Perceived Lack of Caregiving Choice Among Family Caregivers In Canada: Stress Outcomes and Determinants

Background and Purpose: Despite the critical role of family caregivers in the care system, caregiving is not always experienced as a voluntary choice. A perceived lack of caregiving choice has been linked to adverse mental health outcomes, yet existing evidence offers limited insight into how caregiving contexts and culturally-specific social positions shape constrained choice. Given persistent social inequities in caregiving responsibilities, it is essential to examine caregiving choice and caregiver stress through a structural and relational lens. This study investigates the association between perceived caregiving choice and self‑rated stress among family caregivers in Canada, and examines sociodemographic and caregiving‑related determinants of perceiving no caregiving choice.

Methods: This study utilized nationally representative, cross‑sectional data from the 2018 Canadian General Social Survey (GSS): Caregiving and Care Receiving cycle. The analytic sample included 7,397 caregivers aged 15 and over who reported a primary care recipient with a main health condition. The unit of analysis was individual caregivers. Survey weights were applied and rescaled in accordance with Statistics Canada guidelines. Self‑rated stress was dichotomized into lower versus higher stress. Perceived caregiving choice was categorized as having a choice, having no choice, or not stated. Multivariate binary logistic regression models were estimated to assess (1) the association between perceived caregiving choice and stress, and (2) determinants of lacking perceived caregiving choice.

Results: Caregivers who perceived having no choice in taking on caregiving responsibilities were twice as likely to report higher stress compared with those who perceived having a choice (OR = 2.04, 95% CI: 1.79–2.32). Caregivers who did not state whether they had a caregiving choice also reported significantly higher stress than those who reported having a choice (OR = 1.30, 95% CI: 1.13–1.49). Perceived lack of caregiving choice was more common among women, older caregivers, East Asian caregivers, those co‑residing with care recipients, primary caregivers, and caregivers of individuals with mental illness or more severe health conditions. On the other hand, partner caregivers, sibling caregivers, relative caregivers, and non‑kin caregivers are less likely to feel that they have no choice in caregiving.

Conclusions and Implications: These findings highlight perceived caregiving choice as a critical determinant of caregiver stress and demonstrate that constrained choice is patterned by caregivers’ social positions and caregiving contexts rather than individual preference alone. Notably, East Asian caregivers were more likely to perceive having no caregiving choice, suggesting that culturally embedded norms of familial obligation may heighten constrained agency in caregiving roles. The elevated stress among caregivers who did not report a clear caregiving choice further suggests complexity in caregiving decision‑making. Caregivers of individuals with mental illness were also particularly likely to experience constrained caregiving choice and elevated stress, underscoring the need for targeted mental health and social support policies that address stigma and limited alternative supports for family caregivers. Policies and interventions aimed at supporting family caregivers should explicitly recognize limited room for choice, particularly among culturally and relationally obligated caregivers, to address caregiver stress and promote mental health equity.