Work and Health of Parents of Adult Children with Serious Mental Illness

JIEUN SONG University of Wisconsin, Madison

MARSHA R. MAILICK University of Wisconsin, Madison∗

JAN S. GREENBERG University of Wisconsin, Madison∗∗

Work and Health of Parents of Adult Children

with Serious Mental Illness

This study examined the effects of work scheduleflexibility and the spillover of work stress tofamily life on the health of parents of adultchildren with serious mental illness (SMI). Theauthors compared 100 parents of adult childrenwith SMI to 500 parents with nondisabledadult children using data from the WisconsinLongitudinal Study. The detrimental impact onhealth of a lack of work flexibility and of higherlevels of negative work-to-family spillover wasmore pronounced among parents of adultchildren with SMI than parents with nondisabledadult children. The results have significantimplications for developing interventions to helpmidlife families of persons with SMI cope withwork-related stress and for policies that providefor greater work schedule flexibility.

The burden of serious mental illness (SMI)is enormous to the individual and the family.In a given year, an estimated 13 million

Waisman Center, University of Wisconsin–Madison, 1500Highland Ave. Room 557, Madison, WI 53705-2280([email protected]).∗Waisman Center, University of Wisconsin–Madison, 1500Highland Ave. Room 557, Madison, WI 53705-2280.∗∗Waisman Center, University of Wisconsin–Madison, 1500Highland Ave. Room 557, Madison, WI 53705-2280.

Key Words: mental illness, parenting, work scheduleflexibility, work to family spillover, physical health.

American adults (approximately 1 in 17)have a seriously debilitating mental illness(Kessler, Chiu, Demler, Merikangas, & Walters,2005). Mental health disorders are the leadingcause of disability in the United States,accounting for 25% of all years of life lostto disability and premature mortality (WorldHealth Organization, 2004).

Because relatively few persons with SMImarry and public mental health services are oftenfragmented and underfunded (Kessler, Walters,& Forthofer, 1998; Wolfe, Song, Mailick, &Greenberg, 2013), parents often provide ongoingsupport until they no longer have the capacityto continue in this role. These parents facemany challenges in coping with the long-term care of an adult child with SMI, whichtakes a progressive toll on their health andpsychological well-being (Barker, Greenberg,Seltzer, & Almeida, 2012; Ghosh, Greenberg,& Seltzer, 2012; Murphy, Christian, Caplin, &Young, 2007). One such challenge is balancingwork responsibilities with those of helping tosupport their son or daughter with SMI (Brennan,Rosenzweig, Ogilvie, Wuest, & Shindo, 2007;Rosenzweig, Brennan, & Ogilvie, 2002). Muchof the research on families of persons with SMIhas focused on how the burdens of caregivingaffect the world of work (Brennan et al., 2007;Rosenzweig et al., 2002). There is a growingliterature finding that stress at work has a majorimpact on family life in the general population(Eby, Casper, Lockwood, Bodeaux, & Brinley,

122 Family Relations 63 (February 2014): 122–134DOI:10.1111/fare.12043

Work and Health 123

2005; Ilies, Schwind, Wagner, & Johnson, 2007)and that work–family conflicts are a significantpredictor of poor health and well-being (Allen,Herst, Bruck, & Sutton, 2000; Grzywacz &Bass, 2003; van Steenbergen & Ellemers, 2009).Although the great majority of caregivers ofpersons with SMI work (Seltzer, Greenberg,Floyd, Petee, & Hong, 2001), no study has yetexamined how work-related stress that spillsoverinto family life affects the health and well-beingof parents providing support to an adult childwith SMI. In this study, we examined how stressrelated to the work–family interface affects thewell-being of parents of adults with SMI as wellas whether greater work schedule flexibility is aparticularly important resource for these parents.

There is a growing body of researchinvestigating the adverse effects of workand family conflicts on individual well-being.Specifically, work–family conflicts have beenassociated with poor physical health (Greenhaus,Allen, & Spector, 2006), higher cholesterollevels, higher body mass index, lower physicalstamina (van Steenbergen & Ellemers, 2009),and increased alcohol consumption (Frone,Russell, & Cooper, 1997; Grzywacz & Bass,2003). Studies find that work–family conflictsare frequently experienced by families ofpersons with SMI. In a focus group interview of41 employed parents whose children had mentalhealth diagnoses, Rosenzweig et al. (2002)found that these parents experienced significantconflicts between work and family, includingproblems in work performance and interferenceof family demands during the workday.

Although there are various job characteristicsthat may help parents cope with their adultchild’s MI, we focused in the present analysison flexibility in work schedule, which has beenassociated with better physical health (Butler,Grzywacz, Ettner, & Liu, 2009), fewer physicalsymptoms (Janssen & Nachreiner, 2004), andless stress (Almer & Kaplan, 2003; Butler et al.,2009) among working adults. Having a flexiblework schedule may contribute to health andwell-being by enabling individuals to balancecompeting demands from multiple life domainsand consequently reducing conflicts with otherroles (Rozanski & Kubzansky, 2005). Workschedule flexibility also enhances health byincreasing perceived job control, which hasbeen consistently linked to better physical health(Butler et al., 2009), and by promoting positivehealth behaviors such as physical activity and

more sleep (Grzywacz, Casey, & Jones, 2007;Moen, Kelly, Tranby, & Huang, 2011).

Additionally, one of the major stressors forfamilies of persons with SMI is the overallhigher level of uncertainty regarding how theirson or daughter will function from day today. Even when the individual with SMI hasbeen quite stable over time, parents may stillexperience feelings of heightened uncertaintybecause of past experiences seeing their childquickly decompensate after a long period ofstability (Marsh et al., 1996). Having a flexiblework schedule allows parents to respond to crisesin their child’s life while still being able to meettheir obligations to their employer.

Finally, many of the ways that parents helpan adult child with SMI, such as transportationto medical appointments or making calls toclarify public benefits, must be completed duringwork hours. Job flexibility allows the parentto make work accommodations when tasks fortheir child can only be completed during workhours.

Our examination of the effects of workschedule flexibility and work–family conflictson parental health was guided by ecologicalsystems theory (Bronfenbrenner & Morris,1998), which posits that the environmentsurrounding an individual is a multilevelsystem. The different levels of an individual’senvironment interact with one another as wellas with the individuals within the systems,and these interactions influence developmentaloutcomes. Ecological systems theory has guidedpast research investigating the work–familyinterface and its impact on health behaviorsin adulthood (e.g., Grzywacz & Marks, 2000).Within an ecological systems theory, themicrosystem refers to the immediate physicaland psychological environment as well asan individual’s behavioral patterns and roles(e.g., family, work, and school); in this study,parenting a child with SMI was conceptualizedas a factor in the family microsystem, and workschedule flexibility was conceptualized as afactor in the work microsystem. The mesosystemconsists of the interface between microsystems;in this study, the negative spillover from workto family was one dimension of the mesosystem.Other subsystems in ecological systems theory(i.e., the exosystem and the macrosystem)could not be adequately operationalized by theavailable measures in the data set and thus couldnot be modeled in our analysis.

124 Family Relations

Based on the above review of the literatureand ecological systems theory, we investigatedthe following hypotheses by analyzing data fromparents of children with SMI and a closelymatched sample of parents who had childrenwithout disabilities:

1. Mothers and fathers who have an adult childwith SMI will have poorer health profilesthan mothers and fathers who have unaffectedadult children.

2. Mothers and fathers who do not haveflexibility in their work schedules and whoexperience higher levels of negative spilloverfrom work to family will report poorer healththan mothers and fathers who have workschedule flexibility and report lower levelsof negative spillover from work to family,regardless of parent status.

3. The association between work flexibility,work to family spillover, and health ofmothers and fathers will be more salientamong the mothers and fathers of adultchildren with SMI than among comparisongroup mothers and fathers.

METHOD

Data and Sample

The Wisconsin Longitudinal Study (WLS) isa long-term study of a random sample of10,317 women and men who graduated fromWisconsin high schools in 1957; the samplealso includes 5,823 randomly selected siblingsof the graduates. The original sample memberswere surveyed in 1957, 1975, 1992, and 2004,and their siblings were surveyed in 1977,1994, and 2006 (Hauser & Roan, 2006).Most respondents were White, which reflectsWisconsin’s population in the mid-20th century.In this study, we used the sample from the 1992to 1994 survey, which encompasses originalsample members and their siblings. We focusedon the 1992 to 1994 survey because at this timerespondents averaged age 53 and a majority werestill in the workforce, whereas by the subsequentround of data collection, approximately one halfof the WLS respondents were retired. In total,10,353 respondents completed a phone interviewand a self-administered questionnaire (SAQ) in1992 to 1994 (6,875 original respondents and3,478 siblings). In this study, the original samplemembers and their siblings were treated as asingle group of respondents from which a group

of parents of adult children with SMI and acomparison group were selected. In cases inwhich the original respondent and his or hersibling met the criteria for selection into thecomparison group, we randomly selected one toavoid dependency in the data. There were nosuch sibling pairs among the parents of childrenwith SMI.

In the 1992 to 1994 survey, telephone inter-views and mail-back questionnaires were admin-istered to collect information about variousdimensions of respondents’ lives, including fam-ily, work, and health. Parents of individuals withSMI were initially identified through the reviewof an array of variables about caregiving andchildren’s education and disabilities in the 1975to 1977 and 1992 to 1994 WLS surveys, and thesample was confirmed and expanded througha series of direct screener questions asked ofall parents in the 2004 to 2006 survey. Thescreener consisted of a maximum of 31 ques-tions that began by asking parents if any of theirchildren (living or deceased) had SMI, and thespecific diagnosis. The parent was included inthe sample if he or she indicated that the son ordaughter had schizophrenia or bipolar disorder,or a major depression that required hospitaliza-tion or interfered with his or her ability to workor live independently. We included a case in theSMI sample only if the child was the biolog-ical or adoptive child of the WLS respondent.Using these procedures, we identified 333 WLSrespondents who had a child with SMI, of whom175 parents reported that their child’s symptomsbegan before the 1992 to 1994 interview and thechild with SMI was still alive at that point ofdata collection.

The analytic sample for this study includedtwo groups. The first group consisted of parentswho were working full-time (i.e., 35 hours ormore per week) at the time of the 1992 to1994 survey (excluding self-employed), hadcompleted the phone interview and the mail-back questionnaire in 1992 to 1994, and hadchildren with SMI whose conditions startedbefore 1992 to 1994 (N = 100, 67 mothers and33 fathers). The second was a comparison groupof WLS respondents who were working full-time at the time of the 1992 to 1994 survey, hadcompleted the phone interview and the SAQ in1992 to 1994, and did not have any children withSMI, deceased children, or children with eitherdevelopmental disabilities or serious healthproblems. Next, stratified random sampling was

Work and Health 125

used to select a comparison group matched tothe SMI group on age and education (separatelyfor women and men). To increase statisticalpower, rather than selecting one comparisongroup case for each SMI case, we selectedat a ratio of 5:1, resulting in a comparisongroup of 500 parents (335 mothers and165 fathers).

MEASURES

Dependent Variables

Self-rated health. Overall self-rated health wasmeasured by the item, ‘‘How would you rateyour health at the present time?’’ (1 = very poorto 5 = excellent). Numerous studies have shownthat this single item is significantly associatedwith mortality as well as morbidity (Ideler &Benjamini, 1997).

Number of diagnosed illnesses. Respondentsanswered questions asking whether a medicalprofessional ever diagnosed them with one of16 illnesses, including anemia, asthma, arthri-tis, bronchitis, cancer, chronic liver trouble,diabetes, serious back trouble, heart trouble,high blood pressure, circulation problems, kid-ney/bladder problems, ulcer, allergies, multiplesclerosis, or colitis (1 = yes, 0 = no). A count ofthe number of diagnosed illnesses was computedfor each respondent.

Cardiovascular problems. Respondents wereasked whether they had experienced chest painor shortness of breath in the past 6 months. Ifthey answered yes, two more questions wereasked regarding how often they had experiencedthese symptoms (1 = monthly or less often to 4 =daily or more often) and how much discomfortthe symptoms had caused the respondent inthe past 6 months (1 = none to 4 = a lot).Respondents also were asked whether they hadbeen diagnosed with heart problems or highblood pressure by a medical professional andhow much these conditions interfered with whatthey like to do (1 = not at all to 5 = a great deal).Following procedures developed by Warren,Carayon, and Hoonakker (2008), the items werescaled 0 (none of these four cardiovascularhealth problems) to 10 (respondent experiencedboth symptoms daily with a lot of discomfortand was diagnosed with heart trouble and highblood pressure that interfered a great deal withwhat the respondent liked to do).

Musculoskeletal health problems. Respondentswere asked whether they had experienced achingmuscles, stiff/swollen joints, or back pain/strainin the past 9 months. If they answered yes,two more questions were asked regarding howoften they had experienced these symptoms (1= monthly or less often to 4 = daily or moreoften) and how much discomfort the symptomshad caused in the past 6 months (1 = noneto 4 = a lot). Respondents also were askedwhether they had been diagnosed with seriousback trouble by a medical professional and howmuch the back trouble interfered with what theylike to do (1 = not at all to 5 = a great deal).Following procedures developed by Warrenet al. (2008), the items were scaled 0 (none ofthese four musculoskeletal health problems) to10 (respondent experienced all three symptomsdaily with a lot of discomfort and was diagnosedwith serious back trouble that interfered a greatdeal with what the respondent liked to do).

Independent Variables

Parenting status. Parenting status was coded asa dichotomous variable depending on whetherthe respondent had any child with a SMI definedas bipolar disorder, schizophrenia, or majordepression if the depression was accompaniedby a hospitalization or resulted in functionalimpairments (1 = parent of a child with SMI , 0= comparison parent).

Work schedule flexibility. Schedule flexibility atthe workplace was assessed by an item askingthe respondent whether he or she could decidewhen to come to work and when to leave (1 =yes, 0 = no).

Negative work-to-family spillover. Respon-dents were asked to rate the following threeitems to assess negative spillover from work tofamily life: ‘‘To what extent do you agree thatyour job reduces the amount of time you canspend with the family?’’ ‘‘To what extent doyou agree that problems at work make you irri-table at home?’’ and ‘‘To what extent do youagree that your job takes so much energy youdon’t feel up to doing things that need atten-tion at home?’’ (1 = strongly disagree to 5 =strongly agree). The mean of the three itemswas computed, with a higher score indicating agreater level of negative spillover from work tofamily.


Control variables. Background variables asso-ciated with the physical health of adults werecontrolled for in all analyses. These includedthe respondent’s age and socioeconomic status(SES; Marmot & Wilkinson, 2005), marital sta-tus (Liu & Umberson, 2008), and the numberof children in a family (Weng, Bastian, Taylor,Moser, & Ostbye, 2004). Also, we controlled forwhether the respondent lived with the ‘‘target’’child. For respondents with children with SMI,the target child was the child with SMI. For thecomparison group, as part of the WLS surveymethodology, the researchers randomly selectedone child from among the children of the WLSrespondent and a series of questions were askedabout this child, including whether the childlived with the respondent. This child was des-ignated the ‘‘target’’ child for the comparisongroup.

DATA ANALYSIS

Multiple regression models were estimated toexamine the effects of work schedule flexibilityand negative spillover from work to family lifeon each physical health outcome, controlling forage, SES, marital status, number of children, andco-residence status with the target child. In eachmodel, interactions between parent status andwork flexibility and work-to-family spillover(i.e., Parenting Status × Work ScheduleFlexibility, Parenting Status × Negative Work-to-Family Spillover) were added to investigatethe moderating effects of parenting status on theassociations between work flexibility and work-to-family spillover and the physical health ofparents. All models were estimated separatelyfor mothers and fathers. Because the WLSrepresents a simple random sample of one thirdof the 1957 graduating class and randomlyselected siblings, no weights are applied tothe data.

RESULTS

Table 1 presents descriptive statistics for theparents of children with SMI and parents inthe comparison group; results for mothers andfathers are shown separately. There were nodifferences in age, but there were significantdifferences in the number of children, maritalstatus, and co-residence status between mothersof adult children with SMI and mothers inthe comparison group. The mean age of the

mothers was 54 in both groups. Mothers ofchildren with SMI had more children (3.8 vs.3.3), were less likely to be married (63% vs.78%), and were more likely to be living withthe target child (25% vs. 13%) compared to themothers of children without SMI. OccupationalSES, work schedule flexibility, and the levelof negative work-to-family spillover werecomparable between the two groups of mothers.Regarding the health outcomes, there was asignificant difference in the number of diagnosedillnesses: mothers of adult children with SMIself-reported more diagnosed illnesses thanmothers with unaffected adult children. Theother health outcomes were not significantlydifferent between the two groups.

With regard to the fathers of adult childrenwith SMI and comparison fathers with nondis-abled adult children, there were no differencesin either demographic characteristics or work-related characteristics. Overall, fathers wereabout age 53 and had three children, approxi-mately 90% were married, somewhat fewer than20% were living with the target child, and a littleunder 60% had flexibility in their work schedule.The physical health of the fathers did not differbetween the two groups, with the exception ofmusculoskeletal health problems: fathers of chil-dren with SMI reported more musculoskeletalhealth problems than the fathers of unaffectedchildren.

Predicting Maternal Health

Table 2 presents the results of regression anal-yses examining the effects of perceived workflexibility and work–family spillover on moth-ers’ physical health, with the moderating influ-ence of parenting status (having a child withSMI vs. not). Model 1 shows the main effectsof parenting status, work flexibility, and neg-ative work-to-family spillover. Although wehypothesized that mothers of adult children withSMI would report poorer health outcomes thanthe comparison group, there were no associa-tions between parenting status and the healthvariables. Similarly, the main effect of workflexibility was largely unrelated to the healthoutcomes, with one exception; unexpectedly,mothers with higher levels of work flexibilityreported more diagnosed illnesses. In contrast,negative work-to-family spillover was signif-icantly associated with all health outcomessuch that mothers with greater work-to-family

Work and Health 127

Table 1. Descriptive Statistics of Analytic Sample

Mothers (N = 402)

SMI (n = 67) Comparison (n = 335) Range Group Difference

M (SD) M (SD)Age 53.6 (3.3) 53.7 (3.2) 38–64 nsNumber of children 3.8 (1.8) 3.3 (1.5) 1–9 p < .05% Married 62.7 78.4 p < .01% Coresidence w/child 25.4 12.9 p < .001Occupational SES 54.0 (20.5) 51.0 (20.1) 8.7–84 nsWork schedule flexibility .42 (.50) .42 (.49) 0–1 nsNegative W → F spillover 2.9 (.78) 2.7 (.81) 0–5 nsSelf-rated health 4.2 (.62) 4.2 (.67) 1–5 nsNumber of diagnosed illnesses 1.8 (1.7) 1.3 (1.5) 0–14 p < .05Cardiovascular health problems .23 (.67) .13 (.40) 0–3.24 nsMusculoskeletal health problems 1.1 (2.0) .79 (1.6) 0–10 ns

Fathers (N = 198)

SMI (n = 33) Comparison (n = 165) Range Group Difference

M (SD) M (SD)Age 53.1 (3.5) 53.1 (3.4) 39–63 nsNumber of children 2.9 (1.2) 2.9 (1.4) 1–9 ns% Married 90.9 89.1 ns% Coresidence w/child 16.7 18.5 nsOccupational SES 58.0 (25.1) 51.1 (25.7) 4.9–92.3 nsWork schedule flexibility .58 (.50) .55 (.50) 0–1 nsNegative W → F spillover 3.1 (.86) 2.7 (.83) 0–5 nsSelf-rated health 4.1 (.82) 4.2 (.59) 1–5 nsNumber of diagnosed illnesses 1.2 (2.1) 1.1 (1.7) 0–11 nsCardiovascular health problems .29 (.94) .20 (.55) 0–3.75 nsMusculoskeletal health problems 1.3 (2.2) .54 (1.1) 0–9.38 p < .01

SMI = serious mental illness; SES = socioeconomic status; W = work; F = family; ns, nonsignificant.

spillover reported poorer self-rated health, agreater number of diagnosed illnesses, more car-diovascular problems, and more musculoskeletalproblems.

The results in Model 2 portray two interactioneffects (Work Flexibility × Parenting Status;Negative Work-to-Family Spillover × ParentingStatus) on mothers’ musculoskeletal healthproblems and cardiovascular health problems.As shown in Figure 1, mothers of adult childrenwith SMI who had schedule flexibility atwork reported lower levels of musculoskeletalhealth problems compared to mothers who hadadult children with SMI and no work scheduleflexibility, but there was no association betweenwork schedule flexibility and musculoskeletalhealth problems among mothers who did nothave children with SMI. The results also showeda significant interaction effect of work-to-family

spillover and parenting status on one aspectof mothers’ health. As shown in Figure 2, formothers of an adult child with SMI, higherlevels of negative work-to-family spillover weresignificantly associated with a greater number ofcardiovascular health problems as compared tothose reporting low levels of work-to-familyspillover. There were no significant groupdifferences in the effects of work flexibility orwork-family spillover on self-rated health andnumber of diagnosed illnesses.

Regarding the control variables, in general,the results indicated that mothers who hadhigher occupational SES had better healthprofiles: these mothers had better self-ratedhealth, fewer cardiovascular health problems,and fewer musculoskeletal health problemsthan mothers with lower occupational SES.Married mothers had fewer diagnosed illnesses


Table 2. Regression Analysis of Predictors of Physical Health of Mothers of Children with SMI and Comparison Mothers

Self-Rated HealthNumber of

Diagnosed IllnessesCardiovascular

Health ProblemsMusculoskeletalHealth Problems

Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2b (SE) b (SE) b (SE) b (SE) b (SE) b (SE) b (SE) b (SE)

Age −.007(.012)

−.007(.012)

.026(.028)

.024(.028)

.010(.010)

.009(.009)

.044(.035)

.048(.035)

Occupational SES .005∗

(.002).004∗

(.002)−.003(.004)

−.003(.004)

−.004∗∗

(.001)−.004∗∗

(.001)−.013∗∗

(.005)−.0.12∗

(0.05)Marital status (1 = married) .067

(.080).057

(.081)−.355∗

(.181)−.334(.181)

−.059(.058)

−.037(.057)

−.214(.209)

−.217(.209)

Number of children .010(.022)

.010(.022)

−.004(.049)

−.005(.049)

.014(.016)

.013(.015)

−.103(.056)

−.102(.056)

Coresidence with NN or targetchild (1 = yes)

.072(.095)

.075(.096)

.198(.214)

.208(.215)

.035(.068)

.039(.067)

.228(.248)

.187(.247)

SMI vs. Comparison (1 = SMI) .026(.093)

.021(.122)

.276(.209)

.097(.273)

.045(.067)

−.054(.085)

.194(.245)

.622∗

(.312)Work schedule flexibility −.021

(.071)−.026(.077)

.410∗∗

(.159).343∗

(.173).097

(.050).063

(.054).045

(.182).222

(.196)Negative W→ F spillover −.180∗∗∗

(.042)−.158∗∗

(.046).411∗∗∗

(.095).375∗∗∗

(.104).122∗∗

(.030).084∗∗

(.033).409∗∗∗

(.110).380∗∗

(.120)MI × Work schedule flexibility .072

(.183).334

(.411).145

(.129)−1.199∗

(.482)MI × Negative W→ F spillover −.141

(.116).195

(.260).220∗∗

(.081).284

(.301)Constant 4.178 4.189 1.411 1.419 0.157 0.15 0.954 0.883R2 0.07 0.074 0.092 0.096 0.089 0.113 0.08 0.097

SMI = serious mental illness; SES = socioeconomic status; NN = non-normative; W = work; F = family; MI = mentalillness.

∗p < .05. ∗∗p < .01. ∗∗∗p < .001.

FIGURE 1. PREDICTED MUSCULOSKELETAL HEALTH

PROBLEMS BY WORK FLEXIBILITY FOR MOTHERS OF

CHILDREN WITH SERIOUS MENTAL ILLNESS (SMI) AND

COMPARISON GROUP MOTHERS.

than mothers not currently married. None ofthe other control variables was significantlyassociated with health outcomes in workingmothers.

FIGURE 2. PREDICTED CARDIOVASCULAR HEALTH

PROBLEMS BY NEGATIVE WORK-TO-FAMILY SPILLOVER

LEVELS FOR MOTHERS OF CHILDREN WITH SERIOUS

MENTAL ILLNESS (SMI) AND COMPARISON GROUP

MOTHERS.

Predicting Paternal Health

Table 3 presents the results of regression anal-yses examining the effects of family char-acteristics, work flexibility, and work-family

Work and Health 129

Table 3. Regression Analysis of Predictors of Physical Health of Fathers of Children with SMI and Comparison Fathers

Self-Rated HealthNumber of

Diagnosed IllnessesCardiovascular

Health ProblemsMusculoskeletalHealth Problems

Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2

b (SE) b (SE) b (SE) b (SE) b (SE) b (SE) b (SE) b (SE)Age −.031∗

(.018)−.039∗

(.019).109∗

(.047).140∗∗

(.046).031

(.022).046∗

(.022)−.005(.046)

.026(.045)

Occupational SES .006∗∗

(.002).006∗∗

(.002)−.004(.005)

−.003(.005)

.000(.002)

.000(.002)

−.004(.005)

−.004(.005)

Marital status (1 = married) −.153(.154)

−.129(.154)

−.429(.385)

−.352(.375)

.052(.185)

.058(.180)

−.091(.384)

−.126(.376)

Number of children −.017(.034)

−.017(.033)

.012(.084)

.035(.082)

−.003(.039)

.002(.038)

−.043(.084)

−.043(.082)

Coresidence with NN or targetchild (1 = yes)

.156(.117)

.180(.118)

.486(.292)

.559∗

(.287)−.132(.134)

−.133(.132)

−.423(.282)

−.483(.278)

SMI vs. Comparison (1 = SMI) −.015(.126)

−.336(.189)

.364(.309)

.846(.460)

.136(.145)

.548∗

(.212).688∗

(.298)1.735∗∗∗

(.445)Work schedule flexibility .084

(.106)−.182(.113)

−.210(.266)

.004(.276)

−.081(.123)

.061(.129)

−.262(.258)

.076(.271)

Negative W→ F spillover −.141∗

(.056)−.133∗

(.060).144

(.139)−.048(.146)

.068(.066)

.009(.070)

.271(.138)

.218(.147)

MI x Work schedule flexibility .594∗

(.258)−1.410∗

(.622)−.896∗∗

(.288)−1.990∗∗

(.601)MI x Negative W→ F spillover −.061

(.153)1.264∗∗

(.374).394∗

(.173).409

(.362)Constant 4.38 4.413 1.397 1.173 .223 .128 .899 .734R2 .109 .138 .073 .146 .032 .103 .092 .154

SMI = serious mental illness; SES = socioeconomic status; NN = non-normative; W = work; F = family; MI = mentalillness.

∗p < .05, ∗∗p < .01, ∗∗∗p < .001.

spillover on fathers’ physical health, with themoderating influence of parenting status. Model1 presents the main effects of parenting sta-tus, work flexibility, and work–family spillover.As hypothesized, fathers of adult children withSMI reported more musculoskeletal health prob-lems than comparison fathers, but did not differwith respect to the other health outcomes. Workflexibility was not associated with any healthoutcomes as a main effect, but negative work-to-family spillover was significantly associatedwith self-rated health of working fathers.

Consistent with Hypothesis 2, all predictedinteraction effects between work scheduleflexibility and parenting status on fathers’health were significant, including workingfathers’ self-rated health, number of diagnosedillnesses, cardiovascular health problems, andmusculoskeletal health problems. Figure 3illustrates that fathers of adult children withSMI who had flexible work schedules reported

better self-rated health than their peers whohad adult children with SMI but whosework schedules were not flexible. In contrast,although comparison group fathers without workflexibility reported slightly better health thancomparison group fathers with work flexibility,this difference was not significant. Figure 4shows that fathers of adult children with SMIwho reported greater work schedule flexibilityindicated that they had fewer diagnosed illnessesthan fathers whose adult children had SMIand whose work schedules were not flexible.Among the comparison group fathers whohad nondisabled adult children, the number ofdiagnosed illnesses was comparable regardlessof flexibility at work. Figure 5 illustrates thathaving schedule flexibility at work was alsoassociated with reports of fewer cardiovascularhealth problems among fathers of adult childrenwith SMI, but not among fathers with unaffectedadult children. Figure 6 shows that fathers


FIGURE 3. PREDICTED SELF-RATED HEALTH BY WORK

FLEXIBILITY FOR FATHERS OF CHILDREN WITH SERIOUS


FATHERS.

FIGURE 4. PREDICTED NUMBER OF DIAGNOSED ILLNESSES

BY WORK FLEXIBILITY FOR FATHERS OF CHILDREN WITH

SERIOUS MENTAL ILLNESS (SMI) AND COMPARISON

GROUP FATHERS.

whose children had SMI and who had flexiblework schedules reported lower levels ofmusculoskeletal health problems comparedto fathers of children with SMI who didnot have flexible schedules. In contrast, themusculoskeletal health of comparison fathersdid not differ based on whether they had flexiblework schedules.

The results also indicate that the interac-tion between negative work-to-family spilloverand parenting status was significantly associ-ated with fathers’ health, specifically numberof diagnosed illnesses and cardiovascular healthproblems. Figure 7 shows that higher levelsof negative work-to-family spillover was asso-ciated with a greater number of diagnosedillnesses in fathers of adult children with SMIas compared to such fathers reporting lowerlevels of work-to-family spillover. In contrast,there was no difference in the numbers ofdiagnosed illnesses among comparison fatherswho experienced higher or lower levels of


PROBLEMS BY NEGATIVE FAMILY-TO-WORK SPILLOVER

LEVELS FOR FATHERS OF CHILDREN WITH SERIOUS


FATHERS.

FIGURE 6. PREDICTED MUSCULOSKELETAL HEALTH

PROBLEMS BY WORK FLEXIBILITY FOR FATHERS OF

CHILDREN WITH SERIOUS MENTAL ILLNESS (SMI) AND

COMPARISON GROUP FATHERS.

negative work-to-family spillover. Figure 8illustrates that fathers of adult children with SMIwho reported higher levels of negative work-to-family spillover indicated a greater numberof cardiovascular problems compared to theircounterparts with lower levels of negative work-to-family spillover. There was no associationbetween the levels of work-to-family spilloverand cardiovascular health problems amongcomparison fathers.

Regarding the control variables, the resultsshowed that older fathers were less healthythan their younger counterparts: older fathershad poorer self-rated health and more diagnosedillness than younger fathers. Fathers with higheroccupational SES reported better self-ratedhealth than fathers with lower occupational SES.

DISCUSSION

Guided by ecological systems theory, in thisstudy we examined the effects of work flexibility

Work and Health 131

FIGURE 7. PREDICTED NUMBER OF DIAGNOSED ILLNESSES

BY NEGATIVE WORK-TO-FAMILY SPILLOVER LEVELS FOR

FATHERS OF CHILDREN WITH SERIOUS MENTAL ILLNESS

(SMI) AND COMPARISON GROUP FATHERS.


PROBLEMS BY NEGATIVE WORK-TO-FAMILY SPILLOVER

LEVELS FOR FATHERS OF CHILDREN WITH SERIOUS


FATHERS.

and work-to-family spillover on the health ofparents of adult children with SMI. In general,work-to-family spillover (a work and familymesosystem factor) and working in a positionwithout flexibility in one’s schedule (a workmicrosystem factor) had a more detrimentalimpact on health among parents of adult childrenwith SMI than among parents in the comparisongroup, which supports our hypothesis. Workschedule flexibility was associated with betterhealth outcomes for fathers and mothers ofadult children with SMI. Among fathers of adultchildren with SMI, those who reported flexiblework schedules had better health profiles thanthose who did not perceive their work schedulesas flexible (better self-rated health, fewerdiagnosed illnesses, fewer cardiovascular healthproblems, and fewer musculoskeletal healthproblems). Among mothers of adult childrenwith SMI, those with flexible work schedulesreported fewer musculoskeletal problems than

those without flexible schedules. At higher levelsof negative work-to-family spillover, mothers ofadult children with SMI reported significantlymore cardiovascular health problems thanmothers in the comparison group. Fathers ofadult children with SMI who experienced morenegative work-to-family spillover indicatedsignificantly more diagnosed illnesses andmore cardiovascular problems than fathers inthe comparison group. These results provideevidence that the physical health of parents ofadult children with SMI is more vulnerable to theadverse influence of the lack of work scheduleflexibility and to the spillover of stress fromwork to family life than parents of adult childrenwithout disabilities. The results revealing thehealth effects of both microsystem (e.g., parentof a child with developmental disabilities, workschedule flexibility) and mesosystem factors(e.g., work-family spillover) also support theassertion of ecological systems theory thatvarious subsystems in which individuals areembedded influence individual developmentaloutcomes not only via direct affects butthrough their interactions with one another(Bronfenbrenner & Morris, 2006).

Unexpectedly, work schedule flexibility wassignificantly associated with more diagnosedillnesses among mothers regardless of parentingstatus. Supplemental analysis showed thatmothers who had work schedule flexibility alsohad higher occupational SES compared to themothers whose work did not allow a flexiblework schedule. It is possible that workingwomen in higher status positions are exposedto greater job stress due to increased demandsand responsibilities at work. Given empiricalevidence linking stress and health problems(Juster, McEwen, & Lupien, 2009) and findingsthat working women are more vulnerable tothe adverse effects of job strain than workingmen (McDonough & Walters, 2001), workingmothers in higher SES occupations, who aremore likely to have flexible work schedules,might be at an increased risk of health problems.Alternatively, given the cross-sectional natureof the study, it is quite plausible that workingmothers with higher SES are able to negotiatemore flexible work schedules when theyexperience health problems, because employersmight be willing to accommodate these mothers’needs to retain qualified employees. Futurestudies using longitudinal data would improve


the understanding of the causal nature of theseassociations.

In addition, although we predicted poorerhealth profiles of parents of adult childrenwith SMI than comparison parents, the resultsshowed no group differences in health outcomes.Considering that previous empirical evidencehas shown poorer health and well-being amongparents of adult children with SMI, these resultswere unexpected. Mothers who had an adultchild with SMI and remained in the work forceinto their mid-fifties may be a unique subgroup;in fact, earlier studies have shown that parents ofa child with SMI frequently change their work orcareer patterns or quit their jobs and stay hometo accommodate the needs of their child withSMI (Rosenzweig et al., 2002).

Furthermore, whereas approximately 91% offathers of adults with SMI were married, only62.7% of the mothers of adults with SMI weremarried. One criterion for this study was thatthe respondent had to be working full-time.Although in the WLS marital status has littleaffect on whether men are working full-time,this is not the case for women. Whereas only44% of married women were working full-time,70% of divorced women were working full-timein 1992 to 1994. The pressures to work full-timemay be even greater for divorced women whohave a child with SMI because of the additionalcosts of caring for a child with a condition.

Overall, the findings show that parents ofadult children with SMI are more susceptibleto the impacts of work-related stress spillingover into family life than the norm. Familyclinicians are increasingly realizing the benefitsof offering families psychoeducation to helpthem learn about SMI and strategies to copewith their child’s behavior problems andneeds for assistance. Although these programsare successful in teaching families successfulstrategies to better cope with their child’sproblems, there is very little emphasis on howthe world of work may be contributing to thestress of caregiving. Our findings suggest thatwork-related stress may increase stress at home,which not only takes a toll on parental caregiversbut may also affect the quality of life of theindividual with SMI. It would be desirablefor psychoeducation programs for families ofpersons with SMI to be strengthened to includea focus on work place stress management.

With regard to potential policy changes, ourfindings suggest that increasing work schedule

flexibility would be especially beneficial toworking parents who have an adult childwith SMI. In previous studies, parents ofchildren with SMI have noted the importanceof work flexibility for balancing work andcaregiving demands. These parents reportedchoosing jobs with fewer benefits to securethe time and flexibility necessary to managecare duties (Rosenweig et al., 2002). Giventhe previous empirical evidence that increasedwork schedule flexibility is associated with lesswork-family conflict (Moen et al., 2011), thefindings from this study suggest that providingwork schedule flexibility would be especiallybeneficial for working parents who have a childwith SMI.

Some limitations of this study must be noted.The WLS sample consists of mostly non-Hispanic Whites who have obtained at leasta high school education. Thus, although thesample was representative of the Wisconsinpopulation in the mid-20th century, it does notrepresent the current population. In addition,although the WLS is a longitudinal study that hasbeen conducted over 40 years, this analysis useda cross-sectional approach because completeinformation about children’s SMI status wasnot available in the previous wave (1975/1977),and because the majority of parents had retiredby the following wave (2004/2006). The use ofcross-sectional data, however, entails inevitableproblems for interpreting causality. Further,the analysis of data collected in the 1990smight limit the generalizability and applicabilityof the results to current work and familysituations of parents of children with SMI.The relatively small sample of parents ofchildren with SMI (N = 100) also warrantscaution with regard to the generalization ofthe results. Finally, the data were collected aspart of large-scale longitudinal survey. Thereare inherent limitations to surveys that arebased on respondent self-reports. Future studiesmight address some of these limitations byincorporating biomarkers into the measurementof health. In addition, an examination of theeffects of other subsystems in ecological systemstheory (beyond microsystems and mesosystems;e.g., macrosystem factors, such as policiesrelated to families with adult children with SMI)would help increase the theoretical interpretationof the health predictors of working parents ofadult children with SMI.

Work and Health 133

Despite these limitations, this study con-tributes to the literature on the health of par-ents of children with SMI by using a systemsapproach to examine the influence of workflexibility and work–family conflicts on thephysical health of these parents, and by usinga probability sample to eliminate the poten-tial limitations of selection bias. The resultshave significant implications for family policyand family life practitioners. Social policies thatencourage work schedule flexibility for familiescaring for children with disabilities, and inter-ventions that reduce the spillover of stress fromthe work place to the home could help miti-gate the burdens experienced by parents whohave children with SMI and would consequentlyimprove the well-being of these parents.

ACKNOWLEDGMENT

Support for this research was provided by the NationalInstitute on Aging for Project 3 of P01 AG021079, R.M.Hauser, PI; M.R. Mailick, PI of Project 3. Support was alsoprovided by grant P30 HD03352 to the Waisman Center atthe University of Wisconsin-Madison (M.R. Mailick, PI).

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Work and Health of Parents of Adult Children with Serious Mental Illness