Copyright 1996 by The Gerontological Society of America
Journal of Gerontology: SOCIAL SCIENCES
1996, Vol. 5IB, No. 6, S297-S306
Sources of Support and Interpersonal Stress
in the Networks of Married Caregiving Daughters
Findings From a 2-year Longitudinal Study
J. Jill Suitor1 and Karl Pillemer2
'Department of Sociology, Louisiana State University.
Human Development and Family Studies, Cornell University.
2
This research uses data collected on 57 married daughters and 1,069 members of their social networks to examine
patterns of social support and interpersonal stress across the first two years of caring for parents with dementia.
Reports by the caregivers indicated that friends were the most prominent source of emotional support, while siblings
were the greatest source of instrumental support and interpersonal stress, both shortly after the parents' diagnosis and
two years later. Multivariate analyses demonstrated that associates who had caredfor family members themselves were
more likely to have been sources of instrumental support both shortly after diagnosis and two years later. Caregiving
similarity was also the most important factor in explaining both emotional support and interpersonal stress at Tl;
however, its effect diminished across the subsequent two years. These findings suggest that experiential similarity may
become less important in explaining some dimensions of interpersonal relations as individuals move further from
status transitions.
increasing interest in the relationship between
DESPITE
social support and psychological distress among family
caregivers, there has been almost no research on the way in
which the structure of caregivers' interpersonal networks
affects the provision of that support; further, there has been
little investigation of changes in these support processes
across time.
Most research that has attempted to understand support
processes during caregiving has focused on characteristics of
the caregivers and the caregiving context (e.g., Cantor,
1983; Clipp and George, 1990; Cohen, Teresi, and Blum,
1994; Pillemer and Suitor, in press; Quayhagen and Quayhagen, 1988). While this line of work has revealed which
caregivers are the most likely to receive support, it has
provided little information about which members of caregivers' networks are the most likely to provide that support,
or how these patterns change across the caregiving career.
Suitor and Pillemer's work has demonstrated that the
structure of caregivers' social networks was crucial in understanding which friends and family members were likely to be
sources of emotional support and instrumental support, as
well as interpersonal stress, early in the caregiving career
(cf. Suitor and Pillemer, 1993; Suitor, Pillemer, and Keeton,
1995). The present analysis extends this line of research by
examining changes in the patterns of support and interpersonal stress across the first two years of caregiving. To
investigate these patterns we used data collected on 57
married caregiving daughters and 1,069 members of the
daughters' social networks, immediately after the women's
parents were diagnosed with irreversible dementia, and
again two years later.
Sources of Support and Interpersonal Stress
A substantial body of work has examined the ways in
which the "convoy of support" to elderly persons changes
across the later years (Antonucci, 1985; Coward and Dwyer,
1991; Dwyer et al., 1992; Matthews and Rosner, 1988;
Miller and McFall, 1991). However, changes in the support
networks of the individuals who provide informal care to
elderly persons have remained virtually unexamined.
While caregivers appear to receive support from multiple
sources (Clipp and George, 1990; Matthews and Rosner,
1988; Suitor and Pillemer, 1993), we were particularly
interested in the roles of friends and siblings as supporters.
Because siblings frequently coordinate the care of elderly
parents (Coward and Dwyer, 1991; Dwyer et al., 1992;
Matthews and Rosner, 1988; Miller and McFall, 1991), it
has often been assumed that siblings will be the primary
source of one another's support. However, Suitor and Pillemer's (1993) analyses suggest that this may not always be
the case. In particular, they found that while siblings were
the greatest source of instrumental support early in the
caregiving career, friends, rather than siblings, were the
greatest source of caregivers' emotional support; further,
siblings were by far the greatest source of interpersonal
stress in these early stages.
In considering how these patterns might vary across time,
we anticipated that changes in the demands of caregiving
would increase conflict and reduce support between siblings.
In particular, as the parent's illness progresses, new decisions regarding long-term care are likely to be required.
Allan (1977) suggests that such decision making may reactivate past conflicts among siblings, due to both increased
contact and to the sensitive nature of the decisions that must
be made. Further, siblings who refuse to enter into the
decision-making process may be resented for their failure to
participate. Thus, caregivers may experience greater conflict
with siblings as the caregiving career progresses, and increasingly turn to friends for emotional support.
There is an additional basis for anticipating that relations
S297
S298
SUITOR AND PILLEMER
between siblings may become more conflictual over time —
particularly relative to relations with friends. Relations with
friends have a voluntary character (Adams and Blieszner,
1989); if these relationships become strained over issues
involving caregiving, they can be severed relatively easily.
In contrast, siblings are likely to feel obligated to continue to
interact regardless of the quality of their relationship, potentially producing even higher levels of conflict.
Based on these arguments, we anticipated that siblings
would become more prominent sources of interpersonal
stress across the two years of the study, while friends would
become more important sources of emotional support.
Regardless of the configuration of changes in the aggregate patterns of support and stress across the caregiving
career, we believed that it was important to examine whether
the same individuals continued to be named as sources of
support and stress. For example, the same proportions of
friends and kin might be named as sources of support at
different points in the caregiving career, yet the specific
individuals named might differ. The few studies of changes
in social support networks across time suggest that many of
the individuals named at any one point are replaced by others
at a later point, even when the aggregate number of supporters changes little (cf., Morgan, Neal, and Carder, in
press; Suitor and Keeton, in press; Wellman et al., in press).
Such findings are consistent with Antonucci's (1985) suggestion that there is characteristically a "convoy" of supporters which various individuals leave or join across time.
On these bases, we anticipated that there would be substantial turnover of the specific individuals who were named
as sources of support and stress by the caregivers. However,
given the dearth of information on the extent of changes in
interpersonal networks across time, we did not hypothesize a
particular degree of change.
Explaining Support and Interpersonal Stress
Our expectations regarding the factors affecting patterns
of support and stress draw heavily on theories of homophily.
These theories have long argued that individuals are more
likely to develop and maintain supportive relationships with
others who are similar to them on important social dimensions (cf., Feld, 1982; Lazarsfeld and Merton, 1954; Marsden, 1988; Merton, 1968). It has been purported that homophily produces these patterns because individuals who
share social statuses tend to hold similar values and are more
knowledgeable about one another's circumstances, resulting
in greater empathy.
Alternatively, we have suggested that it is similarity of
experience rather than merely similarity of social-structural
characteristics that produces greater empathy — particularly
following status transitions (Suitor, Pillemer, and Keeton,
1995). Building upon a theoretical argument developed by
Thoits (1986), we proposed that associates who have been
through similar experiences are better prepared to help
stressed individuals understand their feelings, and are less
likely to reject individuals because of their distress (Suitor,
Pillemer, and Keeton, 1995). Since associates who have
shared experiences are likely to be structurally similar, the
distinction between these two dimensions of homophily is
seldom made. However, our previous work has shown that
such a distinction is important in understanding patterns of
support and interpersonal stress following status transitions.
Analyses of data on both returning women students and
caregiving daughters (Suitor, Pillemer, and Keeton, 1995)
demonstrated substantial differences in the effects of experiential and structural similarity on patterns of support and
stress. Network members who had experienced a similar
transition were more likely to be a source of emotional
support, and were less likely to be a source of interpersonal
stress, such as criticism, direct interference, or unmet expectations for support. However, none of the structural dimensions of similarity (age, gender, marital status or labor force
status) was consistently related to network members' likelihood of serving as sources of support or stress for either
group of women.
While these findings demonstrate the importance of experiential similarity shortly after the acquisition of a new
status, they do not provide information on the long-term
effects of this dimension of similarity on patterns of support
and stress. It is possible that experiential similarity continues
to affect patterns of support and stress long after an individual acquires a new social status; however, it is also possible
that this dimension of similarity becomes less important in
explaining patterns of support and interpersonal stress as the
individual moves further from a status transition.
In the present context, there are three bases for anticipating that the importance of experiential similarity would
diminish across time. First, over time, friends and relatives
have the opportunity to observe the activities involved in
caregiving; therefore, they may become more understanding, even if they have not been caregivers themselves. In
addition, caregivers may become more proficient at explaining their situation to others, placing them in a better position
to elicit support directly from associates without caregiving
experience, as well as suppress criticism from these individuals. Last, over time, caregivers may become more confident in their roles and therefore may need to rely less on
others who have provided care to elderly relatives. On the
basis of this reasoning, we anticipated that experiential
similarity would become less important in explaining patterns of support and stress across the two years of care.
METHODS
Data Collection
The Time 1 (Tl) data were collected between January of
1989 and March of 1992 during two-hour interviews with
individuals who were identified as the primary caregivers to
elderly relatives with some form of irreversible dementia.
The caregivers completed a total of three interviews at oneyear intervals, beginning shortly after the relative's diagnosis. Since we are presently concerned with changes across a
broader period, we have chosen to use only the data from the
Tl and the T3 interviews for the analyses.
Ninety-one percent of the participants were referred to the
study by physicians at 13 major medical centers in the
northeastern United States that have dementia screening
programs. The remainder of the participants were referred
by psychiatrists and neurologists who work extensively with
dementia patients. We requested that we be placed in contact
CAREGIVING DAUGHTERS' SOCIAL NETWORKS
with the primary caregiver to all of the patients who received
a diagnosis of Alzheimer's disease or a related dementia;
based on the information from each of the sites, we estimate
that we were provided with approximately 90 percent of the
appropriate cases from the medical centers, and approximately 75 percent of the appropriate cases from the private
physicians.
It should be noted that because the sample was not
randomly drawn from the general population, there are
limitations to the generalizability of the findings. However,
the design has one particular advantage over the large majority used in studies of caregiving: It did not draw the participants from the membership of caregiver support groups or
the Alzheimer's Association. We would argue that sampling
strategies employing such groups are inappropriate for the
study of social support and caregiving, because they are
heavily biased in favor of individuals who have already
actively sought sources of social support. Further, the use of
multiple sites in the present study resulted in a sample that
was diverse in terms of rural/urban residence, caregiving
situation, and socioeconomic status. (A detailed report on
the sample is available from the authors.)
One of the major considerations in the design was to
interview the individuals shortly after they had acquired the
formal status of caregiver (see Suitor and Pillemer, 1990, for
a discussion of this issue). In order to accomplish this, we
attempted to limit our sample to individuals whose parents
had been given a diagnosis of dementia within the previous
6 months. (Due to errors in the referral process, a small
number of the care recipients had been diagnosed more than
6 months prior to the first interview.)
We completed interviews with 60 percent of the individuals who were eligible for participation, resulting in a
sample of 256 caregivers. The sample included 118 daughters, 14 sons, 30 daughters-in-law, 53 wives, 25 husbands, 7
siblings, 6 other relatives, and 3 nonrelatives who were
viewed by the respondents as equivalent to kin. Due to a
combination of attrition and death of the respondents, the
number of cases was reduced to 178 by T3.
Previous analyses indicated that the structure and function
of the caregivers' social networks varied substantially by
gender, marital status, and relationship to the patient. Therefore, it was not appropriate to combine the various categories
of caregivers for any of the analyses involving patterns of
support and interpersonal stress. We restricted the present
analysis to the modal category of caregivers — married
daughters who had been interviewed at both Tl and T3 and
who had continued to provide care to their parents across the
period of the study (n = 57).
The Respondents
The mean age of the caregivers was 46.0 (SD = 8.0).
Forty-two percent had completed high school, 25 percent
had completed some college, and 32 percent were college
graduates. Eighteen percent had a total family income of less
than $30,000 during the year of the study, 43 percent had a
total family income between $30,000 and $49,999, and 39
percent had an income of $50,000 or more. Forty percent
were employed part time, 32 percent were employed full
S299
time, and 27 percent were not employed. All but one of the
women were White and non-Hispanic.
The mean age of the parents was 75.5 (SD = 6.8).
Ninety-one percent were mothers; 9 percent were fathers. In
28 percent of the cases the parent lived in the daughter's
home at Tl; in 42 percent of the cases the parent lived
elsewhere in the community, and in 30 percent of the cases
the parent lived in some type of nursing home or board-andcare facility. By the end of the two-year period more than
two-thirds (69%) of the parents were living in nursing
homes, and only 19% were still residing with their daughters. Separate analyses showed that changes in the parent's
residence did not alter the sources of support or interpersonal
stress, nor the factors affecting support and stress. (Tables
are not shown.)
Measurement of Social Network Structure and Function
We used the name-elicitation approaches developed by
Fischer (1982) and Wellman (1979) to collect information
on the structure and function of the caregivers' social networks. We asked each woman whether there was anyone on
whom she relied for a variety of instrumental and emotional
tasks, including tasks related to caregiving, and those not
directly related to caregiving. We also asked whether anyone
had been critical of her caregiving or made her caregiving
more difficult. For each item we asked the first names of the
people who had served as sources of these dimensions of
support and interpersonal stress.
The women named a total of 1,069 associates at Tl and
T3. Following the lead of Fischer (1982) and Wellman
(1979), we conceptualized the "active network" at Tl as
including all of the individuals named at Tl in response to
name elicitation questions. We continued this procedure
when defining the T3 network. Since some individuals
named at one interview were not named at the other, there
was a small difference in the size of the active networks at Tl
(n = 612) and T3 (n = 655).
For each of the 1,069 network members named at either
Tl or T3, we collected data on the individual's demographic
characteristics (age, educational attainment, gender, marital
status, employment status, etc.), and whether the associate
had experience caring for an elderly relative.
For the present analysis, we measured support using three
items. The first two were: (a) "In the past year, has anyone
done anything to try to make it easier for you to care for your
parent?"; and (b) "Does anyone else besides you help your
[relative] with [any of the activities of daily living just
listed]?" Each respondent who answered yes to either question was asked both who had provided that support and
specifically what that individual had done to make things
easier.
Network members were categorized as a source of emotional support if: (a) the caregiver directly stated that a
network member had provided emotional support (e.g.,
"she always supports me emotionally," "he tries to cheer
me up when I'm upset about my mother," etc.); or (b) the
caregiver's response met Cobb's (1976) classic definition of
emotional support — the caregiver's statement indicated that
she viewed herself as loved, cared for and esteemed in terms
S300
SUITOR AND PILLEMER
of the caregiving context (e.g., "my friend Susan is just
there for me in terms of my mother").
Further, we asked each caregiver whom she talked to
about her parent, as one of a series of questions about whom
she relied on for support for personal problems. Any associate who was named as someone the caregiver talked to about
her parent was also considered to be a source of emotional
support.
Two hundred forty-four network members were named as
sources of emotional support regarding caregiving at Tl; 233
network members were named at T3.
Each member was categorized as a source of instrumental
support if the respondent stated that the associate had provided some form of concrete assistance regarding caregiving. The types of instrumental support included providing
direct care to the parent, running errands for the caregiver,
staying with the parent to relieve the caregiver of her responsibilities, contributing household labor, and seeking information for the caregiver (e.g., legal advice, respite care
services, etc.). One hundred eighty-three network members
were named as sources of instrumental support at Tl; 127
were named at T3.
To determine coding reliability for both emotional and
instrumental support, all of the open-ended responses regarding support at Tl were coded separately by two individuals — the first author and a graduate assistant. A reliability
analysis of these coding decisions produced an unmodified
Kappa coefficient of .94 (cf., Brennan and Prediger, 1981).
Last, each network member was categorized as having or
not having been a source of interpersonal stress based on
whether he or she was mentioned when the respondent was
asked whether anyone had: (a) criticized her caregiving; (b)
made it harder for her to provide care to her parent; (c) made
her feel neglected; (d) complained that she had not spent
enough time with them; or (e) provided less help in caring for
the parent than the respondent thought was appropriate. One
hundred thirty-six network members were named as sources
of interpersonal stress at Tl; 144 were named at T3.
Measurement of the Independent Variables
Similarity. — Experiential similarity was a dummy-coded
variable: 0 = associate has not cared for an elderly relative;
1 = associate has cared for an elderly relative.
Although the focus of the study was on the effects of
experiential similarity, we felt that it was important to
include several dimensions of structural similarity in the
multivariate analysis, since these factors are often found to
predict patterns of support and stress in network studies that
do not focus on recent transitions (e.g., Bell, 1981; Feld,
1982; C. Fischer, 1982; L. Fischer, 1986; Gouldner and
Strong, 1987; Oliker, 1989; Wellman and Wortley, 1990).
We selected dimensions of homophily that have been found
most often to be predictors of patterns of support and stress
for women — similarity of age, gender, marital status, and
labor force status.
Age similarity and employment similarity were created
using a combination of data on the respondent and each of
her network members. Age similarity is the absolute difference between the respondent's age and that of her associate.
Employment similarity is a dummy-coded variable; 0 = not
same employment status, 1 = both employed or both not
employed. Since all of the caregivers in the subsample used
in this analysis were married daughters, the associate's
gender (0 = male; 1 = female) and marital status (0 = not
married; 1 = married) were used to measure gender similarity and marital status similarity.
Relationship to the caregiver. — To investigate the
sources of support and interpersonal stress in the first set of
analyses we created 8 categories of associates — spouses,
children, siblings, other kin, in-laws, friends, formal service
providers, and a residual "other" category.
Since it was impractical to include the number of dummy
variables required to maintain separate categories of associates throughout the multivariate analysis, we focused on
those categories necessary to make the distinctions that we
felt were especially salient. In particular, we felt it was
important to examine the separate effects of friends, siblings, spouses, and other kin. To this end, we created four
dummy variables: siblings; friends; spouses; and nonsibling
kin. The variables "friend," "spouse," and "nonsibling
kin" were entered into the regression equations; "siblings"
was used as the reference category.
Proximity. — Previous research has shown that proximity
is often related to patterns of support, particularly in the case
of instrumental support. Thus, we felt it was important to
include this variable as a control throughout the analysis. To
measure proximity, each caregiver was asked how many
miles she lived from each of her associates. The distances
ranged from less than one mile to greater than 3,000 miles;
however, almost two-thirds of the associates lived within 10
miles of the caregivers. Given the skewness of the data, the
decision was made to use the natural log of the variable in the
regression analysis.
A correlation matrix including all of the variables used in
the multivariate analysis is presented in Table 1. We omitted
associates who were minors (e.g., children, grandchildren,
nieces, etc. under the age of 18) or formal service providers
(physicians, paid helpers, etc.) from both the correlation
matrix and the regression analysis.
Collinearity diagnostics were conducted for each of the
six models presented in the regression analysis by calculating the inflation factor (VIF). The VIF indicates how much
the variance of the standard error of each estimate increased
when other predictors are included in the equation (Neter,
Wasserman, and Kutner, 1989). None of the predictors
produced VIFs larger than 3.0, indicating that multicollinearity was not present.
It is important to note another procedure that we employed
throughout the multivariate analysis. Since the associatelevel data used in the multivariate analyses are based upon
the 57 caregivers' reports of their social networks, it is
possible that characteristics of the caregivers could introduce
confounds — particularly considering that there were differences in network size (mean = 10.74, SD = 4.3 at Tl;
mean = 11.49, SD = 4.0 at T3). To address this issue, we
created a dummy variable for each ego (i.e., each caregiver)
and entered those dummy variables into all of the regression
S301
CAREGIVING DAUGHTERS' SOCIAL NETWORKS
Table 1. Correlation Matrix, Means and Standard Deviations (n = 512 at Tl; n = 533 at T3)
(1)
1. Emotional support
2. Instrumental support
3. Interpersonal stress
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
1.00
.17
-.20
.16
.00
.04
.09
-.02
-.10
.00
.02
.14
.10
1.00
-.11
.11
-.06
-.19
-.16
.01
-.12
-.33
.21
.15
-.17
-.07
1.00
-.20
.02
-.04
.00
-.01
.16
-.23
-.01
-.06
4. Associate's caregiving
experience
5. Associate's marital status
.09
.10
-.06
1.00
-.02
.08
.08
-.07
-.09
.15
-.05
.04
.10
.06
.03
-.05
1.00
-.09
.23
-.04
-.05
.05
-.01
.15
6. Associate's gender
.12
-.06
-.02
.06
-.11
1.00
.03
-.09
.08
.40
-.26
-.48
7. Age similarity
.06
-.03
.02
.11
.16
-.01
1.00
.21
-.05
.30
-.44
.18
8. Similarity of labor force
participation
9. Proximity (logged)
.00
-.06
.01
-.01
-.08
-.04
.17
1.00
-.02
.02
-.07
.05
.00
-.00
.14
-.07
-.11
.09
-.10
.01
1.00
-.15
-.09
-.33
-.01
-.23
-.17
.15
-.09
.33
.28
-.01
-.17
1.00
-.69
-.28
11. Nonsibling kin
.06
.07
-.05
-.06
.02
-.21
-.43
-.02
-.02
-.72
1.00
.41
12. Spouse
.12
.03
-.05
.05
.20
-.45
.19
.03
-.32
-.26
.36
1.00
10. Friend
Tl
Mean
(SD)
T3
Mean
(SD)
.44
(.50)
.27
(.44)
.25
(.43)
.50
(.50)
.77
(.42)
.40
(.49)
.16
(.37)
.22
(.41)
.51
(.50)
.62
(.49)
.68
(-47)
10.24
(10.10)
.60
(.49)
2.13
(2.09)
.43
(•50)
.38
(49)
.10
(•29)
.68
(.47)
11.26
(10.77)
.60
(.49)
2.11
(2.00)
.42
(.49)
.41
(.49)
.09
(.28)
Note: The top right diagonal of the matrix presents correlations for Tl; the bottom left diagonal of the matrix presents correlations for T3. Coefficients
greater than .06 are significant at the .05 level.
equations in which the associate was the unit of analysis (cf.,
Alwin, 1976). This method allowed us to control on
respondent-level influences.
RESULTS
Sources of Support and Interpersonal Stress
Table 2 presents our findings regarding sources of support
and interpersonal stress at Tl and T3. An examination of the
overall patterns suggests few differences between Tl and T3
— a finding supported by a log-linear analysis of differences
between the two time points. For each type of support/stress,
the main effects model (Source, Time), with the Source x
Time effect excluded, provided acceptable fit, suggesting
that the patterns of stress and support as a whole did not vary
significantly over the two time periods (L2(6) = 7.33, n.s.
for emotional support; L2(6) = 6.11, n.s. for instrumental
support; and L2(6) = 2.87, n.s. for interpersonal stress).
While the overall pattern changed little from Tl to T3, the
analyses revealed several striking patterns regarding specific
sources of support and stress. Most importantly, friends
were the primary source of emotional support for the caregivers at both Tl and T3 (X = 1.25, Z = 14.85), while
siblings were the primary source of interpersonal stress at
both points (X = 1.20, Z = 9.83). Further, while siblings
continued to be the primary source of informal instrumental
support at T3 (\ = .544, Z = 4.57), formal sources of
support became similarly important by that point (X = .339,
Z = 2.65).
We had hypothesized that siblings would become a
greater source of interpersonal stress across the two years,
and that friends would become a greater source of emotional
support across this period. The data do not support these
hypotheses; rather, the findings indicate that siblings were
no more likely be a source of stress at T3 than at Tl (Time X
Source X = .138, n.s.) while friends were almost equally
likely to be a source of emotional support at T3 and Tl (Time
x Source X = .064, n.s.).
It is possible to speculate that the overall consistency in
the patterns of sources of support and stress at Tl and T3
could be explained by the same associates serving as sources
of support or interpersonal stress at both points. However,
this is not the case. Less than half of those named as a source
of either emotional or instrumental support at T3 had been
named as a source of support at Tl (48% and 42% respectively), and only about one-third of those named as a source
of interpersonal stress at T3 had been named as a source of
stress at Tl (34%).
It is difficult to know whether we should interpret these
findings as indicating high or low stability of sources of
support and stress, given that there is so little comparison
data available from other longitudinal network studies. On
S302
SUITOR AND PILLEMER
Table 2. Distribution of Support and Interpersonal Stress by Category of Associate
(TV = 1069 associates)"
Sources of
Support/Stress
Spouse
Children
Siblings
Other kin
In-law
Friend
Formal service provider
Other
N of associates named
Emotional Support
Instrumental Support
Interpersonal Stress
Tl
T3
Tl
T3
Tl
T3
14.3%
10.2
16.4
7.0
8.2
39.8
2.5
1.6
11.6%
12.4
12.0
11.6
8.2
39.1
4.7
.4
13.1%
13.7
22.4
13.7
8.7
9.3
15.3
3.8
7.9%
8.7
22.8
13.4
11.0
11.0
22.0
3.1
5.6%
11.8
30.6
17.4
5.6
22.2
2.8
4.2
244
233
183
127
5.9%
14.7
37.5
13.2
4.4
22.8
1.5
—
136
144
•The 57 caregivers named a total of 1069 associates at Tl and T3. The N at the bottom of each column represents the total number of associates who were
named as sources of that dimension of support or interpersonal stress. The percentages within the columns represent the distribution of associates that served
as sources of that dimension of support or stress. Some columns do not sum to 100% due to rounding.
one hand, the network stability found among the women in the
present study was much lower than that found across one year
of widowhood in Morgan and colleagues' study (in press);
however, the stability found here was far greater than that
found across a year of enrollment among returning women
students (Suitor and Keeton, in press). Thus, it is difficult to
interpret the findings as indicating particularly high or low
stability. We do believe, however, that the present findings
are consistent with the specificity argument that sources of
support change as individuals experience different stages of
the same problematic circumstance in their lives (Cohen and
McKay, 1984; Morgan, 1989; Pearlin, 1985).
It is important to note that, not surprisingly, there was
more turnover within some categories of associates than
others. For example, friends were more often "replaced" as
sources of support and interpersonal stress than were kin,
consistent with other recent studies of network change (Morgan, Neal, and Carder, in press; Suitor and Keeton, in press;
Wellman et al., in press). The greatest stability of support
and stress was found among siblings; those who were
sources of support at Tl continued to provide support, while
those who were sources of interpersonal stress at Tl continued to pose problems at T3.
Many of the respondents indicated that they were particularly surprised and disappointed by their siblings' attitudes
and behaviors, because they believed that these family
members were "supposed to be" the most helpful. These
feelings may explain the intense negative sentiment the
caregivers displayed when discussing critical or neglectful
siblings. For example, one caregiver expressed a great deal
of anger when discussing her brother:
My one brother, John [a pseudonym], felt that I shouldn't get
too hyper about how [my mother] got this disease and I'd
better get used to it. He felt I wasn't being calm about the
whole thing. I wanted to punch his face in.
We might be tempted to assume that the explanation for
these difficulties lies in preexisting problems in the siblings'
relationships. However, this is not necessarily the case. For
example, another caregiver described her relationship with
her sister as very close prior to their mother's illness, but said
that their relationship had deteriorated due to her sister's
unsupportiveness after caregiving began.
[My sister] is the person I should be [naming as my source of
support]. Kate and I are eighteen months apart and we're like
very, very close and she was my best friend and everything.
She just isn't there for me for this. . . . I've had a real hard
time dealing with that. . . It has really hurt me and I try so
hard not to let it destroy the possibility of us having a
relationship but it gets to that point. . . .
It is also worth noting that while such detrimental changes
were the most common between siblings, they were not
exclusive to these ties. The women often reported that
relationships with friends, spouses, and other kin had deteriorated, due to role partners' lack of sensitivity to the responsibilities and emotions involved in caring for a parent suffering from dementia (cf., Suitor and Pillemer, 1994).
Explaining Support and Interpersonal Stress
The next step in our analysis was to examine which factors
best explained patterns of support and interpersonal stress
across the first two years following diagnosis. We were
particularly interested in investigating the effects of experiential similarity at the two time points.
The logistic regression analysis revealed that experiential
similarity became less important in explaining patterns of
emotional support across the first two years of caregiving, as
we anticipated. As shown in the lefthand columns of Table
3, associates who had been caregivers themselves were more
likely to provide emotional support at Tl than were associates without caregiving experience; however, this effect had
greatly disappeared by T3 (z-score of difference between the
coefficients = 1.87;/? = .061).
In contrast, experiential similarity continued to be important in explaining which associates provided instrumental
support, as shown in the middle columns of Table 3 (z-score
of difference between coefficients = .013; n.s.). In fact,
experiential similarity Was the only factor besides relationship to the caregiver that helped to explain patterns of
instrumental support at both Tl and T3. This suggests that
while caregivers became less reliant on others with similar
S303
CAREGIVING DAUGHTERS' SOCIAL NETWORKS
Table 3. Logistic Regression of Emotional Support, Instrumental Support, and Interpersonal Stress at Tl and T3
(n = 512 adult associates at Tl; n = 508 at T3)
Emotional Support
Independent Variable
Tl
T3
Instrumental Support
Tl
T3
Interpersonal Stress
Tl
T3
Associate's caregiving experience
.994*
(.252)
.305
(.247)
1.131**
(.303)
1.302**
(.371)
-.954**
(.314)
Associate's marital status
.012
(.304)
.307
(.287)
.219
(.351)
Associate's gender
1.188**
(.323)
1.322**
(.317)
.069
(.347)
.459
(.389)
.331
(.387)
Age similarity
.003
(.015)
.002
(.014)
-.053**
(.018)
.745
(.432)
.542
(.418)
-.034
.019
.019
(.020)
-.107
(.304)
.186
(.354)
.765*
(.371)
-.024
(.019)
Similarity of labor force
participation
-.204
(.252)
.163
(-312)
-.108
(.363)
Proximity
-.165*
(.071)
.213
(.248)
.116
(.074)
-.342**
(.090)
-.178
(.107)
.262
(.318)
-.037
(.079)
.419
(.324)
.168
(.096)
-.819*
(.365)
-.706
(.404)
.118
(.380)
.212
(.403)
-3.358**
(.499)
-1.477**
(.467)
-2.765**
(.478)
Spouse
1.941**
(.563)
1.783**
(.560)
.276
(.596)
-3.586**
(.618)
-1.570**
(.516)
-.135
(.710)
-.776
(.706)
-2.367**
(.452)
-1.982**
(.488)
.886
(.722)
Model x2
df
170.697**
64
148.808**
64
198.145**
64
176.178**
64
200.242**
64
171.646**
64
Relationship to Caregiver:
Friend
Nonsibling kin
-1.989**
(.504)
Note: Standard errors are reported in parentheses below each unstandardized coefficient.
•There are 64 degrees of freedom because 56 dummy variables were entered to control differences in characteristics of caregivers.
*p< .05;**p< .01.
caregiving experience for emotional support, they maintained their reliance on fellow caregivers for instrumental
support.
One explanation for the differential long-term effects of
experiential similarity on patterns of emotional and instrumental support may lie in differences in the obstacles to
providing caregivers with these two types of support. Providing emotional support requires only that the associates become more sensitive to the concerns expressed by the caregivers. In contrast, providing the sorts of instrumental
support that the caregivers reported most frequently (e.g.,
respite, personal care of the parent, etc.) requires skills that
most associates would not have developed if they did not have
direct prior experience assisting frail or impaired elderly.
As shown in the righthand columns of Table 3, changes in
the effects of experiential similarity on interpersonal stress
paralleled those found in the analysis of emotional support.
While associates without caregiving experience were more
likely to have been sources of interpersonal stress at T l , they
were no more likely than previous caregivers to have been
named by T3 (z-score of difference between coefficients =
1.94; p = .052).
The decrease in the importance of experiential similarity
in explaining emotional support and interpersonal stress was
also reflected in the qualitative data. In early stages of the
caregiving career the women often explained friends' and
relatives' attitudes and behaviors on the basis of whether the
associates had experience providing care to elderly relatives:
[When you talk to others who have been caregivers] you're
able to verbalize your feelings, what you're going through,
what's happening. . . . You get the support of each other. . . .
They have the full understanding of what you're going
through. . . . That's a big help in itself.
[My friend Laura and I] are a sounding board for one another.
She's here with me every day. She went through [caring for
her mother] last year. Her mother [was in a nursing home] and
I was very supportive of her too.
However, at T3, the issue of caregiving experience was
not raised when the women discussed either associates'
emotional supportiveness or their negative attitudes and
behaviors.
Thus, in sum, these findings supported our hypothesis that
experiential similarity would become less important across the
caregiving career. As already noted, we suggest that this is
because over time caregivers became more adept at explaining
their situation to associates without caregiving experience;
further, those associates became more understanding as they
observed the caregiving situation. In addition, as the caregivers became more confident in their new role and were able
to draw upon their own experiences, they may have needed to
rely less on others with caregiving experience.
It is important to note another pattern revealed in the
multivariate analyses. As we saw in Table 2, friends were
the modal category providing emotional support; however,
the findings presented in Table 3 call into question the
S304
SUITOR AND PILLEMER
conclusions that we might draw from Table 2 alone. The
greater emotional supportiveness from friends shown in
Table 2 could have been produced by the distribution of
associates within one's network. Almost all of the caregivers
had several friends as active members of their networks, yet
most had only one or two siblings or children — thus, there
was a greater number of friends than any particular category
of kin available to be named as a source of support. Therefore, the findings from Table 2 cannot be used to argue that
any one friend was more likely to be a source of emotional
support than was any one sibling or other relative; only that
overall, friends made up the greatest proportion of emotional
supporters.
The pattern of multivariate findings regarding the differential impact of siblings and friends on interpersonal stress
and instrumental support closely parallels those shown in
Table 2. Even when controlling on other relevant variables,
siblings continued to be the most prominent source of both
stress and instrumental support across the two-year period.
Last, the analysis revealed few effects of the structural
similarity variables. While similarity of gender helped to
explain emotional support at both Tl and T3, none of the
other structural similarities were consistently related to support or stress.
DISCUSSION
The analyses presented in this article showed marked
differences in the likelihood that particular categories of
network associates would serve as sources of support or
interpersonal stress for women caring for parents with dementia. Both shortly after the parent's dementia diagnosis
and two years later, friends were the most likely to serve as
sources of emotional support, while siblings were the most
likely to serve as sources of both instrumental support and
interpersonal stress.
Conflict between siblings whose parents require care is a
common pattern (Allan, 1977; Berezin, 1977; Brody et al.,
1989). Such conflict can, in part, be accounted for by parent
care exacerbating unresolved conflicts from the earlier
stages of the sibling relationship. However, examination of
our qualitative data suggests that the problems posed by
caregiving can, over time, also undermine sibling relations
that were previously close and nonconflictual.
Interestingly, the stability in the patterns of support and
stress at Tl and T3 could not be fully explained by the same
associates serving as sources of support or interpersonal
stress at both points, since less than half of those named as
sources of support or stress at T3 had been named as sources
at Tl. Consistent with other recent studies of network
change across time (Morgan, Neal, and Carder, in press;
Suitor and Keeton, in press; Wellman et al., in press),
friends were more often "replaced" as sources of support
and interpersonal stress than were kin.
The findings also demonstrate interesting and potentially
theoretically important patterns regarding the long-term effects of experiential similarity on social support and interpersonal stress. At T l , associates with caregiving experience
were more likely to be sources of both emotional and
instrumental support, and less likely to be sources of interpersonal stress. However, by T3, this dimension of similar-
ity waned in its ability to differentiate between network
members who were and who were not sources of either
emotional support or interpersonal stress.
As discussed earlier, it is possible that as an individual
moves further from a transition, he or she becomes more
proficient at informing others about his or her needs and
constraints. Such increased proficiency might reduce differences between the responses of associates with and without
caregiving experience. Further, as individuals become more
confident in their caregiving role, they feel less need to elicit
emotional support primarily from associates with caregiving
experience, since they can increasingly rely on their own
experience and knowledge. This may be particularly true
when using a sample of individuals whose relatives were
recently diagnosed, because a major function of associates is
probably cognitive guidance — that is, helping the new
caregivers to interpret their situation in this new and unsettling early stage. This type of cognitive guidance is probably
much more important in early stages of the caregiving
career, since the individual can draw on his or her resources
at later stages.
The qualitative data support these explanations. At Tl the
women's statements indicated that they greatly relied on
other caregivers because these were the only individuals who
"truly understood" their situation and could guide them in
their decisions regarding care. However, by T3 the women
increasingly referred to their own experiences when trying to
solve problems, and no longer appeared to feel that only
other caregivers understood their situation.
It is possible to question whether the effect of experiential
similarity also diminished because, overall, the respondents
experienced less caregiving stress or reduced their actual
caregiving responsibilities. However, neither of these explanations appears to account for the reduced effect of experiential similarity. We conducted several analyses to examine
whether experiential similarity was differentially important
for some subgroups. In particular, we divided the sample on
the basis of subjective stress, number of caregiving tasks
performed, hours spent providing care, and nursing home
placement. Analyses across all of these subgroups revealed
the same pattern shown in the full sample.
It is interesting to contrast these findings with those of a
similar longitudinal study of the effects of major life course
transitions on social networks. Suitor and Keeton's (in press)
analysis of mature returning students suggests that, under
some circumstances, experiential similarity continues to be
important in explaining which network members are a
source of emotional support long after the status transition.
Their analysis revealed that the associates who were the most
likely to provide emotional support to returning students,
both immediately after the transition and a decade later, were
those who had attended college themselves.
However, there is an important difference between the
experiences of caregivers and returning students that can
account for the differences in the findings. Returning to school
often results in the adoption of new reference groups and selfidentities (Suitor, 1987; Suitor and Keeton, in press) —
reference groups and identities that are often at odds with less
educated members of their preexisting networks. Returning
students appear to continue to solicit support from fellow
CAREGIVING DAUGHTERS' SOCIAL NETWORKS
college graduates in an attempt to maintain their new images
of themselves in the face of pressure from less educated
associates to return to their previous identities. In contrast,
caregiving does not appear to produce changes in reference
groups and identities; thus, caregivers are not faced with the
necessity to attempt to maintain such transformations.
It is important to note that none of the structural similarity
variables were consistently related to patterns of support or
interpersonal stress. Even gender similarity, which was
important in explaining emotional support at both Tl and
T3, did not consistently affect either instrumental support or
interpersonal stress. As we have discussed elsewhere
(Suitor, Pillemer, and Keeton, 1995), research on social
networks shows little overall consistency in the effects of
structural dimensions of similarity. We believe that the
present findings provide further justification for conducting
more extensive investigations of the conditions under which
structural similarity is important in explaining patterns of
support and stress.
In sum, the findings presented here contribute to a growing literature showing the benefits that individuals receive
from associating with others who have experienced the same
status transition. They also suggest that such contact becomes less important for some dimensions of interpersonal
relations as the individual acquires more experience enacting
his or her new role.
ACKNOWLEDGMENTS
This research was supported by grants from the National Institute of
Mental Health (RO1 MH42163-01 Al) and the National Institute on Aging
(1 P50 AG11711-01) to Karl Pillemer and Jill Suitor. We wish to thank
Dawn Robinson, David L. Morgan, Scott L. Feld, Rebecca McClanahan,
Yoshinori Kamo, and Shirley Keeton for their helpful comments.
Address correspondence to J. Jill Suitor, Dept. of Sociology, Louisiana
State University, Baton Rouge, LA 70803. E-mail: sosuit@lsuvm.
sncc.lsu.edu
REFERENCES
Adams, R.G. and R. Blieszner. 1989. Older Adult Friendship: Structure
and Process. Newbury Park, CA: Sage.
Allan, G. 1977. "Sibling Solidarity." Journal of Marriage and the Family
39:177-184.
Alwin, D.F. 1976. "Assessing School Effects: Some Identities." Sociology of Education 49:294-303.
Antonucci, T.C. 1985. "Personal Characteristics, Social Support, and
Social Behavior." InR.H. BinstockandE. Shanas (Eds.), Handbook of
Aging and the Social Sciences (2nd ed.). New York: Van Nostrand
Reinhold.
Bell, R.R. 1981. World of Friendship. Beverly Hills, CA: Sage.
Berezin, M.A. 1977. "Partial Grief for the Aged and Their Families." In
E.M. Pattison (Ed.), The Experience of Dying. Englewood Cliffs, NJ:
Prentice-Hall.
Brennan, R.L. and D.J. Prediger. 1981. "Coefficient Kappa: Some Uses,
Misuses, and Alternatives." Educational and Psychological Measurement 41:687-699.
Brody, E.M. 1990. Women in the Middle: Their Parent-Care Years. New
York: Springer.
Brody, E.M., C. Hoffman, M.H. Kleban, and C.B. Schoonover. 1989.
"Caregiving Daughters and Their Local Siblings: Perceptions, Strains,
and Interactions." The Gerontologist 29:529-538.
Cantor, M.H. 1983. "Strain Among Caregivers: A Study of Experience in
the United States." The Gerontologist 23:597-604.
Clipp, E.C. andL.K. George. 1990. "Caregiver Needs and Patterns of Social
Support." Journal of Gerontology: Social Sciences 45:S1O2-S112.
S305
Cobb, S. 1976. "Social Support as a Moderator of Life Stress." Psychosomatic Medicine 38:300-314.
Cohen, C , J. Teresi, and C. Blum. 1994. "The Role of Caregiver Social
Networks in Alzheimer's Disease." Social Science and Medicine
38:1483-1490.
Cohen, S. and G. McKay. 1984. "Social Support, Stress, and the Buffering
Hypothesis: A Theoretical Analysis." In A. Baum, S.E. Taylor, and
J.E. Singer (Eds.), Handbook of Psychology and Health, Vol. 4.
Hillsdale, NJ: Laurence Erlbaum.
Coward, R.T. and J.W. Dwyer. 1991. "The Longitudinal Study of Residential Differences in the Composition of the Helping Networks of
Impaired Elders." Journal of Aging Studies 5:391-407.
Dwyer, J.W., J.C. Henretta, R.T. Coward, and A.J. Barton. 1992.
"Changes in the Helping Behaviors of Adult Children as Caregivers."
Research on Aging 14:351-375.
Feld, S.L. 1982. "Social Structural Determinants of Similarity Among
Associates.'' American Sociological Review 47:797-801.
Fischer, C.S. 1982. To Dwell Among Friends. Personal Networks in Town
and City. Chicago: University of Chicago.
Fischer, L.R. 1986. Linked Lives. Adult Daughters and Their Mothers.
New York: Harper and Row.
Gouldner, H. and M.S. Strong. 1987. Speaking of Friendship: MiddleClass Women and Their Friends. Westport, CT: Greenwood Press.
Lazarsfeld, P.F. and R.K. Merton. 1954. "Friendship as a Social Process:
A Substantive and Methodological Analysis." In M. Berger, T. Abel,
and C.H. Page (Eds.), Freedom and Control in Modern Society. New
York: Litton.
Marsden, P. 1988. "Homogeneity in Confiding Relationships." Social
Networks 10:57-76.
Matthews, S.H. andT.T. Rosner. 1988. "Shared Filial Responsibility: The
Family as the Primary Caregiver.'' Journal of Marriage and the Family
50:185-195.
Merton, R.K. 1968. Social Theory and Social Structure. New York: Free
Press.
Miller, B. and S. McFall. 1991. "Stability and Change in the Informal Task
Support Networks of Frail Older Persons. The Gerontologist 31:735-745.
Morgan, D.L. 1989. "Adjusting to Widowhood: Do Social Networks
Really Make It Easier?" The Gerontologist 29:101-107.
Morgan D.L., M. B. Neal, and P. Carder. In press. "The Stability of Core
and Peripheral Networks Over Time.'' Social Networks.
Neter, J., W. Wasserman, and M.H. Kutner. 1989. Applied Linear Regression Models. Homewood, IL: Irwin.
Oliker, S.J. 1989. Best Friends and Marriage: Exchange Among Women.
Berkeley: University of California.
Pearlin, L.I. 1985. "Social Structure and Processes of Social Support." In
S. Cohen and S. L. Syme (Eds.), Social Support and Health. New
York: Academic Press.
Pillemer, K. and J.J. Suitor. In press. "Family Stress and Social Support
Among Caregivers to Persons With Alzheimer's Disease." In G.
Pierce, I. Sarason, and B. Sarason (Eds.), Handbook of Social Support
and Family Stress. New York: Praeger.
Quayhagen, M.P. and M. Quayhagen. 1988. "Alzheimer's Stress: Coping
with the Caregiving Role." The Gerontologist 28:391-396.
Suitor, J.J. 1987. "Marital Happiness of Returning Women Students and
Their Husbands: Effects of Part- and Full-Time Enrollment." Research
in Higher Education 27:311-331.
Suitor, J.J. and S. Keeton. In press. "Once A Friend, Always a Friend?
Effects of Homophily on Returning Students' Support Networks Across
a Decade." Social Networks.
Suitor, J.J. and K. Pillemer. 1990. "Transition to the Status of Family
Caregiver: A New Framework for Studying Social Support and WeilBeing." In S.M. Stahl (Ed.), The Legacy of Longevity: Health, Illness,
and Long-Term Care in Later Life. Beverly Hills, CA: Sage.
Suitor, J.J. and K. Pillemer. 1993. "Support and Interpersonal Stress in the
Social Networks of Married Daughters Caring For Parents with Dementia." Journal of Gerontology: Social Sciences 48:S1-S8.
Suitor, J.J. and K. Pillemer. 1994. "Family Caregiving and Marital
Satisfaction: Bindings from a 1-Year Panel Study of Women Caring for
Parents with Alzheimer's Disease." Journal of Marriage and the
Family 56:681-690.
Suitor, J.J., K. Pillemer, and S. Keeton. 1995. "When Experience Counts:
The Effects of Experiential and Structural Similarity on Patterns of
Support and Interpersonal Stress." Social Forces 73:1573-1588.
S306
SUITOR AND PILLEMER
Thoits, P.A. 1986. "Social Support as Coping Assistance." Journal of
Consulting and Clinical Psychology 54:416-423.
Wellman, B. 1979. "The Community Question: The Intimate Networks of
East Yorkers.'' American Journal of Sociology 84:1201 -1231.
Wellman, B., R. Yuk-lin Wong, D. Tindall, and N. Nazer. In press. "A
Decade of Network Change: Turnover, Persistence and Stability in
Personal Communities.'' Social Networks.
Wellman, B. and S. Wortley. 1990. "Different Strokes from Different
Folks: Community Ties and Social Support." American Journal of
Sociology 96:558-588.
Received April 24, 1995
Accepted May 31,1996
The Gerontological Society of America congratulates
the 1996 recipient of the
KENT AWARD
The DONALD P. KENT AWARD for exemplifying the highest standards of
professional leadership in gerontology through teaching, service, and interpretation
of gerontology to the larger society:
Robert B. Hudson, PhD
Professor of Social Welfare Policy
Editor-in-Chief, The Public Policy and Aging Report
School of Social Work
Boston University
and
the 1996 recipient of the
KLEEMEIER AWARD
The ROBERT W. KLEEMEIER AWARD in recognition of outstanding research in
the field of gerontology:
Vern L. Bengtson, PhD
AARP/University Chair in Gerontology
Professor of Sociology
Andrus Gerontology Center
University of Southern California
Los Angeles