532 Women’s Health Psychology
orientation. Such support may offset negative health conse-
quences. However, since males maintain the majority of key
supervisor positions at this time, these “ndings indicate that
women continue to be at a disadvantage in terms of organiza-
tional advancement.
Women’s Role as Spouse and as Caregiver
Although most women ultimately marry, age at “rst marriage
is increasing (Barnett & Hyde, 2001), divorce remains a
stable entity, and many individuals choose to cohabitate with
an intimate partner. As a result, there are a large number of
unmarried, as well as married, individuals in the workforce.
The research literature addressing multiple roles, however,
has tended to focus on women in traditional heterosexual
marriages.
When examining women•s role as support provider to
their husbands, Waldron and Jacobs (1989) found European
American women who were married or employed, or both
married and employed, had favorable health trends, as op-
posed to European American women who were not married
or employed. Interestingly, for European American women,
marriage had bene“cial ef fects for those who were not work-
ing, while employment had signi“cant health bene“ts for
those who were not married. For African American women,
it was found that employment had positive effects on health,
but only for those with children at home. Furthermore, Afri-
can American women who did not work and stayed home
with their children showed negative health trends.
While research has demonstrated positive health out-
comes related to the marriage (i.e., wife) role, Preston (1995)
studied married and unmarried individuals and found married
women to be in the poorest physical and mental health
and the most vulnerable to stress. A signi“cant main ef fect of
social support on health also was reported, with a positive
correlation between social support and health for married
men, and a negative correlation for married women. In other
words, married men bene“ted, in terms of health, from social
support while married women who received more social sup-
port indicated poorer health.
Women•s role as caregiver, both lay and professional, has
been a primary focus in the research examining multiple roles
because the caregiving role is held by the great majority of
women. Multiple roles do not merely imply juggling work
and household tasks, because women are also the predomi-
nant caregivers and support providers to elderly parents, in-
laws, husbands, and other family members (Preston, 1995;
Walker, Pratt, & Eddy, 1995). Women with this additional
role constitute the •sandwich generation.Ž Such women are at
increased risk for health problems as they experience the
stress and time constraint of providing care to elderly friends,
parents, or other family members while simultaneously pro-
viding care to their own children, supporting their partners,
and functioning as employees in the workplace.
In comparison with population norms and noncaregiver
controls, caregivers reported higher levels of both depressive
symptoms and clinical depression and anxiety (Schulz,
O•Brien, Bookwala, & Fleissner, 1995; Schulz, Visintainer,
& Williamson, 1990). In a review of the empirical research
on psychiatric morbidity and gender differences in care-
givers, Yee and Schulz (2000) found that female caregivers
tended to report higher rates of depression and anxiety and
lower levels of life satisfaction than male caregivers. The
authors suggest these increased rates of depression are
largely attributable to the caregiver role because the rates
reported by female caregivers were higher than female non-
caregivers in the community. This is supported by results
“nding signi“cant increases in psychological distress as
women adjust to the caregiver role, as well as in women who
are continuing to provide care to a disabled or ill person
(Pavalko & Woodbury, 2000). In addition to psychiatric mor-
bidity, women may also be at increased risk for physical ill-
ness because of caregiving, as women caregivers were less
likely than men to engage in preventative health behaviors,
such as exercise, rest, taking time off when sick, and remem-
bering to take medications (Burton, Newsom, Schulz, Hirsch,
& German, 1997). It may be that having a few roles serves as
a buffer against such mental health outcomes as depression,
but occupying additional roles„particularly in combination
with the caregiver role„counterbalances the positive ef fects
reaped from other roles (e.g., employment), further contribut-
ing to role strain (Cleary & Mechanic, 1983). The effects of
caregiving on women are not limited to lay caregivers; over
90% of paid caregivers are also women (Leutz, Capitman,
MacAdam, & Abrahams, 1992).Women Occupying Multiple Roles: Who Benefits
and Who Suffers?Researchers have attempted to investigate different factors
that may increase a woman•s risk for role overload or serve as
a buffer for experiencing distress related to multiple roles. A
major factor that appears to help limit women•s struggles
with “nding a healthy balance between work and home life
and enhance the bene“ts of multiple roles involves social
support from family and friends (Marshall & Barnett, 1991,
1993). For example, women who do not feel they have their
husband•s support or approval concerning their employment
role will experience increased role strain (Elman & Gilbert,
1984). Marks (1977) suggested that role commitment is a