Pathways from Childhood Maltreatment to Caregiver Burden Among Adult Children: The Mediating Role of Filial Piety

Background and purpose: Caregiver burden is the most frequently reported negative health outcome in research on caregiving. Research evidence from meta-analysis indicates that greater filial piety may reduce caregiver burden. Filial piety, as an ideology that sustains intergenerational solidarity, holds significant cultural importance in aging societies. In the traditional narrative of filial culture, children are raised to be respectful, responsible, and motivated to love and repay their parents. Therefore, caregivers with stronger filial piety may view caregiving as a way to conform to social morality, with a stronger sense of gain and achievement, which buffers their caregiving stress. By contrast, childhood maltreatment can erode the trust and warmth that underlie filial reciprocity, resulting in duty-bound compliance of caregiving rather than a genuine motivation. However, empirical evidence linking childhood maltreatment, filial piety, and caregiver burden remains limited. Thus, the current study examines the association between childhood maltreatment and caregiver burden of adult children, and examines whether filial piety mediates the relationship.

Methods: We used convenience sampling at two public hospitals in Shenzhen, China, to recruit caregivers, specifically adult children of hospitalized older adults. This study involved 346 participants, of whom 62.4% were female, with a mean age of 40.34 (SD = 8.34). The major assessment tools included: (1) the Parent-Child Conflict Tactics Scales (CTSPC) to measure respondents’ childhood maltreatment experiences, (2) the Contemporary Filial Piety Scale (CFPS) to measure respondents’ level of filial piety, and (3) the Caregiver Strain Index (CSI) to measure caregiver burden. Data analyses were performed using PROCESS Model 4 with 5000 bootstrap resamples to estimate and test the significance of the direct and indirect effects.

Results: Results showed that various forms of childhood maltreatment, including physical abuse, psychological abuse, and neglect, were all positively linked to caregiver burden of adult children and negatively linked to their filial piety. Additionally, filial piety was negatively associated with caregiver burden. Filial piety particularly acted as a mediator between childhood physical abuse and caregiver burden (indirect effect = 0.0374), between childhood psychological abuse and caregiver burden (indirect effect = 0.0564), and between childhood neglect and caregiver burden (indirect effect = 0.0638), after accounting for demographic factors.

Conclusions and Implications: The findings suggest that childhood maltreatment increases caregiver burden both directly and indirectly by undermining adult children’s filial piety. While filial piety can buffer caregiving strain, its erosion indicates a pathway by which childhood maltreatment compounds the later caregiving burden. Thus, for caregivers who are survivors of childhood maltreatment, trauma-informed supports can be helpful to address triggers and ambivalence. Furthermore, family-based approaches that align caregiving expectations and plan for alternative arrangements are necessary.