The psychological toll of caregiving and the complicated relationship between familial duty, cultural expectations, and mental health
My grandmother has a heart condition.
She cannot drive. My mother takes her to every appointment. She waits, sometimes for hours, and then calls afterward about the results. She schedules the next appointment, and the one after that. The visits themselves can take only minutes, but the responsibility continues long after she leaves the hospital.
My grandparents did not know how to answer their phone. When it rang, they would let it stop and call the person back. I spent a week teaching them how to pick up. The larger problems were never mine. Taxes, paperwork, the printer, a renovation, anything that breaks—if a form is confusing, they call my mother. If they do not know what to do, they call her.
A couple weeks ago, the consequences were more serious. My grandfather tried to climb a ladder to the roof. My mother was underneath him when he fell, landing on her and severely bruising her shoulder. There is a difference now between what my aging grandparents want to do and what they are safely capable of doing on their own.
No one calls this caregiving. There is no bedside, no crisis, no moment when the family admits that something has shifted. There are only the small responsibilities that accumulate on someone’s shoulders, often without negotiation.
Researchers have described this kind of work as “invisible [ … ] health work.” It was found that family caregiving can include administrative work, property maintenance, renovations, and managing access to health services and equipment. The work is easy to overlook precisely because, when it is done successfully, nothing appears to have gone wrong.
There is also the work of remembering. Research on “invisible family load” describes managerial, cognitive, and emotional dimensions of family responsibilities. Care is not only the appointment itself: it is remembering that it exists, arranging what is needed, following up afterward, and keeping track of what happens next.
A meta-analysis of 55 studies involving 9847 carers of older relatives found a large association between subjective caregiver burden and depressive symptoms. Although the finding does not establish causation, it suggests that caregivers’ subjective experience of burden is closely linked to depressive symptoms.
My mother is in the middle of a master’s degree. She also has a child who is still moving through school and parents whose needs do not arrive on a schedule. A call can break her concentration. An errand can cancel an afternoon. Taken one by one, none of these moments seem extraordinary. Together, they have made her the person everyone turns to.
In some East Asian families and communities, caregiving is shaped by filial piety: the expectation that adult children respect, support, and care for their parents. Among Chinese-Canadian caregivers, filial piety can influence how they appraise their responsibilities and may buffer some negative effects of caregiving stress. But this does not mean filial piety is unambiguously protective. A systematic review of East Asian caregivers found that filial culture could be associated with lower caregiver burden while also creating constraints for caregivers.
Filial piety can give responsibility meaning. It can also make responsibility harder to negotiate. Research on filial obligation has found an association between stronger perceived obligation and depressive symptoms, although the evidence was limited and does not establish causation. A 2026 integrative review similarly identified filial piety as one of several cultural values that can deter East Asian caregivers from seeking support.
I wonder if that is part of what makes setting a boundary so difficult for my mother. Saying no is not only about time or energy. When caregiving is understood as a responsibility owed to one’s parents, stepping back can feel like something more than refusing a task.
It is also worth noting that caregiving is not distributed evenly. A systematic review of family caregivers of people with dementia found that most included studies reported higher caregiving burden among female caregivers, although the evidence had important limitations.
I did not notice the weight of my mother’s role for a long time. Two children in university, a teenager at home, graduate school, aging parents—it is a list that never quite ends. She did not complain in the language of burnout. She simply kept answering.
Only recently did I hear her say something I had rarely, if ever, heard before:
“I can’t, Dad.”
For my mother, I wonder whether that sentence was difficult precisely because duty had become so intertwined with love, family, and responsibility.
The research can tell us about burden, depression, gender, and the complicated effects of filial obligation. But it cannot capture the sound of a woman who has answered for years finally saying that she cannot.