impairment, family conflict, and stress while considering the gender and family
composition (i.e. the existence of siblings or a spouse) of adult child caregivers.

Conceptual framework
This study utilizes the stress process model, which incorporates the influence of con-
textual and intervening factors on the relationship between primary stressors and their
outcomes. When the stress process model is applied to caregiving situations (Pearlin,

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472 Journal of Social and Personal Relationships 29(4)

Figure 1. Conceptual model.

Note. The parameters of the model were estimated for the total sample. Additionally, subgroup analyses were
conducted to investigate the moderating effect of primary caregivers gender on the relationships among care
recipient impairment, family conflict, and caregiver stress.

Mullan, Semple, & Skaff, 1990), the key constructs are: the caregiving context, primary
stressors, secondary stressors, and potential mediators. Scharlach and his colleagues
(2006) used the stress process model developed by Pearlin and his colleagues (1990) to
examine how the impact of the caregiving situation on the primary caregiver is mediated
by family conflict. Scharlach and his colleagues found that the primary stressor of care
recipients mental impairment affected caregiver strain only indirectly through the
secondary stressor of family conflict.
The present study builds upon the basic framework of the model formulated by
Scharlach and his colleagues (2006) that conceptualized family conflict as a secondary
stressor for caregivers. The model for our study (see Figure 1) adds to that of Scharlach
and his colleagues in four key ways. First, our study focuses specifically on adult child
caregivers, who are known to experience more family conflict than other family care-
givers (Peisah, Brodaty, & Quadrio, 2006; Weitzman et al., 1999), while Scharlach et al.
studied the general population of caregivers. In addition, Scharlach and his colleagues
study examined only the effects of the mental impairment of care recipients on family
conflict. Our study expands on their model by also examining the influence of care
recipients functional dependency. The third distinctive contribution of our study is its
emphasis on the gender of the primary caregiver. The study by Scharlach and his col-
leagues included the gender of the primary caregiver as a control variable and found that
it had little influence on family conflict. In contrast, others have suggested that the
gender of the primary caregiver is a key factor in understanding the dissonance and
disagreement over parental care (Connidis & Kemp, 2008; Hequembourg & Brallier,
2005; Matthews, 2002). Specifically, our study explores the moderating effect of the
gender of the primary caregiver on the relationships among care recipient impairment,
family conflict, and caregiver stress. Moreover, according to Pearlin et al. (1990),
contextual variables, such as caregiver gender, affect not only each of the stressors and
health outcomes but also the relationships among primary and secondary stressors and

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Kwak et al. 473

health outcomes. Thus, the relationships among care recipient impairment, family
conflict, and caregiver stress may vary depending on the role of gender. Last, our study
includes family composition characteristics as contextual variables in the stress process
and adds them to the conceptual model as exogenous variables. The family composition
characteristics were not examined in Scharlach et al.s model although such character-
istics (i.e. having siblings and spouses) may increase the potential for family conflict
among adult children caregivers (Matthews, 2002; Henz, 2009).
In the following sections, we discuss findings from previous research on the rela-
tionships among these key constructs and, within each of the sections, highlight the role
played by caregiver gender.

Care recipient impairment and family conflict

A care recipients impairment can affect all family members  including primary
caregivers, less involved caregivers and even other family members who do not
provide care  by triggering negative emotions among the members of the family
(Amirkhanyan & Wolf, 2003; Deimling, Smerglia, & Schaefer, 2001). Due to their
responsibilities, primary caregivers may spend less time with other family members
and experience changes in the quality of their relationships with other family mem-
bers, while family members who are less involved in caring for a frail parent may feel
guilty (Ingersoll-Dayton et al., 2003). Several studies demonstrate that a care recipi-
ents need for care requires the family to adapt to caregiving conditions and leads to
changes in family functioning (Deimling et al., 2001; Lieberman & Fisher, 1999;
Mitrani et al., 2006).
The effect of care recipient impairment on family conflict may vary with the gender
of the primary caregiver. Since daughters, more than sons, provide more domestic
assistance and more personal care, both routine and time-consuming activities, daughters
generally become more involved in the care of frail parents (Campbell & Martin-
Matthews, 2003; Hequembourg & Brallier, 2005). This unequal involvement in caregiving
work may cause daughters to attempt to more equitably distribute care responsibilities and
to negotiate the distribution of caregiving among families, which may result in family con-
flicts. We hypothesize a stronger relationship between care recipient impairment and fam-
ily conflict for daughters than for sons.

Care recipient impairment and caregiver stress

Previous research indicates that two aspects of care recipient impairment are related to
caregiver stress: their mental impairment and their physical impairment. With respect to
mental impairment, Ingersoll-Dayton and Raschick (2004) found that caregivers experi-
enced more stress when care recipients had higher levels of cognitive impairment and
behavioral problems. Several studies have demonstrated that mental impairment and prob-
lem behaviors of care recipients are powerful predictors of caregivers depression and
care-giving burden (Li, Seltzer & Greenberg, 1997; Savundranayagam, Hummert, &
Montgomery, 2005). Similarly, the physical impairment of care recipients also influences
the level of caregiver stress (Pinquart & Sorensen, 2004; Starrels, Ingersoll-Dayton,

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474 Journal of Social and Personal Relationships 29(4)

Dowler, & Neal, 1997). Pinquart and Sorensen (2004) also found that the physical impair-
ment of care recipients had a negative effect on caregivers mental health.
Depending on the gender of the primary caregiver, the impact of care recipient
impairment on caregiver stress may differ. Starrels and her colleagues (1997) found
that the association between care recipients impairment and their caregivers stress
was stronger for caregiving daughters than for caregiving sons. A parents increasing
need for care is likely to have a stronger influence on the stress of caregiving daughters
than that of caregiving sons due to variations in the type and amount of caregiving
work performed by daughters and sons. In general, daughters provide the type of
personal and home-based care to parents that requires continuous effort, such as mak-
ing meals, cleaning, and bathing, while it is more characteristic for caregiving sons to
conduct occasional and indirect types of caregiving, such as yard work and financial
management (Campbell & Martin-Matthews, 2003; Hequembourg & Brallier, 2005).
Thus, when a parents impairment becomes severe and he or she needs more assistance,
the increase in the amount of caring work may differ by its type and may have a differ-
ential impact on caregiver stress across gender. We hypothesize that there will be a
stronger relationship between care recipient impairment and caregiver stress for
daughters than for sons.

Family conflict and caregiver stress

Poor family functioning contributes to a high level of caregiver strain (Heru, Ryan, &
Iqbal, 2004) and caregiver distress (Mitrani et al., 2006). In particular, family conflict,
one of the secondary stressors in Pearlin et al.s (1990) stress process model, may
undermine a caregivers psychological and physical health (Strawbridge & Wallhagen,
1991). Family conflict is related to caregiver depression (Smerglia & Deimling, 1997)
and caregiver strain (Scharlach et al., 2006).
With respect to gender differences in the relationship between family conflict and
caregiver stress, a meta-analysis conducted by Tamres, Janicki and Helgeson (2002)
showed that men may be more likely than women to use avoidant or withdrawal beha-
viors as coping strategies in response to stressors in interpersonal situations. Women, in
contrast, are more likely than men to utilize a variety of coping strategies, such as
problem-focused strategies and to express their feelings to others (Tamres et al.,
2002). These findings suggest that when families are involved in providing care for older
parents, sons may be more likely to try to avoid family conflict in the face of disagree-
ments. Since daughters are more likely to use active coping skills, such as seeking social
support from others and using problem-focused strategies (Tamres et al., 2002), they
may experience fewer difficulties in dealing with intra-familial problems. Therefore, the
impact of family conflict on caregiver stress may differ by caregiver gender because of
different coping styles. Although our study does not include a specific measurement of
coping styles, the literature on gender differences in coping strategies points to the
likelihood that family conflict has a stronger effect on caregiver stress for sons than
for daughters. We hypothesize that family conflict will influence caregiver stress more
for sons than for daughters.

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Kwak et al. 475

Family composition as a context for family conflict

Family composition is important in caregiving situations because it influences division
of caregiving work within families (Keith, 1995; Ganong, Coleman, & Rothrauff, 2009).
Studies have found that family composition (i.e. the existence of siblings and spouses) is
related to family disagreement and conflict (Strawbridge & Wallhagen, 1991; Suitor &
Pillemer, 1994; Weitzman et al., 1999).
For adult children caregivers, there is more potential for family conflict over the pro-
vision of parental care between siblings than between any other family members (Peisah,
Brodaty, & Quadrio, 2006; Semple, 1992; Strawbridge & Wallhagen, 1991; Weitzman
et al., 1999). Strawbridge and Wallhagen (1991) found that 65% of adult child caregivers
experienced conflict with siblings over caring for parents. One source of conflict among
siblings is the lack of guiding principles about how caregiving responsibilities should be
distributed (Connidis & Kemp, 2008). When parents need care, adult children must seek
ways to provide support to their frail parents and to make decisions about caregiving. It is
uncommon, however, to have explicit family norms and standards that guide those deci-
sions. This ambiguity may result in different expectations among siblings that can create
conflict as siblings attempt to negotiate caregiving responsibilities (Connidis & Kemp,
2008). Ideally, when adult children have multiple brothers and sisters, they can benefit
from sharing caregiving responsibilities with each other; however, when some of these
siblings do not share in parent care, there is the potential for greater family conflict.
Many adult children caregivers also experience conflict over parent care with their own
spouses (Strawbridge & Wallhagen, 1991). Strawbridge and Wallhagens study (1991)
found that 20% of adult child caregivers experienced conflict with their spouses. Adult
childrens caregiving responsibilities for their parents create the possibilities of conflict
between caregivers and their spouses. Parental care responsibilities take caregivers time
away from their spouses and children (Merrill, 1997) and decrease marital happiness
among couples (Bookwala, 2009). Suitor and Pillemer (1994) found that husbands did not
provide emotional support to caregiving wives because the husbands viewed caregiving as
interfering with the womens performance in other traditional family roles. The lack of
support from spouses decreases marital satisfaction among caregivers and their spouses
(Suitor & Pillemer, 1994), which may affect spousal conflict over parent care. In addition,
when adult children are involved in caregiving, their spouses tend to be involved in
providing care (Henz, 2009). In particular, sons involvement in parental care leads to
daughters-in-law taking direct responsibilities for caregiving (Henz, 2009). Although help
from spouses can be a resource for caregivers, it can also be a source of conflict. Such con-
flict may arise when the caregivers spouse is reluctant to provide care for a parent-in-law
or does not agree with the caregivers decisions related to care. We hypothesize that family
composition factors (i.e. having siblings and having a spouse) will be associated with care
recipient impairment, family conflict, and caregiver stress.

Hypotheses
Building upon Scharlach and colleagues model, we propose four hypotheses con-
cerning the impact of gender and family composition on the relationships among care

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476 Journal of Social and Personal Relationships 29(4)

recipient impairment, family conflict, and caregiver stress. The first three hypotheses
are related to gender differences while the fourth hypothesis is associated with family
composition.

H1. There is a stronger relationship between care recipient impairment and family conflict
for daughters than for sons.
H2. The relationship between care recipient impairment and caregiver stress is stronger for
daughters than for sons.
H3. The relationship between family conflict and caregiver stress is stronger for sons than
for daughters.
H4. Family composition factors (i.e., having siblings and having a spouse) are associated
with care recipient impairment, family conflict, and caregiver stress.

Methods
Sample
This study was based on the National Long Term Care Survey (NLTCS) collected in
2004, in which the respondents were Medicare enrollees aged 65 or over. Data were
collected from multiple sources including care recipients and caregivers. We used
information from the 1923 primary caregivers who participated in the Caregiver Survey,
which was supplemental to the 2004 NLTCS. In this supplement, the focus was on the
primary caregivers who helped, without compensation, the sample care recipients living
in community settings. In addition, the household information collected from care
recipients was utilized to determine whether or not a primary caregiver had a sibling.
Since this study focuses on adult child caregivers, our subsample of primary care-
givers consisted of 861 adult children caregivers in the 2004 Caregiver Survey, including
605 daughters (70%) and 256 sons (30%). Most of the respondents were non-Hispanic
White (86%), and 14% were non-Whites, including non-Hispanic Black, Hispanic or
Latino, American Indian, Asian, and other. Regarding educational background, slightly
less than half the participants did not have any education beyond high school or had not
finished high school (32% and 12%, respectively), 31% attended college without receiv-
ing a degree or had an associate degree, and a quarter of the recipients had a bachelors
degree or more advanced degree (15% and 10%, respectively). In terms of sibling rela-
tionships, 81% had one or more siblings and 19% were only children. With respect to
caregivers marital status, 55% had a spouse or a spousal equivalent partner while
45% did not have a spouse or a partner. With regard to living arrangements, 47% of the
respondents lived with their care recipient.

Measures
Care recipients impairment. The care recipients impairment was measured by three
indicators including their activities of daily living (ADL) score, instrumental activities of
daily living (IADL) score, and problem behaviors. The source of this information was

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Kwak et al. 477

the Caregiver Survey. ADL and IADL scores were based on the number of areas in
which a care receiver needed a caregivers assistance, ranging from 0 to 6 and from 0 to
10, respectively. The variable measuring problem behaviors associated with a care
recipients mental impairment consisted of fifteen items representing care recipients
disruptive behaviors, such as keeping a caregiver up at night, repeating questions,
dressing inappropriately, hiding belongings and forgetting about them, crying easily,
swearing, and becoming suspicious. The problem behaviors were measured by asking
caregivers how many days, in the past week, they had to deal with these problem
behaviors. The frequency of each behavior was assessed by a four-point Likert scale
from 1 (no days in the past week) to 4 (five or more days over the past week). The
scores were summed across the 15 problem behaviors resulting in an index that ranged
from 15 to 60.

Family conflict. Family conflict was defined as overt interpersonal disagreement

(Semple, 1992). The measurement of family conflict included six items of family dis-
agreement about a care receiver or a caregiver, which were derived from the Caregiver
Survey. The questions were: How much disagreement have you had with anyone in
your family because they dont do their share in caring for [a care recipient]?, . . .
because they dont show enough respect for [a care recipient], . . . because they lack
patience with [a care recipient]?, . . . because they dont give you enough help?,
. . . because they dont show enough appreciation of your work as a caregiver? and
. . . because they give you unwanted advice? The six items were assessed using a four-
point scale, ranging from 1 (not at all) to 4 (quite a bit).

Caregiver stress. Caregiver stress, also from the Caregiver Survey, was measured by three
indicators with a five-point Likert scale that focused on emotional, physical, and finan-
cial dimensions (1 not at all, 5 very much). The questions were: How emotionally
stressful would you say that caring for [a care recipient] is for you?, How much of a
physical strain would you say that caring for [a care recipient] is for you?, and How
much of a financial hardship would you say that caring for [a care recipient] is for you?

Family composition. As contextual variables, the characteristics of family composition

included caregivers marital status and the existence of siblings in order to control for
possible effects of the contextual variables on the relationships among care recipient
impairment, family conflict, and caregiver stress (Henz, 2006; Matthews, 2002). Care-
givers marital status, from the Caregiver Survey, was scored dichotomously (0 having
no spouse/partner 1 having a spouse/partner). The existence of siblings among
caregivers was derived from the household information collected from their care-
receiving older parents and was also scored dichotomously (0 having no siblings,
1 having one or more siblings).

Analysis strategy
The analysis plan for the present study consisted of several steps. First, we conducted
descriptive analyses of the study variables and estimated correlations among the

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478 Journal of Social and Personal Relationships 29(4)

variables. Then we examined the relationships among care recipient impairment, family
conflict, and caregiver stress by using a two-step approach (Bollen, 1989). In the first
step, we tested a measurement model on the association between the observed variables
and the latent constructs. In the second step, we conducted structural equation modeling
(SEM) using LISREL 8.5. In this step, we tested for mediation by determining whether
the indirect pathway was significant (Bollen, 1989; MacKinnon, Lockwood, Hoffman,
West, & Sheets, 2002). In our case, we sought to determine whether family conflict
mediated the relationship between care recipient impairment and caregiver stress.
Finally, we investigated the moderating effects of caregiver gender by conducting sub-
group analyses that we describe in greater detail in the Results section.
We employed Weighted Least Square (WLS) estimation because the data consisted of
13 discrete observed variables which do not satisfy the assumption of multivariate
normality of observed variables. The Comparative Fit Index (CFI) and the Root Mean
Square Error of Approximation (RMSEA) were used to assess model fit because the chi-
square statistic is more likely to be significant when a sample size is either larger than
200 or smaller than 100, thus resulting in the rejection of an acceptable model fit (Hair,
Anderson, Tatham, & Black, 1998).

Results
Table 1 presents descriptive statistics and correlations among all variables included in
the study. The correlations among the observed variables supported our construction of
the latent variables. Most of the correlations were in the expected direction. Care reci-
pient impairment, especially problem behaviors, was related to greater family conflict
and higher levels of stress. In addition, family conflict was significantly correlated to
caregivers emotional distress.

Testing the overall conceptual model

The measurement model includes the three latent constructs used in our analysis,
including care recipient impairment, family conflict, and caregiver stress. Factor
loadings for the latent constructs are statistically significant (ranging from l .71 to l
.98, p < .001). The measurement model fit the data well (w2 (df 51, N 861)
143.92, p < .001, RMSEA .046, CFI 0.99). We then tested the overall conceptual
model that included the latent constructs and the contextual variables. The fit indices
indicate that the model is acceptable (w2 (df 69, N 861) 173.23, p < .001,
RMSEA .042, CFI 0.99).
The findings revealing the relationships among the variables in the model are dis-
played in Figure 2. They show that as care recipients impairment becomes more
severe, adult child caregivers experience more family conflict (b .43, p < .001) and
greater stress (b .56, p < .001). In addition, as adult child caregivers experience more
family conflict, they experience greater stress (b .31, p < .001). The indirect effect of
care recipient impairment on caregiver stress through family conflict is also statisti-
cally significant (b .13, p < .001; not shown). Thus, the care recipients impairment

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 Table 1. Correlations and descriptive statistics for variables in the model.
Variables 1 2 3 4 5 6 7 8 9 10 11 12 13 14

1 ADL score 
2 IADL score 0.70 
3 Problem behavior 0.43*** 0.45*** 
4 Not share in care 0.27 0.22 0.34*** 
5 Not show respect 0.20 0.16 0.30*** 0.81*** 
6 Lack patience 0.17 0.13 0.32*** 0.81*** 0.86*** 
7 Not give help 0.30 0.25 0.39*** 0.91*** 0.79*** 0.76*** 
8 Not show appreciation 0.34 0.24 0.36*** 0.84*** 0.77*** 0.70*** 0.91*** 
9 Unwanted advice 0.32 0.20 0.32*** 0.74*** 0.71*** 0.68*** 0.79*** 0.82*** 
10 Physical strain 0.54 0.43* 0.49*** 0.38 0.42 0.37 0.42 0.43 0.34 
11 Emotional distress 0.36 0.35 0.56*** 0.44* 0.39 0.43 0.43** 0.42 0.38 0.74*** 
12 Financial hardship 0.50 0.37 0.44*** 0.40 0.38 0.37 0.44 0.43 0.38 0.64*** 0.63*** 
13 Having a spouse 0.11 0.14 0.09* 0.13 0.08 0.06 0.14 0.17 0.09 0.06 0.01 0.16 
14 Having sibling(s) 0.06 0.04 0.01 0.27 0.17 0.19 0.19 0.25 0.21 0.01 0.04 0.04 0.13 
Mean 1.11 5.24 19.63 1.48 1.27 1.33 1.47 1.42 1.41 1.82 2.29 1.6 0.55 0.82

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S.D. 1.77 2.88 5.72 0.89 0.73 0.76 0.92 0.9 0.87 1.14 1.33 1.08 0.50 0.39

Note: * p < .05; ** p < .01; ***p < .001

479
480 Journal of Social and Personal Relationships 29(4)

Not share in Not show Lack Not give Not show Unwanted
care respect patience help appreciation advice

0.96*** 0.94*** 0.94*** 0.98*** 0.96*** 0.87***

Family conflict Physical

ADL
0.43*** 0.31*** strain
0.93*** 0.92***
Care recipient Caregiver Emotional
IADL 0.78*** impairment 0.56*** 0.85***
stress distress
0.71*** 0.80***
Problem 0.06 0.23*** Financial
behavior hardship
0.16*** 0.07* 0.02 0.03

Having a spouse Having sibling(s)

1.00 1.00

Having Having
a spouse siblings

Figure 2. Structural equation model for the overall sample.

Note. All coefficients are standardized.
*p < .05 ***p < .001

has a direct effect on caregiver stress as well as an indirect effect that is mediated by
family conflict.
Among the contextual variables, being married is associated with less care recipient
impairment (g .16, p < .001). In addition, having siblings is related to less care
recipient impairment and more family conflict (g .07, p < .05; g .23, p <.001,
respectively).

Testing the moderating effect of caregiverls gender

In order to explore how a caregivers gender would influence structural relations among
latent constructs, we constrained the factor loadings of each latent construct to be equal
across gender and estimated the paths between the constructs separately for daughter
caregivers (N 605) and son caregivers (N 256). The results are presented in Figure 3.
For caregiving daughters, care recipient impairment is associated with more conflict
(b .37, p < .001) and more caregiver stress (b .55, p < .001). Family conflict sig-
nificantly mediates the relationship between care recipient impairment and caregiver
stress (b 0.11, p < .001; not shown). In terms of contextual variables, being married is
negatively associated with care recipient impairment (g .22, p < .001). Having
siblings is related to less care recipient impairment and more family conflict (g .16, p
< .001; g .19, p < .01, respectively). However, being married is not significantly
related to family conflict and caregiver stress (p > .05), nor is the existence of siblings
associated with caregiver stress (p > .05).
For caregiving sons, care recipient impairment is related to more family conflict
(b .49, p < .001) and increased caregiver stress (b .56, p < .001). The indirect effect
of care recipient impairment on caregiver stress that is mediated by family conflict is
significant (b .20, p < .001; not shown). With respect to contextual variables, having

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Kwak et al. 481

Figure 3. Structural model for the subgroups: daughters and sons.

Note. Standardized coefficients are first presented for daughters and those presented for sons in parentheses.
**p < .01 ***p < .001

one or more siblings is associated with greater care recipient impairment (g .14, p <
.001) and higher family conflict (g .21, p < .01). However, caregiver stress is not sig-
nificantly related to having siblings (p > .05). Having a spouse is not significantly associated
with care recipient impairment, family conflict, and caregiver stress for sons (p > .05).
In order to determine which paths in the structural model significantly differed by
gender, we conducted the chi-square test of significance. That is, after each of the paths
among care recipient impairment, family conflict, and caregiver stress was first con-
strained to be equal, these constrained models were compared to the model that allowed
the paths to vary as a function of gender. If the model without the constraints fits better
than the models that constrained the relationships among the latent constructs, there is an
interaction effect as a function of gender. The results reveal that one of the paths is sig-
nificantly different between caregiving sons and caregiving daughters; that is, for the
relationship between care recipient impairment and family conflict (Dw2 (df 1)
3.85, p < .05, not shown). These findings indicate that the relationship between care
recipient impairment and family conflict is significantly stronger for caregiving sons
(b .49, p < .001) than for caregiving daughters (b .37, p < .001).

Discussion
The present study examined the mediating role of family conflict in the relationship
between care recipient impairment and caregiver stress for adult child caregivers. For the
most part, the studys findings support the conceptual model developed by Scharlach and
his colleagues (2006) and are consistent with previous studies (Deimling et al., 2001). In
our study, family conflict significantly mediated the relationship between care recipient
impairment and caregiver stress after controlling for possible effects of family compo-
sition factors. Our findings support the interpretation that, when older parents need care,

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482 Journal of Social and Personal Relationships 29(4)

there may be different understandings of impairment and care among families, and adult
children and other family members may have different ideas of the quality and the
amount of care that should be provided to frail parents (Pearlin et al., 1990; Matthews,
2002; Merrill, 1997). Due to these differences, the primary caregiver and other family
members may disagree over the ways to care for frail parents (Connidis & Kemp, 2008;
Matthews, 2002), which, in turn, may lead to family conflict.
The one set of findings that is different from Scharlach et al. (2006) pertains to the
mediating role of family conflict in the link between care recipient impairment and
caregiver stress for adult child caregivers. While their study found that care recipients
mental impairment had only an indirect effect on caregiver strain, the results of the
present study indicate that care recipient impairment also has a direct effect on caregiver
stress. By including functional dependency (e.g. ADL and IADL) as well as mental
impairment in the analytic model and by using a nationally representative dataset, our
study obtains somewhat different results from those of Scharlach and his colleagues
concerning the role of conflict, suggesting that additional mechanisms may explain the
impact of care recipient impairment on caregiver stress.
Our first hypothesis concerning gender differences in the relationship between care
recipient impairment and family conflict was not supported by the data. While we found
that caregivers gender had an important moderating effect on the relationship between
care recipient impairment and family conflict, the gender effect was the opposite of what
we expected. That is, when adult children caregivers parents become more dependent
and need more care, there is a sharper increase in family conflict for sons than for
daughters.
There are several possible reasons for this unexpected finding. One stems from dif-
ferent caregiving patterns between sons and daughters when trying to address a frail
parents needs. When a parents dependency increases, daughters are more likely than
sons to respond to their parents needs by extending their caregiving work hours, which
may lead them not to ask other family members to become involved in caregiving
(Stoller, 1983). Sons are also more likely to view themselves as supervising parental
care, and thus more often delegate the actual provision of care to someone else
(Thompson, 2002), especially female relatives (Stoller, 1990). Therefore, since sons are
more likely to ask for help from other family members than are daughters, there are more
possibilities for sons to experience conflict over the distribution of caring work during
this process of negotiation. Another possible explanation stems from gendered
assumptions about caregiving roles. Since caregiving for older parents has been defined
as womens work, sons caregiving for older parents is often viewed as non-normative.
Because sons may have few role models for male caregiving, they may be less familiar
with skills related to negotiation and coordination of caregiving work, such as verbaliz-
ing problems related to care and arranging help (Harris, 2002). If sons are not familiar
with such caregiving skills, they are at risk for experiencing family conflict over caregiv-
ing. Although our study did not measure whether or not there are gender differences in
asking for help from other family members or in coordinating caregiving work among
family members, our findings concerning the existence of gender differences suggest
that further investigation into such caregiving skills would be a fruitful way of under-
standing the relationship between caregiver gender and family conflict.

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Kwak et al. 483

Our second hypothesis concerning the moderating impact of gender on the rela-
tionship between care recipient impairment and caregiver stress was not supported.
That is, there was no gender difference in the relationship between care recipient
impairment and caregiver stress. This finding may be related to the nature of our
study sample, which consisted of sons and daughters who were primary caregivers of
older parents. As care-receiving parents impairment becomes more severe, the
changes in caregiving work, which are closely related to caregiver stress (Pinquart
& Sorenson, 2004), may not differ among sons and daughters because they are pri-
mary caregivers who have already assumed major responsibilities for providing rou-
tine assistance to their parents, including both personal and instrumental help
(Chumbler, Grimm, Cody, & Beck, 2003; Gonzalez-Salvador, Arango, Lyketsos, &
Barba, 1999; Harris, 1998). As primary caregivers, adult children, regardless of their
gender, may experience a similar degree of care-giving stress as their parents level of
impairment increases.
The third hypothesis related to gender differences in the relationship between family
conflict and caregiver stress was also not confirmed by the study data. We found no gender
differences in the relationship between family conflict and caregiver stress. Our results
concerning lack of gender differences indicate that when the family network experiences
conflict over caregiving, the spillover to caregiver stress is equally strong for sons and
daughters who are primary caregivers. It may be that our original rationale was at fault for
why sons would experience more stress than daughters due to family conflict. We earlier
conjectured that due to mens use of avoidant and withdrawal forms of coping (Tamres
et al., 2002) they would be more negatively impacted by family conflict than would
women. While such gender differences have been found within the general population
(Tamres et al., 2002), perhaps these differences do not occur for those who are caregivers.
It may be that caregivers experience a more limited range of coping strategies, so gender
differences are less prominent. To further address this issue, it would be useful for future
research to examine gender-related coping strategies with family conflict about caregiving.
Finally, our fourth hypothesis concerning the influence of family composition factors
was partially supported. Specifically, family composition factors were significantly
associated with care recipient impairment and family conflict, but not with caregiver
stress. Of particular interest within this constellation of findings is the distinctive role of
siblings in family conflict as compared to the role of spouses. As expected, having
siblings is related to family conflict for both caregiving daughters and sons. This finding,
which is consistent with previous research (Matthews, 2002; Strawbridge & Wallhagen,
1991; Weitzman et al., 1999), shows that siblings can be a source of stress by increasing
family conflict over caregiving, regardless of the gender of the primary caregivers.
However, having a spouse is not associated with family conflict for either caregiving
daughters or caregiving sons. This result suggests that caregivers spouses may not be a
major source of family conflict. Although some studies indicate that adult children
caregivers experience conflict with their spouses (Strawbridge & Wallhagen, 1991),
other studies report that spouses provide emotional or practical support and help care-
givers to cope (Campbell, 2010; Litvin, Albert, Brody, & Hoffman, 1995). These mixed
findings concerning the ways in which spouses impact caregiving may help account for
our lack of significant effects.

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484 Journal of Social and Personal Relationships 29(4)

In summary, the present study examined the role of gender in relation to family
conflict and caregiver stress for adult children. We found that as parents impairment
increases, adult sons experience more family conflict than do caregiving daughters.
However, the relationship between their parents impairment and their own caregiving
stress is similar for caregiving sons and daughters as is the relationship between family
conflict and caregiver stress. Taken together, our study suggests that there are more
similarities than differences in the ways in which sons and daughters experience the
stress process when they are primary caregivers.

Study limitations and implications for future research

Our studys contributions to understanding the impact of gender on family conflict
among adult child caregivers notwithstanding, several limitations of this study should be
noted. First, the present study is based on cross-sectional data, which is not effective in
ascertaining the causal relationship between family conflict and caregiver stress in the
long term. It is possible that the hypothesized causal relationships could be bidirectional;
that is, caregiver stress and family conflict may influence one another. Future research
that uses longitudinal data on family conflict and caregiver stress would be helpful to
enhance our understanding of the complexity of these relationships. Second, the survey
provided no detailed information about actual support and help from other family mem-
bers or their views on caring for older parents. This information may be fruitful in articu-
lating how care recipient impairment results in family conflict and stress and why there
are gender differences in the association between care recipient impairment and family
conflict. Third, no information was provided in the survey about the role of care-
receiving parents with respect to family conflict. When adult children are caregivers,
the participation of older parents in decisions related to care is critical in diminishing
family conflict (Matthews, 2002). Thus, future research needs to include information
about the role of care recipients and other family members in family discord and care-
giver stress. Finally, we need to attend to additional contextual factors when exploring
the stress process for adult child caregivers. Further information is needed about how
issues such as the demands of employment and the support of adult childrens children
play a role in this stress process.
Despite its limitations, findings from the present research demonstrate the impact of
family conflict on caregiver stress and indicate the need for family intervention to
alleviate the stress of adult child caregivers. Additionally, our study highlights the
importance of taking into account the gender of primary caregivers when attempting to
understand the nature of family conflict experienced by adult child caregivers. Research
that further explores some of the issues that emerged from the present study will help
shed light on this important aspect of family relationships in later life.

Acknowledgements
The authors would like to express their gratitude to Laura Klem for her assistance with the
data analysis and to Ruth Dunkle, Sarah Burgard, and Jiann Zhang for their comments on earlier
versions of this paper.

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Kwak et al. 485

Funding
This research was funded by the National Institute on Aging (NIA) training program
(T32-AG000117).

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