Running head: CARETAKING AND STRESS REACTIVITY
Caretaking Behaviors and Stress Reactivity in
Adolescents of Depressed Parents
Kelsey Hudson
Vanderbilt University
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Abstract
This study was designed to explore the correlates of stress reactivity and caretaking
behaviors in an at-risk sample of children living with a parent who has experienced at
least one episode of major depressive disorder during the lifetime of their child.
Specifically, the mechanisms of stress responses “fight or flight” and “tend and befriend”
were used to define the stress response to parental depression. In a sample of 180 families
of parents with a history of major depressive disorder, observed and reported caretaking
behaviors and levels of stress-reactivity were examined. The association of children’s
emotional and instrumental caretaking behaviors with levels of physiological and
emotional stress response will be identified.
Keywords: caretaking, stress reactivity, child depressive symptoms
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Introduction
Parental depression is associated with significantly increased risk for behavioral
and emotional problems in children and adolescents (Cummings & Davies, 1994;
Goodman, 2007). The lifetime prevalence of major depressive disorder (MDD) is
approximately 16% in the U.S., with young adulthood marking a period of increased
prevalence of the disorder (Kessler et al., 2003). This means that a significant number of
children will grow up in homes with parents who suffer from MDD. Because depression
is such a prevalent mental health problem in our country today and because offspring of
depressed parents have a dramatically increased risk of becoming depressed and
experiencing other mental health problems, it is important to understand the processes
that place these children at risk and that may protect some children from these risks.
One mechanism of risk involves disruptions in parenting. Depressed parents are
more likely than non-depressed parents to engage in negative parenting (e.g., Champion
et al., 2009), which includes withdrawn, distancing, or intrusive behaviors. Withdrawn
and distancing behaviors “reflect the degree to which the parent is uncaring, apathetic,
uninvolved, ignoring, aloof, unresponsive, self-focused, and/or adult-oriented” (Melby &
Conger, 2001). Examples of withdrawn/distancing behaviors include missing opportunities to respond to the child’s comment, sitting passively while the child engages in
any particular behavior, or saying to the child, “I have too many things to do to be
concerned with your problems.” Withdrawn behaviors physically and/or psychologically
distance the parent from the child. Intrusive behaviors are defined as “intrusive and overcontrolling behaviors that are parent-centered rather than child-centered” (Melby &
Conger, 2001). Examples of intrusive behavior include interrupting, telling the child how
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to solve a problem or task, or giving a continuous barrage of questions or directions
without giving the child the chance to initiate any behavior on his/her own. Parents with
current or past depression display high rates of both withdrawn and intrusive behaviors in
their interactions with their children, and these parenting behaviors are associated with
increased risk of internalizing and externalizing problems in children (e.g., Jaser et al.,
2005).
The negative parenting behaviors associated with parental depression are a source
of significant chronic stress for a child or adolescent. Children of depressed parents need
resources and skills to cope with and manage their stress so that they can develop
sufficient coping and regulation skills that are needed throughout adulthood. Coping
“describes how people mobilize, modulate, manage, and coordinate their behavior,
emotion, and attention (or fail to do so) under stress” (Skinner & Zimmer-Gembeck,
2009). The child may cope with stress using primary control engagement coping
(problem solving, expression of emotion), secondary control engagement coping
(acceptance, positive thinking), or disengagement coping (avoidance, denial) (ConnorSmith et al., 2000). Secondary control coping is best suited to deal with uncontrollable
sources of stress, including the stressors faced by children of depressed parents (e.g.,
Jaser et al., 2005).
Multiple studies have shown primary and secondary control coping to be more
effective ways of managing stress than disengagement coping (e.g., Weisz & Thurber,
1997). In a randomized clinical trial with 111 families of parents with a history of major
depressive disorder, Compas and colleagues provided the first evidence that changes in
secondary control coping and positive parenting can mediate the effects of a family group
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cognitive-behavioral preventive intervention on depressive, internalizing, and
externalizing symptoms in adolescents; such changes accounted for approximately half of
the effect of the intervention on the outcomes (Compas et al., 2010).
Secondary control coping skills are particularly important to teach children and
adolescents with depressed parents since they cannot control their parent’s depression.
Depressed parents’ symptoms are reflected in their interactions with their children. In a
study examining maternal stress and adolescent stress in response to mothers with and
without a history of depression, Jaser and colleagues (2008) found that mothers with a
history of depression exhibited greater levels of sadness during interactions with their
children than mothers without a history of depression; likewise, the adolescent children
of these mothers experienced higher rates of internalizing and externalizing symptoms
than children of mothers without a history of depression. They found that secondary
control coping mediated the effect of parental sadness on children’s adjustment, in that
higher levels of secondary control coping were related to fewer child depressive
symptoms (Jaser et al., 2008).
The stressors associated with having a depressed parent may elicit certain stress
responses from children. One way that children may respond to their parent’s depression
is by trying to care for or tend to their parent. A child’s caretaking behaviors involve
somewhat of a role reversal, as the child may take on some age-inappropriate parental
roles. Two ways that a child may try to attend to a depressed mother’s needs (or
withdrawn or distanced behaviors) include caring for her either emotionally or
instrumentally (Champion et al., 2009; Cummings & Davies, 1995; Radke-Yarrow et al.,
1994). Emotional caretaking is defined as a child’s awareness of parents’ personal and
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emotional problems. The child may suggest solutions, act as a referee in conflicts
involving their parent, or even take responsibility for their parent’s problems.
Instrumental caretaking includes taking on adult roles in the family, such as ageinappropriate behaviors like caring for younger children, helping to pay bills, or taking
care of multiple chores. This type of caretaking can also be displayed during interactions
with a parent if the child directs the focus of the interaction.
At a broader level, two models of biobehavioral responses to stressful situations
outlined by Taylor and colleagues (2000) can be used to understand children’s responses
to the stress of living with a depressed parent. Their research suggests that females
exhibit a different type of stress response than males. While the “fight or flight” model
has traditionally been used to represent the stress response for both genders, the “tend and
befriend” model may be more accurate in describing women’s response. “Fight or
flight” is characterized as the activation of the sympathetic nervous system, which then
innervates the adrenal medulla and eventually results in the secretion of catecholamines
norepinephrine and epinephrine into the bloodstream. This response is a survival
mechanism to prepare for an active response to threat (Taylor et al., 2000). In contrast,
“tend and befriend” is characterized as a pattern of behavior that involves caring for
offspring (tending) and creating social resources and networks to further facilitate care
(befriending).
Children may experience physiological responses to the stress of having a
depressed mother. Research on fight or flight has shown that the basic acute stress
response does not differ between gender (e.g., Jezova, Skultetyova, Tokarev, Bakos, &
Vigas, 1995), but that the protective measures immediately following the release of stress
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hormones may be different for women than men (Taylor et al., 2000). Fleeing and/or
fighting in response to stress may be more adaptive for males, as a female’s stress
response may be more oriented towards protecting offspring. Studies have shown that
the male hormone testosterone has been linked to hostility and aggressive behavior (e.g.,
Brismar, 1994; Olweus, Mattson, Schalling, & Low, 1980; Archer, 1990) and to rough
play (Collaer & Hines, 1995), providing evidence that fighting or fleeing in the face of a
threat may be especially adaptive for males.
Contrarily, females may experience a different physiological response to stress
(“Tend-and-Befriend), specifically marked by displaying nurturing activities that promote
safety and protect the self by creating and maintaining social networks (Taylor et al.,
2000). These two stress responses are important to examine in the context of maternal
depression, as having a depressed mother is a source of chronic stress.
Previous Findings
Parenting behaviors from a depressed mother may elicit certain caretaking
behaviors in children. Radke-Yarrow and colleagues (1994) found that children may try
to take care of the mother by tending to her needs, but that gender accounted for the
caretaking behaviors displayed. These researchers wanted to examine gender, affect,
impulse control problems, and the mother-child attachment relationship. They observed
clinically depressed and well mothers with their children (aged 24-48 months of age)
over a 3-day span in a naturalistic setting. Their complex findings suggested that there
are gender differences in caring behaviors of children of depressed mothers. Girls
exhibited more caring behaviors towards the mother, while boys exhibited caretaking
behaviors only when the mother was severely depressed.
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Cummings and Davies (1994) compiled a review of many findings concerning
maternal depression and child development, finding that children may take on roles
usually identified with parents, whether emotional or instrumental, and that the
caretaking behaviors may be negative or positive. Since heavy amounts of ageinappropriate caretaking behaviors may hinder a child’s natural development of identity
and independence, these behaviors are important to study.
Champion and colleagues (2009) examined caretaking behaviors as predictors of
adjustment in adolescents. As part of a preventive intervention, they brought depressed
mothers and children into the lab and videotaped them as they talked for 15 minutes
about a pleasant and a stressful task, respectively. They measured caretaking behaviors
using parent reports, self-reports, questionnaires, and observed behavior. Their findings
indicate that caretaking behaviors were related to anxiety and depression in adolescents
with depressed mothers. Specifically, they found that in adolescents with depressed
mothers, only emotional caretaking behaviors were related to their anxious-depressive
symptoms and social competence.
Limitations of Previous Research
Limitations in this area of study are found in the lack of research concerning
caretaking roles in the specific context of maternal depression. Considerable research has
focused on other stressful situations, but not the stress associated with parental
depression. Many studies have examined similar behaviors but for abuse, divorce, or life
events that cause chronic stress (Champion et al., 2009). In addition, more research is
needed to understand the associations between caretaking behaviors and characteristics of
depression.
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Other limitations include the measures of caretaking behaviors. Caretaking has
most often been measured using self-reports. Reports by the parent and child, while still
an accepted method of measuring caretaking behavior, could be augmented with more
information by measuring additional aspects of caretaking, like level of reciprocity and
duration using direct observations of children’s interactions with their parents (Jurkovic,
1999). Observed behavior is one of the measures included in the current study, and is an
important measure because there may be differences in reported behaviors versus
observed behaviors. When trained coders with no previous knowledge of a family
watches the interaction tasks and rates the child on his/her caretaking behaviors, a
potentially less biased perspective is added to the measurement of caretaking.
One specific problem in current research lies in defining “caretaking behaviors.”
Defining caretaking brings up an important issue because it causes for a lack of
consistency in the literature. Some researchers label the behaviors as “parentification”
(Jurkovic, 1999). This label is focused on the child taking on adult-specific tasks. Some
researchers label the behaviors as instrumental and emotional caretaking, but from a
report-based perspective. In our research, we describe emotional caretaking and
instrumental caretaking in terms of observed behavior and reported measures.
Current Study
Given the importance of understanding the potential costs and benefits of
caretaking behaviors, particularly within the context of prevention programs, this study
was designed to examine the association of children’s emotional and instrumental
caretaking behaviors with levels of physiological and emotional stress. I hypothesize that
there are differences in caretaking behaviors when gender is a factor. Further, I expect
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that the female stress response will be marked by more self-reported and observed
caretaking behaviors (following the Tend-And-Befriend model) and that male stress
response will be marked by more physiological responses to stress. Finally, I expect
caretaking to be associated with adolescent depressive symptoms.
Method
Participants
The sample consisted of 180 children (ages 9-15-years) and their parents. All
parents had experienced at least one episode of major depressive disorder (MDD) during
the lifetime of their child, with 132 in a current episode of depression. One hundred sixty
of the parents were mothers and 20 were fathers, with a mean age 41.9 years. Eighty-two
percent of the parents were Euro-American, 11.2% were African American, 1.1% were
Asian American, 2.2% Hispanic American, 0.6% were American Indian or Alaska
Native, and 2.2 % mixed ethnicity. The annual household income for the families ranged
from below $5,000 to over $180,000, with mean annual income between $40,000 and
$60,000. Education levels for the parents ranged from less than high school to completion
of a graduate program: 5.6% of the parents had not completed high school, 8.9% had a
high school education, 30.6% had received a degree from a technical school or had
completed at least one year of college, 31.7% had received a degree from a 4 year
college, and 23.3% had completed graduate education. Sixty-two percent of parents were
married, 21.7% were divorced, 5% were separated, 10.6% had never married, and 1.1%
was widowed.
Children in the sample included 91 boys (mean age =11.2) and 89 girls (mean age
= 11.8 years). Seventy-four percent of children were Euro-American, 12.8% were
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African American, 3.3% were Asian American, 1.7% was Hispanic American, 0.6% was
American Indian or Alaska Native, and 7.2 % were mixed ethnicity. In order to determine
the children who might be at risk for depression, children were screened and excluded
from the study if they met criteria for current major depressive disorder. In families with
more than one child in the targeted age range, one child was randomly selected for
inclusion in the analyses to avoid possible problems of non-independence of children
within the same family.
Measures
Adolescents’ depressive symptoms. The Child Behavior Checklist (CBCL), the
Youth Self-Report (YSR), and the Center for Epidemiologic Studies of Depression
(CES-D) were used to assess children’s depressive symptoms. The CBCL was used to
assess symptoms of anxiety/depression (as a measure of general emotional distress) and
total internalizing and externalizing problems in children and adolescents. The CBCL
includes a 118-item checklist of problem behaviors that parents rate as 0 (not true),
1 (somewhat or sometimes true), or 2 (very true or often true) of their child in the past 6
months.
The CES-D is a self-report measure of the frequency of 20 depressive symptoms
over the past week using a 4-point Likert scale. The use of self- report scales such as the
CES-D as a measure of depressive symptoms has been successfully validated with both
adults (Dohrenwend & Shrout, 1984) and adolescents (Fendrich et al., 1990; Lewinsohn
et al., 1991). The CES-D is short and easy to read, has been successfully administered in
several large school samples (Lewinsohn et al., 1991; Schoenbach et al., 1982), and has
good psychometrics with youth (Roberts et al., 1990).
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Adolescents completed the Youth Self Report (YSR, Achenbach, 1991) to provide
their own perceptions of their functioning. Items on this scale include the child’s
involvement in organizations and teams, number and frequency of contact with friends,
and a rating of how well the child is able to get along with others relative to peers.
Reliability and validity of the CBCL, YSR, and CES-D are well established (Achenbach
& Rescorla, 2001; Fendrich et al., 1990; Lewinsohn et al., 1991).
The Affective Problems scales from the CBCL and YSR were used in the current
analyses as an index of children’s depressive symptoms (items include lack of enjoyment,
sleep disruption, appetite disturbance, sadness, suicidal ideation, underactivity, feelings
of worthlessness). The discriminant validity of the Affective Problems scales in
predicting diagnoses of depression has been established (Ferdinand, 2008; van Lang et
al., 2005).
Internal consistency for the scales used in this study were  = .84 for the CBCL, 
=.90 for the YSR, and  = .88 for the CES-D. All children in the sample completed the
YSR to allow for complete data on all measures. The internal consistency for the YSR
Affective Problems scale was adequate with the younger 9-10- year-old group in the
current sample ( = .80). Raw scores on the CBCL and YSR scores were used in all
analyses to maximize variance (i.e., some variability is lost when the raw scores are
converted to T-scores). A composite measure of adolescents’ affective symptoms was
created by converting scores from adolescent and parent reports to z-scores and
calculating the mean z-score for each participant ( = .80).
Children’s stress reactivity. The parental depression version of the Responses to
Stress Questionnaire (RSQ; Connor-Smith et al., 2000; Jaser et al., 2005, 2008) was used
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to assess levels of adolescents’ stress reactivity in response to stressors related to their
parents’ depression (e.g., My mom/dad seems to be sad or cries a lot of the time; My
mom/dad does not want to do things with the family; My mom/dad is too upset, tense,
grouchy, angry, and easily frustrated). Items from the involuntary engagement/stress
reactivity factor were used in the present study to assess stress reactivity involved in the
Fight-or-Flight model (Connor-Smith et al., 2000). Items on this factor reflect
physiological reactivity (e.g., increased heart rate), emotional reactivity (e.g., becoming
upset by previously non-threatening events), and intrusive or uncontrollable thoughts
(e.g., inability to stop thinking about a problem when attempting to sleep). Adolescents
and their parents were asked separately to rate each item with regard to the
degree/frequency with which the adolescent responded to the identified stressors.
To control for response bias and individual differences in base rates of item
endorsement, proportion scores were calculated by dividing the score for each factor by
the total score for the RSQ (Vitaliano, Maiuro, Russo, & Becker, 1987). Internal
consistency for the involuntary engagement/stress reactivity factor was  = .75 for
parents and  = .82 for adolescents.
Adolescents’ caretaking behaviors. Three measures were used to assess
caretaking behaviors by adolescents directed toward their depressed parent: direct
observations of children and their parents, composite parent and child reports of child
caretaking behaviors on the RSQ, and children’s reports of their caretaking on the
Parentification Questionnaire for Youth (PQ-Y; Godsall & Jurkovic, 1995).
Observations of caretaking. First, the emotional and instrumental caretaking
codes adapted from the Iowa Family Interaction Ratings scales (IFIRS) were used to code
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videotaped interactions between each child and his or her parent (Melby & Conger,
2001). Parents and children participated in two 15-minute interactions, first about a
pleasant activity that the parent and child enjoyed doing together in the past couple of
months (i.e., Task 1, positive task), and second about a recent stressful time when the
parent was depressed, down, or grouchy, making it difficult for the family (i.e., Task 2,
stressful task). The sequence of the discussion of the positive topic followed by the
discussion of the stressful topic was used to allow for analyses of changes in children’s
emotions in response to a stressor.
The IFIRS is a global coding system comprised of codes that reflect content of
conversation, emotional affect, and non-verbal behavior to determine scoring (Melby &
Conger, 2001). There are multiple codes in the system, but the two of interest for this
study are labeled in the IFIRS as Instrumental caretaking and Emotional caretaking.
Instrumental caretaking includes the extent to which the child takes care of the parent or
takes on tasks or responsibilities that may be typically considered parental roles. The
emotional caretaking code includes the extent to which the child takes care of the
emotional needs of the parent or takes on an emotional burden that may be ageinappropriate. All codes have a 9-point scale, 1 representing “not at all characteristic”
and 9 representing “mainly characteristic.”
Coders focus on frequency and intensity of the behaviors and verbal statements to
assign each participant a score on all codes. Each 15-minute parent-child interaction was
coded by two independent raters (doctoral students in clinical psychology and advanced
undergraduate research assistants). Coders completed extensive training to learn the
codes in the IFIRS system and to become reliable with other coders. After coding each
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parent-child interaction, the two coders then met to assign consensus codes for any codes
that differed by two or more points on the 1 to 9 scale. They attained a consensus score
for each discrepant code by discussing the examples they noted for each code and
referring to the coding manual to verify their examples. Training for coding the
interactions consisted of approximately 35 hours of instruction and practice, including
reading and studying the manual, taking a written test on the content, coding specific
interactions to test for reliability, and meeting weekly with a team of experienced coders.
Once a newly trained coder achieved agreement with 80% of codes on an
interaction with scores previously established by trained coders, he or she was considered
prepared to code independently and able to complete consensus on interactions with other
coders. All coders attended weekly meetings throughout the study, during which coders
could discuss recently coded interactions and clarify questions in order to prevent drift
between coders. For the present study, consensus codes were used for all testing;
however, the original scores for each rater were used to determine inter-rater reliability.
Ratings showed adequate inter-rater reliability (73% inter-rater agreement).
Child and parent reports of caretaking: RSQ. Items 61-64 from the parental
depression version of the Responses to Stress Questionnaire (RSQ; Connor-Smith et al.,
2000; Jaser et al., 2005, 2008) were used to assess levels of adolescents’ caretaking in
response to stressors related to their parents’ depression (e.g., I try to be on my best
behavior so mom/dad won’t get upset; I try to be helpful with things around the house; I
cheer my mom/dad up to make him/her feel better; I try to get my parents to stop
arguing). A composite score was created for caretaking by converting parent and child
reports to standardized scores (z-scores).
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Children’s reports of caretaking: PQ-Y. The Parentification Questionnaire-Youth
(PQ-Y; Godsall & Jurkovic, 1995) is an adaptation of the Parentification Questionnaire
(PQ; Sessions & Jurkovic, 1986) modified for children and adolescents and written at a
3rd grade reading level. This measure is a 20-item, yes-no self-report questionnaire that
assesses the subjective experience of caretaking responsibility between children and their
families. The items include both emotional caretaking (e.g., “I often feel like a referee in
my family,” “I feel I’m asked too often to take care of some other family member”) as
well as instrumental caretaking (e.g., “I often have to do other family members' chores,”
“I have to help a lot with the family bills”). Internal consistency reliability of this
measure is adequate (α = .75-.83) and in the current sample was also found to be
adequate (α = .80).
Procedure
After expressing an interest in the study, each parent completed an initial phone
interview to determine initial eligibility for the baseline assessment of the prevention
study. If the parent was determined eligible from the phone interview, the family then
participated in various baseline assessments in the laboratory to assess psychological
history and ultimately determine eligibility for randomization into the intervention trial.
These assessments included clinical interviews with the parent and child, questionnaires
completed by parents and children, and two 15-minute-long video taped parent-child
interactions between the parent and the child.
Before beginning the diagnostic interviews, the parent and child completed a form
to identify something pleasant they had recently done together and something stressful
and difficult for the family that had occurred the last time the parent was sad, down,
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and/or irritable. The parents and children were informed that these topics would later be
used for the videotaped discussions. Upon completion of the diagnostic interviews, the
parent and child participated in the two video taped discussions. The positive task (i.e.,
the pleasant activity) was administered first. A cue card was provided with questions to
guide the discussion. The interviewer filled in the cue cards using the form the parent
and child completed before the interviews. Questions for the first task included: “What
happened when we ___?”, “How did we feel when we ___?”, “What are some other fun
activities would we like to do together?”, “What prevents us from doing fun activities
together?”.
After 15 minutes, the interviewer entered the room to exchange the cue cards and
to tell the parent and child to switch to the stressful topic for the second 15-minute
interaction (i.e., discussing stress related to the parent’s depression). The cue card for the
second task contained the following questions: “What happened the last time___?”,
“What kinds of feelings or emotions do we usually have when mom/dad is sad, down,
irritable, or grouchy?”, “What do we do to reduce the stress when mom/dad is sad, down,
irritable or grouchy?”. After 15 minutes, the interviewer turned off the camera and
conducted a short debriefing with the parent and child to ask how the interactions went
and to answer any questions.
Families were screened to determine eligibility, primarily to discern that at least
one parent in the family had experienced at least one major depressive episode or
dysthymia during the child’s lifetime. If two parents met criteria for depression or
dysthymia, the parent who initially contacted the study was designated as the target
parent. The following parental diagnoses or characteristics were excluded from the
CARETAKING AND STRESS REACTIVITY
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sample: bipolar I, schizophrenia, or schizoaffective disorder. Child diagnoses that led to
exclusion from the study included mental retardation, pervasive developmental disorders,
alcohol or substance use disorders, current conduct disorder, bipolar I disorder, and
schizophrenia or schizoaffective disorder. Additionally, if a child in the family met
criteria for current depression or was acutely suicidal, the family was placed on hold, and
a re-assessment procedure was applied.
The Institutional Review Boards at the two participating university research sites
approved all procedures in the study. Doctoral students in clinical psychology completed
extensive training for the structured clinical interviews and conducted all interviews in
psychology laboratories at the two universities. All participants provided informed
consent prior to participation in the study, and each participant received $40
compensation for their participation in the baseline assessment.
Data Analyses
Through prior research and empirical literature on caretaking, potential correlates
of caretaking behaviors (e.g. stress reactivity and depressive symptoms) were identified.
Correlations were run with 3 measures of caretaking to examine relationships to stress
reactivity and depressive symptoms in adolescents. Independent and paired sample ttests were conducted to compare means and standard deviations.
Results
Gender Comparisons
Independent sample t-tests were used to compare means and standard deviations
for measures of children’s stress reactivity, caretaking behaviors, and depressive
symptoms. Results are presented separately for boys and girls in Table 1. Boys and girls
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were significantly different on the self-reported RSQ Involuntary Engagement scale, with
girls (M = .23) reporting higher levels than boys (M = .22), t = -2.75, p = .01.
Additionally, girls’ (M = 3.10) levels of Instrumental caretaking during Task 1 were
higher than boys (M = 2.75), approaching significance (t = -1.71, p = .09).
It is noteworthy that there were no significant gender differences on any of the
caretaking measures: Emotional caretaking Task 1 (MBoys= 2.42, MGirls= 2.47, t = .20,
p = .84), Instrumental caretaking Task 1, Emotional caretaking Task 2 (MBoys= 3.83,
MGirls= 3.85, t = -.08, p = .94), Instrumental caretaking Task 2, (MBoys= 3.21, MGirls=
3.37, t = -.60, p = .55); PQ-Y (MBoys= 5.75, MGirls= 6.32, t = -1.01, p = .31); RSQ (MBoys=
-.04, MGirls= .04, t = -.59, p = .56). Further, there were no gender differences on parent
reported Involuntary Engagement (MBoys= .24, MGirls= .25, t = -.78, p = .43) or
Involuntary Disengagement (MBoys= .18, MGirls= .17, t = .84, p = .40). Child reported
Involuntary Disengagement (MBoys= .17, MGirls= .17, t = .21, p = . 83) was also
insignificant.
Finally, no gender differences were found among measures of depressive
symptoms, including child reported YSR Affective Problems (MBoys= 57.09,
MGirls= 55.98, t = .99, p = .32), CES-D (MBoys= 13.78, MGirls= 14.36, t = -.36, p = .72),
and parent-reported Affective Problems from the CBCL (MBoys= 59.93, MGirls= 60.94, t =
-.83, p = .41). Overall, gender differences among caretaking, stress reactivity, and
depressive symptoms were minimal.
Correlational Analyses
Measures of caretaking behaviors. Correlations among the three measures of
children’s caretaking behaviors are presented in Table 2. Emotional Caretaking in Task 1
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was significantly associated with Instrumental caretaking in Task 1 (r = .25, p < .01),
Emotional caretaking in Task 2 (r = .27, p < .01), and Instrumental caretaking in Task 2
(r = .23, p < .01). Instrumental caretaking in Task 1 was not related to Emotional
caretaking in Task 2 (r = .12, p = .12). However, Emotional and Instrumental caretaking
in Task 2 showed a moderately strong correlation (r = .46, p < .01). The PQ-Y was not
significantly correlated with Emotional caretaking in Task 1 (r = .01, p = .96) or Task 2
(r = -.09, p =.25), nor was it correlated with Instrumental caretaking in Task 1 (r = .10,
p = .22) or Task 2 (r = .09, p = .25). Caretaking as reported by the RSQ was associated
with Emotional caretaking in Task 1 (r = .20, p < .05) and Task 2 (r = .17, p < .05). RSQ
caretaking was not significantly associated with Instrumental caretaking in Task 1
(r = .08, p = .33) or Task 2 (r = .12, p = .13). Additionally, RSQ caretaking was not
significantly related to the PQ-Y (r = -.07, p = .34). The correlational analyses
summarize that observed caretaking behaviors are related and seem to measure the same
construct; in contrast, the lack of significant associations among observed behaviors and
the PQ-Y provide evidence that the two measures are measuring different aspects of
caretaking.
Caretaking, stress reactivity and depressive symptoms. Correlations among
measures of stress reactivity and caretaking are presented in Table 3. In observing the
relationship between caretaking and stress reactivity, it is noteworthy that none of the
observed caretaking were related to measures of stress reactivity. However, measures of
stress reactivity were significantly related to child-reported parentification at a p < .01
level, showing that “parentification” and stress reactivity measure similar constructs.
The PQ-Y was significantly associated with Involuntary Disengagement parent reports
CARETAKING AND STRESS REACTIVITY
21
(r = .24, p < .01) and child self-reports (r = .34, p < .01), and with Involuntary
Engagement child reports (r = .25, p < .01). In contrast, the PQ-Y was not associated
with parent-reported Involuntary Engagement (r = .01, p = .93). Only child-reported
Involuntary Disengagement was related to the RSQ composite caretaking scale, showing
a negative association between child stress reactivity and combined child and parent
reports of caretaking (r = -.16, p < .05). These intriguing findings show that children who
report more levels of parentification as labeled on the PQ-Y also report higher levels of
stress reactivity.
To summarize, the correlations among children’s caretaking, stress reactivity, and
depressive symptoms are presented in Table 4. Observed Emotional caretaking in Task 1
was not associated with YSR Affective Problems (r = 03, p = .74) or the CES-D (r = .08,
p = .34) but was significantly associated with parent-reported Affective Problems on the
CBCL (r = .19, p < .05). Emotional Caretaking in Task 2 was not associated with child
reported Affective Problems (r = -.10, p = .21) or parent reported Affective Problems
(r = .03, p = .71), but was found to be significantly and negatively associated with selfreported depressive symptoms on the CES-D (r = -.16, p < .05), indicating that children
who engaged in Emotional caretaking during the negative tasked viewed themselves as
having fewer symptoms of depression. Instrumental caretaking was not associated with
depressive symptoms in either task. Interestingly, the PQ-Y was significantly associated
with all 3 measures of depressive symptoms (YSR: r = 35, p < .01; CES-D: r = .44,
p < .01; CBCL: r = .18, p < .05). Caretaking as measured by the RSQ was not associated
with depressive symptoms. Measures of stress reactivity were significantly associated
with child depressive symptoms. Child-reported Affective Problems from the YSR were
CARETAKING AND STRESS REACTIVITY
22
significantly related to reports of Involuntary Engagement by parents (r = 23, p < .01) and
children (r = .42, p < .01) and to Involuntary Disengagement by parents (r = .22, p < .01)
and children (r = .39, p < .01), indicating that Affective Problems reported by children
themselves are highly associated with both parent and child reports of stress reactivity.
Depressive symptoms from the CES-D were associated with Involuntary Disengagement
reported by parents (r = .18, p < .05) and children (r = .42, p < .01). The CES-D was also
associated with child-reports of Involuntary Engagement (r = .49, p < .01), but not with
parent reports of the same factor (r = .14, p = .07).
Discussion
This study was designed to extend past research on the costs and benefits of
caretaking behaviors in children with depressed parents. Given that adolescents with
depressed parents are at a higher risk for psychopathology, it is important to conduct
additional research on the specific behaviors that may prevent this at-risk sample from
developing depression.
Previous studies have relied heavily on retrospective reports of caretaking
behaviors. It is noteworthy that we were able to observe child and adolescent caretaking
in a laboratory setting as well as by parent- and child-reports; using multiple measures of
caretaking allows for a more broad assessment of the behaviors. Children in this sample
did exhibit levels of caretaking behaviors (ranging from 2.4 to 3.8 on a 9 point scale)
during the positive and negative task, as evidenced by the means presented in Table 1. In
comparing gender differences among children, significant differences were found in
means of self-reported Involuntary Engagement, showing girls (M = .23) to display
higher levels than boys (M = .22). This finding provides interesting evidence that girls in
CARETAKING AND STRESS REACTIVITY
23
this sample reported themselves as significantly experiencing more rumination, intrusive
thoughts, emotional and physiological arousal, and involuntary action. Additionally,
there is evidence to suggest that girls (M = 3.10) displayed higher levels of Instrumental
caretaking in the first observation task (i.e., a discussion of positive topic|) than boys (M
= 2.75), as the p-value approached significance (p = .09). Except for the previous two
findings, gender differences in caretaking behaviors, stress reactivity, and depressive
symptoms were minimal. This was somewhat unexpected, as some evidence has
identified girls to be at a higher risk when living with a depressed parent (e.g., RadkeYarrow et al., 1994).
Overall, results from the independent sample t-tests found minimal gender
differences. The lack of significant gender differences in these at-risk children may be
caused, in part, by the substantial amount of chronic stress experienced by members of a
family with a depressed parent. Although findings on gender differences in children
living with depressed parents are highly inconsistent, prior studies have also shown
minimal gender differences in children and adolescents living with a depressed parent,
suggesting that both genders may be equally affected due to the extreme familial stress.
One hypothesis, the Equalization hypothesis, posits that sons and daughters have an
equivalent number of symptoms or diagnoses of depression (Foster et al., 2008). Our
results support this theory, showing both boys and girls to have elevated scores on stress
reactivity and depressive symptoms with minimal differences (see Table 1).
Although results found that caretaking behaviors were present in both observed and
reported measures, the correlational analyses indicate that the different measures of
caretaking may be assessing different constructs. Results showed that the observed in-
CARETAKING AND STRESS REACTIVITY
24
task Emotional and Instrumental caretaking behaviors were significantly correlated with
each other (r’s ranged from .23 to .46, Table 2), suggesting that the two types of
caretaking behaviors are measuring a similar construct. As stated previously, these two
measures are based on the intensity and frequency of behaviors in the interaction task,
and may also include some behaviors at home. Additionally, the findings show that only
Emotional Caretaking is moderately but significantly associated with depressive
symptoms as reported by parents (CBCL) and children (CES-D), as shown in Table 4.
This suggests that observed Emotional caretaking may be related to child depressive
symptoms; however, these constructs are distinct and future research is needed to draw
conclusions about their associations.
Correlational analyses among all three caretaking measures (Table 2) also showed
that the PQ-Y was not associated with observed caretaking on either task, suggesting that
the two measures are capturing very distinct aspects of caretaking, or that they may not
be assessing the same construct. The PQ-Y was also not associated with the RSQ
caretaking measures. Many of the items on the PQ-Y are posed in a negative fashion
(e.g., “I seem to get the blame for most of what happens in my family”) and may
encourage generalizations about the child and adolescent behavior within the family. The
Emotional and Instrumental caretaking codes as defined by the IFIRS scales specifically
distinguish emotional from task-related caretaking behaviors, and rely on specific
caretaking criteria that may be age-inappropriate (e.g., child suggests a solution to a
mother’s marital problem) and less on generalized behavior in the home. The PQ-Y is a
Yes or No questionnaire, which may influence a child to answer “yes” on a question even
if the behavior occurs at a low or moderate level, whereas the Emotional and
CARETAKING AND STRESS REACTIVITY
25
Instrumental caretaking codes are assessed on a 9 point scale, and can measure children’s
caretaking at low, moderate, and high levels. Words such as “often”, “seem”, and “feel”
are common among items on the PQ-Y, and may encourage a more broad and subjective
perspective in a child reporting caretaking behaviors at home. These differences may
account for the lack of significant association between the two measures. The composite
score for child caretaking as measured by the RSQ was associated with Emotional
Caretaking on both tasks, suggesting that the Emotional Caretaking code and the RSQ
items measure similar aspects of caretaking (e.g. soothing a distressed parent or taking
blame for a problem).
Results from correlational analyses among depressive symptoms, caretaking, and
stress reactivity (Table 4) confirm previous research and provide further evidence that
stress reactivity is an important factor in understanding adolescent depressive symptoms.
Observed caretaking was generally not associated with depressive symptoms, with two
exceptions: Emotional caretaking Task 1 was moderately and positively associated with
CBCL Affective Problems (r = .19), and Emotional Caretaking Task 2 was moderately
and negatively associated with CES-D depressive symptoms (r = -.16). The CBCL
assesses parents’ perception of their children’s social competence in the past 6 months,
with Affective Problems being a subscale included in measuring overall social
competence.
The positive association between Affective Problems and Emotional caretaking
when discussing a pleasant task is interesting and may suggest that depressed parents in
our sample viewed their child’s caretaking in a non-stressful situation as problematic.
Previous research has shown depressed parents to display more withdrawn and intrusive
CARETAKING AND STRESS REACTIVITY
26
behaviors when interacting with their children (i.e. Radke-Yarrow et al., 1994; Jaser et
al., 2007). The association found between parents’ report of child Affective Problems
and caretaking behaviors in a pleasant task may further this evidence, suggesting that the
depressed parent may not view caretaking behaviors as appropriate unless they are being
cared for during stressful interactions. The negative association found between
Emotional caretaking Task 2 and the CES-D depressive symptoms (r = -.16) shows that
children who exhibited Emotional caretaking while talking about a negative task also
reported lower levels of depressive symptoms. This association may result from the
child’s understanding of Emotional caretaking as an encouraged and/or accepted
behavior- a viewpoint that may or may not be encouraged by the depressed parent. While
this may be true, it is important to note that caring for others is a basic human tendency;
not all caretaking behaviors are inappropriate. Previous studies have suggested that
moderate levels of caretaking may be acceptable for child adjustment (i.e. Cummings and
Davies, 1994), and the negative association between child-reported depressive symptoms
and Emotional Caretaking during a negative interaction may support prior research (as
the mean caretaking level during Task 2 was moderate- 3.8 for both boys and girls).
Another important finding was the association of the PQ-Y with all three
measures of depressive symptoms (r’s ranged from .18 to .44). This finding, in
conjunction with the lack of association between observed caretaking, RSQ caretaking
items, and depressive symptoms, is important in considering the different constructs of
caretaking. The strong association among all three measures of depressive symptoms and
the PQ-Y suggests that the PQ-Y may measure aspects of caretaking that are also
involved in symptoms of depression. As previously stated, this may be the result of the
CARETAKING AND STRESS REACTIVITY
27
wording of the PQ-Y, which has negative undertones. The more negative wording may
appeal more to children who are already more inclined to negative thinking and
functioning (and therefore higher on measures of depressive symptoms). More generally,
the PQ-Y may simply be a more accurate assessment of the kinds of negative caretaking
behaviors that we are interested in when trying to understand risky behaviors in at-risk
adolescents. More research is needed to understand the precise caretaking behaviors or
mindsets that are related to depressive symptoms.
Results showing stress reactivity reported by both children and parents are
presented in Table 3 and Table 4. Stress reactivity was mostly significantly associated
with depressive symptoms (r’s ranged from .18 to .49, Table 4), supporting previous
research; however; depressive symptoms from the CES-D were not related to parentreported Involuntary Engagement and CBCL affective problems were not related to
child-reported Involuntary Disengagement. These insignificant findings may be caused
by differences in child and parent perceptions. Specifically, parents reporting on their
child’s rumination, intrusive thoughts, and arousal (Involuntary Engagement) may not
have a clear knowledge of these problems unless they have specifically discussed those
topics with their child. Similarly, the CBCL is a parent-reported questionnaire and may
not show associations with child reports of involuntary disengagement (e.g., emotional
numbing, cognitive interference) due to lack of discussion or a difference in perception.
The Tend-And-Befriend model, which provides a complementary model to the
well-known Fight-or-Flight model of stress, posits that humans may also have
biobehavioral tendencies that focus on affiliative and nurturing processes (providing and
receiving mutual protection) in the face of distress. The findings from this study support
CARETAKING AND STRESS REACTIVITY
28
this model, providing evidence that adolescents exhibit caring behaviors in response to a
chronic stressor. Hypotheses involving gender differences relating stress reactivity in this
sample to the Taylor Tend-And-Befriend model were not supported. Specifically, males
and females in the sample generally did not show marked differences in caretaking or
stress reactivity. Both boys and girls in the current study reported exhibiting caretaking
behaviors at home (RSQ: M = -.04 for boys, M = .04 for girls); PQ-Y: M= 5.75 for boys,
M = 6.32 for girls) and during both the positive and negative tasks (M = 2.42 Task 1 and
2.75 Task 2 for boys; M= 2.47 Task 1 and 3.10 Task 2 for girls). Although there were no
statistically significant gender differences, it is noteworthy that girls in the sample scored
higher on Emotional and Instrumental Caretaking during both tasks, on the PQ-Y, and on
the RSQ Caretaking scale than boys. More research on children with depressed parents is
needed to comprehend potential gender differences that may be important considerations
when conducting preventive interventions.
There are noteworthy limitations to this study that should be addressed. First,
only 20 fathers were included in the sample of depressed parents. Although gender
differences in children were minimal in our study (and have been minimal in prior
research on children of depressed parents), parent gender may be an important factor in
researching child caretaking. Second, there is evidence to suggest discrepancies in
current measures of caretaking behaviors. Although this study included observed and
reported measures of caretaking, these measures may not be accurately assessing the
same construct, as evidenced by the associations (and lack thereof) among the PQ-Y,
RSQ Caretaking, and observed Emotional and Instrumental Caretaking. Specifically,
there is not a standardized definition of “caretaking behavior” in current literature.
CARETAKING AND STRESS REACTIVITY
29
Differences in defining caretaking may lead to the measurement of different constructs
when researching these behaviors.
Given the empirical evidence to date on child caretaking behaviors, future research
should focus on standardizing definitions of caretaking so that specific aspects of the
construct may be examined to determine potential consequences. Specifically, examining
which aspects of caretaking are harmful to children’s adjustment will allow researchers to
understand which behaviors and/or coping skills are most beneficial to teach these at-risk
children when conducting preventive interventions. The findings from this study show
that measures such as the PQ-Y may assess caretaking behaviors that are particularly
important in understanding caretaking as it relates to depressive symptoms, whereas
observed behavior may assess other aspects of caretaking. Understanding the specific
aspects of caretaking that negatively affect child adjustment is imperative, since some
degree of caretaking is not only typical but also expected in most families. Examining
the costs and benefits of caretaking behaviors in children of depressed parents will direct
researchers to more accurately develop preventive interventions for families suffering
from the consequences of depression.
CARETAKING AND STRESS REACTIVITY
30
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CARETAKING AND STRESS REACTIVITY
33
Table 1. Means and standard deviations of gender differences in measures of child
caretaking and stress reactivity.
t-test
1. EC 1
2.42
t = -.20 n.s.
p = .84
2. IC 1
2.75
1.38
3.10
1.38
t = -1.71 n.s.
p = .09
3. EC 2
3.83
2.11
3.85
2.17
t = -.08 n.s.
p = .94
4. IC 2
3.21
1.77
3.37
1.68
t = -.60 n.s.
p = .55
5. PQ-Y
5.75
3.58
6.32
3.76
t = -1.01 n.s.,
p = .31
6. RSQ Caretaking
-.04
.86
.04
.79
t = -.59 n.s.
(Composite)
p = .56
7. RSQ IE (Parent
.24
.05
.25
.05
t = -.78 n.s.
on Child)
p = .43
8. RSQ ID (Parent
.18
.03
.17
.03
t = .84 n.s.
on Child)
p = .40
9. RSQ IE (Child)
.22
.03
.23
.04
t = -2.75
p = .01
10. RSQ ID
.17
.03
.17
.03
t = .21 n.s.
(Child)
p = .83
11. YSR Affective
57.09
7.89
55.98
6.83
t = .99 n.s.
Problems
p = .32
12. CES-D
13.78
10.45
14.36
11.03
t = -.36 n.s.
p = .72
13. CBCL
59.93
7.92
60.94
8.18
t = -.83 n.s.
Affective Problems
p = .41
Note. EC 1: Observed Emotional Caretaking-Task 1; IC 1: Observed Instrumental
Caretaking-Task 1; EC 2: Observed Emotional Caretaking-Task 2; IC 2: Observed
Instrumental Caretaking, Task 2. PQY: Parentification Questionnaire for Youth. RSQ:
Responses to Stress Questionnaire. IE: Involuntary Engagement; ID: Involuntary
Disengagement. YSR: Youth Self-Report. CES-D: The Center for Epidemiological
Studies Depression Scale. CBCL: Child Behavior Checklist. n.s: Not Significant.
M (Boys)
SD (Boys)
1.35
M (Girls)
2.47
SD (Girls)
1.52
CARETAKING AND STRESS REACTIVITY
Table 2. Correlation among measures of EC, IC (both tasks), PQ-Y Total, and RSQ
Caretaking Scale (boys and girls).
1.
2.
3.
4.
5.
1. EC 1
2. IC 1
.25**
3. EC 2
.27**
.12 n.s.
4. IC 2
.23**
.27**
.46**
5. PQ-Y
.004 n.s.
.10 n.s.
-.09 n.s.
.09 n.s.
6. Composite
.20*
.08 n.s.
.17*
.12 n.s,
-.07 n.s.
RSQ Caretaking
*p < .05, ** p < .01
Note. EC 1: Observed Emotional Caretaking-Task 1; IC 1: Observed Instrumental
Caretaking-Task 1; EC 2: Observed Emotional Caretaking-Task 2; IC 2: Observed
Instrumental Caretaking, Task 2. PQ-Y: Parentification Questionnaire for Youth.
RSQ: Responses to Stress Questionnaire. n. s.: Not significant.
34
CARETAKING AND STRESS REACTIVITY
35
Table 3. Correlations among measures of stress reactivity and caretaking.
1. RSQ IE (Parent on
Child)
2. RSQ ID (Parent on
Child)
3. RSQ IE (Child)
4. RSQ ID (Child)
EC 1
IC 1
EC 2
IC 2
PQ-Y
-.02 n.s.
p = .76
-.07 n.s.
p = .37
-.02 n.s.
p = .80
-.13 n.s.
p = .11
.02 n.s.
p = .81
-.04 n.s.
p = .60
.03 n.s.
p = .67
-.07 n.s.
p = .38
-.12 n.s.
p = .14
-.05 n.s.
p = .56
-.14 n.s.
p = .08
-.05 n.s.
p = .52
-.07 n.s.
p = .40
-.02 n.s.
p = .80
-.07 n.s.
p = .37
.01 n.s.
p = .90
.01 n.s.
p = .93
.24**
.25**
.34**
RSQ Composite
Caretaking
.10 n.s.
p = .18
-.12 n.s.
p = .11
-.01 n.s.
p = .92
-.16*
*p < .05, ** p < .01
Note. RSQ: Responses to Stress Questionnaire; IE: Involuntary Engagement; ID: Involuntary
Disengagement; EC 1: Observed Emotional Caretaking-Task 1; IC 1: Observed Instrumental
Caretaking-Task 1; EC 2: Observed Emotional Caretaking-Task 2; IC 2: Observed Instrumental
Caretaking, Task 2. PQ-Y: Parentification Questionnaire for Youth.
CARETAKING AND STRESS REACTIVITY
36
Table 4. Correlations among children’s caretaking, stress reactivity, and depressive symptoms.
EC 1
IC 1
1. YSR
.03 n.s -.01 n.s
Affective p = .74 p = .87
Problems
2. CES-D .08 n.s -.01 n.s
p = .34 p = .89
EC 2
IC 2
PQ-Y
RSQ
Caretaking
IE
Parent
Report
ID
Parent
Report
IE
Child
Report
ID
Child
Report
-.10 n.s
p = .21
-.07 n.s
p =.39
.35**
.09 n.s
p = .26
.23**
.22**
.42**
.39**
-.16*
-.06 n.s
p = .46
.44**
.11 n.s
p = .15
.14 n.s
p = .07
.18*
.49**
.42**
3. CBCL .19*
.04 n.s .03 n.s .05 n.s .18*
.07 n.s
.41**
.37**
.19*
Affective
p = .64 p = .71 p = .55
p = .37
Problems
*p < .05, ** p < .01
Note. EC 1: Observed Emotional Caretaking-Task 1; IC 1: Observed Instrumental CaretakingTask 1; EC 2: Observed Emotional Caretaking-Task 2; IC 2: Observed Instrumental Caretaking,
Task 2. PQ-Y: Parentification Questionnaire for Youth. RSQ: Responses to Stress Questionnaire.
.10 n.s
p = .20