Skip to main content Accessibility help

We Are Caregivers: Social Identity Is Associated with Lower Perceived Stress among Rural Informal Caregivers

  • Lisa Carroll (a1), Jessica Chippior (a1), Shazya Karmali (a1), Deepika Sriram (a1) and Renate Ysseldyk (a1)...


Informal caregivers often experience high stress levels with little support, especially in rural settings. With a mixed-methods approach, this research explored experiences of rural informal caregivers, including how social identification as a caregiver, social interactions, and formal and informal coping support related to perceived stress. Major focus group themes (n = 8) included lacking available services, balancing challenges, unmet practical needs, and strong community identity. Survey data (n = 22) revealed that perceived coping support (e.g., having someone to turn to), social interactions, and caregiver identity (e.g., perceiving the role as important to one’s self-concept) were associated with lower life upset stress, but only caregiver identity was associated with managing the personal distress and negative feelings associated with caregiving stress. Results suggest that, although available rural services may fall short, other options might alleviate caregiver stress, including facilitating access to coping support, encouraging social interactions, and enhancing caregiver social identity.

Les aidants naturels ressentent fréquemment de hauts niveaux de stress dans des contextes où les sources d’appuis sont limitées, particulièrement en milieu rural. Cette recherche a fait appel à une approche à méthodes mixtes afin d’explorer les expériences d’aidants naturels vivant en milieu rural, en considérant les liens entre le stress perçu et l’identité sociale de l’aidant, les interactions sociales, ainsi que les appuis formels et informels favorisant l’adaptation. Les thèmes principaux qui sont ressortis dans les groupes de discussion (n = 8) incluaient : le manque de services accessibles, la conciliation des difficultés rencontrées, les besoins pratiques non satisfaits, la forte identité communautaire. Les données de l’enquête (n = 22) ont révélé que le soutien perçu (p. ex. pouvoir compter sur quelqu’un), les interactions sociales et l’identité d’aidant (rôle perçu comme important pour l’image de soi) étaient tous associés à une diminution du stress provenant de bouleversements de la vie, mais seule l’identité d’aidant était associée à une atténuation de la détresse personnelle et des émotions négatives liées au stress de l’aidant. Ces résultats suggèrent que, bien que la disponibilité des services dans les milieux ruraux soit insuffisante, d’autres options pourraient aider à amoindrir le stress de l’aidant, telles que l’accroissement de l’accès à des services de soutien, la promotion des interactions sociales pour les aidants et les personnes âgées et la valorisation de l’identité sociale de l’aidant.


Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Renate Ysseldyk, Ph.D. Department of Health Sciences Carleton University 1125 Colonel By Drive Ottawa, ON K1S 5B6 (


Hide All

Our appreciation to the staff and volunteers of Almonte General Hospital and Mills Community Support. Thanks also to Sue Aitken for her assistance. Student authors Carroll, Chippior, Karmali, and Sriram contributed equally to the study.



Hide All
Abu Bakar, S. H., Weatherley, R., Omar, N., Abdullah, F., & Aun, N. S. M. (2014). Projecting social support needs of informal caregivers in Malaysia. Health & Social Care in the Community, 22(2), 144154.
Alpert, P. T. (2014). Who’s caring for the caregiver? Home Health Care Management & Practice, 26(4), 266268.
Amaro, L. M. (2017). Dyadic effects of gratitude on burden, conflict, and contribution in the family caregiver and sibling relationship. Journal of Applied Communication Research, 45, 1.
Barrett, P., Hale, B., & Butler, M. (2014). Family care and social capital: Transitions in informal care. Dordrecht, NLD: Springer Science+Business Media.
Bastawrous, M. (2013). Caregiver burden—A critical discussion. International Journal of Nursing Studies, 50, 431441.
Bee, M., Barnes, P., & Luker, K.A. (2009). A systematic review of informal caregivers’ needs in providing home-based end-of-life care to people with cancer. Journal of Clinical Nursing, 18(10), 13791393. doi:10.1111/j.1365-2702.2008.02405.x
Bevans, M. F., & Sternberg, E. M. (2012). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. Journal of the American Medical Association, 307(4), 398403. doi:10.1001/jama.2012.29.Caregiving
Bjerregaard, K., Haslam, S.A., Mewse, A., & Morton, T. (2015). The shared experience of caring: A study of care-workers’ motivations and identifications at work, 37(1), 113138. Ageing and Society. doi:10.1017/S0144686X15000860
Blair, J., Volpe, M., & Aggarwal, B. (2014). Challenges, needs, and experiences of recently hospitalized cardiac patients and their informal caregivers. Journal of Cardiovascular Nursing, 29, 1. doi:10.1097/JCN.0b013e3182784123
Bland, J.M., & Altman, D. G. (2009). Analysis of continuous data from small samples. BMJ, 338, a3166.
Blomqvist, Å., Busby, C., & Canadian Electronic Library (Firm). (2012). Long-term care for the elderly: Challenges and policy options. Toronto, ON: C.D. Howe Institute.
Brannen, C., Johnson Emberly, D., & McGrath, P. (2009). Stress in rural Canada: A structured review of context, stress levels, and sources of stress. Health & Place, 15, 219227.
Brazil, K., Kaasalainen, S., Williams, A., & Dumont, S. (2014). A comparison of support needs between rural and urban family caregivers providing palliative care. The American Journal of Hospice & Palliative Care, 31(1), 1319. doi:10.1177/1049909112474712
Brown, R. M., & Brown, S. L. (2014). Informal caregiving: A reappraisal of effects on caregivers. Social Issues and Policy Review, 8(1), 74102. doi:10.1111/sipr.12002
Cameron, J. E. (2004). A three-factor model of social identity. Self and Identity, 3, 239262. doi:10.1080/13576500444000047
Campbell, J., Bruhm, G., & Lilley, S. (1998). Caregivers’ support needs: Insights from the experiences of women providing care in rural Nova Scotia. Report to the Maritime of Excellence. Retrieved from
Canadian Home Care Association. (2007). The integral role of home care in improving access to care. Ottawa, ON: Author.
Chappell, N. L., & Dujela, C. (2008). Caregiving: Predicting at-risk status. Canadian Journal on Aging/La Revue canadienne du vieillissement, 27, 169179. doi:10.3138/cja.27.2.169
Chappell, N. L., Dujela, C., & Smith, A. (2015). Caregiver well-being: Intersections of relationship and gender. Research on Aging, 37(6), 623645.
Chappell, N. L., Dujela, C., & Smith, A. (2014). Spouse and adult child differences in caregiving burden. Canadian Journal on Aging/La Revue canadienne du vieillissement, 33(4), 462472. doi:10.1017/S0714980814000336
Chappell, N. L., & Funk, L. M. (2011). Social support, caregiving, and aging. Canadian Journal on Aging/La Revue canadienne du vieillissement, 30, 355370. doi:10.1017/S0714980811000316
Copeland, J. N., Lieberman, A., Oravivattanakul, S., & Tröster, A. I. (2016). Accuracy of patient and care partner identification of cognitive impairments in Parkinson’s disease–Mild cognitive impairment. Movement Disorders, 31(5), 693698.
Crosato, K.E., & Leipert, B. (2006). Rural women caregivers in Canada. Rural and Remote Health, 6, 520.
Cumming, T. B., Cadilhac, D. A., Rubin, G., Crafti, N., & Pearce, D. C. (2008). Psychological distress and social support in informal caregivers of stroke survivors. Brain Impairment, 9(2), 152169.
Deschamps, J., & Devos, T. (1998). Regarding the relationship between social identity and personal identity. In Worchel, S., Morales, J.F., Páez, D., & Deschamps, J. (Eds.), Social identity: International perspectives (pp. 112). London, ENG: Sage Publications Ltd.
DesMeules, M., PongR., W. R., W., Read Guernsey, J., Wang, F., Luo, W., & Dressler, M.P., (2012). Rural health status and determinants in Canada. In Kulig, J. C., & Williams, A. M. (Eds.), Health in rural Canada. Vancouver, BC: UBC Press.
Donorfio, L. K. M., Vetter, R., & Vracevic, M. (2010). Effects of three caregiver interventions: Support, educational literature, and creative movement. Journal of Women & Aging, 22(1), 61.
Diehl-Schmid, J., Schmidt, E.-M., Nunnemann, S., Riedl, L., Kurz, A., Förstl, H., … Cramer, B. (2013). Caregiver burden and needs in frontotemporal dementia. Journal of Geriatric Psychiatry and Neurology, 26(4), 221229. doi:10.1177/0891988713498467
Do, Y. K., Norton, E. C., Stearns, S. C., & Van Houtven, C. H. (2015). Informal care and caregiver’s health. Health Economics, 24(2), 224237.
Doosje, B., Ellemers, N., & Spears, R. (1995) Perceived intragroup variability as a function of group status and identification. Journal of Experimental Social Psychology, 31(5), 410436. doi:10.1006/jesp.1995.1018
Duxbury, L., Higgins, C., & Schroeder, B. (2009). Balancing paid work and caregiving responsibilities: A closer look at family caregivers in Canada. Canadian Policy Research Networks, 1199. Retrieved from
Eades, B. (2018). About Almonte: Municipal info. Retrieved from
Edelman, P., Kuhn, D., Fulton, B.R., & Kyrouac, G.A. (2006). Information and service needs of persons with Alzheimer’s disease and their family caregivers living in rural communities. American Journal of Alzheimer’s Disease & Other Dementias, 21(4), 226233. doi:10.1177/1533317506290664
Ferrari, J. R., Kapoor, M., Bristow, M., & Bowman, W. H. (2006). Community elder-care in Tasmania: Examining whether caregivers believe they “make-a-difference” in an urban and rural island. Journal of Prevention and Intervention in the Community, 32, 115131.
Forbes, D. A., Markle-Reid, M., Hawranik, P., Peacock, S., Kingston, D., Morgan, D., & Jansen, S. L. (2008). Availability and acceptability of Canadian home and community-based services: Perspectives of family caregivers of persons with dementia. Home Health Care Services Quarterly, 27(2), 7599. doi:10.1080/01621420802022548
Forbes, D. A., Morgan, D., & Janzen, B. L. (2006). Rural and urban Canadians with dementia: Use of health care services. Canadian Journal on Aging, 25(3), 321330. doi:10.1353/cja.2007.0003
Grant, J. S., Clay, O. J., Keltner, N. L., Haley, W. E., Wadley, V. G., Perkins, M. M., & Roth, D. L. (2013). Does caregiver well-being predict stroke survivor depressive symptoms? A mediation analysis. Topics in Stroke Rehabilitation, 20(1), 4451.
Greenaway, K., Haslam, S.A., Cruwys, T., Branscombe, N.R., Ysseldyk, R., & Heldreth, C. (2015). From “we” to “me”: Group identification enhances perceived personal control with consequences for health and well-being. Journal of Personality and Social Psychology, 109, 5374.
Greene, J. G., Smith, R., Gardiner, M., & Timbury, G. C. (1982). Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: A factor analytic study. Age and Ageing, 11(2), 121126.
Harbison, J., Coughlan, S., Karabanow, J., & VanderPlaat, M. (2005). A clash of cultures: Rural values and service delivery to mistreated and neglected older people in eastern Canada. Practice, 17(4), 229246.
Haslam, S. A., Jetten, J., O’Brien, A., & Jacobs, E. (2004). Social identity, social influence and reactions to potentially stressful tasks: Support for the self-categorization model of stress. Stress and Health, 20(1), 39.
Haslam, S. A., O’Brien, A., Jetten, J., Vormedal, L., & Penna, S. (2005). Taking the strain: Social identity, social support, and the experience of stress. British Journal of Social Psychology, 44(3), 355370.
Haslam, C., Haslam, S.A., Ysseldyk, R., McCloskey, L.G., Pfisterer, K., & Brown, S. (2014). Social identification moderates cognitive health and well-being following story- and song-based reminiscence. Aging and Mental Health, 18(4), 425434. doi:10.1080/13607863.2013.845871
Herron, R.V., Rosenberg, M.W., & Skinner, M.W. (2016). The dynamics of voluntarism in rural dementia care. Health & Place, 41, 3441.
Hinojosa, M. S., Rittman, M., & Hinojosa, R. (2009). Informal caregivers and racial/ethnic variation in health service use of stroke survivors. Journal of Rehabilitation Research and Development, 46(2), 233.
Hsieh, H.F., Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–88.
Hughes, N., Locock, L., & Ziebland, S. (2013). Personal identity and the role of “carer” among relatives and friends of people with multiple sclerosis. Social Science and Medicine, 96, 7885.
Hystad, P., & Carpiano, R.M. (2012) Sense of community-belonging and health-behaviour change in Canada. Journal of Epidemiology and Community Health, 66(3), 277283.
Innes, A., Morgan, D., & Kostineuk, J. (2011). Dementia care in rural and remote settings: A systematic review of informal/family caregiving. Maturitas, 68(1), 3446. doi:10.1016/j.maturitas.2010.10.002
Jetten, J., Haslam, C., & Haslam, S. A. (Eds.). (2012). The social cure: Identity, health and well-being. New York, NY: Psychology Press.
Keating, N., Swindle, J., & Fletcher, S. (2011). Aging in rural Canada: A retrospective and review. Canadian Journal on Aging/La Revue canadienne du vieillissement, 30, 323338. doi:10.1017/S0714980811000250
Khan, F., Pallant, J., & Brand, C. (2007). Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis. Disability and Rehabilitation: An International, Multidisciplinary Journal, 29(16), 12411250.
Kuluski, K., Williams, A. P., Berta, W., & Laporte, A. (2012). Home care or long-term care? Setting the balance of care in urban and rural Northwestern Ontario, Canada. Health & Social Care in the Community, 20(4), 438–48. doi:10.1111/j.1365-2524.2012.01064.x
Lambert, S. D., Bowe, S. J., Livingston, P. M., Heckel, L., Cook, S., Kowal, P., & Orellana, L. (2017). Impact of informal caregiving on older adults’ physical and mental health in low-income and middle-income countries: A cross-sectional, secondary analysis based on the WHO’s Study on global AGEing and adult health (SAGE). BMJ Open, 7(11), e017236.
Liu, J., Lu, N., & Lou, V. W. Q. (2017). Care tasks in the stress process for family caregivers in urban China. Clinical Gerontologist: The Journal of Aging and Mental Health, 40(5), 428434.
Luhtanen, R., & Crocker, J. (1992). A collective self-esteem scale: Self-evaluation of one’s social identity. Personality and Social Psychology Bulletin, 18(3), 302318.
Majerovitz, S. D. (2001). Formal versus informal support: Stress buffering among dementia caregivers. Journal of Mental Health and Aging, 7(4), 413423.
Millenaar, J. K., de Vugt, M. E., Bakker, C., van Vliet, D., Pijnenburg, Y. A. L., Koopmans, R. T. C. M., & Verhey, F. R. J. (2016). The impact of young onset dementia on informal caregivers compared with late onset dementia: Results from the NeedYD study. The American Journal of Geriatric Psychiatry, 24(6), 467474.
Moore, H., & Gillespie, A. (2014). The caregiving bind: Concealing the demands of informal care can undermine the caregiving identity. Social Science and Medicine, 116, 102109.
Morgan, D. G., Semchuk, K. M., Stewart, N. J., & D’Arcy, C. (2002). Rural families caring for a relative with dementia: Barriers to use of formal services. Social Science & Medicine, 55(7), 11291142.
O’Connor, D. L. (2007). Self-identifying as a caregiver: Exploring the positioning process. Journal of Aging Studies, 21(2), 165174.
Office of the Auditor General of Canada. (2012). Long-term-care home placement process. Ministry of Health and Long-Term Care. Retrieved from:
Omoto, A. M. (Ed.). (2014). Processes of community change and social action. New York, NY: Psychology Press.
Ontario Caregiver Coalition. (2014). Resources. Retrieved from
Ontario Ministry of Labour. (2018). Family caregiver leave. Retrieved from
Paulson, D., & Lichtenberg, P. A. (2011). Effect of caregiver family status on care recipient symptom severity and caregiver stress at nursing home intake. Clinical Gerontologist: The Journal of Aging and Mental Health, 34(2), 132143.
Peeters, J.M., Van Beek, A.P.A, Meerveld, J.H.C.M., Spreeuwenberg, P.M.M., & Francke, A.L. (2010). Informal caregivers of persons with dementia, their use of and needs for specific professional support: A survey of the National Dementia Programme. BMC Nursing, 9(1):9.
Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18(2), 250267.
Proulx, C., & Le Bourdais, C. (2014). Impact of providing care on the risk of leaving employment in Canada. Canadian Journal on Aging/La Revue canadienne du vieillissement, 33(4), 488503. doi:10.1017/S0714980814000452
Rand, S., & Malley, J. (2014). Carers’ quality of life and experiences of adult social care support in England. Health & Social Care in the Community, 22(4), 375385.
Remillard, M.L., Mazor, K.M., Cutrona, S.L., Gurwitz, J.H., & Tjia, J. (2014). Systematic review of the use of online questionnaires among the geriatric population. Journal of the American Geriatrics Society, 62(4), 696705. doi:10.1111/jgs.12747
Ross, N. (2002). Community belonging and health. Health Reports (Statistics Canada, Catalogue 82-003); 13(3), 3339.
Rural Ontario Institute. (2013). Overcoming rural health challenges: Exploration, discussion, insight. Rural Health Provincial Health Report: Forum proceedings. Guelph, ON: Author. Retrieved from
Rutherford, A., & Bowes, A. (2014). Networks of informal caring: A mixed-methods approach. Canadian Journal on Aging/La Revue canadienne du vieillissement, 33(4), 473487. doi:10.1017/S0714980814000361
Sanford, J. T., Johnson, A. D., & Townsend-Rocchiccioli, J. (2005). The health status of rural caregivers. Journal of Gerontological Nursing, 31(4), 2531.
Sanford, J. T., & Townsend-Rocchiccioli, J. (2004). The perceived health of rural caregivers. Geriatric Nursing, 25(3), 145148.
Silva, A. L., Teixeira, H. J., Teixeira, M. J. C., & Freitas, S. (2013). The needs of informal caregivers of elderly people living at home: An integrative review. Scandinavian Journal of Caring Sciences, 27(4), 792803. doi:10.1111/scs.12019
Sinha, M. (2013). Portrait of caregivers, 2012. Spotlight on Canadians: Results from the General Social Survey, 89–652(89), 121. Retrieved from Statistics Canada website
Sklenarova, H., Krümpelmann, A., Haun, M. W., Friederich, H., Huber, J., Thomas, M., … Hartmann, M. (2015). When do we need to care about the caregiver? Supportive care needs, anxiety, and depression among informal caregivers of patients with cancer and cancer survivors. Cancer, 121(9), 15131519.
Skinner, M.W. (2008). Voluntarism and long-term care in the countryside: The paradox of a threadbare sector. The Canadian Geographer, 52(2), 188203.
Statistics Canada. (2009, January 28). Data and definitions. Ottawa, ON: Author. Retrieved from
Steffens, N. K., Cruwys, T., Haslam, C., Jetten, J., & Haslam, S. A. (2016). Social group memberships in retirement are associated with reduced risk of premature death: Evidence from a longitudinal cohort study. BMJ Open 6(2): e010164. doi:10.1136/bmjopen-2015-010164
Stewart, M., Barnfather, A., Neufeld, A., Warren, S., Letourneau, N., & Liu, L. (2006). Accessible support for family caregivers of seniors with chronic conditions: From isolation to inclusion. Canadian Journal on Aging/La Revue canadienne du vieillissement, 25, 179192. doi:10.1353/cja.2006.0041
Stewart, N. J., Morgan, D. G., Karunanayake, C. P., Wickenhauser, J. P., Cammer, A., Minish, D., & Hayduk, L. A. (2014). Rural caregivers for a family member with dementia: Models of burden and distress differ for women and men. Journal of Applied Gerontology, 35(2), 150178. doi:10.1177/0733464813517547
Sun, F., Roff, L. L., Klemmack, D., & Burgio, L. D. (2008). The influences of gender and religiousness on Alzheimer disease caregivers’ use of informal support and formal services. Journal of Aging and Health, 20(8), 937953. doi:10.1177/0898264308324652
Tajfel, H. (1978). Differentiation between social groups. London, ENG: Academic Press.
Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict. In Austin, W. G. & Worchel, S. (Eds.), The social psychology of intergroup relations (pp. 3347). Monterey, CA: Brooks/Cole.
Tryssenaar, J., & Tremblay, M. (1999). Aging with a serious mental disability in rural Northern Ontario: Family members’ experiences. Psychiatric Rehabilitation Journal, 25(3), 225264.
Vaingankar, J., Chong, S., Abdin, E., Picco, L., Jeyagurunathan, A., Zhang, Y., … Subramaniam, M. (2016). Care participation and burden among informal caregivers of older adults with care needs and associations with dementia. International Psychogeriatrics, 28(2), 221231. doi:10.1017/S104161021500160X
Verbakel, E. (2014). Informal caregiving and well-being in Europe: What can ease the negative consequences for caregivers? Journal of European Social Policy, 24(5), 424441.
Vitaliano, P. P., Young, H. M., & Zhang, J. (2004). Is caregiving a risk factor for illness? Current Directions in Psychological Science, 13(1), 1316. doi:10.1111/j.0963-7214.2004.01301004.x
von Känel, R., Dimsdale, J. E., Mills, P. J., Ancoli-Israel, S., Patterson, T. L., Mausbach, B. T., & Grant, I. (2006). Effect of Alzheimer caregiving stress and age on frailty markers interleukin-6, C-reactive protein, and D-dimer. The Journals of Gerontology: Series A Biological Sciences and Medical Sciences, 61(9), 963969.
Wagner, M., & Brandt, M. (2015). Loneliness among informal caregivers aged 50+ in Europe. In Borsch-Supan, A., Kneip, T., Litwin, H., Myck, M., & Weber, G. (Eds.), Ageing in Europe: Supporting policies for an inclusive society (pp. 179188). Berlin, GEU: Walter de Gruyter GmbH & Co KG.
Williams, A., Sethi, B., Duggleby, W., Ploeg, J., Markle-Reid, M., Peacock, S., & Ghosh, S. (2016). A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective. International Journal for Equity in Health, 15(1), 40.
Witcher, C. S. G., Holt, N. L., Spence, J. C., & Cousins, S. O. (2007). A case study of physical activity among older adults in rural Newfoundland, Canada. Journal of Aging and Physical Activity, 15(2), 166183.
World Health Organization. (1994). Division of Mental Health & Alzheimer’s Disease International (Chicago). Alzheimer’s disease: Help for caregivers. Geneva, CHE: Author. Reprinted June 2000, January 2006.
Ysseldyk, R., Haslam, S. A., & Haslam, C. (2013). Abide with me: Religious group identification amongst older adults promotes health and well-being by maintaining multiple group memberships. Aging and Mental Health, 17(7), 869879. doi:10.1080/13607863.2013.799120
Ysseldyk, R., Paric, A., & Luciani, T. (2016). Transferable practices for knowledge mobilization: Lessons from a community-engaged health study. Technology Innovation Management Review. 6(9), 4652.
Zhu, C. W., Scarmeas, N., Ornstein, K., Albert, M., Brandt, J., Blacker, D., & Stern, Y. (2015). Health-care use and cost in dementia caregivers: Longitudinal results from the Predictors Caregiver Study. Alzheimer’s & Dementia, 11(4), 444454.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed