Sample Research Paper on Labour of Love on the Sandwich Generation


The term “sandwich” generation defines individuals who are wedged between the
competing demands of caring for at least one dependent child and one or more aging parent/in-
law. Of the estimated 8.1 million caregivers in Canada, 28% of them were classified as
“sandwiched.” Presently, little is known about the unique experiences of those providing care
at both ends of the generational ladder and how they cope with their stressors. As a result of
caregiver burden, sleep disturbance, depressive symptoms, turnover intention, and job
satisfaction may also be negatively impacted by mindfulness-based stress reduction (MBSR).
This research paper proposes conceptual framework consisting of three multigenerational
caregiving practices (eldercare, spousal support, and childcare) offered by sandwich generation
and the associated effects on caregiver resilience on job satisfaction, turnover retention, sleep
disturbance, and depressive symptoms.
Keywords: Sandwich generation, resilience, caregiving, mindfulness-based stress
reduction (MBSR), eldercare, spousal support, childcare, job satisfaction, turnover retention,
sleep disturbance, and depressive symptoms

Labour of Love: The Effects of Caregiver Resilience on the Sandwich Generation


Work-life balance research highlights the dissimilarity between work-to-family and
family-to-work conflict. Work-to-family conflict occurs when work demands and stressors
conflict with the responsibilities of family life, resulting in decreased attention to family life, and
is allied with reduced marital satisfaction (Green, Bull Schaefer, MacDermid, & Weiss, 2011).
Nevertheless, family-to-work conflict (family-related demands hindering performance in the
work environment) has been understudied. A family demand individuals face is caring for both
growing children and aging adults, referred to as the sandwich generation. An individual from
the sandwich generation could be anywhere from 40-65 years of age (Ward & Spitze, 1998). Of
the estimated 8.1 million caregivers in Canada, 28% of them were classified as “sandwiched”
(Boyczuk & Fletcher, 2016). Current estimates suggest that 9% to 13% of households in the
United States of America are sandwiched (Hammer & Neal, 2008; Ruppanner & Bostean, 2014).
The purpose of this study is to explore the lived experiences of the sandwich generation
who have the responsibility of caring for their elderly parents and/or in-laws, their spouse as well
as their children while juggling paid employment. Sandwich generation caregivers are
individuals who concurrently care for their aging parents and dependent children (Miller, 1981).
With an aging population, there is a pressing need to explore caregiver resilience for sandwich
generation caregivers.
In the organizational behaviour literature, caregiving is rarely examined as a significant
and multifaceted behaviour (Bear, 2019). Effective caregivers are accessible, sympathetic, and
receptive whenever called upon (Bowlby, 1973). In addition, they ‘neither encroach nor
abandon, that is, are neither too impassive (when others seek proximity or help) nor overactive

and imposing (when others need to explore and operate on their own); instead they ensure to be
present and to assist should the need arise’ (Kahn, 1998, p.43). While caregiving is an imperative
part of the “life” component of work-life research and is vital to human survival (Bowlby, 1982;
Mikulincer & Shaver, 2007), it is normally evaluated in the family domain in terms of time
devoted to childcare or eldercare (Bedeian, Bure, & Moffett, 1988; Payne, Cook & Diaz, 2011).
However, for numerous individuals, caregiving is more than the sum of hours spent or an
arrangement; instead, it is a bounding experience for which they have exclusive aims in multiple
domains, such as work, family, and society. With an aging population, there is a pressing need
for caregivers. Caregivers are discovering that their roles are lengthier as a result of older adult
longevity (Abramson, 2015). Caregiver burden is the influence of the demands allied with
caregiving such as physical, psychological, social, and financial demands (George & Gwyther,
1986). Caregiving has more adverse effects on women’s health in comparison to men (Caputo,
Pavalko, & Hardy, 2016; Chesley & Moen, 2006; Marks, 1998; Marks, Lambert, & Choi, 2002;
Pinquart & Sörenson, 2006, 2011). Despite the fact that multigenerational caregivers face a
burden, coping mechanisms have been understudied and require special attention.
Caregivers experience stress related to role strain, role clarity, and role expectations. Role
strain may develop as a result of role expectations from the caregivers. As caregivers seek role
clarity, there is an amplified risk for caregivers to suffer from emotional exhaustion. Role clarity
is apparent for the caregiver when the seeming equilibrium of the familial relationships is
attained (Boss, Doherty, La Rossa, Schumm, & Steinmetz, 1993; Price, Price, & McKenry,
2010). As families face obstacles and challenges, stress escalates. Particularly, caregivers
experience stress. For caregivers, a range of stressors could occur such as finances, time, and

communication within the family system (Price et al., 2010). When faced with stressors,
caregivers who employ effective coping strategies are better off.
While stressors and strains occur in caregiving situations, there are positive aspects of
caregiving. Sandwich generation caregivers benefit from high levels of resiliency and coping
mechanisms (Abramson, 2015). Resilience is the ability to endure and rebound from
predicaments and adversities from a psychological perspective (Walsh, 1996; Fredrickson, 2001)
whereas, organization and management studies defines it as the skill and the capacity to be
vigorous under conditions of immense stress and change and to become stronger in the process
(Coutu, 2002; Cooper, Flint-Taylor & Pearn, 2013). Research indicates that resilient individuals
with elevated positive emotions and the ability to manage negative emotions can find meaning
and deal with the stressful events or conditions at work (Avey, Luthans & Jensen 2009; Tugade
& Fredrickson 2004; Cooper 2013). Research signifying the relationship between spirituality and
resilience has been observed in the civilian caregiving research and has been conjectured to
function as a determinant of resilience by aiding caregivers to come together, comprehend, find
meaning or purpose in the stressful situation (i.e., caregiving), harvest strength from a higher
power, and ultimately overcome stress (Black & Lobo, 2008; Bormann, Warren, Regalbuto,
Glaser, Kelly, Schnack & Hinton, 2009; Wilks, Spurlock, Brown, Teegen & Geiger, 2018).
Sharma, Marin, Koenig, Feder, Iacoviello, Southwick & Pietrzak, (2017) discovered the
protective role of spirituality was also observed among service members and veterans.
Research Question
Primary research question
 What are the Effects of Caregiver Resilience on the Sandwich Generation?”

Secondary Research Questions
 How does caregiving resilience affect the job satisfaction and turnover intention?
 Do Sandwich Generation caregiver’s health behaviours change once they enter the
multigenerational caregiving role?
Research Objectives
 To examine the lived experiences of sandwich generation caregivers
 To determine the influence of multigenerational caregiving on sandwich generation
caregiver’s health and the associated effect on employment status (job satisfaction and
turnover intention)

Literature Review
The Sandwich Generation as Primary Caregivers
Miller (1981) first credited the definition of Sandwich Generation caregivers as
individuals caring for their children, spouses, and parents concurrently. In the last decade, both
the Canadian and United States government have been advocating for a shift from the formal
caregiving in hospital setting to informal caregiving in the home settings due to the current
healthcare system characterized with shortage of healthcare workers, increasing aging
population, and withering government funds (Bear, 2019). Formal caregiving is provided at
monetary costs by personal support workers, occupational therapists, and nurses contracted by
the government or community care access centres to offer home care and community support
services to the children, older persons, and any other group of individuals with continuing
complex care needs. Informal caregiving is the unpaid help provided to family members and
friends (Barrah et al., 2004; Black & Lobo, 2008; Avey, Luthans, & Jensen, 2009). The
Sandwich Caregivers are responsible for the provision of informal caregiving ranging from

instrumental to emotional support. The government prefer keeping individuals in the home care
setting to health care setting to reduce the financial strain on health care systems and workers.
The consequent results is that the Sandwich Generation caregivers continue to bear increased
caregiving burden, strain, and stressors.
Gender Roles in Caregiving
Globally, women are often responsible for assuming the roles of being the caregivers,
either by necessity or choice, to the children, their spouses, or aging family members.
Historically, men have been socialized as the breadwinners of the family and raised to solely
invest their time in their respective careers, which has placed ultimate limitations on their
responsibilities in caregiving. Women are associated with the helping and nurturing roles, and
caregiving aligns with these characteristics (Boss et al., 1993). Therefore, in the Sandwich
Generation, women are the most responsible gender for the caregiving role. As a result, women
are more suffer from effects of caregiving resiliency than men. They are more likely to move in
and out employment, record high turnover intention, experience sleeplessness, and become
victim of depressive symptoms due to the increased work-life balance burden (Brody, 2003).
Effects of Caregiver Resilience on Sandwich Generation
Igarashi et al. (2013) conducted a qualitative study to examine the non-financial costs
experienced by sandwich generation caregivers. The participants did indicate that care provided
to the aging parents was often unanticipated, unpredictable, and distressing. The sandwich
generation lacked any preparation on how to take care of their parents or in-laws and struggled
with their changing health status. Besides, the increased care tasks conflicted with such
opportunities available to them as career, personal growth, and travelling. Similarly, Voydanoff
& Donelly (1999) determined that the amount of time spent by sandwich generation caregivers

caring for their parents and children had a positive correlation with their psychological distress.
Hammer & Neal (2008) agree with the findings by reporting that the married sandwich
generation caregivers were experiencing higher levels of depression than the general population,
with about 24 – 38% scoring above the depression cutoff score. The researchers, Hammer and
Neal, found out that the sandwich generation caregivers were victims of experiencing higher
rates of work-family conflicts recording greater levels of absenteeism from work.
In support of the findings by Igarashi et al. (2013), Voydanoff and Donelly (1999), and
Hammer & Neal (2008), Robinson et al. (2003) reported that sandwich generation caregiving
influenced increased chronic stress and missed obligations leading to decreased productivity and
job satisfaction in the workplaces. Equally, Stephens, Franks, and Townsend (1994) support
these findings by positing that women in multiple roles such as being a caregiver, mother, and
wife at the same time experienced accumulated stress in all these roles of eldercare, spousal
support, and children and recorded decreased well-being, in comparison to the women who only
experienced stress in a single caregiving role. Remennick (1999) agree with the deliberations of
Stephens, Franks, and Townsend (1994) by investigating the sandwich generation caregivers
who immigrated from Russian to Israel and exercised multiple care roles, and reported that they
had diminished well-being owing to the depressive symptoms associated with caring for more
than one care recipient. Rubin and White-Means (2009) further support these deliberations by
hypothesizing that the sandwich generation caregivers may have a reduced life quality due to
engaging in more care duties than they can handle as a result of the accumulation of multiple
There are studies that have focused on explaining the costs experienced by the sandwich
generation caregivers. For instance, Pines, Neal, & Hammer (2011) carried out a focus group

with sandwich generation caregivers who are dual-earners and determined that changes in the
health of the parents, spouses, and children were the factors influencing the stress they
experienced in caregiving. The study found out that there was a positive correlation between
stress associated with caregiving needs and job burnout triggering increased turnover intention to
exit one’s career path. Similarly, Green (2012) conducted a qualitative study on the purpose of
examining the families caring for aging parents and children with disabilities. The results of
study corresponded with those of Pines, Neal, & Hammer (2011) and provided an indication that
the onset parental aging needs cause loss of support previously provided for the children with
special needs, this support is fundamental for increasing the coping abilities of caregivers to
maintain well-being.
Majority of the studies on sandwich generation caregiving have focused on the negative
effects associated with job burnout triggering reduced job satisfaction, increased turnover
intention, and increased depressive impacts on health. However, there are also limited evidence
in existence citing the benefits of informal caregiving. For example, Christensen, Stephens, and
Townsend (1998) conceived that caregivers that occupy multiple roles developed mastery
feelings. The mastery feelings infer that an individual can influence the life events and gains
competency in their management. In the study, Christensen, Stephens, and Townsend deliberated
that the management of multiple care roles by the sandwich generation caregivers had positive
contributions to the psychological well-being of an individual, hence, high levels of mastery was
considered to influence increased life satisfaction. The findings of Marks (1977) coincided with
those of both Marks et al. (2008) and Christensen, Stephens, and Townsend (1998) by theorizing
that though having multiple care roles may not present any negative effect on the psychological
health, it has the potential of contributing to positive health outcomes such as increased physical

health and psychological well-being. Similarly, Stephens & Townsend (1997) agreed with the
arguments of both Marks (1977) and Christensen, Stephens, & Townsend (1998) that caregiving
has positive health outcomes by reporting that the mastery derived in the labor of love was a
driving force for helping buffer the stress linked with the burden of children, spousal, and
parental caregiving. The proposition of Stephens & Townsend (1997) is further supported by
Cooper, Flint-Taylor, & Pearn (2013) who argued that the occupation of caregiving roles by both
men and women may be beneficial to those who were previously performing few care roles by
helping create a sense of belonging and meaning in life. Caputo, Pavalko, & Hardy (2016) also
shares the same argument by describing the positive effect of caregiving on sandwich generation
caregiving by elucidating that it provides a sense of status security, status enhancement, and ego
Allen & Martin (2017) carried out an investigation on the positive effects of caregiver
resilience on the sandwich generation women in multiple roles as a caregiving daughter to the
parents (elderly population), wife, and mother. The researchers determined that the caregiving
daughters-in-law and daughters developed the feeling of being rewarded by their engagement in
multiple caregiving roles. The accumulation of these rewards in any two of the three roles as a
wife, mother, or daughter had significant result in the elevation of well-being when compared to
the women who did feel that their participation in the multiple roles were stressful. Further, the
findings of Pines, Neal, & Hammer (2011) supported those of Allen & Martin (2017) by finding
out that the couples in sandwich generation did report job burnout at significantly lower levels
than the general population in different employment occupations. The results from the focus
group provided an indication that strong marriages served to assist the sandwich generation
caregivers decrease couple and job burnout, even though they may have multiple stressors such

as work, caring for aging parents, and parenting. The findings of these two studies are an
illustration that the engagement in multiple roles is of benefit to other areas of life among
sandwich generation caregivers, which is correspondingly supported by Ingersoll-Dayton, Neal,
and Hammer (2001).
Ingersoll-Dayton, Neal, & Hammer (2001) explained that the sandwich generation
caregivers experienced benefits in multiple caregiving role in the sense that the care provided is
considered as a reciprocation of the same help offered to them while young. The older adults
may have offered different help ranging from emotional and financial support, household tasks,
to childcare to the sandwich generation as their sons or daughters, and the care provided to them
in form of eldercare is in return an appreciation. Ingersoll-Dayton et al. (2001) contend that the
potential benefits affiliated to caregiving are dependent on either the current or past familial
relationship with the recipient of the care. In relation to the same focus by Ingersoll-Dayton,
Neal, & Hammer (2001), Pope (2013) examined the possible influence that caregiving has on the
perspective of adult daughters regarding their future in the later life. The results were of
revelation that the experience of caregiving present the potential of providing benefits such as
gaining awareness on the practice of aging successfully. Likewise, Igarashi, Hooker, Coehlo, &
Manoogian (2013) found that sandwich generation caregivers learned the caregiving experience
from their parents. The practice of caregiving is, therefore, made a generation habit past from
one group of individuals to another. The researchers argue that the situation creates the
opportunity for the elderly who were once caregivers to receive the same care once they are old
from the young population who might have emulated a similar path.



Proposition 1: Multiple caregiving roles as perceived by sandwich generation caregivers
negatively affect job satisfaction in career positions
Proposition 2: Multiple caregiving roles as perceived by sandwich generation caregivers
positively affects turnover intention in the employment field
Proposition 3: Caregiver resilience in the continued participation of multiple roles by sandwich
generation caregivers negatively affects health outcomes

Conceptual Framework

Caregiving Model Mediator
When caring for the loved ones ranging from the elderly, spouses, to children, age serves
as the mediator for the resilience between multigenerational caregiving roles and consequential
effects on sandwich generation. The three variables of eldercare, spousal support, and childcare

are associated with job satisfaction, turnover intention, sleep disturbance, and depressive
symptoms. The older the sandwich generation caregiver becomes, the more severe the effects of
caregiving resilience on job satisfaction, turnover intention, sleeplessness, and depressive
symptoms the caregiver is likely to experience, and the vice is true. Increased provision of
eldercare, spousal support, and childcare by the Sandwich Generation caregivers reduces their
job satisfaction, which in turn increases turnover intention by the sandwich generation women
compelling them to leave their employment engagements to offer care to the respective family
members. Conversely, increased provision of eldercare, spousal support, and childcare by the
Sandwich Generation caregivers increases their risk of suffering from depressive symptoms and
sleep disturbance.
Underlying Theories
Symbolic Interaction Theory
Symbolic interaction theory holds that when analysing the family dynamics and
caregivers, there different components of interaction ranging from roles, rituals, gestures, social
norms, identities, salience to social acts that must be taken into consideration (Smith & Hamon,
2012). The interactions among the family members, friends, and entire community are
responsible for shaping the ways in which families interact. Each caregiver has varieties of roles.
With every role, there are associated diverse perceptions and identities aligned with it. As more
responsibilities are developed by the caregivers, there is a consequent growth in the need for
analysing the caregiving resources. The caregiving resources play essential roles in the overall
caregiving perceptions by the caregivers and the factors linked with caregiving strain.

Family Stress Theory
The caregivers often experience stress related to role clarity, role expectations, and role
strain. Role strain undergoes evolution as the caregivers’ role expectations increase. The increase
in role expectations compel the caregivers to seek for role clarity, which increases the risk to
experience emotional exhaustion or overload. However, role clarity to reduce the associated
burden becomes much evident for the caregivers in the situation where there is the achievement
of the perceived familial relationship equilibrium. Family stress theory supports the necessity of
positive communication interactions among the care recipients and caregivers. The theory
suggests that the availability of such resources as communication, time, and money influence the
quality of caregiving relationship (Boss, 1992; Boss et al., 1993).
Role Theory
Role theory states that individuals must meet the demands inferred in their roles if they
wish to be successful (Greenhaus & Beutell, 1985; Kahn, Wolfe, Quinn, Snoek, & Rosenthal,
1964). When employed individuals become caregivers, they must learn how to manage the new
demands although incompatible family and work role demands often compete for time and can
result in behavioural pressures (Allen & Martin, 2017; Greenhaus & Beutell, 1985), creating
family-to-work conflict. Employed caregivers must harmonize their roles by prioritizing
demands across both life domains (Barrah, Shultz, Baltes, & Stolz, 2004; Kossek et al., 2017).

Social Role Theory
Social role theory proposes that social groups form attitudes and beliefs about the social
roles of men and women, particularly in work settings (Eagly, 1987, 1997; Eagly & Steffen,
1984; Eagly, Wood, & Diekman, 2000). Throughout history, females have assumed the majority

of caregiving roles and have provided care to aging family members and children (Ford, Good,
Barrett, Harrell, & Haley, 1997; Gerstel & Gallagher, 2001; Pinquart & Sörenson, 2006; Kahn,
McGill & Bianchi, 2011; Pavalko & Wolfe, 2016). Men have been socialized to be
breadwinners, whereas, women are expected to be caregivers. Men were raised to invest large
amounts of time in their careers, which have ultimately placed limitations on their caregiving
responsibilities (Moen et al., 1994). Wives and daughters are responsible for “home and kinship”
(Moen, Robison, & Fields, 1994) and are three times more likely than sons to be primary
caregivers to older parents and to become “women in the middle” undertaking multiple roles as
spouse, mother, daughter, and employee (Brody, 2004).
Attachment Theory
The family relationships among sandwich generation caregivers are multifaceted. An
important factor in relationship quality is perceived degree of closeness between the caregiver
and care recipient. An assured attachment is essential for older adults in a stage of increased
dependence on their caregivers. Attachment theory describes how individuals develop relational
attachment orientations through repeated ‘caregiving’ interactions with significant others
(Ainsworth, Blehar, Waters & Wall, 1978; Bowlby, 1980). Attachment theory posits a useful
lens to better understand caregiver and care recipient relationships (Santona, Tagini, Sarracino,
De Carli, Pace, Parolin & Terrone, 2015). Within family caregiving situations, communication
patterns change to varying degrees for family systems (Mancini & Blieszner, 1989; Nussbaum,
Pecchioni, Robinson, & Thompson, 2013). Recurrent contact with family members inherently
leads to an increased need for communication.



For this conceptual research paper, the design method employed was descriptive. The
descriptive method was based on locating, evaluating, and assembling diverse body of literature
on the topic of “Effects of Caregiver Resilience on the Sandwich Generation” In regards to the
two objectives of this paper seeking to answer the research questions, there were four major
themes revealed through the descriptive method of analysing the diverse body of literature on the
specified topic, which described the lived experiences of caregivers, their perceived health, and
participation in economic activities (employment). These themes included (1) The roles of the
caregivers, (2) The balancing act of caregiving, (3) There are usually stormy seas in caregiving
and it is always not rainbows and sunshine, and (4) The caregiving roles amidst the turmoil
experienced have some silver linings. A summary of the themes and subthemes are provided in
the Table 1 below, and their explanation provided in the discussion section.
Table 1: Themes and Subthemes of sandwich generation caregivers’ lived experiences



The purpose of this conceptual research paper was to explore the lived experiences of
sandwich generation women and the influence multigenerational caregiving roles had on their
health behaviours and economic engagements such as employment to determine the feelings of
caregivers on job satisfaction and turnover intentions. The paper provides in-depth analysis of
the literatures focused on the tasks involved in the sandwich generation caregiving and their
effects on caregivers’ health and other life commitments such as work.

According to Allen & Martin (2017), the care for spouses and children requirements are
significantly less challenging compared to the care demanded by the in-laws/parents (older
population). The care provided to the older care recipients was perceived to be requiring more
time as it was more demanding. Conversely, the care provided to the spouses and children was
expected and, therefore, was perceived by the caregivers as being more manageable.
In a study conducted by Caputo, Pavalko & Hardy (2016), using a sample participants of
24 sandwich generation caregivers, the caregivers provided an explanation on how their
children’s and spouses’ care was different from the older care recipients’ care. All of the
participants agreed that increased caregiving demands resulted in a decrease in the time spent
with the immediate family members or to participate in full-time employment, which caused
reduced job satisfaction and increased turnover intentions. In the study, the children, spouses,
and in-laws/parents were included in the tug-of-war and juggling act that caused exhaustion and
strain, which negatively impacted the caregivers’ health. As a result, sandwich generation
caregivers experiencing great challenges when providing help to their care recipients and the
difficulty in balancing other areas of life such as work and being a parent (father or mother of the
children), spouse (wife or husband), and a daughter or son (to the older adults).
Physical caregiving is an important aspect of care involving cooking, moving houses,
cleaning, bathing, toileting, managing finances, purchasing foods, dressing, and feeding the care
recipients. Chesley & Moen (2006) highlighted that these physical caregiving roles were good
indicators of the time and amount of assistance needed by the care recipients, and are specific to
the multigenerational caregivers. The study noted that the caregiving tasks did differ between the
genders with the women typically responsible for the provision of nurturing role while the men
are involved in the provision of transportation and managing finances for the care recipients. In

some cases, the women complete all these caregiving tasks for the older adults with the men
being left with the duties of childcare when elderly care recipients demand more of the
caregivers’ time. The situation suggests that men assist in the caregiving phenomenon mostly by
looking after the children. However, the women are the ones involved in performing the majority
of the care tasks that are more demanding such as caring for the parents and in-laws.
The sandwich generation caregivers provide emotional support to the care recipients
(children, spouse, and elderly). Emotional caregiving serves to provide comfort and empathy to
the care recipients, especially those with severe health conditions. The caregivers play huge
emotional role as the care recipients with health conditions requires significant support to help
the older adults cope with stressors and losses of life. Emotional caregiving is extended to the
care recipients with higher care needs, making it just as important as the physical care.
The provision of physical and emotional caregiving takes up inordinate amounts of time
for the sandwich generation caregivers. The caregivers experience time constraints that they have
been subjected to due to demands of the caregiving roles. The caregivers must consistently either
be physically available or on-calls with their care recipients. Although the caregivers rarely put
records of the amount of time they often spend on their caregiving roles on weekly basis,
previous literature has determined that caregivers balancing the caregiving roles with
employment usually spend approximately 34 hours per week completing the tasks of caregiving
(Duxbury et al., 2009). The amount of time spent completing the caregiving roles further
confirms the time commitment associated with the care for multigenerational care recipients.
Most of the care tasks are often completed both with and without the presence of the care
recipients, specifically the financially and administrative related tasks. Therefore, caregiving
continues even after the caregivers have physically left their respective care recipients.

Rubin and White-Means (2009) reported that the sandwich generation caregivers spend
more time caring for their children, spouses, and parents/in-laws when compared to other
caregiving members of the family. Therefore, the study relates to proposition 2: “Multiple
caregiving roles as perceived by sandwich generation caregivers positively affects turnover
intention in the employment field” and proposition 3: “Caregiver resilience in the continued
participation of multiple roles by sandwich generation caregivers negatively affects health
outcomes due to increased sleep disturbance and depressive symptoms” as time is a major
limitation when it comes to the sandwich generation caregivers attempting to complete their
roles, especially the employed caregivers. The caregivers either juggle their care and work
responsibilities successfully or at sometimes experience tugs-of-war between their care demands
and work obligations, which compels them to sacrifice their involvement in other activities of
life. The increased care recipients’ demands means more caregiving burden causing heightened
feelings of depression due to the inability to complete all the care needs within the required time
and less time to sleep. The increased care duties and lack of adequate time to get enough sleep
trigger increased turnover intentions influenced by the inability to balance care and work
demands, which results in caregivers quitting their part-time or full-time employment
responsibilities to focus their attention on attending to the care recipients. Similar findings were
determined by Dhar (2012), who issued the revelation that the participants (sandwich generation
caregivers) felt that their roles were clashing with each other making it difficult to complete their
tasks in caregiving and other competing priorities. The caregivers are largely under the control of
the demands of their care recipients, which makes participating in employment engagement more
of an option.

Roles transitions, as one of the characteristics of multigenerational caregiving roles
explained by Evandrou & Glaser K (2004), relate to proposition 3: “Caregiver resilience in the
continued participation of multiple roles by sandwich generation caregivers negatively affects
health outcomes.” Role transition often occurs when there is expansion in the caregivers’ roles as
a result of the increasing number of care recipients or care needs. It trigger the changes in
relationships between the caregivers and care recipients. For example, the health demands of a
caregiver cause relationship to transition from being either a daughter or son to a caregiver for
the older adults. explained that the daughters and sons as caregivers to the in-laws and parents
often develop the feelings that their relationships change from being a mother-daughter to
caregiver-care recipient, when their fathers and mothers needed more eldercare. As health status
changes, the caregivers are required to constantly negotiate their relationship with the care
recipients. All the role transitions on multigenerational caregiving indicate complexities in the
caregivers’ roles, which make the sandwich generational caregivers’ roles become more
challenging and end up placing increased demands on their lives. The increased demands on the
sandwich generation caregivers make them convey the frustration and resentment feelings
because of the considerable amount of their time demanded by the care recipients and the
overwhelming care responsibilities. The care tasks required for the caregivers to perform coupled
with the issue of limited time make the caregivers feel stifled and obligated to perform the care
roles. These findings were similar to those of Green et al. (2011) whose participants felt
resentment towards their respective caregiving roles because of not choosing to be informal
caregivers. Further, McGill, & Bianchi (2011) reported that the adult daughters and sons pointed
out that the involvement in caregiving roles prompted the feelings of frustration and anger. These

results depict that caregivers have negative feelings arising from the increased caregiving
burden, which affect their mental health due to increased depressive symptoms.
The sandwich generation caregivers revealed that their health was compromised by their
active involvement in the multiple caregiving roles. The effects on health was largely contributed
by sandwich generation caregivers placing the needs and demands of their care recipients a
priority at the expense of their health. Kossek et al. (2017) believe that the caregivers put their
health needs last since they care for their recipients when both at work and home having little
time address their personal health condition. The study relates to proposition 3: “Caregiver
resilience in the continued participation of multiple roles by sandwich generation caregivers
negatively affects health outcomes.” The responsibilities of work, family, and caregiving
consumed majority of the caregivers’ time, leaving barely enough time for attending to their
health. The amount of time available to address personal health needs as a caregiver is important
to recognise as it poses major limitations to the caregivers’ health and potential ramification on
their abilities to complete their work obligations and caregiving tasks. An unhealthy population
of caregivers presents the risk of their care recipient needs going unmet, which has the likelihood
of causing further complications such as the inability to assist the elderly with activities of daily
living and medical care. Therefore, the caregivers’ health not only influences themselves alone
abut also the lives of their care recipients. The sandwich generation caregivers report that their
multiple caregiving roles affect their levels of physical activities. The caregivers feel that the
increased care needs of their care recipients, which always come first, limit them from getting as
much exercise as they may intend. The caregivers also have feeling that even if they may have
the spare time to participate in physical exercises, after completing the care tasks, they are often
too exhausted to indulge in the physical activities. Marks (1997) and Pope (2013) confirm that

the multiple role caregivers are less likely to participate in exercising activities in comparison to
the non-caregivers or those caring only for their parents due to increased exhaustion, which
results to health deterioration.
The nutritional habits of sandwich generation caregivers is influenced by their multiple
caregiving roles. O'Sullivan (2015), Boyczuk & Fletcher (2016), and Christensen, Stephens, &
Townsend (1998) deliberate the interesting situation revealed by the caregivers that they would
sometimes rather not eat or skip meals due to buy schedules leaving them with not time for
eating. These studies relate to proposition 3: “Caregiver resilience in the continued participation
of multiple roles by sandwich generation caregivers negatively affects health outcomes.” The
lack of eating or under eating leads to the failure to provide enough sustenance that eventually
become detrimental to the caregivers’ health. For instance, consuming less optimal calories
amounts can result in a decrease in the energy expenditures, which may make it increasingly
difficult for the caregivers to complete caregiving responsibilities and other activities. It is an
imperative requirement that the caregivers look after themselves and their nutrition to enable
them complete the care roles successfully and concurrently remain healthy.
The study by Spielman, Yang and Glovinsky (2011) deliberated that the sandwich
generation caregivers perceive that their energy and sleep levels are influenced by their multiple
caregiving roles. The study relates to proposition 3: “Caregiver resilience in the continued
participation of multiple roles by sandwich generation caregivers negatively affects health
outcomes due to increased sleep disturbance.” The care recipients usually need the multiple care
roles around the clock both during the day and at night. The caregivers are unable to have
enough sleep since they must be constantly awake and alert to respond to the recipients’ care
needs whenever necessary. The caregivers become both mentally and physically exhausted by

the problem of sleep disturbance. Sleep deprivation make the caregivers feel fatigued making it
difficult to complete the care tasks or be productive in the workplaces. Multiple caregiving roles
influence the caregivers’ sleep patterns and contribute to exhaustion compromising the ability to
participate actively in the caregiving roles or other life engagements such as work, consequently
increasing the turnover intentions due to the inability to balance the work and care demands
considering the deterioration in health status.
Bormann et al. (2009) and Pinquart & Sörensen (2006) report that the caregivers involved
in multiple care giving roles experience mental health problems. The studies relate to proposition
3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation
caregivers negatively affects health outcomes due to increased depressive symptoms” and
proposition 1: “Multiple caregiving roles as perceived by sandwich generation caregivers
negatively affect job satisfaction in career positions.” The mental health was influenced by the
intense caregiving demands requiring them to spend a lot of their time on caregiving tasks at the
expense of any other life engagement such a work. Sandwich generation, being the primary
caregivers for the care recipients with dementia results in increased feelings of irritability, stress,
and anxiety associated with negative health. The increased stress, anxiety, and irritability
feelings causes apparent strain that reduces job satisfaction due to mental health problems
affecting commitment and concentration at work as a result of the inability to balance the care ad
employment demands. The apparent strain on mental health creates the need to emphasize on the
significance of adopting coping strategies for buffering the stressors linked with
multigenerational caregiving roles owing to the effects caused to caregiving and other work

The studies by Kossek et al. (2017). Moen, Robison & Fields (1994), and O’Sullivan
(2015) all have a consensus finding that the caregivers’ employment engagement is
compromised due to putting the needs of the care recipients ahead of their own leading to
increased depressive symptoms and sleep disturbance. The studies relate to proposition 1:
“Multiple caregiving roles as perceived by sandwich generation caregivers negatively affect job
satisfaction in career positions” and proposition 2: “Multiple caregiving roles as perceived by
sandwich generation caregivers positively affects turnover intention in the employment field.”
The increased care burden posses challenges to the caregivers creating perceived tug-of-war
between caregiving and working. The caregivers must constantly negotiate the important
caregiving tasks, which compels them to neglect other obligations at the detriment of their well-
being such as social activities, physical activities, and nutrition) leading to the compromising of
their health. Therefore, it is due to the increased caregiving roles demands and deterioration of
health that the sandwich generation caregivers’ job satisfaction and turnover in the workplaces
are negatively affected. Owing to the involvement in multiple caregiving roles to meet the care
needs of their care recipients (the children, spouses, and older adults), the participation of
sandwich generation caregivers in other life activities such as work become affected. Increased
physical, mental, psychological, and emotional health problems influence the caregivers to
record reduced levels of job satisfaction, which consequently serve to propel the increased
turnover intentions. In other words, a caregiver who is heavily involved in the caregiving roles
finds it challenging to balance the work demands, should he or she be employed, with the
responsibilities of caring for their children, spouses, and parents/in-laws who might be in need of
their help. Since the care needs to the children, spouses, and parents/in-laws is often

indispensable, the caregivers are prompted to forego their jobs and focus their attention to the
caregiving roles.
Although the multiple caregiving roles place extensive demands on their lives, the
sandwich generation caregivers still look past the challenges and recognize the positive moments
in their roles. The caregivers perceive a sense of gratitude in their caregiving roles and are
usually thankful for the experiences. The spouses are appreciative of their partners’ role in
supporting each other’s caregiving roles. The caregivers reveal that they become much closer
with their children and parents/in-laws due to their involvement in the caregiving roles.
Evandrou & Glaser (2004) report improved familial relationships between the caregivers and
care recipients due to the participation in multiple caregiving roles. However, the increased
involvement in caregiving roles requires that the caregivers have flexible jobs, which is not
always the universal case for all the caregivers. Therefore, some caregivers are obliged to forego
their work engagements and focus their attention on the caregiving roles, especially the women
since they have been historically perceived as the gender bestowed with the mandate of looking
after the children and parents/in-laws.
However, the joy that the sandwich generation caregivers report to be finding in their
caregiving roles to the care recipients keeps them motivated even if their efforts do not attract
economic rewards. The caregivers have a genuine feeling that their caregiving roles bestow them
with immeasurable but unquantifiable rewards providing sense of fulfilment in their lives, and
this why they can afford to lose their jobs and all the associated economic gains and focus their
efforts in caring for their recipients provided they have enough financial resources to sustain
them. Hammer & Neal (2008), Black & Lobo (2008), and Bear (2019) report that the sandwich
generation caregivers derive joy from their roles and this helps them to buffer the stressors linked

with their care tasks. The caregivers have feelings of reward when occupying multiple caregiving
roles as they are convinced that they are repaying for the care that their parents provided to them
at young age and the care that their children would provide to them too once they are old.
The multigenerational caregiving roles is more of an intergenerational succession practice
for reciprocation of care. Igarashi et al. (2013) suggested that the involvement of sandwich
generation caregivers in the multiple caregiving roles was guided the hope that the children get
the necessary preparation for their potential roles of caregiving in the future. The caregivers felt
they are responsible to take care of the older adults (their in-laws and parents) so that their
children can learn how to take care of them in the future. The understanding of the complexities
of multigenerational caregiving roles by the children would better equip them as the future
caregivers. The children would make the caregiving roles less burdensome and develop the
ability on how to balance their care tasks with the health needs and work engagements to ensure
that they have improved health outcomes, increased job satisfaction, and reduced turnover
intentions, since these are areas most affected by the multiple caregiving roles.

Recommendation and Conclusion

Future Directions
Through the continued understanding of the factors, perceptions, and lived experiences of
the caregiving strain and burden affecting job satisfaction, turnover intentions, and caregivers’
sleeping pattern, and depressive symptoms, future research is needed to determine the
caregivers’ needs. The sandwich generation caregivers care for their respective care recipients
including children, spouses, and older adults, however, the question that remains unanswered is,
“who care for the caregivers?” Therefore, future study is needed to focus on the caregiving
resources to provide greater understanding of the effective strategies that can help reduce the

caregivers’ strain associated with feelings of emotional distress, physical burden, and stressor
factors affecting their health and other economic engagement such as work. The future research
should qualitatively explore how the stress-related feelings affecting the caregiver’s health can
be reduced to eliminate the risks of burden and promote self-help techniques and self-care that
will allow the caregivers balance their care recipients’ need with their work engagements
whether in part-time or full-time employment.
The participation in caregiving by the sandwich generation caregivers is unquestionably
both a rewarding and challenging role. The multigenerational caregiving roles enable the
caregivers to share their lived experiences. The reflection on the current and past experiences
allows the caregivers to provide in-depth examination of their caregiving roles for their children,
spouses, and the aging in-laws/parents. There were the challenges of reduced job satisfaction,
increased turnover intentions, and compromised health outcomes, specifically in reference to
increased depressive symptoms and sleeplessness, which were influenced by the demands of
multiple caregiving roles on the caregivers.
In spite of the challenges, the participation in multiple caregiving roles by the sandwich
generation caregivers also presents some silver linings realized through the balancing acts of
completing care responsibilities and other life’s engagement duties that presents the inevitability
of change in the future. Therefore, this paper provides a holistic perspective on both the positive
and negative effects of multigenerational caregiving roles on the sandwich generation caregivers’
health and employment. The understanding of the associated impacts of caregiving roles on the
caregivers’ health and other life engagement such as work provides better anticipation of the care
and work demands. The caregivers develop an insight to be more cognizant of their health and

balance the demands of their care recipients with their economic responsibility roles, especially
when employed.



Abramson, T. A. (2015). Older adults: The “panini sandwich” generation. Clinical
Gerontologist, 38(4), 251-267.
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. N. (2015). Patterns of attachment: A
psychological study of the strange situation. Psychology Press.
Allen, T. D., & Martin, A. (2017). The work-family interface: A retrospective look at 20 years of
research in JOHP. Journal of Occupational Health Psychology, 22(3), 259.
Avey, J. B., Luthans, F., & Jensen, S. M. (2009). Psychological capital: A positive resource for
combating employee stress and turnover. Human Resource Management, 48(5), 677-693.
Barrah, J. L., Shultz, K. S., Baltes, B., & Stolz, H. E. (2004). Men's and women's eldercare-based
work-family conflict: Antecedents and work-related outcomes. Fathering: A Journal of
Theory, Research & Practice about Men as Fathers, 2(3).
Bear, J. B. (2019). The caregiving ambition framework. Academy of Management Review, 44(1),
Bedeian, A. G., Burke, B. G., & Moffett, R. G. (1988). Outcomes of work-family conflict among
married male and female professionals. Journal of Management, 14: 475–491.
Black, K., & Lobo, M. (2008). A conceptual review of family resilience factors. Journal of
Family Nursing, 14(1), 33-55.
Bormann, J., Warren, K. A., Regalbuto, L., Glaser, D., Kelly, A., Schnack, J., & Hinton, L.
(2009). A spiritually based caregiver intervention with telephone delivery for family
caregivers of veterans with dementia. Alzheimer's Care Today, 10(4), 212-220.
Boss, P. (1992). Primacy of perception in family stress theory and measurement. Journal of
Family Psychology, 6(2), 113-119.

Boss, P., Doherty, W. J., LaRossa, R., Schumm, W. R., & Steinmetz, S. K. (Eds.).
(1993). Sourcebook of family theories and methods: A contextual approach. Springer
Science & Business Media.
Boss, P.G., Doherty, W. J., LaRossa, R., Schumm, W. R., & Steinmetz, S. K. (1993).
Sourcebook of family theories and methods: A contextual approach. New York: Plenum
Bowlby, J. (1973). Self-reliance and some conditions that promote it. British Journal of
Psychiatry, 130, 201-210.
Bowlby, J. (1980), Attachment and loss: Sadness and depression. New York: Basic Books.
Bowlby, J. (1982). Attachment and loss. Volume 1: Attachment (2nd ed.). New York: Basic
Boyczuk, A. M., & Fletcher, P. C. (2016). The ebbs and flows: Stresses of sandwich generation
caregivers. Journal of Adult Development, 23(1), 51-61.
Brody, E. M. (2003). Women in the middle: Their parent-care years. Springer Publishing
Caputo, J., Pavalko, E. K., & Hardy, M. A. (2016). The long‐term effects of caregiving on
women's health and mortality. Journal of Marriage and Family, 78(5), 1382-1398.
Chesley, N., & Moen, P. (2006). When workers care: Dual-earner couples' caregiving strategies,
benefit use, and psychological well-being. American Behavioral Scientist, 49(9), 1248-
Christensen, K. A., Stephens, M. A., & Townsend, A. L. (1998). Mastery in women’s roles and
well-being: Adult daughters providing care to impaired parents. Health Psychology,
17(2), 163-171.

Cooper, C.L., Flint-Taylor, J., and Pearn, M. (2013). Building resilience for success: A resource
for managers and organizations. Basingstoke: Palgrave Macmillan.
Coutu, D. L. (2002). How resilience works. Harvard Business Review, 80(5), 46-56.
Dhar, R. L. (2012). Caregiving for elderly parents: A study from the Indian perspective. Home
Health Care Management and Practice, 24(5), 242-254.
Duxbury, L., Higgins, C., & Lee, C. (1994). Work-family conflict: A comparison by gender,
family type, and perceived control. Journal of Family Issues, 15(3), 449-466.
Duxbury, L., Higgins, G., & Schroeder, B. (2009). Balancing paid work and caregiving
responsibilities: A closer look at family caregivers in Canada. Victoria Order of Nurses,
1- 199.
Eagly, A. (1987). Sex differences in social behavior: A social-role interpretation. Hillsdale, NJ:
Lawrence Earlbaum Associates.
Eagly, A. H. (1997). Sex differences in social behavior: Comparing social role theory and
evolutionary psychology. Abingdon: Routledge.
Eagly, A. H., & Steffen, V. J. (1984). Gender stereotypes stem from the distribution of women
and men into social roles. Journal of Personality and Social Psychology, 46(4), 735.
Eagly, A. H., Wood, W., & Diekman, A. B. (2000). Social role theory of sex differences and
similarities: A current appraisal. The Developmental Social Psychology of Gender, 12,
Evandrou M and Glaser K (2004) Family, work and quality of life: Changing economic and
social roles through the life course. Ageing & Society, 24, 771–791.
Fingerman, K. L., Pillemer, K. A., Silverstein, M., & Suitor, J. J. (2012). The baby boomers’
intergenerational relationships. The Gerontologist, 52(2), 199-209.

Ford, G. R., Goode, K. T., Barrett, J. J., Harrell, L. E., & Haley, W. E. (1997). Gender roles and
caregiving stress: An examination of subjective appraisals of specific primary stressors in
Alzheimer's caregivers. Aging & Mental Health, 1(2), 158-165.
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-
and-build theory of positive emotions. American Psychologist, 56(3), 218.
George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: a multidimensional examination
of family caregivers of demented adults. The Gerontologist, 26(3), 253-259.
Gerstel, N., & Gallagher, S. K. (2001). Men's caregiving: Gender and the contingent character of
care. Gender & Society, 15(2), 197-217.
Green, S. (2012). Convergent caregiving: Exploring eldercare in families of children with
disabilities. Journal of Loss and Trauma, 18(4), 289-305.
Green, S. G., Bull Schaefer, R. A., MacDermid, S. M., & Weiss, H. M. (2011). Partner reactions
to work-to-family conflict: Cognitive appraisal and indirect crossover in couples. Journal
of Management, 37(3), 744-769.
Hammer, L. B., & Neal, M. B. (2008). Working sandwich-generation caregivers: Prevalence,
characteristics and outcomes. The Psychologist-Manager Journal, 11(1), 93-112.
Igarashi, H., Hooker, K., Coehlo, D. P., & Manoogian, M. M. (2013). “My nest is full”:
Intergenerational relationships at midlife. Journal of Aging Studies, 27(2), 102-112.
Ingersol-Dayton, B., Neal, M. B., & Hammer, L. B. (2001). Aging parents helping adult
children: The experience of the sandwich generation. Family Relations, 50(3), 262-271.
Kahn, J. R., McGill, B. S., & Bianchi, S. M. (2011). Help to family and friends: Are there gender
differences at older ages?  Journal of Marriage and Family, 73(1), 77-92.

Kahn, R. L., Wolfe, D. M., Quinn, R. P., Snoek, J. D., & Rosenthal, R. A. (1964). Organizational
stress: Studies in role conflict and ambiguity.
Kahn, W. (1998). Relational systems at work. In B. M. Staw and L. L. Cummings (Eds.),
Research in Organizational Behavior, Vol. 20 (pp. 39-76). London: JAI Press.
Kossek, E. E., Thompson, R. J., Lawson, K. M., Bodner, T., Perrigino, M. B., Hammer, L. B., &
Wipfli, B. (2017). Caring for the elderly at work and home: Can a randomized
organizational intervention improve psychological health?
Levinson, D. J. (1986). A conception of adult development. American psychologist, 41(1), 3.
Mancini, J. A., & Blieszner, R. (1989). Aging parents and adult children: Research themes in
intergenerational relations. Journal of Marriage and the Family, 275-290.
Marks, N. F., Lambert, J. D., & Choi, H. (2002). Transitions to caregiving, gender, and
psychological well‐being: A prospective US national study. Journal of Marriage and
Family, 64(3), 657-667.
Marks, N. F., Lambert, J. D., Jun, H., & Song, J. (2008). Psychosocial moderators of the effects
of transitioning into filial caregiving on mental and physical health. Research on Aging,
30(3), 358-389.
Marks, S. R. (1977). Multiple roles and role strain: Some notes on human energy, time and
commitment. American Sociological Review, 42(6), 921-936.
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and
change. New York: Guilford Press.
Miller, D. A. (1981). The ‘sandwich’ generation: Adult children of the aging. Social Work,
26(5), 419-423.

Moen, P., Robison, J., & Fields, V. (1994). Women's work and caregiving roles: A life course
approach. Journal of Gerontology, 49(4), 176-186.
Mowday, R. T., Steers, R. M., & Porter, L. W. (1979). The measurement of organizational
commitment. Journal of Vocational Behavior, 14(2), 224-247.
Novak, M., & Guest, C. (1989). Caregiver response to Alzheimer's disease. The International
Journal of Aging and Human Development, 28(1), 67-79.
Nussbaum, J. F., Pecchioni, L. L., Robinson, J. D., & Thompson, T. L. (2013). Communication
and aging. Routledge.
O'Sullivan, A. (2015). Pulled from all sides: The sandwich generation at work. Work, 50(3), 49 1
-494. doi: l 0.3233/WOR-141959.
Patton, M. Q. (2002). Two decades of developments in qualitative inquiry: A personal,
experiential perspective. Qualitative Social Work, 1(3), 261-283.
Pavalko, E. K., & Wolfe, J. D. (2016). Unpaid care work. Gerontology: Changes, challenges,
and solutions. Santa Barbara: Praeger, 181-203.
Payne, S. C., Cook, A. L., & Diaz, I. (2011). Understanding childcare satisfaction and its effect
on workplace outcomes: The convenience factor and the mediating role of work-family
conflict. Journal of Occupational and Organizational Psychology, 85: 225–244.
Pines, A. M., Neal, M. B., Hammer, L. B., & Icekson, T. (2011). Job burnout and couple burnout
in dual-earner couples in the sandwiched generation. Social Psychology Quarterly, 74(4),
Pinquart, M., & Sörensen, S. (2006). Helping caregivers of persons with dementia: which
interventions work and how large are their effects? International Psychogeriatrics, 18(4),

Pinquart, M., & Sörensen, S. (2011). Spouses, adult children, and children-in-law as caregivers
of older adults: a meta-analytic comparison. Psychology and Aging, 26(1), 1.
Pope, N. D. (2013). Views on aging: How caring for an aging parent influences adult daughters’
perspectives on later life. Journal of Adult Development, 20(1), 46-56.
Price, S. J., Price, C. A., & McKenry, P. C. (Eds.). (2010). Families & change: Coping with
stressful events and transitions. Sage.
Remennick, L. I. (1999). Women of the “sandwich” generation and multiple roles: The care of
Russian immigrants of the 1990s in Israel. Sex Roles, 40(5-6), 347-378.
Robinson, M. M., Barbee, A. P., Martin, M., Singer, T. L., & Yegidis, B. (2003). The
organizational costs of caregiving: A call to action. Administration in Social Work, 27(1),
Rospenda, K. M., Minich, L. M., Milner, L. A., & Richman, J. A. (2010). Caregiver burden and
alcohol use in a community sample. Journal of Addictive Diseases, 29(3), 314-324.
Rubin, R. M., & White-Means, S. I. (2009). Informal caregiving: Dilemmas of sandwiched
caregivers. Journal of Family and Economic Issues, 30(3), 252-267.
Rubin, R. M., & White-Means, S. I. (2009). Informal caregiving: Dilemmas of sandwiched
caregivers. Journal of Family and Economic Issues, 30(3), 252-267.
Ruppanner, L., & Bostean, G. (2014). Who cares? Caregiver well-being in Europe. European
Sociological Review, 30(5), 655-669.
Santona, A., Tagini, A., Sarracino, D., De Carli, P., Pace, C. S., Parolin, L., & Terrone, G.
(2015). Maternal depression and attachment: the evaluation of mother–child interactions
during feeding practice. Frontiers in Psychology, 6, 1235.

Sharma, V., Marin, D. B., Koenig, H. K., Feder, A., Iacoviello, B. M., Southwick, S. M., &
Pietrzak, R. H. (2017). Religion, spirituality, and mental health of US military veterans:
Results from the National Health and Resilience in Veterans Study. Journal of Affective
Disorders, 217, 197-204.
Smith, S. R., & Hamon, R. R. (20 1 2). Exploringfamily theories (3rd ed.). New York: Oxford
University Press.
Spielman, A., Yang, C. M., & Glovinsky, P. B. (2011). Principles and Practice of Sleep
Stephens, M. A. P., & Townsend, A. L. (1997). Stress of parent care: Positive and negative
effects of women’s other roles. Psychology and Aging, 12(2), 376-385.
Stephens, M. A. P., Franks, M. M., & Townsend, A. L. (1994). Stress and rewards in women’s
multiple roles: The case of women in the middle. Psychology and Aging, 9(1), 43-52.
Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to
bounce back from negative emotional experiences. Journal of Personality and Social
Psychology, 86(2), 320.
Voydanoff, P., & Donnelly, B. (1999). Multiple roles and psychological distress: The
intersection of the paid worker, spouse, and parent roles with the role of the adult child.
Journal of Marriage and Family, 61(3), 725-738.
Walsh, F. (1996). The concept of family resilience: Crisis and challenge. Family Process,
35(3), 261-281.
Ward, R. A., & Spitze, G. (1998). Sandwiched marriages: The implications of child and parent
relations for marital quality in midlife. Social Forces, 77(2), 647-666.

Wilks, S. E., Spurlock, W. R., Brown, S. C., Teegen, B. C., & Geiger, J. R. (2018). Examining
spiritual support among African American and Caucasian Alzheimer's caregivers: A risk
and resilience study. Geriatric Nursing, 39(6), 663-668.