The Impact of Work On The Mental Health of Parents of Children With Disabilities

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LISA A.

MORRIS University of Southern Maine

The Impact of Work on the Mental Health of Parents


of Children with Disabilities

There is a growing literature examining the Grzywacz & Bass, 2003; Melchior, Berkman,
impact of work and family responsibilities Niedhammer, Zins, & Goldberg, 2007). Of par-
on the psychological well-being of parents of ticular concern are families with heavier-than-
children with disabilities and other special average caregiving responsibilities, including
needs. A number of studies using small, parents of children with disabilities (Brennan
nonprobability samples of mothers find that & Brannon, 2005; Canning, Harris, & Kelle-
work provides a respite from the stressful effects her, 1996; Rosenzweig, Brennan, & Ogilvie,
of caregiving. Using data from the National 2002). Research consistently shows that parents
Survey of American Families, this study found of children with disabilities and other excep-
higher mental health among working mothers tional needs have heavier caregiving duties than
of older children with disabilities compared to parents of typically developing children and
their nonworking counterparts and mothers of that they are more likely to experience mental
typically developing children, a result consistent and emotional distress (Deater-Deckard, 2004;
with caregiver-specific positive spillover. No U.S. Department of Health and Human Ser-
significant differences in mental health were vice, 2008), raising concern about the effects
found among working and nonworking mothers of work–family conflict on the well-being of
of younger children with disabilities or among caregivers.
fathers. Results also indicate that caregiver Research investigating the effect of work on
mothers who are experiencing high levels of parents of children with disabilities and health
parent-role stress benefit more from work, and conditions is sparse; but, on balance, it suggests
that the beneficial effects from work persist until that working outside the home may offset the
rather high levels of work (50 or more hours per stressful effects of caregiving. The empirical
week). evidence of caregiver-specific mental health
benefits from work is, however, based primarily
There is a growing literature examining the on small, nonprobability samples (Freedman,
impact of work and family responsibilities on Litchfield, & Warfield, 1995; Gottlieb, 1997;
the psychological well-being of working parents Lewis, Kagan, Heaton, & Cranshaw, 1999;
(Barnett & Baruch, 1985; Barnett & Marshall, Parish, 2006; Thyen, Kuhlthau, & Perrin, 1999;
1992; Frone, 2000; Goodman & Crouter, 2009; Warfield, 2001, 2005). Moreover, though there
has been an increase in the study of fathers in
work and family research in general (Bianchi &
Muskie School of Public Service, University of South-
Milkie, 2010; Hill, 2005; Levine & Pittinsky,
ern Maine, P.O. Box 9300, Portland, ME 04104 1997), most of the studies examining the effects
(lmorris@usm.maine.edi). of work on the mental health of parent caregivers
Key Words: family and work, family caregivers, children have been conducted using mother-only samples
with disabilities, parent stress, parent mental health. (one exception is Warfield, 2005) or nearly
Family Relations 63 (February 2014): 101–121 101
DOI:10.1111/fare.12050
102 Family Relations

mother-only samples (McDonald, Poertner, & 1986; Voyandoff, 2002). While some studies
Pierpont, 1999). have examined the effects of work-family on
In an effort to confirm the possibility of a a more expansive set of outcomes (see, e.g.,
caregiver-specific positive spillover effect, an Gareis, Barnett, Ertel, & Berkman, 2009), most
earlier study conducted by the author of this of the work to date has focused on the impact of
article (Morris, 2012) used a nationally represen- work and family on parents’ psychological well-
tative sample of married mothers (N = 43,342) being. This report also focuses on psychological
from the National Survey of American Families well-being, which enhances consistency and
(NSAF) to examine the relationship between comparability.
mental health, work, and caregiving. The study Role theory conceptualizes the dynamics
compared the relationship between work and between work and family roles as ‘‘spillover’’
mental health among mothers of children who effects. Spillover can be negative (conflict,
were in poor to fair health, had disabilities, strain) or positive (facilitation, enhancement,
or exhibited behavior problems, and mothers enrichment) and can occur in either direction:
of typically developing children. The findings from work to family and from family to
suggested that mothers of older children with work. Psychological distress is a symptom
special needs do benefit more than other mothers of negative spillover, occurring when family-
from working outside the home. The analysis based stressors undermine work performance
also indicated that the positive mental health or, vice versa, when work-related stressors
effects from work were larger among caregiver undermine the quality of parenting and family
mothers who worked full-time, during the day, relationships. Alternatively, conflict can be
and in executive, managerial, or professional time based; for example, when time spent
occupations. The study reported here expands on at work leaves too little time for home,
this earlier work by using a sample of mothers interfering with the functioning of parenting
and fathers as well as single and married or and family relationships and causing mental
partnered parents, and employing a more robust and emotional strain (Barnett & Marshall,
analysis of the relationships between work, 1992; Greenhaus & Powell, 2006; Grzywacz,
caregiving, and mental health. Specifically, Almeida, & McDonald, 2002; Grzywacz & Bass,
the analysis employed a more precise defini- 2003; Hanson, Hammer, & Colton, 2006; Hill,
tion of child disability and examined of the 2005; Tiedje et al., 1990; Voyandoff, 2002,
relation between parent-role stress and mental 2004).
health. In contrast, improved psychological well-
being is a symptom of positive spillover
(Greenhaus & Powell, 2006; Hill, 2005;
CONCEPTUAL FRAMEWORK Voyandoff, 2002). Positive spillover effects are
The primary objective of this study was to posited to be the result of a transfer of attitudes,
investigate whether the relationship between skills, or abilities from one role to another role.
work and mental health was different for parents For example, in a study conducted by Tiedje et al.
of children with disabilities and parents of (1990, p. 70), one mother said ‘‘Enjoying my
typically developing children. The study also work makes it easier to enjoy my children too. I
investigated whether the associations between feel better about myself.’’ Alternatively, positive
work, caregiver status, and mental well-being spillover occurs when participation in one role
differed for mothers and fathers and among buffers the individual from strain resulting from
married or partnered and single parents, and participation in another role. In this case, mental
whether parent-role stress and certain job and emotional distress is lowered by work
conditions attenuated the relationship between (family) rewards or resources offsetting family
work and parent mental health. In keeping (work) stressors. It could also be that simply
with other research on the impact of work and having some time away from home responsi-
family responsibilities on parent well-being, role bilities is in itself stress reducing (Greenhaus &
theory was used to frame the analysis. Role Powell, 2006; Hill, 2005; Voyandoff, 2002). For
theory seeks to explain how individuals balance example, in the study by Tiedje et al. (1990), a
multiple roles, such as spouse, parent, caregiver, mother said, ‘‘The distance and time away from
and employee, and the consequences for role the children gives me a better perspective about
performance and well-being (Barnett & Baruch, them and their behavior’’ (p. 70).
Work and Mental Health 103

Positive psychological outcomes can also PREVIOUS RESEARCH


be produced in the absence of spillover Work–family conflict and negative spillover
between family and work domains simply have been the focus of most studies (Bar-
as an additive effect, whereby individuals’ nett & Marshall, 1992; Bianchi & Milkie,
participation in and satisfaction with each 2010; Voyandoff, 2004); however, increas-
additional role incrementally increases their ingly researchers are looking for and finding
overall psychological well-being. Similarly, a positive psychological effects (Gareis et al.,
decline in psychological well-being can result 2009; Greenhaus & Powell, 2006; Grzywacz
when the negative effects of work (or family) & Bass, 2003; Grzywacz & Marks, 2000; Han-
generate net losses in psychological well- son et al., 2006). Using a nationally represen-
being (Greenhaus & Powell, 2006; Voyandoff, tative sample (N = 1,986) from the National
2002). Survey of Midlife Development in the United
Work–family dynamics and spillover effects States, Grzywacz and Bass (2003) examined
are also predicted to be influenced by individual the impact of work–family conflict and facil-
characteristics and attitudes, family structure, itation on the mental well-being (depression,
and work conditions (Voyandoff, 2002). Differ- anxiety, and problem drinking) of working par-
ent types of families will have different resources ents. As theory predicts, they found a negative
and abilities for balancing work and family, and relationship between work–family conflict and
these differences will influence the direction and mental well-being and a positive relationship
intensity of spillover between work and fam- between work–family facilitation and mental
ily. The inclusion of variables capturing family well-being. Interestingly, they also found evi-
structure and socioeconomic status helps explain dence that work–family facilitation buffers the
the conditions under which specific relationships negative consequences of work–family conflict.
between work, family, and mental well-being Based on the analysis of a random sam-
occur (Canning et al., 1989; Minnotte, 2012; ple of 158 married women college professors,
Voyandoff, 2002). Family and gender norms Tiedje et al. (1990) found that those experienc-
and expectations also influence the experiences ing high work–family enhancement and low
of caregiving and work as well as work–family work–family conflict scored higher on mea-
dynamics (Barnett & Marshall, 1992; Coltrane, sures of mental health, whereas those expe-
1996; Hill, 2005; Lewis et al., 1999; Lin, Fee, & riencing low enhancement and high conflict
Wu, 2012; Minnotte, Minnotte, Pedersen, Man- scored lower. In another study, Hanson et al.
non, & Kiger, 2010; Usdansky, Gordon, Wang, (2006) examined the relationship between three
& Gluzman, 2012; Voyandoff, 2002). Tradi- dimensions of work–family positive spillover:
tional sex role theory proposes that fathers are behavior-based instrumental positive spillover,
more invested in work, emotionally and tempo- value-based instrumental positive spillover, and
rally, and mothers are more invested in family affective positive spillover. Using a sample of
and caregiving. Due to these gender differences 193 employees from two companies, they found
in role demands and salience, gender moderates significant positive correlations between men-
the relationships between work, family, and psy- tal well-being and work-to-family value- and
chological well-being, producing different out- behavior-based instrumental positive spillover
comes for mothers and fathers. Attitudes about and family-to-work behavior-based instrumental
work, work-role quality, and specific job condi- positive spillover.
tions are also influential either as rewards and Although most of the research has been
resources or constraints and stressors. Although conducted on parents of typically developing
research consistently demonstrates positive or children, there are a handful of studies
neutral mental health effects from work (Bar- examining the impact of work–family on the
nett & Baruch, 1985), studies also find that psychological well-being of parents of children
hours, work schedules, job complexity, and with disabilities and special health care needs.
autonomy as well as job satisfaction and job Although some studies found that working
security are related to work–family dynamics outside the home is detrimental to the well-
and mental health outcomes (Grzywacz & But- being of parent caregivers (McDonald, Poertner,
ler, 2005; Pedersen, Minnotte, Kiger, & Mannon, & Pierpont, 1999), a number of other studies
2009; Usdansky et al., 2012; Voyandoff, 2002, reported positive spillover effects. A study
2005). by Thyen et al. (1999) collected information
104 Family Relations

on work and mental well-being from 70 interest. In her 2001 study, Warfield used a sam-
mothers of children with chronic disease (study ple (N = 56) of employed mothers of children
group) and 58 mothers of children with acute with behavior problems obtained from an early
health conditions (comparison group). Using intervention program to examine the impact of
linear regression models with maternal mental work and caregiving demands on parent stress,
health scores as the dependent variable and a measure that encompassed the parent’s mental
group membership (study vs. comparison), and emotional well-being and the parent’s
employment status, and the interaction of group perception of parenting role quality and marital
and employment as independent variables, they satisfaction. Using linear regression methods
found a statistically significant and positive and interactions between caregiving demands
interaction effect, suggesting that employment and work variables (hours, workload intensity,
moderated parent stress specifically for mothers and level of interest in work) as independent
of children with chronic disease. variables, she found that the level of work
A number of qualitative studies also report interest moderated the negative influence of
positive mental health outcomes from work. increased caregiving on parent stress, but only at
Based on four focus groups of working parents lower levels of caregiving (i.e., high caregiving
of children with developmental disabilities, difficulties resulted in higher stress no matter
Freedman et al. (1995) found evidence of what the level of work interest). In a second
positive spillover, from work to family and study, using a sample (N = 51) of working
family to work, especially among mothers of married couples with children with disabilities
children with behavioral problems. Many of the obtained through the same intervention program
parents said that having a child with disabilities and the same analytic approach, Warfield (2005)
positively influenced their attitudes toward work found a similar relationship between parent
and enhanced their performance. Parents cited stress and work, moderated by work interest,
psychological benefits from working, with some among mothers and fathers, although the results
specifically describing work as a ‘‘respite’’ were statistically significant only for mothers.
or ‘‘a welcome distraction’’ (p. 510). Other Although intriguing, these studies were con-
parents stated that their experiences raising ducted on small, nonrandom samples. As
children with disabilities made them better described earlier, the current author conducted
able to handle difficult work situations. In an study (Morris, 2012) using a large, nation-
a focus group study (N = 8) conducted by ally representative sample of married mothers.
Parish (2006), mothers of adolescents with The analysis used linear regression models with
developmental disabilities reported emotional interactions between child special needs by type
and psychological benefits from working outside (disabilities, poor health, and behavior prob-
the home as well as boosts to self-esteem, despite lems) and maternal employment status. To gauge
facing considerable difficulties balancing work the extent to which bias caused by simultaneity
and caregiving and suffering from feelings of between the dependent variable (parental mental
isolation and depression. Lewis et al. (1999) health) and employment variables might be driv-
reported that almost all the mothers in their ing the results, logistic regression models using
sample of 40 families with children with dichotomized versions of caregiving responsi-
disabilities specifically highlighted the positive bilities (children with behavior problems vs.
psychological benefits from employment, even children with only positive behaviors; children
when balancing work and family was stressful. in fair to poor health vs. children in good or
Several stated specifically that work provided excellent health) and parent mental health (high
respite: one mother said, ‘‘I went back to work anxiety and depression vs. low to no anxiety
in desperation to get out . . . it saves my sanity,’’ and depression) were also estimated, and the
and another said, ‘‘It’s not just earning money, results compared to those obtained using linear
it’s giving me some space of my own, and it gives models with interactions. Results produced by
me something to concentrate on, and while I’m both approaches were consistent with a posi-
at work I’m busy . . . not wallowing in self pity tive spillover effect from work among mothers
. . . it keeps you sane’’ (p. 565). of older children (age 6–17) with disabilities,
Two studies by Warfield (2001, 2005) health conditions, and behavior problems. Using
produced evidence consistent with positive a subsample of working caregiver mothers, the
spillover among parents with high levels of work study also found evidence that the positive
Work and Mental Health 105

mental health effects from working outside the in child-raising, women continue to be the
home may be limited to caregiver mothers who primary person in charge of child and family
work full-time, during day-time hours (between caregiving (Bianchi & Milkie, 2010; Coltrane,
6 am and 6 pm), and in executive, managerial, or 1996; Harrington, Deusen, & Humberd, 2011;
professional occupations. Parish, 2006). Moreover, though most mothers,
even those with very young children, work
outside the home, fathers still tend to work more
THIS STUDY hours (U.S. Bureau of Labor Statistics, 2012).
The study reported here expands on this earlier In addition, fathers may face workplaces that
research (Morris, 2012) by examining the are less family friendly compared to mothers
relationship between work and psychological (Harrington et al., 2011; Hill, 2005; Williams,
well-being among mothers and fathers as well 2010). That said, this expectation was tempered
as single and partnered/married parents. In by research showing that, despite high rates
addition, this study also addresses a limitation of employment among mothers, sociocultural
of the earlier one by employing a more ambivalence regarding the appropriateness of
precise operationalization of child disability with working mothers (Usdansky et al., 2012;
which to identify caregiver parents. Specifically, Williams, 2000, 2010) persists, especially for
restricting the definition to include only parents mothers of children with disabilities (Lewis
of children with functional limitations improves et al., 1999).
the validity of the findings and enables a A second question examined whether the
more reliable comparison to other work–family effects of work and family caregiving are
studies. This study also tests whether parent-role different for partnered and single parents.
stress moderates the relationship between work Although it was expected that the effects of
and parent mental health, thus providing a more work would differ significantly for partnered and
nuanced analysis of the work–family dynamics single parents, the direction of difference could
of caregiver parents. Last, the potentially not be proposed a priori. Although research
biasing effects caused by simultaneity between shows that among married couples, mothers do
mental health and employment are addressed relatively more caregiving, there is still some
differently, this time by employing two-stage sharing of family and home responsibilities
least squares instrumental variables estimation within parenting couples (Coltrane, 1996; Essex
techniques and comparing the results to those & Hong, 2005; Lewis et al., 2000; Parish,
obtained using the standard, single equation 2006). Therefore, it might be expected that
linear models with interaction effects. psychological benefits from work would be
The primary question guiding this study smaller for single parents because of greater
examined whether the relationship between work–family conflict offsetting the mental health
work and parent mental health is different benefits of work. However, it may be that heavier
for caregiver parents (those with children with caregiving responsibilities among single parents
disabilities) and parents of typically developing lead to greater parent-role stress, which in turn
children. Based on role theory and the balance may create more of a need for a break from
of findings from the existing research, it was caregiving and, hence, larger positive spillover
expected that work would have larger mental effects.
health benefits for parents of children with A third question investigated whether the
disabilities compared to other parents. Due to relationship between work and parent mental
gender differences in role demands and salience, health differed according to specific job condi-
the dynamics between work, caregiving, and tions. Specifically, it was hypothesized that any
mental health were expected to be different caregiver-specific mental health benefits from
for mothers and fathers. Specifically, it was work would be offset by greater work–family
expected that beneficial mental health effects conflict at higher levels of work (hours per
from work, if present, would be smaller for week). Because working irregular shifts has been
fathers than mothers because fathers typically found to be associated with increased stress
engage in less caregiving. Research shows and depression (Campione, 2008), it was also
that despite substantial increases in labor force predicted that parents of children with disabil-
participation among women with children and ities who work daytime shifts would benefit
some smaller increases in fathers’ involvement more from work than caregivers who work
106 Family Relations

shifts outside 6 am to 6 pm. Studies also show parent respondent was most often, though not
that women in higher-level jobs have greater always, the mother or the father of the child
job and life satisfaction (Campione, 2008) and (78% of parent respondents were mothers, 17%
lower work–family strain (Swanberg, 2005), and were fathers, and 5% were some other adult
that women employed in entry-level, nonprofes- in the household). In addition to answering
sional occupations have more rigid schedules the questions about the sampled child(ren),
(Golden, 2008; McCrate, 2002). A study by questions were also asked about the parent
Wellington (2006) showed that women with respondent and his or her spouse or partner
greater family-care burdens were more likely if the spouse or partner lived in the same
to be self-employed, presumably because of household. Data were extracted from all three
greater control over workload, hours, and sched- waves of the NSAF and merged to create a
ule. Therefore, the analysis also tested whether pooled, cross-sectional sample of families. The
the relationship between work and parent mental sample used here was restricted to biological,
health differed according to parent’s occupation custodial parents identified as the MKA to the
and self-employment status. sampled child(ren), including 63,075 mothers
The final question investigated whether and 14,599 fathers. (Note: the married/partnered
parent-role stress moderates the relationship mothers and fathers used in this study are not
between work and mental health among parents married to each other; they are the MKAs from
of children with disabilities (Lin et al., different families.)
2012; Warfield, 2001, 2005). Although it was
expected that the effect of working outside Measures
the home would be different for caregiver
parents reporting high levels of stress, the Dependent variable. Parent mental health was
direction of effect was not clear. On the one based on a scale rating the severity of anxiety
hand, high levels of parent-role stress may and depression symptoms using a 5-item mental
reflect heavier caregiving duties and greater health instrument that asked how often in the
work–family conflict, which in turn may offset past month (1 = all of the time, 2 = most of
the beneficial effects from working outside the the time, 3 = some of the time and 4 = none of
home. On the other hand, parents experiencing the time) the respondent felt (a) very nervous,
higher levels of parent-role stress may have a (b) calm or peaceful, (c) downhearted and
greater need for a break from caregiving, and, blue, (d) happy, and (e) so down in the
hence, experience larger respite effects. dumps that nothing could cheer him or her
up. Responses to the questions about being
nervous, sad, and downhearted were reverse
METHOD coded and summed to create a score ranging
from 5 to 20, with higher scores indicating
Data and Sample
greater mental and emotional well-being. The
Data used in the analysis came from the NSAF measure, adapted from a 38-item scale
National Survey of American Families (NSAF), used in the Medical Outcomes Study (MOS),
a representative sample of the U.S. civilian performed well on psychometric assessments
population of children and adults younger than of internal reliability and construct validity as
age 65 (see Urban Institute and Child Trends, well as benchmark comparisons using the MOS
2002). The survey was administered by the sample and a general population sample (Ehrle
Urban Institute in 1997, 1999, and 2002 to & Anderson Moore, 1997). The NSAF also
three cross-sectional samples of approximately benchmarks poor mental health. A measure
40,000 households each. In households with was created by summing the responses to the
children younger than age 18, up to two children five mental health items and multiplying by 5
were sampled for in-depth data collection: to create a score (ranging from 25–100, with
one younger than age 6 and one between higher scores indicating better mental health)
ages 6 and 17. Interviews were conducted calibrated to a 100-point scale used by the MOS.
with ‘‘the most knowledgeable adult’’ (MKA), The MOS defined a cutoff for ‘‘poor mental
defined as the adult in the household who health’’ as scores 67 and below, based on the
was most knowledgeable about the sampled lowest 19% (coming as close as possible to
child’s well-being, health, and education. The the bottom quintile) of a general population
Work and Mental Health 107

sample. When using the same cutoff point are giving up more of your life to meet your
in the NSAF sample, the lowest 17% of the (child’s/children’s) needs than you expected,
sample were identified as having poor mental and (d) angry with your (child/children)?’’
health, a result similar to the MOS result based Responses were summed to create a scale
on a general population sample (see Ehrle & score ranging from 4 to 16, with higher
Anderson-Moore, 1997). scores indicating lower levels of parenting stress
and aggravation. The NSAF also benchmarks
Independent variables. Employment status was high parent-role stress. A score less than or
based on the parent’s answer (yes or no) to the equal to 11 identifies parents experiencing high
NSAF question: ‘‘Are you currently working? levels of parent-role stress. The continuous
Hours per week was based on the question: measure and this indicator variable were used
‘‘Considering all the jobs you have right now to test whether the relationship between work
(including self-employment), how many hours and mental well-being was influenced by
per week on average do you work?’’ A shift the level of parent-role stress. The NSAF
variable was also included to compare the adapted the scale from a measure used in
mental health of parents who worked regular the National Evaluation of Welfare-to-Work
day-time hours between 6 am and 6 pm to Strategies (NEWWS) project and assessed the
those who worked nonregular shifts. A variable psychometric properties by comparing outcomes
identifying those respondents who worked in the NSAF sample with the control group
in executive, supervisory and professional used in the NEWWS evaluation. Given the
occupations enabled the comparison to those substantial differences between the NSAF and
who work in other occupations. A variable the NEWWS samples and how the scales
flagging self-employed parents was used to were used in each survey, point estimates
test whether these parents experienced greater were not comparable; however, NSAF staff
mental health benefits from work compared to did examine patterns among socioeconomic
other working parents. subgroups and the outcomes were similar
across both samples: parent-role stress increased
Child disability status. All NSAF parent respon- with poverty, single parenthood, and lower
dents were asked of each randomly selected child parent education. Based on the strength of
(one younger than age 6 and one between ages the sociodemographic subgroup patterns in
6–17) the following question: ‘‘Does (CHILD) the NSAF data and their comparability with
have a physical, learning, or mental health con- patterns in the Jobs Opportunity and Basic
dition that limits (his/her) participation in the Skills Program/NEWWS control group data, the
usual kinds of activities done by most children measure’s psychometric properties were deemed
(his/her) age/or limits (his/her) ability to do reg- sufficiently valid and reliable (Ehrle & Anderson
ular school work?’’ The question reflects the Moore, 1997).
federal definition of disability that requires that
the condition result in significant functional lim- Control variables. A number of demographic
itations. This was used to create two dummy variables were included as controls and to exam-
variables identifying parents who have a young ine the conditions under which specific relation-
child (age 0–5) with a disability and parents ships between work, family, and mental well-
who have an older child (age 6–17) with a dis- being occur. Demographic variables included
ability to compare them to parents with typical the parent’s relationship status, education, age,
children. and race, as well as household income and the
number of children age 0 to 5 and the number
Parent-role stress. The NSAF measured parent- age 6 to 17. The NSAF asks respondents about
role stress created by summing 4-point scale their marital and partner status, thus enabling the
responses (1 = all of the time, 2 = most of identification of parents whose spouse or partner
the time, 3 = some of the time, 4 = none of lives with them. Income was controlled using
the time) to the following four items: ‘‘How a categorical variable measuring annual house-
much during the past month have you felt (a) hold income relative to the federal poverty line
your (child/children) much harder to care for based on money income received in the prior
than most, (b) your (child/children) does/do year by each person in the household age 15 and
things that really bother you a lot, (c) you older, including nonmarried partners. Sources
108 Family Relations

of income counted include money wages or Although the intent of the analysis was to
salary, net income from self-employment, Social examine the effect of work on parent mental
Security, Supplemental Security Income, inter- health, it is likely that there is a reverse rela-
est and dividends, alimony and child support, tionship between work and parent mental health
Veteran’s benefits, and unemployment insur- (i.e., anxiety and depression causing the parent
ance and worker’ compensation payments. A to cut back on hours or leave the workforce
variable flagging those parents who reported altogether). A strong reciprocal relationship
their current health as excellent or good (as between mental health and employment would
opposed to fair or poor) was also included in all inflate positive spillover effects and deflate
multivariate models. Last, a variable indicating negative spillover effects (for a more extensive
whether the parent receives employer-provided discussion, see Morris, 2012). To gauge the
health insurance was included as a control. bias caused by simultaneity between parental
Previous research found a significant associa- mental health and employment, instrumental
tion between employer-provided health benefits variables estimation was employed, and the
and higher mental well-being among mothers of results compared to those obtained using the
children with disabilities, health conditions, and basic interaction models described earlier.
behavior problems, although the link was largely Employment status (for both main and inter-
due to the strong correlation between full-time action effects) was instrumented using the
hours and the receipt of health benefits (Morris, NSAF variable ‘‘number of weeks worked
2012). last year.’’ The variable was highly correlated
with current employment status but only very
weakly correlated with current mental health
Analysis Plan status. Moreover, the number of weeks worked
A series of regression equations with interactions in the prior year was highly correlated with
were estimated to examine the relationships the endogenous variable (current employment
between work, caregiving, and parent mental status) even after all the other independent vari-
health and address the research questions. To ables were controlled for. The adjusted R2 for
investigate whether work impacted the psycho- the first stage equation regressing employment
logical well-being of parents of children with on all the independent variables was 0.115,
disabilities differently than parents of typically while the adjusted R2 for the equation with
developing children, interactions between the weeks worked last year to the model was 0.540,
child’s disability status by age (0–5 years and indicating the variable was a suitable instrument
6–17 years) and the parent’s employment status for current employment status. Other instrumen-
and job conditions were tested. Three-way tal variables were tested including current state
interactions between the parent’s gender, unemployment rate and variables measuring
caregiver status (as indicated by their child’s the parent’s attitudes toward welfare and work.
disability status), and employment status were Using Stata’s instrumental variables diagnostics
used to assess whether work and caregiving (estat endogenous, estat firststage, and estat
affected the mental health of mothers and fathers overid) it was determined that the variable
differently. Regression models with three-way ‘‘number of weeks worked last year’’ performed
interactions between the parent’s relationship better than the others in terms of strength and
status, caregiver status, and employment status validity.
were estimated on subsamples of mothers and All models were estimated using survey
fathers to assess if work and caregiving affected commands in Stata (StataCorp, 2007) to adjust
married or partnered and single parents differ- for the effects of NSAF’s complex sample
ently. To test the hypothesis that the relationship design. Like most large surveys, the NSAF
between work and mental health is moderated by is based on a stratified cluster sample rather
parent-role stress, regressions using interactions than a pure random sample (Brick, Ferraro, &
between the parent’s employment status and a Strickler, 2004). Taylor-series linearization was
dummy variable identifying those parents expe- used to compute standard errors adjusted for
riencing high levels of parent-role stress were the sample design effects. Stata survey data
estimated. Formal statistical testing (incremental analysis options are useable for regular linear
F test, Wald test) was conducted to confirm that regression as well as instrumental variables
interaction effects were statistically significant. regression.
Work and Mental Health 109

RESULTS to mothers of children with disabilities, whose


mean score is 14.7. Fathers of typically develop-
Descriptive Statistics
ing children scored, on average, 16.7, compared
Table 1 displays (weighted) sample characteris- to fathers of children with disabilities, whose
tics and the descriptive statistics for the variables mean score is 15.9, which is slightly higher than
used in the regression analyses. Fathers were, on the mean score (15.6) found among the general
average, older, less poor, more educated, and population. Nonworking mothers and fathers
more likely to be married or partnered, com- of children with disabilities have mental health
pared to mothers. Overall employment rates scores close to the cutoff (13.4) designating poor
were higher for fathers compared to moth- mental health. Nonworking mothers of children
ers, and fathers worked more hours. Mothers with disabilities are twice as likely as the gen-
and fathers of children with disabilities were eral population to be in poor mental health (40%
somewhat less likely to be working, but among compared to 19%). Nonworking fathers of chil-
employed parents, the effect of having a child dren with disabilities are also much more likely
with disabilities on hours worked was relatively to be in poor mental health (36%).
small, and insignificantly so among mothers. Table 1 provides preliminary evidence that
Mothers reported higher levels of depression working outside the home provides additional
and anxiety, compared to fathers; they also mental health benefits for parents of children
ranked higher on the parent stress scale. As with disabilities: though working parents in
expected, parents of children with disabilities, general scored higher on the mental health
especially parents of older children with disabil- scale, the difference in mean mental health
ities, reported higher levels of depression and scores between working and nonworking parents
anxiety and parent stress. of children with disabilities was larger than
As discussed, the mental health measures between working and nonworking parents
contained in the NSAF are adapted from those of children who were typically developing.
used in the MOS. Compared to MOS results Among working mothers of typically developing
produced using a general population survey, children, the mean mental health score is 16.0,
the overall mean mental health score among compared to 15.8 among those not working,
mothers in the NSAF (15.8) is slightly above whereas mean mental health scores are 15.0 and
the average of the U.S. population (15.6) and 14.2 for working and nonworking mothers of
the percentage in poor mental health is the children with disabilities, respectively. Among
same (19%). Fathers have, on average, slightly working fathers of typically developing children,
higher average mental health scores (16.7) than the mean mental health score is 16.8, compared
the general population (15.6) and are also less to 15.5 among those not working, and mean
likely to be experiencing poor mental health mental health scores are 16.1 and 14.1 for
(12% compared to 19%).1 The finding of lower working and nonworking fathers of children
mental health among mothers in general, relative with disabilities, respectively. The same pattern
to fathers, is consistent with other research emerges when observing rates of poor mental
(Voyandoff, 2002). health. For example, the difference in the
As predicted, parents of children with disabil- likelihood of being in poor mental health (a raw
ities and nonworking parents have lower mental score of 13.4 or below) between working (15%)
health scores than the general population aver- and nonworking (20%) mothers of typically
age (15.6) and rates of poor mental health that developing children is 5 percentage points,
are significantly higher than the general popu- compared to a difference of 12% between
lation (19%). Mothers of typically developing working (28%) and nonworking (40%) mothers
children scored, on average, 15.9, compared of children with disabilities. A similar pattern is
found among fathers, although the difference is
smaller. In addition to providing preliminary
1 The higher levels of mental health, particularly among
evidence of positive spillover from work,
fathers, probably reflects the fact that the NSAF is a parent-
altogether the findings indicate that the mental
only sample as well as differences between the NSAF health of fathers suffers more from nonwork
and MOS survey item construction and response categories than the presence of a child with disabilities, a
and the way the two surveys were administered (Ehrle & finding consistent with traditional gender norms
Anderson-Moore, 1997). and family dynamics.
110 Family Relations

Bivariate analysis (not included here in or professional occupation (r = .07, p < .001);
the interest of space but available from the works 35 to 49 hours per week (r = .02,
author on request) also showed a significant p < .001); works more than 50 hours per week
and positive relationship between work and (r = .03, p < .001); and day shift (r = .04,
parent mental health (r = .10, p < .001), and p < .001). Bivariate correlations also revealed a
weaker but still positive relationships between relatively strong negative relationship between
parent mental health and executive, managerial, parent mental health and parent-role stress

Table 1. Sample Description by Parent’s Gender and Employment Status and Child Disability Status

Mothers

Working Nonworking
Mothers of mothers of mothers of Working Nonworking
typically Mothers of typically typically mothers of mothers of
All developing children with developing developing children with children with
mothers children disabilities children children disabilities disabilities
% or M % or M % or M % or M % or M % or M % or M
Variable (SD) (SD) (SD) (SD) (SD) (SD) (SD)

Parent and household characteristics


Mental health score (5–20, higher score 15.81 15.95 14.72 16.03 15.77 15.04 14.20
means less depression and anxiety) (2.66) (2.52) (3.10) (2.44) (2.79) (2.89) (3.33)
Poor mental healtha 19% 17% 33% 15% 21% 28% 40%
Age (years) 35.57 35.47 36.50 36.23 33.9 37.60 34.90
(7.60) (7.84) (7.43) (7.56) (8.16) (7.05) (7.71)
Race (1 = White, 0 = all other) 80% 80% 79% 79% 82% 81% 77%
Has bachelor’s degree 22% 23% 14% 26% 17% 17% 9%
Has no high school diploma 29% 28% 38% 23% 39% 31% 47%
Partnered/married 61% 68% 57% 67% 72% 58% 55%
Number of children age 0 to 5 (number) 0.66 0.68 0.52 0.55 0.94 0.37 0.73
(0.81) (0.81) (0.77) (0.73) (0.91) (0.65) (0.88)
Number of children 6 to 17 (number) 1.32 1.28 1.61 1.30 1.25 1.59 1.65
(1.07) (1.07) (1.01) (1.00) (1.19) (0.87) (1.20)
Parent in good to excellent health 90% 91% 77% 93% 88% 83% 67%
(1 = yes, 0 = fair or poor health)
Family income (relative to poverty line)b 2.74 2.78 2.38 3.03 2.30 2.74 1.84
(1.27) (1.26) (1.28) (1.15) (1.32) (1.19) (1.23)
Has child age 0 to 5 with a disability 2% na 17% na na 12% 25%
Has child age 6 to 17 with a disability 9% na 0.83 na na 0.88 0.75
Parent-role stress score (4 to 16, higher 6.05 5.95 6.92 5.93 5.99 6.87 6.99
score means more stress) (1.86) (1.76) (2.30) (1.72) (1.84) (2.26) (2.37)
Highly stressed (1 = high parent-role 9% 8% 21% 7% 9% 20% 21%
stress, 0 = moderate to low or no
stress)
Currently employed 66% 67% 60%
Employed parents’ job conditions
Self-employed 9% 10% 9% 10% 9%
Typical hours per week 36.78 36.70 37.52
(average) (12.25) (12.30) (12.63)
Works 1 to 34 hours/week 29% 30% 27% 30% 28%
Works 35 to 49 hours/week 58% 58% 58% 58% 57%
Works 50 plus hours/week 12% 12% 15% 12% 15%
Works during day (between 6 am to 83% 83% 79% 83% 79%
6 pm)
Executive, managerial, or professional 33% 33% 28% 34% 28%
occupation
Receives health insurance benefits from 77% 77% 71% 77% 71%
employer
Sample size 63,040 55,812 7,042 38,160 17,602 4,372 2,667
Work and Mental Health 111

Table 1. Continued

Fathers
Working Nonworking
Fathers of fathers of fathers of Working Nonworking
typically Fathers of typically typically fathers of fathers of
All developing children with developing developing children with children with
fathers children disabilities children children disabilities disabilities

Parent and household characteristics


Mental health score (5 to 20, higher score 16.65 16.70 15.88 16.82 15.47 16.10 14.08
means less depression and anxiety) (2.45) (2.40) (2.97) (2.29) (3.06) (2.76) (3.47)
Poor mental healtha 12% 11% 21% 9% 29% 18% 36%
Age (years) 39.18 39.08 40.56 38.95 40.45 40.22 43.53
(8.09) (8.13) (7.26) (7.96) (9.66) (7.09) (9.29)
Race (1 = White, 0 = all other) 81% 80% 87% 81% 72% 87% 81%
Has bachelor’s degree 33% 34% 27% 35% 20% 30% 11%
Has no high school diploma 22% 22% 29% 21% 32% 25% 48%
Partnered/married 78% 79% 70% 80% 62% 74% 55%
Number of children age 0 to 5 (number) 0.57 0.59 0.44 0.59 0.49 0.43 0.41
(0.73) (0.73) (0.70) (0.74) (0.71) (0.70) (0.73)
Number of children 6 to 17 (number) 1.29 1.27 1.63 1.27 1.23 1.66 1.57
(1.04) (1.03) (1.01) (1.03) (1.06) (1.03) (0.97)
Parent in good to excellent health (1 = yes, 93% 94% 85% 95% 79% 89% 61%
0 = fair or poor health)
Family income (relative to poverty line)b 3.18 3.21 2.83 3.29 2.36 3.03 1.87
(1.07) (1.06) (1.19) (0.99) (1.30) (1.07) (1.19)
Has child age 0 to 5 with a disability 1% na 14% na na 14% 11%
Has child age 6 to 17 with a disability 5% na 86% na na 86% 89%
Parent-role stress score (4 to 16, higher 5.72 5.67 6.47 5.66 5.83 6.40 6.96
score means more stress) (1.67) (1.63) (2.02) (1.60) (1.94) (1.93) (2.22)
Highly stressed (1 = high parent-role 6% 6% 15% 5% 10% 13% 21%
stress, 0 = moderate to low or no stress)
Currently employed 91% 91% 84%
Employed parents’ job conditions
Self-employed 12% 12% 12% 12% 12%
Typical hours per week 46.92 47.03 44.91
(average) (11.57) (11.60) (10.79)
Works 1 to 34 hours/week 4% 4% 7% 4% 7%
Works 35 to 49 hours/week 57% 57% 61% 57% 61%
Works 50 plus hours/week 39% 39% 32% 39% 32%
Works during day (between 6 am to 6 pm) 83% 83% 78% 83% 78%
Executive, managerial, or professional 34% 34% 27% 35% 27%
occupation
Receives health insurance benefits from 83% 83% 79% 83% 83%
employer
Sample size 14,586 13,506 1,056 12,201 1,294 889 166
Source: National Survey of American Families (1997, 1999, 2002 waves).
Notes: Data adjusted for complex sampling design of the NSAF.
a Parents in poor health have raw mental health scores of below 13.4. The cutoff is based on the mental health scores of the bottom

approximately 20% of the U.S. population (see Erhle & Anderson-Moore, 1997). b Family income as a percentage of poverty: 0.5 (less than
50%), 1 (between 50% and 100%), 1.5 (between 100% and 150%), 2 (between 150% and 200%), 3 (between 200% and 300%), 4 (300% or
more). All mother-father differences are statistically significant to at least the p < .10 level except for number of children age 6 to 17 years,
percent White, percent who work day shift, percent who work 35 to 49 hours per week, and percent who work in executive, managerial, or
professional occupations. Among mothers, all differences between those with and without a child with disabilities are statistically significant
to at least the p < .10 level except for percent White, percent self-employed, and percent who typically work 35 to 49 hours per week. Among
mothers of typically developing children, all differences between those working and those not working are statistically significant to at least the
p < .10 level. All differences between working and nonworking mothers of children with disabilities are statistically significant to at least the
p < .10 level except the percent experiencing high levels of parent-role stress. Among fathers, all differences between those with and without a
child with disabilities are statistically significant to at least the p < .10 level except for percent self-employed. Among fathers of typical children,
all differences between those working and those not working are statistically significant to at least the p < .10 level except for the number of
children age 6 to 17. All differences between working and nonworking fathers of children with disabilities are statistically significant to at least
the p < .10 level except for the number of children age 0 to 5 and the number of children age 6 to 17.
112 Family Relations

(r = −0.36, p < .001), and a weak but significant and fathers.2 Results displayed in columns 3
negative relationship between parent-role stress (mothers) and 4 (fathers) of Table 2 indicate
and currently employed (r = –0.04, p < .001). that no significant additional benefits from work
Taken together, these results are consistent with accrued to married/partnered mothers of children
the hypothesis that the relationship between with disabilities.
work and mental health is influenced by the level Table 2 also displays the results from
of parent-role stress, and that caregiver parents ordinary least squares regressions examining
who are highly stressed benefit more from the relationship between different job conditions
working. (hours, occupation, shift) and parent mental
health using subsamples of employed mothers
and fathers. To test the hypothesis that mental
Regression Results health benefits from work disappear at high
Regression results are displayed in Table 2. The levels of work, a number of different hours per
study’s main hypothesis predicted that parents week specifications were estimated to determine
of children with disabilities would experience at what point mental health benefits from
work might be offset by time constraints and
greater mental health benefits (reduced depres-
work–family conflict. Among mothers, none of
sion and anxiety) from working outside the
the interactions between job conditions and child
home than would parents of typically developing
disability status was found to be statistically
children. It was also expected that caregiver-
significant, except for the interaction identifying
specific positive effects would be larger for
mothers of older children with disabilities who
mothers compared to fathers. To test these
typically work 50 or more hours per week, which
hypotheses, three-way interactions between par-
was negatively associated with mental well-
ent’s employment status, gender, and variables
being. Among fathers, none of the interactions
identifying parents of children with disabili-
between job conditions and child disability status
ties (age 0–5–6–17) were added to regression
were significant, except those identifying fathers
models. The significant positive coefficient for
of disabled children (age 0–5 and 6–17) who
the three-way interaction between employment
worked during the day, which were negatively
status, female gender, and the presence of a
associated with mental well-being.
child age 6 to 17 with a disability (ß = .943,
The final column in Table 2 displays
p < .10, 95% confidence interval [CI]: [0.004,
regression results investigating the relationship
1.881]) indicates that mothers of older children
between parent’s employment status and level of
with disabilities benefit more from work than
parent-role stress, using a subsample of parents
do other parents. Specifically, it is estimated
of children with disabilities. The significant
that the increase in the mean mental health
positive coefficient on the two-way interaction
score among caregiver mothers of older chil- between parent’s employment status and high
dren with disabilities as a result of going to parent-role stress (ß = .508, p < .10, 95% CI
work is about 1 point (or, based on the 95% [–0.114, 1.130]) indicates that these parents
CI estimates, between 0.004 and 1.881 higher). experience additional beneficial effects from
Results produced using the instrumental vari- working outside the home. Specifically, working
ables approach were largely similar to those caregiver parents who are experiencing high
produced by the linear interaction models, indi- levels of parent-role stress score about a half
cating that the findings suggestive of a positive point higher on the mental health scale (or,
spillover effect from work were not merely an according to the 95% CI estimates, between
artifact of simultaneity between parent mental 0.01 point lower and 1.13 points higher).
health and employment status. For the sake of
simplicity and in the interest of space, these
results are not shown here. 2
To assess whether the combined effects of Higher-order interaction models can, in general, be
unreliable and the effects difficult to interpret, but because
work and caregiving are different for married or there were a small number of single fathers with a child
partnered and single parents, models with three- with disabilities (especially children younger than age 6)
way interactions between parent’s relationship analysis of models including four-way interactions between
status, employment status, and child disability parent’s employment, gender, marital/partner status, and
status were estimated on subsamples of mothers child disability status by age were particularly unreliable.
Work and Mental Health 113

Table 2. Ordinary Least Squares Estimates of the Association between Work, Caregiving, and Parent’s Mental Health

Full Full
sample: sample: Parents of
Mothers and Mothers and Employed Employed children w/
Variables fathers fathers Mothers Fathers mothers fathers disabilities

Parent’s age 0.004∗ 0.005∗ 0.005∗ 0.002 0.002 –0.001 –0.013


(0.002) (0.002) (0.003) (0.005) (0.003) (0.005) (0.008)
Parent’s race (White = 1) –0.398∗∗ –0.406∗∗ –0.443∗∗ –0.307∗ –0.496∗∗ –0.253∗ –0.588∗∗
(0.045) (0.045) (0.052) (0.095) (0.058) (0.102) (0.168)
Parent’s sex (female = 1) –0.432∗∗ 0.216 na na na na –0.687∗
(0.037) (0.135) (0.190)
Parent has bachelor’s degree 0.140∗∗ 0.139∗∗ 0.217∗∗ –0.058 0.116∗ –0.022 0.183
(0.034) (0.034) (0.038) (0.073) (0.049) (0.086) (0.143)
Parent partnered/married 0.430∗∗ 0.419∗∗ 0.783∗∗ –0.037 0.289∗∗ 0.387∗∗ 0.401∗
(0.041) (0.041) (0.087) (0.278) (0.055) (0.092) (0.141)
Parent in good to excellent health 1.504∗∗ 1.483∗∗ 1.484∗∗ 1.264∗∗ 1.303∗∗ 1.239∗∗ 1.856∗∗
(0.062) (0.062) (0.067) (0.169) (0.087) (0.189) (0.1573)
Household incomea 0.200∗∗ 0.199∗∗ 0.1898∗∗ 0.184∗∗ 0.147∗∗ 0.114∗∗ 0.369∗∗
(0.016) (0.016) (0.018) (0.037) (0.025) (0.042) (0.351)
Number of children age 0 to 5 0.201∗∗ 0.193∗∗ 0.196∗∗ 0.164∗∗ 0.139∗∗ 0.158∗∗ 0.153
(0.024) (0.024) (0.027) (0.059) (0.037) (0.058) (0.100)
Number of children age 6 to 17 0.102∗∗ 0.010∗∗ 0.099∗∗ 0.090∗ 0.094∗∗ 0.113*** 0.005
(0.017) (0.017) (0.019) (0.038) (0.025) (0.039) (0.073)
Has disabled child age 0 to 5 –0.327∗ 0.166 –0.037 0.784 –1.04∗ 1.614# na
(0.132) (0.492) (0.473) (1.072) (0.407) (0.736)
Has disabled child age 6 to 17 –0.455∗∗ 0.127 –0.690∗ –0.864 –0.374#* –0.273 na
(0.060) (0.425) (0.187) (0.565) (0.231) (0.545)
Parent-role stressb –0.466∗∗ –0.466∗∗ –0.476∗∗ –0.417∗∗ –0.456∗∗ –0.409∗∗ see below
(0.010) (0.009) (0.011) (0.021) (0.012) (0.022)
Currently employed 0.165∗∗ 0.770∗∗ 0.406∗∗ 0.625∗∗ na na 0.325∗
(0.038) (0.135) (0.084) (0.244) (0.147)
Interactions between parent employment status and child disability status
Female ∗ Employed –0.712∗∗
(0.141)
Female ∗ Disabled child 0 to 5 –0.477
(0.536)
Female ∗ Disabled child 6 to 17 –0.999#
(0.438)
Employed ∗ Disabled 0 to 5 –0.017 –0.447 –1.048
(0.599) (0.600) (1.690)
Employed ∗ Disabled 6 to 17 –0.358 0.417∗ 0.164
(0.460) (0.223) (0.727)
Female ∗ Employed ∗ Disabled 0 –0.142
to 5
(0.656)
Female ∗ Employed ∗ Disabled 6 0.943∗
to 17 (0.478)
114 Family Relations

Table 2. Continued

Full Full
sample: sample: Parents of
Mothers and Mothers and Employed Employed children w/
Variables fathers fathers Mothers Fathers mothers fathers disabilities

Interactions between parent employment status, relationship status, and child disability status
Married/Partnered ∗ Employed –0.488∗∗ 0.382
(0.093) (0.291)
Married/Partnered ∗ Disabled 0 to 5 –0.067 –1.048
(0.5158) (1.328)
Married/Partnered ∗ Disabled 6 to 17 –0.073 1.515#
(0.222) (0.855)
Married/Partnered ∗ Disabled 0 to 5 ∗ 0.201 1.472
Employed (0.624) (1.898)
Married/Partnered ∗ 0.077 –0.989
Disabled 6 to 17 ∗ Employed (0.274) (0.987)
Parent employment conditions
Self-employed 0.237∗∗ –0.243#
(0.063) (0.126)
Executive, managerial, professional 0.077 –0.039
occupation (0.048) (0.086)
Day shift (between 6 am and 6 pm) 0.106# –0.006
(0.059) (0.097)
Has employer-provided health 0.270∗∗ 0.216#
insurance (0.059) (0.115)
Works 35 to 49 hours/weekc –0.026 0.168
(0.048) (0.169)
Works 50 plus hours/weekc –0.143∗ 0.001
(0.071) (0.173)
Interactions between parent employment conditions and child disability status
Self-employed ∗ Disabled 0 to 5 0.176 0.412
(0.489) (0.886)
Self-employed ∗ Disabled 6 to 17 0.013 0.971
(0.286) (0.670)
Executive/management/professional 0.227 0.515
∗ Disabled 0 to 5
(0.308) (0.637)
Executive/management/professional 0.153 –0.509
∗ Disabled 6 to 17
(0.162) (0.349)
Day shift ∗ Disabled 0 to 5 0.133 –1.359∗
(0.304) (0.628)
Day shift ∗ Disabled 6 to 17 0.073 –0.798∗
(0.223) (0.367)
Employer-provided health insurance 0.323 –0.257

Disabled 0 to 5 (0.373) (0.887)
Employer-provided health insurance 0.213 0.632

Disabled 6 to 17 (0.176) (0.653)
Works 35 to 49 hours/week 0.377 –0.531

Disabled 0 to 5 (0.339) (0.994)
Works 35 to 49 hours/week –0.183 0.045
∗ Disabled 6 to 17
(0.177) (0.510)
Work and Mental Health 115

Table 2. Continued

Full Full
sample: sample: Parents of
Mothers and Mothers and Employed Employed children w/
Variables fathers fathers Mothers Fathers mothers fathers disabilities

Works 50plus hours/week ∗ Disabled 0.236 –0.539


0 to 5 (0.452) (1.048)
Works 50plus hours/week ∗ Disabled –0.631∗ 0.446
6 to 17 (0.252) (0.484)
Interactions between parenting stress and employment status
High parent stress –0.216∗∗
(0.895)
High parent stress∗ employed 0.508#
(0.315)
Sample size 77,626 77,626 62,814 14,561 42,617 13,107 6,792
R2 (adjusted) 0.2100 0.2139 0.2108 0.1511 0.1809 0.1263 0.2318
Source: National Survey of American Families (1997, 1999, 2002 waves).
Notes: Data adjusted for the complex sampling design of the NSAF. Beta coefficients are not standardized (standardized
coefficients not available using Stata’s survey commands). Standard errors are presented in parentheses. Sample excludes
parents with more than one child with disabilities.
a
Family income as a percentage of poverty: 0.5 (less than 50%), 1 (between 50% and 100%), 1.5 (between 100% and
150%), 2 (between 150% and 200%), 3 (between 200% and 300%), 4 (300% or more). b Parent-role stress scale score (4–16)
is coded such that higher scores are indicative of greater levels of stress/aggravation. c Reference category includes those who
work less than 35 hours per week.
# p < .10, ∗ p < .05, ∗∗ p < .01

DISCUSSION Importantly, the psychological benefits from


This study adds to the existing work–family work do not appear to be due to mothers of
children with disabilities working fewer hours.
literature in two important ways. First, it
Mothers of children with disabilities were some-
examined the relationships between caregiving,
what less likely to be employed; when employed,
work, and mental health among mothers and
however, they worked the same number of hours,
fathers using a nationally representative sample. on average, as mothers of children who are typ-
Second, by investigating whether parent-role ically developing (see Table 1). Moreover, the
stress attenuates the relationship between work results of this study indicate that the beneficial
and parent mental health, it provided a more effects from work for mothers of older children
thorough analysis of the work–family dynamics with disabilities disappear only at high levels of
of caregiver parents. In general, the results work (50 or more hours per week).
showed some evidence of a positive effect from The analysis also investigated whether the
work, at least among mothers of older children relationship between work and mental health
with disabilities. The results also suggested was moderated by parent-role stress. Not
that the psychologically harmful effects of surprisingly, the results showed a strong negative
high parent-role stress may be offset, at least relationship between parent-role stress and
somewhat, by working outside the home. mental well-being. However, work does not
Using three-way interactions between par- appear to make things worse. In fact, the
ent’s employment status, gender, and variables significant two-way interaction between parent’s
identifying parents of disabled children (age 0–5 employment status and the variable signaling
and 6–17), the analysis confirmed the hypothe- high levels of parent-role stress indicates that
sis for mothers of older children with disabilities highly stressed parents experience larger benefits
that work provides additional mental health ben- from working outside the home, compared to
efits. This result is consistent with respite effects caregiver parents who are experiencing less
from work found in earlier, smaller studies. stress. This is consistent with the hypothesis that
116 Family Relations

parents experiencing higher levels of parent- not appear to be a significant difference in the
role stress have a greater need for a break from benefits accruing to married/partnered and sin-
caregiving, and, hence, experience larger respite gle mothers. The absence of difference here
effects. might reflect a lack of significant sharing of
The finding that only mothers of older home and family duties among married and
children with disabilities benefit from work may partnered parents. All of the mothers in the
reflect a greater need for respite, and/or sources focus group study by Parish (2006) reported
of satisfaction outside the home, despite higher that they bore a disproportionate amount of the
levels of work–family conflict (Brennan & caregiving responsibilities, even those who were
Brannan, 2005; Parish, 2006). This result might married or partnered. Using a nationally repre-
also reflect concerns about leaving younger sentative sample of parents, Minnotte (2012)
children, especially those with disabilities, did not find reduced levels of work–family con-
in the care of others (Lewis et al., 1999). flict among partnered parents. She speculated
Another possibility is that younger children with that competing work–family responsibilities and
disabilities require more therapeutic or medical unmet expectations about sharing home and fam-
treatments, doctor’s visits, and other appoint- ily responsibilities created stress and frustration
ments, thus increasing work–family conflict. that canceled out the potential benefits of ‘‘an
In other words, work itself might be respite, extra pair of helping hands.’’
but the care coordination aspects of the child’s Altogether, the results of this study indicate
condition may offset any positive spillover. that work is not necessarily harmful to the
The finding that fathers of children with mental well-being of parents of children with
disabilities do not experience additional psy- disabilities and may even produce significant
chological benefits from work is consistent with positive spillover effects. It should also be noted
less involvement in caregiving, however, this that the overall mean mental health score among
finding might also reflect higher work–family nonworking parents of children with disabilities
conflict. Table 1 shows that fathers work more was above the ‘‘poor mental health’’ cutoff
hours than mothers, and that though fathers found in the general population (13.4), indicating
of children with disabilities work fewer hours a special resilience among these parents. If there
than other fathers, they still work, on aver- is a mental health-enhancing spillover effect
age, 45 hours per week. In comparison, working from work, supporting parents of children with
mothers of children with disabilities worked, on disabilities in work and reducing work–family
average, 37 hours per week. It could also be conflict has importance beyond the obvious
that fathers face a less family-friendly work- short-term and long-term economic impacts
place, with employer expectations of the ‘‘ideal (Porterfield, 2002; Powers, 2002; Stabile &
worker,’’ a person unencumbered by family Allin, 2012). In addition to compromising the
responsibilities, greater for fathers compared to mental health of parents, caregiver mental
mothers (Harrington et al., 2010; Hill, 2005; and emotional distress can interfere with
Williams, 2010). the parent–child relationship and undermine
It was tentatively proposed that married and children’s healthy emotional, cognitive, and
partnered parents of children with disabilities physical development (Deater-Deckard, 2005;
would benefit more than single parents of chil- Downey & Coyne, 1990; Ehrle & Anderson-
dren with disabilities from working outside the Moore, 1997; Perry-Jenkins & Gillman, 2000;
home because sharing of home and family Walker, Ortiz-Valdes, & Newbrough, 1989).
responsibilities would reduce work–family con- Public and employer support to assist working
flict. Indeed, bivariate analysis did show that parents of children with disabilities to help
married/partnered parents experienced lower them maintain employment may be justified
levels of parent-role stress. However, the regres- (Boushey, 2011; Hill, Martinson, Ferris, &
sion results did not support the hypothesis: the Baker, 2004; Leiter, Krauss, Anderson, &
interaction between parent’s relationship status, Wells, 2004; Williams, 2000). Compensatory
parent’s employment status, and child disability time, alternative scheduling, and compressed
status was not found to be significantly differ- work weeks as well as schedule predictability
ent from zero. In other words, though mothers help working parents and caregivers resolve
of older children in general experience posi- work–family conflicts (Boushey, 2011). Of
tive mental health effects from work, there does course, such benefits will be supportive only
Work and Mental Health 117

to the extent that the parents feel that their friends) and formal (social services), would
commitment to work will not be questioned improve the analysis (McDonald et al., 1999;
if they avail themselves of such family- Perry-Jenkins, Repetti, & Crouter, 2000). More
friendly options. Right-to-request legislation precise measurement of the actual division of
is needed to protect working caregivers who labor within the household and across extended
request alternative schedules and to encourage family and noncustodial parents as well as
employers to accommodate such requests satisfaction with that division of labor (Essex
(Boushey, 2011). In addition, research finds & Hong, 2005) is also needed. It should also
that the work–family problems facing parents be noted that the regression results produced
of children with disabilities are often related here show a strong, independent association
to difficulties accessing child care. Mothers of between mental well-being and income, with
children with disabilities express concern about poorer parents experiencing significantly higher
the costs (Lukemeyer, Meyers, & Smeeding, rates of anxiety and depression. There is
2000) and quality of child care available to their also a strong link between parent-role stress
child (Lewis et al., 1999; Parish, 2006). For and income, with poor parents experiencing
families with older children with disabilities, significantly higher stress (Ehrle & Anderson-
schools are an important component of care Moore, 1997). Because the challenges facing
(Epstein et al., 2005). Therefore, support might low-income parents of children with disabilities
also include grants to schools to increase the are likely to be considerably greater than those
supply of care options and subsidies to offset facing other parents, the impacts of work and
higher costing child care for older children with the types of work–family supports needed by
exceptional needs (Lukemeyer et al., 2000). these families warrants particular attention by
Positive spillover is a plausible explanation researchers, policy analysts, and practitioners.
for the results reported here. Nonetheless, the The analysis would also benefit from control
study is subject to a number of limitations. of child care quality and cost. Concern about
First, I speculate that working outside the the quality of child care may have a moderating
home provides a break from caregiving, effect on the mental health benefits from work
which in turn has a positive impact on the (Gordon, Usdansky, Wang, & Gluzman, 2011).
caregiver’s psychological well-being; however, Controlling for child care expenses would also
there are alternative or additive explanations. improve the analysis. The NSAF did not query
For example, Greenhaus and Powell (2006) parent’s perceptions of child care quality but
posit that a parent’s involvement in work did ask parents about child care use, type, and
enhances her caregiving through the acquisition expense, so these variables were not included in
of resources (e.g., skills, knowledge, material the current analysis. However, the questions vary
resources, social support, etc.), which in turn somewhat across waves (1997, 1999, and 2002)
improves her mental and emotional well-being. and too many cases were missing information,
More research is needed to determine whether especially about child care expense. Control
gains in psychological well-being are direct (i.e., of household income relative to poverty and
work as respite from caregiving reduces stress) the categorization of child disability status
or indirect (i.e., improved mood comes from according to age (0–5 years and 6–17 years)
enhanced efficacy in caregiving, which in turn should control for the effect of child care
comes from developmental gains from work). expenses to some degree, and to a lesser, more
The policy and practice implications differ indirect way, child care quality.
considerably depending on the mechanism by Caution must also be taken when interpreting
which participation in work produces positive and using these findings due to the reciprocal
mental health impacts, and the mechanisms may relationship between work and parent mental
not be universal. health. Measures were taken to confirm mental
As well, the field has yet to sufficiently health benefits from work separate from the
identify how these differences might vary endogenous effects between work and parent
among subgroups of families and/or according mental health, but the methodology is still
to community characteristics, family resources, limited by the fact that the data are cross
and the presence and quality of supports. sectional. Additionally, the disability measure
Controlling for differences in coping skills available in the NSAF is relatively crude. It
and social support, informal (family, relatives, is based on only one question and does not
118 Family Relations

account for the type or severity of the child’s to family and family to work, especially among
disability, detailed information about functional mothers of children with behavioral problems,
status, or the absence or presence of behavior but that parents (usually mothers) reduced their
problems. Additional research is needed to work hours because of difficulty finding appro-
capture the complexity of child needs, the extent priate and affordable child care and balancing
of parent caregiving involved, and the nature of work and caregiving responsibilities. Addi-
interactions among these factors and sources of tionally, parents in the Freedman et al. study
support. The pooling of samples across the three commented on working extra hard and ‘‘bending
waves of the NSAF produced larger samples over backwards’’ or being ‘‘super achievers’’
than used in previous studies; however, the to make up for the fact that they might need
number of single parents, especially fathers, with to ask for concessions or work–family accom-
a child with special needs was small, making it modations (p. 510). This calls in to question
difficult to quantitatively verify whether work the sustainability of positive spillover effects
has beneficial or harmful mental health effects. and highlights the potential limits to workplace
Last, it should also be noted that estimated policy changes; there is a corresponding need to
effect of going to work on the mental health examine the attitudinal and cultural influences
of caregiver mothers is modest. The point on parent, employer, and coworker perceptions
estimate on the three-way interaction between of dual roles and the strain they may produce.
employment status, female gender, and child- Workplace policies are but one of several con-
disability status indicates that participation in textual factors that combine to influence how
work increases the mean mental health score individuals ultimately experience and manage
among mothers of disabled children by just their complex roles as parents, spouses/partners,
under 1 point (ß = .943) whereas the 95% CI employees, colleagues, and extended family
indicates the effect of work on average mental members. There remain complex social expec-
health scores could be nearly nonexistent or tations, gendered perceptions of caregiving
nearly 2 points. The average mental health score and employment, and the pervasive influence
among the nonworking mothers of children of socioeconomic status on adaptation. Taken
with disabilities in this sample was 14.2; a together, these factors influence employee
1-point increase to about 15 brings the mean productivity, parent stress, and the mental health
score among caregiver mothers closer to the of family members, and there are economic and
population average of 15.6 and reduces by human costs associated with each. Given the
about 5% the number in poor mental health. centrality of work–family balance in the lives of
Although these predicted improvements in families, and the national commitment to family
maternal mental health are certainly hopeful, the fundamental social unit, it behooves us to
the role of work as a solution to caregiver stress better understand how policy and practice can
should not be overstated. support the optimal function of parents who have
Parents of children with disabilities may children with extraordinary caregiving needs.
benefit from going to work, but work–family
conflict has an independent impact on parent ACKNOWLEDGMENT
mental health that should not be ignored This research on which this paper is based was supported
(Grzywacz & Bass, 2003). Indeed, though by funding from the Association for Public Policy Analysis
this study found evidence suggesting that and Management/NSAF Small Research Grants Program in
working outside the home may somewhat offset collaboration with the Annie E. Casey Foundation.
parent-role stress, stress was higher among
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