The Influence of Cultural Values on Mental Health of Korean Caregivers for Older Adults: Systematic Review

Background and Purpose: Due to deeply ingrained cultural factors, Korean caregivers caring for older adults may be more vulnerable to adverse effects on mental health when compared to other racial/ethnic groups. The primary objectives of this systematic review were to: a) provide a comprehensive review of the relationship between cultural factors (e.g., filial responsibility/obligation, familism, gender role, and religious affiliation) and mental health among Korean caregivers; and b) identify potential influential factors, such as demographic factors, caregiver-care recipient relationship status (e.g., daughter, daughter-in-law, or spouse), relationship quality of caregiver and care-recipient, and constructs of social support/conflict on the effects of caregiving among Korean caregivers.

Methods: The electronic databases searched included PubMed, PsycINFO (ProQuest), Scopus (ELSEVIER), EBSCO, and the Cochrane library. Inclusion criteria were as follows: 1) published peer-reviewed articles (e.g., qualitative studies, quantitative studies, mixed-method studies, and clinical trials), 2) English-language publications, 3) publications focused on adult Korean informal caregivers (i.e., Koreans in South Korea, Korean immigrants, and Korean Americans living in the U.S.; ≥ 20 years old) caring for older adults, 4) assessments of cultural factors (e.g., filial responsibility, familism, gender roles, and religions), and 5) inclusion of mental health measures (e.g., emotional burden/pressure, depressive symptoms, anxiety, psychological distress, guilt, frustration, life satisfaction, feelings of abandonment and entrapment) as captured using validated instruments or diagnosed by clinicians. Exclusion criteria included: 1) non-peer-reviewed publications, 2) institution-based research/reports, 3) dissertations, 4) published abstracts, 5) non-English publications, 6) focus on formal caregiving services, and 7) provision of caregiving for young children and youth (< 19 years old). Based on inclusion/exclusion criteria, selected studies were extracted and coded using Covidence.

Results: An initial search across five databases resulted in 1,985 potentially eligible studies, of which 1,854 irrelevant and 49 duplicated studies were removed. After considering full-text reviews (n = 82), 17 studies were included in the systematic review—specifically, five qualitative and 12 quantitative studies. In studies meeting inclusion criteria, Korean caregivers with a strong sense of filial responsibility and familism had worse mental health outcomes when compared to their counterparts with low levels across these constructs. Active participation in religious activities was associated with more healthful profiles of mental health for caregivers. Korean caregivers’ relationship type with a care-recipient, social conflict, and the quality of the relationship between caregiver and care-recipient were variables acting as influential factors for mental health outcomes. Daughter-in-law caregivers reported lower relationship quality with care-recipient and higher depressive symptoms when compared to daughters. The relationship between cultural values and mental health did not vary based on sociodemographic characteristics such as age, sex, and education.

Conclusions and Implications: Overall, the current systematic review highlights that Korean caregivers with a strong sense of filial responsibility and familism experienced greater emotional burden and pressure, such as depressive symptoms, anxiety, stress, guilt, frustration, low life satisfaction, abandonment, and entrapment. Moreover, relationship type and quality also influenced the mental health of caregivers. Targeted interventions are needed to improve the mental health of Korean caregivers, which are tailored based on important cultural factors.