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of Family Issues
Consequences of Filial Support for Two Generations: A Narrative

and Quantitative Review
Eva-Maria Merz, Hans-Joachim Schulze and Carlo Schuengel
Journal of Family Issues 2010 31: 1530 originally published online 22 March
2010
DOI: 10.1177/0192513X10365116
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Consequences of
Filial Support for
Two Generations:
A Narrative and
Quantitative Review
Journal of Family Issues

31(11) 15301554
The Author(s) 2010
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0192513X10365116
http://jfi.sagepub.com
Eva-Maria Merz1,2,
Hans-Joachim Schulze2,
and Carlo Schuengel2
Abstract
This narrative and quantitative review synthesizes findings from 55 (N = 54,550)
studies on the association between providing support to elderly parents and
well-being of adult children as well as well-being of parents, in an endeavor
to determine the prevailing direction of effects, magnitude of effects, and
possible factors that may moderate these effects. The relation between caring
for an elderly parent and well-being and/or caregiver burden in adult
children was found to be insubstantial. Likewise, being cared for by adult
children was found to be weakly related to well-being in elderly parents.
More complex models including psychological aspects of caring; aspects of
the intergenerational relationship, such as quality; and the inclusion of both
the adult childs and the parents perspectives on providing and receiving
support appear more promising for understanding caregiving and well-being
in intergenerational relationships beyond childhood.
Keywords
intergenerational solidarity, well-being, caregiver burden, meta-analysis
1
Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands

VU University Amsterdam, Amsterdam, Netherlands
Corresponding Author:
Eva-Maria Merz, Department of Social Demography, Netherlands Interdisciplinary
Demographic Institute, PO Box 11650, 2502AR The Hague, Netherlands
Email: Merz@nidi.nl
1531
Merz et al.
Because of increased longevity, parents and children share a longer period of

their lives than ever before. This includes the time when parents enter into
their elderly life phase, which may or may not be a period of good health and
which generally leads toward an increasing appeal for support from next of
kin. Social support and short-term caring may place greater demands on families, especially on adult children, than before (Silverstein, Burholt, Wenger,
& Bengtson, 1998; Umberson, 1992; Zarit & Eggebeen, 2002) and are
increasingly viewed as important issues in adult development (Bradley &
Cafferty, 2001). Adult children have to deal with the deteriorating health of
their parents and with challenges associated with shrinking capacities. This
may be expressed in caring behavior or other forms of intergenerational support (Cicirelli, 1993). However, time, effort, and energy cannot be stretched
endlessly before intergenerational support starts to diminish the well-being
of those who take it on them to care for their parents. For care recipients, care
is generally thought to benefit well-being (Levitt, Guacci, & Weber, 1992),
whereas for care providers, it has been suggested that filial care is detrimental (Cicirelli, 1993; Townsend & Franks, 1995). However, this view has been
questioned (e.g., Silverstein, Chen, & Heller, 1996), and some have argued
that the reverse may be true, that parents well-being decreases as a result of
depending on their adult offspring associated with losing autonomy (G. R. Lee
& Ellithorpe, 1982; Silverstein et al., 1996) and that children experience joy
and fulfillment in caring for parents because of the opportunity to give back
to loved ones. Amirkhanyan and Wolf (2003) even suggested that caring for
an elderly parent may be a strategy to cope with the emotional reactions to
the parents suffering and impending death. In summary, authors disagree on
the costs and rewards of filial caring for both generations.
A systematic review of the evidence was undertaken to address these
inconsistencies in the literature. The present review synthesizes findings
from 55 studies (totaling N = 54,550 participants) on the association between
giving and receiving care and well-being of adult children and their parents,
in an endeavor to determine the prevailing direction of effects, magnitude of
effects, and moderating factors that have been proposed in explanation of
disparate findings. One such moderating factor is type of care. Instrumental
care has been found to have different effects on well-being than emotional
care (e.g., Zunzunegui, Bland, & Otero, 2001). Another factor may be gender,
as several studies have reported that caring is gendered and that women are
more often expected to care for members of the family than men (e.g., Marks,
1998), which may lead to differential effects of caring on well-being (Marks,
Lambert, & Choi, 2002; Starrels, Ingersoll-Dayton, Dowler, & Neal, 1997).
Cultural background will also be examined as a moderating factor because
1532
Journal of Family Issues 31(11)
norms concerning family care can vary among different cultural backgrounds
(e.g., Fuligni & Pedersen, 2002; Kwak, 2003).
Method
Literature Search
The studies included in the present meta-analysis were identified from the
psychological, sociological/gerontological, and medical literature through
the electronic databases Web of Science (Social Sciences and Arts and
Humanities citation indices), ERIC (Education Resources Information
Center), MEDLINE/PubMed, PsycINFO, AgeLine, and SocIndex (Sociology citation Index) in the time period 1945 to 2007, using the following
keywords: intergenerational support AND well(-)being (100 results),
intergenerational solidarity AND well(-)being (26 results), (parent)
care AND well(-)being (772 results), parent care AND adult children
(934 results), caring AND well(-)being (139 results), caregiving AND
well(-)being (660 results), social support AND burden (983 results),
intergenerational support AND burden (18 results) or filial maturity
(23 results), filial maturity AND well(-)being (7 results), elderly parents
AND adult children (218 results), and caregiver burden (1,530 results).
Furthermore, the reference lists of the retrieved articles were checked on
relevant studies.
Inclusion and Exclusion Criteria

The following six criteria were used to decide whether studies could be
included in the present analysis: First, all studies had to report associations
between providing support and well-being or receiving support and wellbeing in adult childparent relationships. Second, we limited our definition
of care as covering various types of emotional support in the form of affectionate interaction and face-to-face contact, various kinds of communicative
exchange (advice, decisions, reassurance), instrumental care (household
chores, shopping), and temporary care in case of illness or partially providing
for services usually done by professionals (bathing, helping in and out of
bed). Studies in which children took over the daily nursing role for their
chronically ill parents were excluded, because this type of care would not be
comparable with support in other studies because of much higher time and
energy effort. Studies in which children were supporting their parents only
financially were excluded too. Third, in contrast to earlier meta-analyses that
1533
Merz et al.
focused on caring and well-being in a broader range of roles (children, parents, partners, brothers, or sisters; Pinquart & Srensen, 2003, 2004, 2005,
2006), only studies investigating caregiving and receiving in adult child
parent dyads were included. Consequently, studies reporting spousal or other
familial caring relationships were excluded from our review. Studies on professional caregiving were also excluded from this meta-analysis. Fourth,
studies had to describe original quantitative research and include sufficient
data to determine effect sizes. Moreover, the studies had to be published in
English. Finally, to establish a minimum study quality (Wortman, 1994), only
studies published in scientific, peer-reviewed journals were included in the
meta-analysis. If there were more than one study based on the same sample,
only one report was included in the analyses (e.g., Ingersoll-Dayton, Starrels,
& Dowler, 1996; Starrels et al., 1997; Zhan, 2005, 2006). Of all reviewed
studies, 55 satisfied the above-mentioned criteria and were included in our
review. Publication years of these studies ranged between 1981 and 2007.
Coding Procedure
A detailed coding scheme was used to record the following study characteristics: country, design, sample size, predominant sex of sample, mean age of
both the parent and child generation, cultural background of the respondents
(Western vs. non-Western), effect size type (bivariate vs. multivariate), and
marital status. The kind of care the older generation received from their adult
children was differentiated into instrumental and emotional care.
All studies included in the statistical meta-analytic procedure were coded
by the first author. The second and the third authors each coded 10 studies, of
which 5 were the same. In other words, 5 studies were coded by all three
authors, 10 by the first and second authors, and 10 by the first and third
authors. The remaining studies were coded by the first author. Following the
coding procedure an interrater reliability check (Cohens k or intraclass correlations) was performed. Reliability coefficients ranged from k = .77 to 1.0
and r = .88 to 1.
Calculation of Effect Sizes

If studies reported multiple effect sizes for the association between variants
of a given dependent and independent variable, these were averaged so that a
combined effect size could be entered into the meta-analysis. This led to a
total data set of k = 56 effect sizes. Two different meta-analyses were conducted in this study: one on the association between receiving care from adult
1534
children and parental well-being, often indicated by depressive symptoms,

and the other on the relation between caring for an older parent and the wellbeing of the adult child, often measured as caring stress or caregiver burden.
In the first meta-analysis investigating the association between receiving
care and parental well-being, effect sizes were only included if health status
of the parent was statistically controlled, because health may be a confounder,
because of its association with well-being (Silverstein et al., 1996). For the
evaluation of magnitude of effect size, Cohens (1988) criteria for small (r =
.10-.29), medium (r = .30-.49), and large (r = .50) effect sizes were used.
Effect sizes smaller than r = .10 were considered insubstantial.
Statistical Analyses
A meta-analytic approach with a fixed-effects model (Hedges & Vevea, 1998)
was used to examine the combined effect sizes of studies investigating the
association between care and well-being of the parent generation on one hand
and caring and well-being of the child generation on the other hand. The correlation coefficient (r) was chosen as the effect size statistic. If a study did not
include adequate effect size statistics but reported that there was no significant effect, the effect size was conservatively estimated as p = .50 (Lipsey &
Wilson, 2001; Mullen, 1989). The resulting effect sizes were inserted in the
statistical package Comprehensive Meta-Analysis (Version 2; Borenstein,
Rothstein, & Cohen, 2000). Combined effect sizes were calculated by weighting each study as a function of sample size (Mullen, 1989; Rosenthal, 1991).
The overall statistics were computed by combining data across outcomes and
treating these as independent. Differences between groups of effect sizes (i.e.,
categories of a moderator) were interpreted as significant when the 95% confidence intervals (CIs) did not overlap. Whether the various effect sizes that
were averaged into an overall effect size all estimated the same population
effect sizes was investigated with tests of heterogeneity, performed with the
Q statistic (see Lipsey & Wilson, 2001) to determine whether exploratory
analyses including additional study characteristics as moderating factors
were necessary, using meta-analytical regression analysis.
Results
General Results Concerning Study Characteristics
Measures of well-being typically consist of a global assessment of various
aspects of a persons life (Diener, 1984). Well-being in most of the included
1535
Merz et al.
studies was measured either as life satisfaction, caregiver stress/burden or

depression, usually with the Center for Epidemiologic Studies Depression
Scale (CES-D; Radloff, 1977). The CES-D is a frequently used subjective
well-being measure showing validity and reliability in studies of elderly populations (Thompson & Heller, 1990). Other concepts used to refer to well-being
were positive and/or negative affect (e.g., Silverstein et al., 1996), mental
health (e.g., Li & Seltzer, 2003), or morale (e.g., Chen & Silverstein, 2000).
Review of Studies on Association Between

Receiving Care and Well-Being of the Parent Generation
Studies on parents as receivers of care from their children do not show
unequivocal support for the notion that such caring improves their wellbeing. Several factors have been described as important determinants of the
association between received support and well-being in the elderly. These
factors include structural aspects such as marital status as well as individual
characteristics, such as expectations or characteristics of the relationship
between care recipient and care provider, such as quality. Additionally, different associations between support and well-being have been found across
cultures. In non-Western societies (e.g., China), filial care is viewed as devotion and dedication to parents and therefore often positively contributes to
the well-being of the elderly (Cheng & Chan, 2006). Conversely, one could
argue that filial care is taken for granted in these societies and may therefore
not explicitly contribute to an increased well-being in parents, a finding
reported by Silverstein, Cong, and Li (2006). Other studies, comparing
respondents from African descent and White elders found general differences
in amount of help received and parental satisfaction with filial care. Ethnic
groups from collectivistic backgrounds are expected to hold more favorable
views on family support and are therefore more likely to provide help and
care to older family members (Coleman, Ganong, & Rothrauff, 2006).
Especially for the widowed elderly, support from adult children has been
considered valuable for helping elderly individuals to cope with having lost
a partner and other challenges associated with aging, such as deteriorating
capacities (Silverstein & Bengtson, 1994). A Spanish study found that generally low emotional support and receipt of instrumental support were
associated with lower self-rated health. For widowers who did not share
living arrangements with their children, a lack of emotional support and
instrumental support was associated with higher depression too (Zunzunegui
et al., 2001). Conversely, Mutran and Reitzes (1984) found no associations
between depression and receiving support from children for married elderly
1536
people, whereas negative self-feelings were reduced for widowers who

received filial care.
Different associations between support and well-being of the parent generation were found for different types of filial care received. Several studies
separately addressed the effects of instrumental and emotional care. For
example, Chen and Silverstein (2000) investigated intergenerational relationships in China and found that emotional care and financial support from
children were positively associated with older parents morale. Receiving
instrumental care from children, however, did not significantly predict parents well-being. Furthermore, it was found that the effect of receiving support
was mediated by parents satisfaction with their children. Similar results were
obtained in a German study on different types of supportive behavior and
subjective well-being conducted by Lang and Schtze (2002); receiving
emotional care was positively associated and receiving informational care
was negatively associated with parents satisfaction with aging. Tangible support (support with household chores, shopping or other errands) was not
associated with older parents satisfaction with aging.
Although a majority of studies reported a positive association between
support received from children and well-being of elderly parents, effect sizes
were often small, and results depended on structural factors or relationship
characteristics. We empirically summarized the association between receiving care and well-being of the older generation by combining k = 22 effect
sizes (see Table 1), based on a total of n = 20,931 participants.
No significant differences were found between the groups of studies on
effects of instrumental care as compared with studies on emotional care
(overlapping CIs). Therefore, these groups of studies were combined. The
meta-analytical results for the association between receiving care and wellbeing of the older generation revealed a combined correlation of r = .03,
which was a significant (p < .001) but insubstantial effect. This set of studies
was heterogeneous (Q = 51.52, p < .001), and explanatory moderator analyses were conducted (see Table 2). Publication year, gender, and ethnicity of
the respondents were not found to be significant moderators of the association between receiving care and well-being of elderly parents. Significant
differences were found between studies using a positive operationalization of
well-being and studies with a negative operationalization (no overlap in CIs).
The subset of studies using a mere positive operationalization found a slightly
larger, significant, but still insubstantial, association between receiving care
from adult children and well-being, whereas in the subset with negative wellbeing concepts, this association was not significant. The subset of studies
with negative well-being concepts was homogeneous, whereas the subset of
1537
Concept
Well-Being
ES Reported
in Study
r = .07
r = .04
r = -.03
r = .26
r = .15
r = -.05
r = -.04
r = -.02
r = .02
r = .05
r = -.08
r = .03
r = .27
r = .14
r = -.02
r = -.01
r = .11
r = .02
r = -.05
r = -.06
r = .03
r = .04
r = .03
Correlation
Calculated
0.85
2.32*
-1.15
2.18*
4.94***
2.11*
-0.95
-0.67
0.40
1.13
1.02
1.14
2.60**
2.21*
-0.67
-0.67
2.23*
0.54
-0.89
-1.01
1.28
1.44
4.23***
Z Value
Note: ES = effect size; CI = confidence interval.

a. If well-being consisted of a combination of positive and negative conceptualization, the effects were coded in positive direction.
*p < .05. **p < .01. ***p < .001.
Silverstein and Bengtson (1994)

146 Combineda
p = .40
3,039 Positive
b = .04
Chen and Silverstein (2000)
Zunzunegui et al. (2001)
1,193 Negative
p = .25
Lang and Schtze (2002)
70 Positive
b = .26
1,056 Positive
b = .15
Kim and Kim (2003)
Mutran and Reitzes (1984)
1,503 Combined
b = .06
Silverstein et al. (1996)
539 Combined
p = .25
Umberson, 1992
2,057 Negative
p = .50
G. R. Lee and Ellithorpe (1982)
403 Positive
b = .02
603 Negative
b = .05
Whitbeck, Hoyt, and Tyler (2001)
Cheng and Chan (2006)
164 Negative
b = .08
Silverstein et al. (2006)
1,561 Combined
p = .26
Markides, Costley, and Rodriguez (1981)
98 Positive
b = .27
Lowenstein and Katz (2005)
248 Positive
b = .14
1,263 Negative
p = .50
Li, Liang, Toler, and Gu (2005)
Weinstein, Glei,Yamazaki, and MingCheng (2004) 2,409 Negative
p = .50
G. R. Lee, Netzer, and Coward (1995)
388 Negative
b = .11
Dunham (1995)
727 Negative
b = .02
Markides and Krause (1985)
308 Combined
b = -.05
McCulloch (1990)
284 Positive
b = -.06
Lowenstein, Katz, and GurYaish (2007)
1,713 Positive
b = .03
Davey and Eggebeen (1998)
1,168 Combined
b = .04
Total
20,931

Study
N
Table 1. Association Between Receiving Care and Well-Being of the Parent Generation
-0.09 to 0.23
0.01 to 0.08
-0.09 to 0.02
0.03 to 0.47
0.09 to 0.21
0.004 to 0.11
-0.13 to 0.04
-0.06 to 0.03
-0.08 to 0.12
-0.03 to 0.13
-0.07 to 0.23
-0.02 to 0.08
0.07 to 0.46
0.02 to 0.26
-0.07 to 0.04
-0.05 to 0.03
0.01 to 0.21
-0.05 to 0.09
-0.16 to 0.06
-0.18 to 0.06
-0.02 to 0.08
-0.02 to 0.10
0.02 to 0.04
95% CI
1538
studies with positive well-being concepts remained heterogeneous. Marital

status was found to be a significant moderator for the whole set of studies.
Parents who were widowed or divorced appeared to benefit significantly
more from the care they received from their adult children than did stillmarried parents. Age also had a significant effect on the association between
receiving care and well-being of the elderly; the older the parents, the higher
their well-being because of receiving care. All statistics regarding moderator
analyses can be found in Table 2.
Because some of the studies included in this meta-analysis did not report
appropriate exact statistics, effect sizes had to be conservatively estimated as
probability level (p). Excluding those studies from the analyses provided a
similar insubstantial overall effect size of r = .04 (p < .001) on a still heterogeneous set of studies.
Review of Studies on Association Between

Providing Care and Well-Being of the Child Generation
For the association between providing support to an elderly parent and the
well-being of adult children, too, various factors seem to play a contributing
role. Fulfilling competing roles, such as being an employee, a parent, and a
romantic partner, while at the same time caring for an elderly parent, may put
adult children under considerable pressure. Marks (1998), for example, pointed
to conflicting demands between the roles of being an employee and caregiver. Positive and negative experiences in other family roles and in employment
buffered or exacerbated caring stress (Stephens & Townsend, 1997; Stephens,
Townsend, Martire, & Druley, 2001).
Additionally, individual factors or relationship factors have been found to
moderate the association between providing care and filial well-being. Individual factors refer to characteristics of care provider or recipient, such as
gender, age, or marital status. Regarding factors concerning the relationship,
attachment, and relationship quality have been found important moderators
and mediators in this association. Cicirelli (1993) found in his study on attachment as a motive of caring behavior for daughters that significant associations
existed between amount of care given to mothers and subjective burden of
daughters. In his study on attachment between adult daughters and their
mothers and consequences on caring, Carpenter (2001) found a significant
correlation between providing instrumental care and caregiver burden, whereas
the association between providing emotional care to older mothers and caregiver burden in daughters was not significant. A German study found that
caregiver burden was predicted by the extent of care and the perceived reciprocity in the relationship (Schwarz, Trommsdorff, Albert, & Mayer, 2005).
1539
Merz et al.
Table 2. Moderator Analyses on the Association Between Receiving Care and

Parental Well-Being

ES
Z Value
95% CI
Categorical
moderator
Positive 8
r = .06
4.93***
0.04 to 0.08
24.67**
conceptualization
well-being
Negative 8
r = -.01 0.58
-0.03 to 0.02
9.90
conceptualization
well-being
Combination 6
r = .03
2.06
-0.01 to 0.06
6.03
conceptualization
well-being
Continuous
moderator
% Married
14
r = .04
5.07***
0.03 to 0.06
26.16*
Point estimate -.00
-2.16*
-0.002 to -0.001
slope
Point estimate
.13
3.15**
0.04 to 0.20
intercept
Mean age
14
r = .04
4.12***
0.02 to 0.05
30.61**
Point estimate
.01
3.73***
0.01 to 0.02
slope
Point estimate -.71
-3.55*** -1.10 to -0.32
intercept
Note: CI = confidence interval.
*p < .05. **p < .01. ***p < .001.
Several studies have addressed individual caregiver characteristics

as important contributors to well-being as a consequence of caregiving.
For example, in a prospective study, Marks et al. (2002) investigated the
transition to caregiving. They found that this transition generally was
associated with increased depressive symptoms. However, for adult
daughters, caring for a parent also had beneficial effects on their psychological wellness.
Characteristics of the care recipient too have been shown to play a role in
care providers well-being. Llacer, Zunzunegui, Gutierrez-Cuadra, Bland,
and Zarit (2002) found that providing care to people older than 65 years in
Spain was positively associated with well-being. However, emotional
care was consistently associated with higher levels of well-being whereas
1540
instrumental care did not predict well-being significantly. Furthermore,

parental impairment was found to moderate this impact on daughters wellbeing. Caring for an elderly parent with cognitive impairments seemed to
diminish the well-being of adult daughters, whereas physical impairments
did not take a toll (Li & Seltzer, 2003).
A great majority of the above-discussed studies used cross-sectional data
to investigate the association between filial support provision and well-being
in adult children. Amirkhanyan and Wolf (2003), however, explored the pathways of well-being and stress in caring adult children, applying a longitudinal
design. Controlling for severe care needs of elderly parents, they did not find
that caring predicted increased or decreased symptoms of depression.
Generally, a majority of studies reported that providing care to elderly
parents was negatively associated with filial well-being. However, few studies also found positive or no associations between caring and caregiver
well-being. In other words, this association appeared to be partly dependent
on moderating factors, some of which also have been discussed in the section
above. We empirically determined the association between providing care to
an elderly parent and the adult childs well-being by combining k = 34 effect
sizes (see Table 3), including a total of n = 33,619 participants.
The meta-analytical results revealed a combined effect of r = -.07, which
was a significant (p < .001) but insubstantial effect. This set of effect studies
was heterogeneous (Q = 353.29, p < .001). Therefore, exploratory moderator
analyses were undertaken (see Table 4). Only three of the included studies
(Carpenter, 2001; Schwarz et al., 2005; Zhan, 2005) explicitly distinguished
between types of care (i.e., instrumental and emotional care) provided to
elderly parents. No different meta-analyses were therefore calculated for
subgroups including only instrumental or emotional care. Twenty-one studies investigated well-being as a negative concept, 12 studies as a combination
of positive and negative well-being, and one study used a mere positive conceptualization. The combined effect sizes for the subsets of studies were
differing significantly from each other, but the sets remained heterogeneous
(see Table 4).
Publication year was a significant moderator of the association between
caregiving and well-being. More recently conducted studies found larger
absolute effect sizes. Studies including older caring children reported weaker
results. Studies including higher percentages of Western respondents provided more negative effect sizes (i.e., stronger absolute effect sizes). Studies
including more female caregivers (adult daughters) had stronger absolute
effect sizes. Furthermore, there was a significant difference between studies
including bivariate and studies reporting multivariate effect sizes. Studies
1541
Negative
Negative
Negative
Combineda
Negative
Negative
Combined
Combined
Negative
Negative
Negative
Combined
Negative
Negative
Combined
Combined
Negative
Negative
Negative
Negative
Positive
Combined
Combined
Cicirelli (1993)
Pruchno and Kleban (1993)
Starrels et al. (1997)
Marks (1998)
Carpenter (2001)
Schwarz et al. (2005)
Marks et al. (2002)
Llacer et al. (2002)
Umberson (1992)
Li and Seltzer (2003)
Gupta (2000)
Atienza and Stephens (2000)
Zhan (2002)
Amirkhanyan and Wolf (2003)
Stephens and Townsend (1997)
Choi and Marks (2006)
Loomis and Booth (1995)
Li, Seltzer, and Greenberg (1999)
Stephens et al. (2001)
Amirkhanyan and Wolf (2006)
Dwyer, Lee, and Jankowski (1994)
Spitze, Logan, Joseph, and Lee (1994)
Stephens, Franks, and Atienza (1997)
78
424
1,585
296
80
265
8,286
127
2,057
139
118
103
110
8,345
296
152
373
168
278
7,009
135
763
105
Concept
Well-Being

Study
N
Correlation
Calculated
r = .24
r = .08
r = .23
r = -.02
r = .17
r = .45
r = -.02
r = -.08
r = .02
r = .06
r = .32
r = -.30
r = -.15
r = -.01
r = -.22
r = -.14
r = -.01
r = .22
r = .24
r = .19
r = -.33
r = -.03
r = -.32
ES Reported
in Study
r = .24
r = .08
b = .23
p = .40
r = .17
b = .45
b = -.03
p = .38
p = .28
p = .50
b = .32
b = -.30
r = -.15
p = .50
r = -.22
p = .25
r = -.01
r = .22
b = .24
b = .19
b = -.33
p = .44
r = -.32
Table 3. Association Between Caring for an Older Parent and Well-Being of the Adult Child Generation
2.12*
1.81
9.32***
-0.25
1.24
7.79***
-1.92
-0.91
1.09
0.67
3.50***
-3.14**
-1.56
-0.67
-3.85***
-1.71
-0.12
2.87**
4.06***
15.75***
-3.89***
-0.77
-0.81
Z value
(continued)
0.02 to 0.44
-0.01 to 0.18
0.18 to 0.28
-0.13 to 0.10
-0.08 to 0.35
0.35 to 0.54
-0.04 to 0.00
-0.25 to -0.09
-0.02 to 0.07
-0.11 to 0.22
0.14 to 0.47
-0.47 to -0.12
-0.33 to 0.04
-0.03 to 0.01
-0.33 to -0.11
-0.29 to 0.02
-0.11 to 0.10
-0.36 to -0.07
0.13 to 0.35
0.16 to 0.21
0.17 to 0.47
-0.10 to 0.04
-0.27 to 0.11
95% CI
1542
4.17***
-1.57
-1.67
-0.43
-13.66***
0.16
-0.21
2.29*
2.90**
2.41*
1.50
0.67
Z value

a. If well-being consisted of a combination of positive and negative conceptualization, the effects were coded in positive direction.
*p < .05. **p < .01. ***p < .001.
r = .40
r = -.06
r = -.11
r = -.05
r = -.07
100
Negative
r = .40
818
Negative
b = -.06
252
Combined
b = -.11
95
Combined
b = -.05
31,644
r = .06
p = .50
r = .02
r = -.02
r = .20
r = .22
r =.14
r = .14
Correlation
Calculated
ES Reported
in Study
b = .02
b = -.02
r = .20
b = .22
b = .14
r = .14
112
110
130
171
297
112
Combined
Negative
Negative
Negative
Negative
Combined
Negative
Strawbridge, Wallhagen, Shema,

and Kaplan (1997)
Stull, Bowman, and Smerglia (1994)
Zhan (2005)
M.-D. Lee (2007)
Barber (1988)
Murphy et al. (1997)
Townsend, Noelker, Deimling,
and Bass (1989)
Strawbridge and Wallhagen (1991)
Mui (1995)
Peters-Davis, Moss, and Pruchno (1999)
Stephens, Franks, and Townsend (1994)
Total
130
Concept
Well-Being

Study
N
Table 3. (continued)
0.22 to 0.55
-0.12 to 0.01
-0.23 to 0.02
-0.24 to 0.16
-0.09 to -0.06
-0.17 to 0.20
-0.21 to 0.17
0.03 to 0.36
0.07 to 0.36
0.03 to 0.25
-0.04 to 0.32
-0.11 to 0.23
95% CI
1543
Merz et al.
Table 4. Moderator Analyses on the Association Between Providing Care and

Filial Well-Being

ES
Z Value
95% CI
Categorical
moderator
Negative
21
r = .09
13.98***
0.08 to 0.11
conceptualization
well-being
Combination
12
r = -.03 -3.39*** -0.05 to -0.01
conceptualization
well-being
Bivariate ES
14
r = -.15 -7.62*** -0.19 to -0.11
Multivariate ES
20
r = -.07 -12.04*** -0.08 to -0.06
Continuous
moderator
Publication year
34
r = -.07 -13.66*** -0.09 to -0.06
Point estimate -0.004
-3.38*** -0.007 to -0.002
slope
Point estimate
8.51
3.35***
3.54 to 13.50
intercept
23
r = -.04 -6.02*** -0.05 to -0.03
% Western
-3.91*** -0.003 to -0.001
slope
Point estimate
0.11
2.83***
0.03 to 0.19
intercept
% Female
29
r = -.05 -7.32*** -0.06 to -0.04
-9.17*** -0.005 to -0.003
slope
0.18
7.09***
0.14 to 0.24
Point estimate
intercept
Mean age
22
r = -.05 -7.25*** -0.06 to -0.04
Point estimate
0.003
3.23**
0.001 to 0.005
slope
-4.12*** -0.33 to -0.12
intercept
290.80***
27.20**
54.42***
282.45***
353.29***
173.05***
231.81***
210.28***

*p < .05. **p < .01. ***p < .001.
with bivariate effects sizes found stronger negative associations between

caregiving and well-being of adult children than did studies using multivariate analysis methods. The exact statistics of the moderator analyses can be
obtained from Table 4.
1544
Because some of the studies included in this meta-analysis did not provide
appropriate exact statistics, effect sizes had to be conservatively estimated as
probability level (p). Excluding those studies from the analyses provided a
similar small overall effect size of r = -.11 (p < .001) on a still heterogeneous
set of studies.
Discussion
It is reasonable to expect that giving care to elderly parents takes a toll on
childs well-being, whereas receiving care is associated with increased wellbeing for elderly parents. The results of our review support the notion that
caring for an elderly parent is associated with stress and depression in adult
children, but the effects are very small. Several studies suggested that the
burden of caring may be offset by individual characteristics, for example,
problem-focused coping with the stress of having a needy parent or relationship characteristics such as quality or attachment and positive views of the
parent, which leads to a satisfactory balance of the childrens and the parents
needs. Being cared for by adult children was likewise found to be weakly
related to well-being in elderly parents. Several studies suggested that the
benefits of receiving care may be offset by feelings of unwanted dependency
and loss of autonomy. Other studies focused on structural factors, such as
marital status or living situation, as possible moderators of the relation between
receiving care from adult children and well-being of the elderly parents.
Below, we elaborate on these findings, in particular on moderating factors in
the association between intergenerational care and well-being in parents and
adult children and offer some directions for future research.
Moderating Factors in the Relation Between

Support Receipt and Parental Well-Being
Previous reviews of the effects of care or social support on physical and
mental health (e.g., Uchino, Cacioppo, & Kiecolt-Glaser, 1996) suggested
that care is a multidimensional concept and that, for example, instrumental
and emotional care should be distinguished. Emotional support has been
found to be more important than instrumental support and associated with
positive effects in the elderly (e.g., Zunzunegui et al., 2001). Summarizing
the evidence, however, revealed no differences between the effects of instrumental and emotional care on the well-being of parents receiving care from
children. More than actual emotional or instrumental support, the perceived
quality of support may be crucial (e.g., Jasinskaja-Lahti, Liebkind, Jaakkola,
1545
Merz et al.
& Reuter, 2006). Little is as yet known about the qualities of instrumental or
emotional support that determine their effectiveness in engendering feeling
support. Instrumental support, if timed well and contingent on the perceived
needs of the parents, may lift the spirits of a parent as much as support that is
entirely emotional or social in nature.
In addition to different types of care, this study also investigated care
recipient characteristics, including marital status and age. With regard to marital status of parents, our results mainly confirmed expectations, based on
earlier work. Parents with a partner benefited less from filial care than divorced
or widowed ones. Married parents may be able to direct their needs to their
partner and might be less dependent on their adult children. With respect to
age, it was found that older parents benefited more from filial support than
younger parents. It has been suggested that older persons are better capable
to integrate complex positive and negative emotions because of more experience and tolerance of ambiguity in later stages of the life span (Magai, 2001).
This might be an explanation for the fact that older people generally value
support from their adult offspring more than younger parents by trying to
maximize positive affect and dampen negative emotions.
Another significant moderating factor was the conceptualization of the
outcome variable well-being. Studies using mere positive conceptualizations
found significantly stronger effect sizes than studies including negative wellbeing measures. Diener (1984) pointed to the need of more rigorously defined
constructs referring to subjective well-being. In the current meta-analysis,
studies with negative, positive, and combined concepts of well-being were
integrated but produced different results. The concepts included depression,
positive and negative mood, life satisfaction, and affect balance but were all
referred to as well-being in the original studies. It seems imaginable that very
different interpretations are related to those concepts that might explain a part
of the heterogeneity found in the different sets of studies. It is also possible
that part of the stronger positive associations between received support and
positive well-being may be the result of bias to answer questions in the
positive direction. To resolve this issue, research including more than one
perspective on core variables or clearer operationalizations of core variables
is necessary.
Moderating Factors in the Relation Between

Support Provision and Filial Well-Being
Several moderating factors have been found to qualify the association
between providing care to elderly parents and filial well-being. Daughters,
1546
younger adult children, and children with a Western cultural background

experienced more caregiver burden than sons, older children, and children
with a non-Western background. The gender difference may be dependent on
the number and weight that is given to various other roles women have to
fulfill in their middle ages, such as being a wife, mother, and/or an employee.
Although some studies found differences between caring sons and daughters,
the evidence also indicated that gender differences regarding the effects of
caregiving are small to very small (Pinquart & Srensen, 2006). A similar
explanation regarding different roles and responsibilities might be true for
the finding that younger adult children experienced more burden than older
caregivers. Younger adult children might have their own children to care for and
experience more pressure in their different responsibilities (although the
sandwich generation has been dispelled as a myth; Loomis & Booth, 1995).
Furthermore, they may have more difficulty with accepting that their parents
are becoming older and start to demand care. In other words, filial maturity
does not seem to be fully attained (see Brody, 1985; Marcoen, Verschueren,
& Geerts, 1997).
Non-Western societies tend to take caring for an elderly parent for granted:
more so than Western societies. This might be an explanation for the fact that
non-Western children appeared to experience less burden from their caring
activities than Western children. Parent care may be experienced as normative and may lead to smaller declines in well-being of adult children with a
non-Western background. In addition, multigenerational households are more
common in non-Western societies. This way of living together in broader
family settings might ease caring for elderly parents and for their own children at the same time because of its greater flexibility.
General Conclusions, Limitations, and Future Directions

The narrative review of the individual studies suggests that the parentchild
relationship may be a very special type of relationship, with multiple facets
that have often opposite effects on well-being. Usually, bonds between adult
children and their parents are strong and emotionally close. Caring for the
elderly might therefore be less stressful for adult children than for other (professional) caregivers. Additionally, adult children might experience caring as
compensation for the effect of having frail, weak, and finally dying parents
(Amirkhanyan & Wolf, 2003). The amount and kind of exchanged care
between parents and their adult offspring seem to be determined by filial
norms (Pype, Marcoen, & Van Ranst, 1996), obligations (Cicirelli, 1993), and
parents expectations. These parental expectations may be based on the idea
1547
Merz et al.
of having cared for children throughout their childhood, adolescence, and

young adulthood and therefore being worth of support and care in return.
However, elderly parents may also continue to offer support to their adult
children because they have the idea that relationships have to be balanced, and
they do not want to only be a burden for their children. Reciprocity and mutual
caring are central within intergenerational relationships during the whole life
course, and childparent relationships most of the time remain stronger than
most other social ties (Berger & Fend, 2005; Logan & Spitze, 1996). Caring
emanates from the history of, very often exclusive, interactions and exchanges
between parents and children across the life span. During childhood, parents
generally care for their children and on average experience satisfaction and
fulfillment in taking this responsibility (Gabriel & Bodenmann, 2006). When
children become adults, patterns of support and care change. Some children
may be more prone to address their parents needs than others, but in general,
most children attain a certain level of filial maturity, which means that adult
children are prepared to take on a caring role toward their parents (Brody,
1985). Additionally, persons with greater well-being can exert a positive
influence on their relationship partners, especially in close relationships such
as parentchild ones. Well-being and satisfaction contribute to peoples resilience and help them cope with various challenges such as providing and
receiving support. If well-being is high, a positive interplay with others wellbeing, which again might contribute to their own well-being, seems imaginable
(Merz, Consedine, Schulze, & Schuengel, 2009).
It has to be noted that some methodological study characteristics point to
shortcomings and limitations of the current review. Generally the effects
under investigation were very small, even though they were statistically significant and effect sizes were heterogeneous. It seems promising to design
studies based on more complex models, including moderating factors of the
associations between intergenerational care and well-being. One strong
candidate of relationship characteristics might be attachment, as shown in
the studies by Carpenter (2001) and Cicirelli (1993). Attachment theory
(Ainsworth, 1973; Bowlby, 1984) might provide an important theoretical
basis to formulate multivariate models including relationship history, quality
of the relationship, and emotional closeness as moderating factors in the
association between caring and well-being of elderly parents and their adult
children (Merz, Schuengel, & Schulze, 2007). Including attachment measures into the investigation of intergenerational care and well-being might
contribute to a better understanding of the complexity of intergenerational
relationships and consequences for well-being.
1548
Additionally, it would be interesting and fruitful to integrate both caregiver and care recipient reports on their well-being and exchange of care. The
perception of care received and provided and characteristics of the intergenerational relationship may differ for adult children and their parents because
of different feelings of overload and other commitments.
In summary, the current report offers a general review on the associations
between intergenerational support and well-being of adult child and parent
generations. Specifically, it provides support for the notion that providing
and receiving intergenerational care is not generally but conditionally related
to well-being. Given longevity, increasing numbers of older adults in modern
society, and growing demands on intergenerational support, work detailing
the particular patterns and consequences of filial support need to be key
topics in the social sciences.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the authorship
and/or publication of this article.
Funding
The author(s) received no financial support for the research and/or authorship of this
article.
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Journalhttp://jfi.sagepub.

Consequences of Filial Support for Two Generations: A Narrative

>> Version of Record - Sep 27, 2010

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Journal of Family Issues

Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands

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Because of increased longevity, parents and children share a longer period of

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Journal of Family Issues 31(11)

Inclusion and Exclusion Criteria

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Calculation of Effect Sizes

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Journal of Family Issues 31(11)

children and parental well-being, often indicated by depressive symptoms,

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studies was measured either as life satisfaction, caregiver stress/burden or

Review of Studies on Association Between

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Journal of Family Issues 31(11)

people, whereas negative self-feelings were reduced for widowers who

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Note: ES = effect size; CI = confidence interval.

Silverstein and Bengtson (1994)

Journal of Family Issues 31(11)

studies with positive well-being concepts remained heterogeneous. Marital

Review of Studies on Association Between

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Table 2. Moderator Analyses on the Association Between Receiving Care and

Several studies have addressed individual caregiver characteristics

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Journal of Family Issues 31(11)

instrumental care did not predict well-being significantly. Furthermore,

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Note: ES = effect size; CI = confidence interval.

Strawbridge, Wallhagen, Shema,

Table 4. Moderator Analyses on the Association Between Providing Care and

Note: ES = effect size; CI = confidence interval.

with bivariate effects sizes found stronger negative associations between

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Journal of Family Issues 31(11)

Moderating Factors in the Relation Between

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Moderating Factors in the Relation Between

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Journal of Family Issues 31(11)

younger adult children, and children with a Western cultural background

General Conclusions, Limitations, and Future Directions

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of having cared for children throughout their childhood, adolescence, and

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Journal of Family Issues 31(11)

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and change in affective parent-child relationship from adolescence to adulthood].

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Journal of Family Issues 31(11)

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Journal of Family Issues 31(11)