TABLE 1.
Characteristics of included studies.
| Author year country | Study design | Study objective (s) | Subjects’ description: sample size mean age CG M (SD) CR M (SD) | Care recipient’s health condition | Predictors/correlates | Outcome measures | Key findings | Levels of evidence for interdependence |
| Bouldin et al. (2019); United States | Cross-sectional survey study | To identify groups of Heart Failure (HF) patients and their informal caregivers and to compare how these groups agree on the patients’ depressive symptoms |
N = 201 dyads CGs: relatives (daughters, sons, siblings or friends; 69% female), mean age = 46.3 (12.9) CRs: relatives (99% male), mean age = 68.3 (10.4) |
Heart failure | CGs and CRs: Relationship characteristics (17 items about level of closeness and frequency of negative emotions during dyadic interactions) Communication (11 items about frequency and type of interactions) |
CGs and CRs: CRs’ depressive symptoms (CES-D 10) Dyads’ agreement on patient depressive symptoms (Dyadic scores of CES-D-10) |
Four different groups of dyads were identified based on relationship and communication between the dyad members: Collaborative (n = 102, 51%); Avoidant (n = 33, 16%); Distant (n = 35, 17%); Antagonistic (n = 31, 16%). 1. Dyads’ relationship and communication characteristics were related to CRs’ depressive symptoms: dyads characterized by more positive interactions or fewer interactions (12% of Collaborative dyads and 6% of Distant) perceived fewer depressive symptoms in CRs (CES-D > 10). 2. CGs’ ratings of CRs’ depressive symptoms (CES-D) were moderately similar to CRs’ own self-assessments (k = 0.18). Concordance and correlation between CG and CR were higher in Distant (k = 0.44; r = 0.39) and Collaborative (k = 0–19; r = 0.32) dyads. |
1. Associations between CR/CG interpersonal variables (relationship characteristics and communication patterns) and CG/CR emotional wellbeing (CRs’ depressive symptoms perceived by both CG and CR) 2. CG and CR in collaborative and distant dyads showed correlations on CRs’ depressive symptoms |
| Heid et al. (2016); United States | Qualitative semi-structured interviews | To investigate the process by which older adults influence their care in families, the way the daughter caregivers respond to such influence and the disagreements in care between older adults and caregivers |
N = 10 dyads CGs: adult daughters, mean age = 51.20 (10.10) CRs: parents, mean age = 79.20 (9.09) |
Older adults | N/A | Dyadic behaviors responses to navigating goal differences in care | 1. Findings highlighted how CGs and CRs resolve conflicts when there are differences in their care goals: CGs more often reason with their CRs, while CRs walk away from the situation or “let go” of CG’s requests. If the CR lets go of the request, the CG’s goal is met. However, when the CR continues to act on goal, is the CG the one who let go of the request, letting the CR’s goal met. 2. CGs and CRs described similar response strategies to the conflict (e.g., let go or brainstorm a new solution). |
1. Associations between CR/CG interpersonal variables (dyadic behaviors responses to goal differences in care) and CG/CR emotional wellbeing (reciprocity) 2. CG and CR reported similar patterns of responses to goal differences in care |
| Hollis-Sawyer (2001); United States | Cross-sectional; Mixed method study | To explore the factors (individual differences and relationship role-related factors) that could predict the positive, growth-oriented responses to the caregiving experience for both caregiving daughters and care-receiving mothers |
N = 122 dyads CGs: adult daughters, age range = 18–60 CRs: mothers, age range = 57–90 |
Older adults with physical impairments | CGs and CRs: Perceived family role changes (11 close-ended items and 5 open-ended items) Personality traits (NEO FFI-Form S Scale) Intellectual abilities (Culture Fair Intelligences Matrices Scale 3) |
CGs and CRs: Degree of positiveness in caregiving pair: personal growth (3 close-ended items and 9 open-ended items); role congruency (4 open-ended items) | Some CRs’/CGs’ individual-difference factors (e.g., CR fluid intellectual ability B = 0.25 p ≤ 0.01, CR openness in personality B = 0.54 p ≤ 0.01 and CG neuroticism (B = −0.44 p ≤ 0.01) were associated with the caregiving relationship (i.e., perceived positiveness in the relationship) for both the dyad members. | Associations between CR/CG intrapersonal variables (fluid intellectual ability, CR openness in personality and CG neuroticism) and the CG-CR relational wellbeing (quality of relationship) |
| Kim et al. (2008); United States | Cross-sectional survey study | To investigate the effect of (dis)similarity in psychological distress between mothers with cancer and their caregiving adult daughters on each person’s quality of life |
N = 98 dyads CGs: adult daughters, mean age = 40.76 (11.74) CRs: mothers, mean age = 67.12 (12.01) |
Cancer | CGs and CRs: Socio-demographics Psychological Distress (POMS-SF) |
CGs and CRs: Quality of life (MOS SF-36 or MOS SF-12) | 1.CRs’ greater distress was associated with CGs’ worsen mental health (quality of life domain), but not vice versa; (partner effects: B = 0.14 p ≤ 0.05). 2. Significant moderate covariations were found between CGs and CRs psychological distress (r = 0.27 p ≤ 0.05). |
1. Associations between CR intrapersonal variables (psychological distress) and CG emotional wellbeing (quality of life) 2. CG and CR showed similarity in the levels of psychological distress |
| Martini et al. (2001); Canada | Cross-sectional survey study | To examine how feelings of interpersonal control, perspective taking, and attributions are related to satisfaction with supportive help given to older mothers by their adult daughters |
N = 44 dyads CGs: adult daughters, mean age = 44 (8.76) CRs: mothers, mean age = 73 (7.71) |
Aging | CGs and CRs: Interpersonal control (ISOC) Perspective taking abilities (SDPT) Attributions (Helping Attributions Scale) |
CGs and CRs: Satisfaction with the helping relationship | CGs’ and CRs’ feelings of interpersonal control and perceptual accuracy (i.e., understanding of the partners’ thoughts) were associated with the other partners’ satisfaction with the helping relationship [CRs’ predictors on CGs’ relationship satisfaction: F(4, 34) = 20.35, p ≤ 0.01; CGs’ predictors on CRs’ relationship satisfaction: F(4, 32) = 3.56, p ≤ 0.05]. |
Associations between CR and CG interpersonal variables (interpersonal control and perceptual accuracy) and the CG-CR relational wellbeing (quality of relationship) |
| Romano et al. (2020); Australia | Cross-sectional survey study | To investigate how caregiver attachment insecurity in combination with care recipient attachment insecurity exacerbates caregiver burden |
N = 70 dyads CGs: adult children (17 men, 53 women), mean age = 51.1 (0.9) CRs: older parents (18 men, 52 women), mean age = 80.4 (7.8) |
Aging | CGs and CRs: Adult Familial Attachment Scale | CGs: Caregiver burden (ZBI) | Care recipient attachment anxiety in pair with caregiver avoidant attachment were significantly and positively associated with caregiver burden (B = 0.29 (1.54), p ≤ 0.01). | Associations between CR/CG intrapersonal variables (attachment orientation) and CG emotional wellbeing (burden) |
| Shawler et al. (2018); United States | Longitudinal survey study | To test the impact of the quality of the mother-daughter relationship, inner strength, and perceived control on hypertension (HTN) self- management and health related quality of life (HRQOL) for both members of the dyad |
N = 51 dyads at the baseline N = 46 dyads at follow-up CGs: adult daughters, mean age = 52.5 CRs: mothers, mean age = 78.1 |
Hypertension | CGs and CRs: Perceived inner strength of the relationship (ISQ) Perceived control on the illness (CAS-R; CAS-Family). |
CGs and CRs: HTN self-management behaviors (Blood Pressure; Hill-Bone Scale) HRQOL (SF-36) |
CG’s/CRs’ perceived strength of the relationship increased their own quality of life: mothers (b = 0.33, p = 0.049) and daughters (b = 0.65, p = 0.002) over time; CRs’ perceived strength of the relationship reduced CGs’ emotional problems (b = −1.22, p = 0.007). | Associations between CR/CG interpersonal variables (perceived strength of the relationship) and CG/CR emotional wellbeing (quality of life) |
| Gilligan et al. (2017); United States | Longitudinal survey study (second wave from the Within-Family Differences Study-II) | To explore whether children’s serious health conditions affected the flow of expressive and instrumental support between mothers and both the offspring with health conditions and other offspring in the family |
N = 369 triads CGs: mothers, mean age = 77.8 (3.2); siblings: mean age = 49.4 (5.8) CRs: adult children (N = 1,338; 20% of them with a serious health condition; 67.8% female; 32,2% male), mean age = 49.4 (5.8) |
Various health conditions | CGs and CRs: Socio-demographics Clinical information |
CGs and CRs: Items about type (expressive and instrumental) and frequency of provided and received support | CRs’ illnesses affected the interpersonal and intergenerational different patterns of family support: 1. mothers were more likely to provide expressive (B = 1.21 (0.14) p ≤ 0.01) and instrumental (B = 0.87 (0.16) p ≤ 0.01) support to their adult children with health conditions (CR) than to their children without health concerns (secondary CG); 2. mothers (CG) with a higher proportion of children with health conditions (CR) were more likely to receive expressive support (B = 0.22 (0.08) p ≤ 0.01) from children without health conditions (secondary CG). | Associations between CR intrapersonal variables (health conditions) and CG-CR relational wellbeing (reciprocity in social support) |
| Jones and Morris (2013); United Kingdom | Qualitative semi-structured interviews | To explore the experiences of adult stroke survivors and their parent caregivers |
N = 1 dyad and 5 triads CGs: parents (6 mothers and 5 fathers), mean age = 65.54 CRs: adult children, mean age = 36.33 |
Stroke | N/A | 4 themes: 1. emotional turmoil 2. significance of parents 3. negotiating independence vs. dependence 4. changed relationship |
The findings highlighted specific features of the parents-young adult survivors’ relationship: some of them reported detrimental impact between CGs and CRs due to the illness, other reported couple problems between the parents and others experienced positive outcomes such as a sense of growth. | Associations between CR intrapersonal variable (health condition) and CG-CR relational wellbeing (quality of relationship) |
| Katapodi et al. (2018); United States | Cross-sectional survey study | To describe family support in young breast cancer survivors (YBCS) and their relatives; identify demographic, clinical and psychosocial characteristics as predictors of family support; and determine the interdependence of support in young breast cancer survivors’ relative’s family units |
N = 189 dyads and 121 triads CGs: first/second degree relatives (N = 431), mean age = 43.4 (11.9) CRs: YBCS, (N = 310), mean age = 51.4 (5.8) |
Breast cancer | CGs and CRs: Socio-demographics Clinical characteristics Cost related lack of access to care Anxiety and depression Perceived Breast Cancer Risk CRs: Fear of Cancer Recurrence (CARS) Self-efficacy after cancer |
CGs and CRs: Family support (MIS; Family Support in Illness Scale; FHI) | CRs’ depressive symptoms, prior diagnosis, were associated with lower CGs’ perceived family support (B = −0.369 p ≤ 0.05); CRs’ older age and higher self-efficacy were associated with CGs’ higher family support (B = 0.032 p ≤ 0.05; B = 0.116 p ≤ 0.05); CGs’ higher income (B = 0.019 p ≤ 0.05) was associated with CGs’ higher perceived support. | Associations between CR and CG intrapersonal variables (CR: depressive symptoms, older age, higher self-efficacy; CG: income) and CG-CR relational wellbeing (reciprocity in social support) |
| Knussen et al. (2005); United Kingdom | Longitudinal survey study | To determine whether deterioration in family relationships could be explained by baseline values and changes in subjective and/or objective primary stressors |
N = 132 dyads CGs: relatives (55% female; 45% male; adult children, in-laws, nieces or nephews, or grandchildren), mean age = 44.46 (10.90) CRs: relatives (78% female; 22% male), mean age = 76.59 (7) |
Hearing difficulties | CRs and CGs: Socio-demographics CRs: Objective caregiving stressors (MMSE; ADL; BEA; GHABP; GDS-15) CGs: Subjective stressors (CADI; MI) |
CGs and CRs: Family relationships (FRI) | CRs’ health conditions and CGs’ negative reactions to care caused detrimental changes in family relationships over time for both the dyad members [R2 = 0.20, F(6, 99) = 4.14, p < 0.001]. | Associations between CR and CG intrapersonal variables (CR: health conditions; CG: reactions to care) and CG-CR relational wellbeing (quality of relationship) |
| Rand et al. (2017); United Kingdom | Cross-sectional survey-study | To explore the interdependence of three care related Quality of Life (QoL) attributes: control over daily life, social participation and occupation within the caregiving relationship |
N = 264 dyads CGs: relatives (46% male), n = 135 (45.3%) ≥ 65 yearsa CRs: relatives (41,6% male), n = 168 (56.4%) ≥ 65 yearsa |
Aging | CGs and CRs: Socio-demographics Household finances Self-rated health Satisfaction with services Social Care context (ASCS; SACE; items from the Survey of Carers in Households) CRs: Activities of Daily Living scale (I/ADLs) |
CRs and CGs: Quality of life dimensions; control over daily life, social participation, occupation (ASCOT) |
1. Higher level of CRs’ long-term needs, lower satisfaction with services and their older age were associated with lower ratings of CGs’ control: number of I/ADLs (B = −0.145 (0.048), p ≤ 0.01) and satisfaction with services: (B = 0.652 (0.317), p ≤ 0.05); and of CGs’ social participation: aged 65 + years (B = 0.775 (0.317), p ≤ 0.05) and number of I/ADLs (B = −0.108 (0.044), p ≤ 0.05). 2. CGs’ difficulties with household finances were significantly associated with lower ratings of control over daily life by CRs (B = −0.751 (0.350), p ≤ 0.05). 3. Moderate correlations were found between CGs’ and CRs’ control over daily life (r = 0.32, p ≤ 0.01). |
1. Associations between CR intrapersonal variables (ADL, age, satisfaction with services) and CG emotional wellbeing (quality of life) 2. Associations between CG intrapersonal variables (difficulties with finances) and CR emotional wellbeing (quality of life) 3. CG and CR showed correlations in control over daily life |
| Raveis et al. (2000); United States | Cross-sectional survey study | To investigate individual and situational factors as predictors of psychological distress of adult daughter caregivers |
N = 164 dyads CGs: adult daughters, mean age = 38.6 (7.6) CRs: parents (42% men), mean age = 68.8 (6.1) |
Cancer | CGs Socio-demographics Physical health Living arrangements Caregiving experience (items derived from a pool of items assessing caregiver reactions) Interpersonal support (ISEL) CRs Socio-demographics Clinical information Health outcomes (RAND Health Survey—1 item) |
CGs Anxiety (STAI-S) |
CRs’ characteristics (e.g., advanced stage of the disease, increased time from diagnosis, poorer general health) were associated with the level of anxiety in caregiving daughters [R2 = 0.098, F(6, 131) = 2.370, p = 0.033]. Greater caregivers’ perceived availability of social support (i.e., facilitators) was associated with less caregiver’s level of anxiety [change in R2 = 0.173, F(6, 121) = 5.618, p = 0.001]. |
Associations between CR/CG intrapersonal variables (CR: health conditions; CG: perceived availability of social support from others) and CG emotional wellbeing (anxiety) |
| Wu et al. (2021); China | Cross-sectional survey study (From the Chinese Longitudinal Healthy Longevity Survey) | To describe the characteristics of older adult care recipients and their adult-child caregivers, and to examine whether these characteristics are associated with caregiver burden |
N = 168 dyads CGs: adult children (64.3% were male), mean age = 56.7 (7.3) CRs: older parents (56.6% female), mean age = 92.3 (9.5) |
Aging | CGs and CRs: Socio-demographics Care related variables CGs: Filial Piety Scale CRs: Activities of daily living (ADL) Positive emotions (3 items created ad hoc for the study) |
CGs: Caregiver burden (ZBI) | CRs positive emotion status [B = −0.227 (−0.412, −0.042), p ≤ 0.01], multiple chronic conditions [B = 0.513 (0.081, 0.945), p ≤ 0.01], and CG intensity of care [B = 0.225 (0.061, 0.389), p ≤ 0.01], were associated with caregiver burden. | Associations between CR intrapersonal variables (CR positive emotions and multiple chronic conditions) and CG emotional wellbeing (burden) |
aMissing information on mean age. CG, caregiver; CR, care recipient; M, mean; SD, standard deviation; B, beta coefficients; CES-D, Center for Epidemiologic Studies Depression Scale; STAI-S, State Anxiety Scale of the State-Trait Anxiety Inventory; ISEL, Interpersonal Support Evaluation List; ASCS, Adult Social Care Survey; SACE, Survey of Adult Carers in England; ASCOT, Adult Social Care Outcomes Toolkit; POMS-SF, Profile of Mood States-Short Form; MOS-SF, Medical Outcomes Study 36-Item; BEA, Better Ear Average; GHABP, Glasgow Hearing Aid Benefit Profile; ADL scale, Activities of daily living; CADI, Carers’ Assessment of Difficulties Index; MMSE, Mini-Mental State Examination; GDS-15, Geriatric Depression Scale; FRI, Family Environment Scales; MIS, Lewis Mutuality and Interpersonal Sensitivity Scale; FHI, Family Hardiness Index; ISOC, Interpersonal Sense of Control Scale; SDPT, Self-Dyadic Perspective-Taking Scale; NEO FFI-Form S Scale, Personality Inventory; ISQ, Inner Strength Questionnaire; CAS-R, The Control Attitude Scale-Revised; CAS-Family, The Control Attitude Scale-Family; SF-36, Medical Outcomes Study 36-Item Short Form Health Survey; ZBI, Zarit Burden Inventory.