Indian Journal of Science and Technology, Vol 8(S1), 434–439, January 2015
ISSN (Online) : 0974-5645
ISSN (Print) : 0974-6846
DOI: 10.17485/ijst/2015/v8iS1/59361
Effect of Filial Piety and Intimacy on
Caregiving Stress among Chinese Adult
Married Children Living with Parents
Yun-Jeong Kim* and Hyun-Jung Kang
Department Elderly of Welfare, Hanseo University, Seosan, Korea; [email protected], [email protected]
Abstract
This study investigated how filial piety and intimacy were applied to family caregiving stress. Data were obtained from a
survey of 295 family caregivers in Xuan Ceobg and Chi Zhou, a city in An Hui Province of China from January to February
2014. The majority of caregiving was being provided for one’s own parents 78.3%, which was twice the rate of caregiving
for a spouse’s parents. On responsibility, ‘caregiving by sharing with brothers/sisters equally’ was most common at 52.9%,
followed by main caregiver at 27.5% and sole caregiver at 19.7%. Of living with elderly parents, 40.3% of caregivers did
and 59.7% did not. The mean score for filial piety was 3.28 points, intimacy was 4.12 points, and caregiving stress was
2.19 points on a 5-point Likert scale. Of caregivers living with parents, filial piety increased caregiving stress but intimacy
reduced stress for sole caregivers. Only caregivers not living with parents could reduce caregiving stress with intimacy.
Keywords: Caregiving Stress, Chinese Adult Children, Component, Filial Piety, Intimacy, Living with Parents
1. Introduction
The population in China is aging faster than in developed
countries due to the reduced birth rate and increased
average life expectancy, in part from the birth control
policy that began in the 1970s. The number of persons
aged 65 years and over in China was 200 million people
in 2014, and is expected to rise to 300 to 400 million by
2041 and 430 million by 2053. Approximately 9 economically active persons (15–64 years old) supported
one elderly person in 2002, and it is expected that 5
persons will support one elderly person in 2019, so the
demand and burden of caregiving and social security
will increase1. The family has been central to the social
organization of Chinese societies2. However, studies have
shown that caring for elderly parents is associated with
caregiver stress3. Because of family caregiving for old parents lasts for years and reasonably serves as the effects
of caregiving stress4. Filial piety, a prominent Confucian
principle, is a traditional caregiving value in China that
*Author for correspondence
emphasises honor and devotion to one’s parents. This
family-centered cultural construct implies that adult children have a responsibility to sacrifice individual physical,
financial, and social interests for the benefit of parents
or other family members. This attitude may manifest as
showing concern for parents’ health, providing housing
and financial support to parents, and respecting parental
authority5. Bidirectional in nature, filial piety prescribes
cultural and social norms that dictate how children and
parents should treat each other. In exchange for the love
and respect of children, parents are expected to provide
financial assistance, childcare, and lessons and wisdom
gleaned from life experience6. It is considered the first of
all virtues in Chinese society and has psychological implications for the formation of Chinese social relations7.
Filial piety showed promise in finding stress among
caregivers of Chinese heritage8, providing social support
and a way to cope. The hypothesis that cultural values
would operate through cognitive appraisals of caregiving as less burdensome had conceptual appeal, and has
Yun-Jeong Kim and Hyun-Jung Kang
been a staple of discussion of group differences in caregiver stress for years8. In Canada, filial piety served as a
protective function to reduce the negative effects of stressors and to enhance the positive effect of appraisal factors
on caregiving burden of Canadian-Chinese9. Caregivers’
belief in Chinese beliefs was associated with lower levels
of distress, fewer depressive symptoms, greater self-efficacy, and more positive caregiving experiences10.
Chinese caregivers reported a cultural expectation that
the first-born son and his wife are primary caregivers for
aging parents, regardless of infirmity. In China, filial care
is viewed as devotion and dedication to parents and often
positively contributes to the well-being of the elderly11.
However, with rapidly development of industrialization,
urbanization and ‘Westernisation’ in recent decades, the
social foundation for filial piety has been greatly undermined in Chinese society11,12. It is argued that filial piety
continues to be a prevailing belief and is a well-regarded
value within the Chinese culture, even in nontraditional
societies11.
Social conditions are changing and have come to redefine children’s obligations to their parents13–15. Therefore,
a higher level of filial piety would predict a more positive
appraisal of the caregiving situation by caregivers, though
it does not mean that caregivers do not feel burdened9. In
considering a variable to reduce the caregiving stress on a
different level, filial piety consciousness is necessary. This
study focused on the intimacy between adult children and
their parents. If the filial piety consciousness is a typical
Chinese value concerning parents, intimacy reflects the
quality of a child’s relationship with parents. Intimacy is
a concept used as the subjective tie in an existing relative relation, with special feelings or a special sense of
sharing and sense of mutual cooperation with parents16.
It means the sharing of feelings and thoughts, a feeling
of connection, and the ability to form openly supportive and harmonious relationships with others17. Factors
of family and caregiving are intertwined, with level of
intimacy being a determining motive of deciding caregiving responsibility18 and providing care19. Love was the
top reason given by children of all ages in caring for parents20, suggesting that a greater parent-child attachment
resulted in deeper emotional caregiving21–23 found that
a higher level of intimacy between elderly couples correlated with a higher spouse caregiving consciousness.
Intimacy between children and elderly parents can be a
deciding factor in caregiving or caregiving responsibility,
and contributed to reducing the burden felt by caregiv-
Vol 8 (S1) | January 2015 | www.indjst.org
ers24. Reported that the quality of relationship between
caregivers and elderly parents can lower the burden and
psychological stress of children. In the study on the family caregivers in China by1, a lower burden was felt if
intimacy was high. Caregivers and elderly parents living
together 24 hours a day inevitably contributes to caregiving stress25.
Competing social values and circumstances, such as
geographical distance, competing roles and responsibilities,
and increasingly demanding employment expectations,
are examples of challenges that Chinese family caregivers may face when fulfilling filial obligations. This study
investigated how filial piety and intimacy applied to family caregiving stress to address two major subjects: 1)
current level of filial piety, intimacy and caregiving stress;
2) effects of filial piety and intimacy on caregiving stress
according to status of living with parents.
2. Methodology
2.1 Procedures
Data were obtained from a survey of family caregivers in
Xuan Ceobg and Chi Zhou, a City in An Hui Province
of China, based on gender and caregivers living with or
without elderly parents. A total of 295 of 315 questionnaires from January to February 2014 were used, after
excluding those with incomplete data.
2.2 Material
‘Caregiving stress’ was measured using Zarit’s Burden
Interview26, with 22 items rated on a 5-point Likert scale.
Items were scored from 1 to 5, with a higher score indicative of greater caregiving stress. Cronbach’s alpha for this
study was 0.92. ‘Filial piety’ was measured using27. It was
translated English by28, 13-item, 5-point Likert scale, with
a higher score indicative of higher filial piety. ‘Intimacy’
was measured using a single item, ‘How is your relationship with your parents?’ with a 5-point Likert scale (1 =
very poor to 5 = excellent).
Socio-economic characteristics of the elderly were
measured by gender, age and academic background.
Caregiving characteristics were measured by primary
caregiving parent (1 = my parents, 2 = spouse’s parents,
3 = none), responsibility of caregiving (1 = entirely, 2 =
mainly, 3 = shared, 4 = none), and status of living with
parents. ‘Living with parents’ used single item of ‘Do you
live with your parents?’ with an answer of “Yes” or “No”.
Indian Journal of Science and Technology 435
Effect of Filial Piety and Intimacy on Caregiving Stress among Chinese Adult Married Children Living with Parents
2.3 Statistical Analysis
Descriptive statistics were used to analyse participants’
socio-demographic characteristics. A t-test was performed
to examine differences in caregiving stress, filial piety and
intimacy according to whether caregivers were living
with parents. Pearson’s correlation tests were employed
to examine the strength of multicollinearity between levels of caregiving stress, filial piety and intimacy. Finally,
multiple regression was used to evaluate the effect of filial
piety and intimacy on caregiving stress. Statistical analyses
were performed using a Statistical Package for the Social
Sciences (SPSS/WIN 21.0, Company, City/Country) and
P<0.05 was considered to indicate statistical significance.
2.4 Socio-demographic and Caregiving
Characteristics
Of the 295 participants, 56.5% were women and 43.5% were
men with a mean age of 40.97 years (SD = 7.546 years).
Nearly all respondents were currently married (95.9%) and
had a high school or university education (86.4%). Of all,
75.6% lived in a big city, 51.7% considered themselves religious, and 41.2% were unemployed or full-time housewives.
The mean subjective economic level was 3.06 points.
3. Results
3.1 Caregiving Characteristics
The majority of caregiving was being provided for one’s
own parents at 78.3%, which was twice the rate of caregiving for a spouse’s parents. On responsibility, ‘caregiving by
sharing with brothers/sisters equally’ was most common
at 52.9%, followed by providing majority of caregiving at
27.5% and sole responsibility for caregiving at 19.7%. On
living with elderly parents, 40.3% of caregivers lived with
parents and 59.7% did not (Table 1).
3.2 Level of Filial Piety, Intimacy and
Caregiving Stress
Descriptive statistics for caregiving stress, filial piety and
are shown in Table 2. The mean score for filial piety was
3.28 points (SD = 0.467), intimacy was high at 4.12 points
(SD = 0.664), and caregiving stress was low at 2.19 points
(SD = 0.590).
3.3 Effects of Filial Piety and Intimacy on
Caregiving Stress among those Living
with Parents
Prior to multiple regression analysis, bivariate analysis was performed on selected control variables, and
Pearson’s correlation analysis was conducted to confirm
multicollinearity (data not shown). Caregiving stress was
the dependent variable in this study. Table 3 presents the
results of multiple regression analysis, determining the
factors associated with caregiving stress according to
whether children were living with parents.
Education level, primary caregiving parents, and caregiving responsibility were treated as dummy variables
before regression analysis was performed.
For caregivers living with parents, seven variables
presented in Table 3 explained 13.9% of variances in caregiving stress. The effects on caregiving stress on caregiving
responsibility, filial piety and intimacy were significantly
associated with levels of caregiving stress. For sole careTable 2. Differences in cultural values and
caregiving (N=295)
Mean
S.D
Filial piety
3.28
0.467
Intimacy
4.12
0.664
Caregiving stress
2.19
0.590
Table 1. Characteristics of participants
Caregiving Characteristics
Primary caregiving parent (n = 295)
Caregiving responsibility (n = 295)
Living with their parents (n = 295)
436 Vol 8 (S1) | January 2015 | www.indjst.org
My parents
Spouse’s parents
Sole caregiver
Main caregiver
Shared with brother/sister equally
Live together
Not living together
Number
%
231
78.3
64
58
81
156
119
176
21.7
19.7
27.5
52.9
40.3
59.7
Indian Journal of Science and Technology
Yun-Jeong Kim and Hyun-Jung Kang
givers, filial piety increased caregiving stress and greater
intimacy reduced stress.
For caregivers not living with parents, seven variables
explained 14.4% of variances in caregiving stress. Only
the effects of intimacy on caregiving stress were significantly associated with levels of caregiving stress. Intimacy
reduced caregiving stress (Table 3).
4. Discussion
This study investigated how filial piety and intimacy were
applied to family caregiving stress, and addressed two
major subjects: 1) the current level of filial piety, intimacy and caregiving stress; 2) effect of filial piety and
intimacy on caregiving stress according to status of living
with parents. Data were obtained from a survey of family
caregivers in Xuan Ceobg and Chi Zhou, a city in An Hui
Province of China, based on gender and caregivers living with or without elderly parents. A total of 295 of 315
questionnaires from January to February 2014 were used,
after excluding those with incomplete data.
The mean score for filial piety was above the midpoint
at 3.28 points, and lower than 3.93 points of Korean women
with filial piety consciousness reported by29. Chinese caregivers scored intimacy at 4.12 points, which was higher
than 3.53 points reported by30. Caregiving stress at 2.19
points was similar to the result of 2.14 points from30.
For caregivers living with parents, sole responsibility
for caregiving and higher filial piety resulted in higher
caregiving stress, and higher intimacy reduced stress.
For caregivers not living with parents, higher intimacy
reduced caregiving stress.
This outcome is open to two interpretations. First,
in the case of caregivers living with elderly parents, a
higher caregiving responsibility and a higher filial piety
resulted in more caregiving stress. Filial piety is not only
an ideology, but also a set of social practices that continues to be an influential factor on the reality of adults
and their families31. Within the context of Chinese culture, providing care to older adults is an obligation and
a highly regarded traditional practice and belief32. It is a
family-centered cultural construction in which children
are expected to sacrifice their own interests physically,
financially, and socially for the benefit of their parents or
family as a responsibility33. In the opinion of33, this can
be interpreted that filial piety means caregiving responsibility, and the level of caregiving responsibility and filial
piety increase caregiving stress. Further, the filial piety is
affection for parents and the self-sacrifice and devotion,
which may be viewed as an unsuitable concept for adult
married children in modern China. Based on results of
this study, filial piety can be interpreted as social pressure to provide caregiving rather than individual choice
based on an emotional relationship. Changing circumstances in family structure, living environment, housing,
employment, and economy are factors that do not allow
traditional filial piety to be nurtured2,34. A higher filial
piety was correlated with greater caregiving stress, which
Table 3. Effects of filial piety and intimacy on caregiving stress
(N = 295)
Caregiving Stress
Live Together
B
(Constant)
β
2.263
Non-Living
t
B
3.755
3.614
***
β
t
7.317***
Control Variable
Age
Education
Subjective Economic level
.009
.010
–.143
.136
.008
–.123
1.447
.083
–1.308
–.001
.113
–.138
–.006
.086
–.137
–.085
1.174
–1.878
Caregiving Characteristics
Primary Caregiving Parents
Caregiving Responsibility
–.182
.277
–.121
.221
–1.340
2.415*
–.050
.014
–.036
.007
–.470
.101
Filial Piety
.244
.203
2.123*
.070
.053
.695
Intimacy
–.179
–.199
–2.103
–.296
–.323
–4.054***
F
R2
2.570*
.139
*
4.035***
.144
p<.05, **p<.01, ***p<.001
Dummy var.: Education (1 = high school), Primary caregiving parents (1 = my parents), Caregiving responsibility (1 = entirely).
*
a
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Indian Journal of Science and Technology 437
Effect of Filial Piety and Intimacy on Caregiving Stress among Chinese Adult Married Children Living with Parents
may be caused by a caregiver realizing that he/she cannot reduce the burden due to filial duty, contributing to
increased caregiving stress. Our results contrast previous
research8,9,35 that found filial piety has a protecting role
in caregiving stress8,9,35. In this study, overall caregiving
stress was low at 2.18 points. However, high filial piety
implies that emphasis on cultural values may have a negative effect on lowering caregiver stress.
Second, in contrast with filial piety increasing caregiver stress of those living with elderly parents, the level
of intimacy between adult married children and elderly
parents may be a protective factor in reducing caregiver
stress regardless of cohabitation status. In short, a higher
affective intimacy with elderly parents correlated with less
caregiving stress, as reported in previous research1,23,24
emphasising intimacy or attachment for caregiving. This
supports a study that found intimacy provided a higher
caregiving motivation than caregiving obligation36.
For caregivers living with elderly parents, the level of
caregiving responsibility and filial piety acted as factors
that increased caregiving stress. However, results of this
study show that greater intimacy can lower caregiving
stress regardless of cohabitation status. As attachment is
connected to caregiving and in the life process37, a program to improve parent-child relationships and intimacy
is needed for adolescent children and middle-aged parents before caregiving becomes an issue.
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