Widowhood and depressive symptoms among older Chinese: do gender and source of support make a difference?

Older Parents Benefit More in Health Outcome From Daughters' Than Sons' Emotional Care in China

OBJECTIVE

To examine whether older parents in China would benefit more from daughters' care than from sons' emotional care.

METHOD

Analysis of the unique data sets of the Chinese Longitudinal Healthy Longevity Survey conducted in 2002, 2005, and 2008-2009 in 22 provinces.

RESULTS

As compared with having son(s), having daughter(s) is significantly more beneficial at older ages in China, with regard to maintaining higher cognitive capacity and reducing mortality risk. Such daughter advantages in providing emotional care to older parents are more profound among the oldest-old aged 80+ as compared with the young-old aged 65 to 79 and surprisingly more profound in rural areas as compared with urban areas, even though son preference is much more common among rural residents.

DISCUSSION

We describe how educational campaigns aimed at informing the public about the benefits of daughter(s) for older parents' health outcome could help promote gender equality and reduce traditional son preference, especially in rural China.

Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India

BACKGROUND

Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender.

METHODS

Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural-urban location for men and women, separately. We then assess these associations when widowhood accounts for duration.

RESULTS

Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0-4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5-9 years were not, compared to married women.

CONCLUSIONS

Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India.

Intergenerational support and depression among Chinese older adults: do gender and widowhood make a difference?

Using four-wave panel data of 1,327 older adults in rural China, this study examined potential gender and marital status differences in the relationships between three forms of intergenerational support (monetary, instrumental and emotional support) and the level of depression of the older adults. Results from a pooled time-series fixed-effects model showed that receiving and providing monetary support had a comparable beneficial effect on mothers and fathers, but mothers benefited more psychologically than fathers from closer relationships with their children. Exchanges in instrumental support was not related to either mothers' or fathers' level of depression. Widowhood further affected the gendered relationships between support and depression in that recently widowed fathers had a significantly higher level of depression when they received more monetary support from their children. In contrast, providing monetary support to children was associated with a significantly higher level of depression among recently widowed mothers. We explained the findings in the context of familial and gender norms in the Chinese culture and temporal needs for family support that link with bereavement coping stages among older adults. We argued that the gender and marital status patterns observed in this study are attributive to more fundamental differences in men's and women's social positions in the Chinese society.

Widowhood, Socio-Economic Status, Health and Wellbeing in Low and Middle-Income Countries

Using data on women aged 50 and over from the WHO's Survey of Ageing and Adult Health for China, Ghana, India, the Russian Federation and South Africa (N=17,009), we assess associations between widowhood and socio-economic, health and quality of life deprivations. We find variations in the prevalence and timing of widowhood across the study countries, and associations between widowhood and being in the poorest wealth quintile for all five countries. For other deprivations, national experiences varied, with stronger and more consistent effects for India and China. These findings challenge generalised claims about widowhood and call for more contextualised analysis.

How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand

Living arrangements and family support for older persons have become an increasingly important policy concern in developing and rapidly aging Asia. Formulating a sound elderly care policy for the region will benefit from empirically examining how living arrangements, particularly coresidence, and intergenerational exchanges of financial, instrumental, and emotional support are associated with old-age psychological health. This study analyzes data from nationally representative aging surveys in Myanmar, Vietnam, and Thailand for 2011-2012 to offer a comparative perspective from Southeast Asia where various kinship systems coexist. Results suggest that coresidence with a child of culturally preferred gender significantly improves the emotional health of Vietnamese and Thai elders but with different implications. In Vietnam, living with a married son is more beneficial to parents' psychological wellbeing than living with other children. In Thailand, coresidence regardless of the child's gender improves old-age psychological wellbeing but living with a daughter brings greater benefits than living only with son. Evidence points to the importance of understanding the dominant kinship system that may shape normative filial expectations and gender role expectations within the family. In Vietnam and Thailand, the positive association holds even after intergenerational support is controlled, suggesting that the value of culturally preferred coresidence goes beyond practical functions. In Myanmar, there are almost no significant differences in psychological wellbeing among elderly across various living arrangements, except between coresidence and network living arrangements. For all settings, we do not find evidence in support of network family arrangements as a complete substitute for coresidence in terms of promoting old-age psychological wellbeing after filial support is controlled. Our study highlights important cultural nuances for theorizing the nature of the relationship between living arrangements and old-age psychological health, and presents the important need for more rigorous investigation of the causal links between these two phenomena in future research.

Social change and birth cohort increase in loneliness among Chinese older adults: a cross-temporal meta-analysis, 1995-2011

BACKGROUND

In China, rapid economic growth and increasing social problems constitute the two basic characteristics underlying contemporary social change. With dramatic social change, loneliness in older adults may have changed across birth cohorts, thus altering older adults' mental health. The present study aims to identify birth cohort changes in Chinese older adults' loneliness and the social indicators underlying these changes.

METHODS

Cross-temporal meta-analysis was utilized to investigate changes in Chinese older adults' loneliness from 1995 to 2011. We analyzed 25 studies (N = 13,280 adults; age ≥ 60 years) employing the University of California at Los Angeles Loneliness Scale. We correlated loneliness scores with social indicators and matched these correlations for three periods: ten years before the data collection, five years before data collection, and during the year of data collection.

RESULTS

Loneliness levels in Chinese older adults have increased by 1.02 standard deviations from 1995 to 2011. Social indicators such as increased urbanization level, personal medical expenditure, divorce rate, the Gini coefficient, and unemployment rate significantly predicted loneliness in Chinese older adults. Decrease in social connectedness and increase in levels of health threat may be responsible for the observed increase in levels of loneliness.

CONCLUSIONS

Cross-temporal meta-analysis revealed a birth cohort increase in loneliness among Chinese older adults. We conclude that changes in social connectedness and levels of health threat likely play an important role in predicting loneliness in the population of Chinese elderly adults.

Do social relationships buffer the effects of widowhood? A prospective study of adaptation to the loss of a spouse

The idea that strong social relationships can buffer the negative effects of stress on well-being has received much attention in existing literature. However, previous studies have used less than ideal research designs to test this hypothesis, making it difficult to draw firm conclusions regarding the buffering effects of social support. In this study, we examined the buffering hypothesis in the context of reaction and adaptation to widowhood in three large longitudinal datasets. We tested whether social relationships moderated reaction and adaptation to widowhood in samples of people who experienced loss of a spouse from three longitudinal datasets of nationally representative samples from Germany (N = 1,195), Great Britain (N = 562), and Australia (N = 298). We found no evidence that social relationships established before widowhood buffered either reaction or adaptation to the death of one's spouse. Similarly, social relationships that were in place during the first year of widowhood did not help widows and widowers recover from this difficult event. Social relationships acquired prior to widowhood, or those available in early stages of widowhood, do not appear to explain individual differences in adaptation to loss.

Sex differences in trajectories of depressive symptoms among older Taiwanese: the contribution of selected stressors and social factors

OBJECTIVES

We assessed female-male differences in depressive symptoms among older Taiwanese and quantified the contribution of sex differences in exposure and response to selected covariates in explaining the gap.

METHODS

Using data from six survey waves over 18 years for a nationally representative cohort of 4049 Taiwanese aged 60+, we employed growth curve analysis to model individual-level trajectories of depressive symptoms across age.

RESULTS

Among older Taiwanese, women's disadvantage with respect to social position and employment accounted for about 40% of the sex difference in depressive symptoms. Sex differences in decision control and exposure to widowhood and financial decline played surprisingly little role. Although we found no evidence that the effects of marriage, recent widowhood or recent child death varied by sex, living apart from one's children appeared to be more detrimental for women than for men in this society. Moreover, the effect of living with children depended on the arrangement: living with an unmarried son was more strongly associated with depressive symptoms than living with a married son and daughter-in-law.

CONCLUSION

Sex differentials in social position and employment are major contributors to the sex difference in depressive symptoms among older Taiwanese, yet sex differences in exposure or response to selected stressors appear to play little role. Differential vulnerabilities to particular living arrangements may also contribute to women's excess psychological distress, although more research is needed to elucidate the mechanisms by which living arrangements influence depressive symptoms in Taiwan.

Antenatal depressive symptomatology, family conflict and social support among Chengdu Chinese women

To investigate the association between demo-socio-economic status, obstetric variables, family conflict, social support and antenatal depressive symptoms among 1,609 Chinese women from four regional public hospitals during their second trimester of pregnancy in Chengdu. The vulnerable factors of depressive symptoms were explored in terms of their demo-socio-economic, obstetric, and Chinese family relational aspects, as well as in terms of social support. The women were identified as having depressive symptoms using the Edinburgh Postnatal Depression Scale. Marital conflict and parent-in-law conflict were assessed using the Dyadic Adjustment Scale and the Stryker Adjustment Checklist, respectively. The Interpersonal Support Evaluation List was used to measure the functional aspects of the perceived availability of social support. The prevalence rates of antenatal mild to severe and severe depressive symptoms were 35.9 and 7.3%, respectively. The logistic regression analysis revealed that participants who had been married for a shorter time, had a single source of financial support, a poor marital and mother-in-law relationship, and who lacked social support were more likely to have mild to severe depressive symptoms (P<0.05). Participants who were younger, who had lived in Chengdu for a shorter period of time, had a shorter duration of marriage, solo financial support, poor marital relationship, and poor social support were more likely to have severe depressive symptoms (P<0.05). The findings provide important information for prenatal screening, public health and social policies to help in the reduction of antenatal depressive symptoms among the Chengdu population.

Psychological aspects of widowhood and divorce

Despite advances in standard of living of the population, the condition of widows and divorced women remains deplorable in society. The situation is worse in developing nations with their unique social, cultural and economic milieu, which at times ignores the basic human rights of this vulnerable section of society. A gap exists in life expectancies of men and women in both developing and developed nations. This, coupled with greater remarriage rates in men, ensures that the number of widows continues to exceed that of widowers. Moreover, with women becoming more educated, economically independent and aware of their rights, divorce rates are increasing along with associated psychological ramifications. The fact that widowed/divorced women suffer from varying psychological stressors is often ignored. It has been concluded in various studies that such stressors could be harbingers of psychiatric illnesses (e.g., depression, anxiety, substance dependence), and hence should be taken into account by treating physicians, social workers and others who come to the aid of such women. A change in mindset of the society is required before these women get their rightful place, for which a strong will is needed in the minds of the people, and in law-governing bodies.

Vulnerability, life events and depression amongst Moslem Malaysian women: comparing those married and those divorced or separated

INTRODUCTION

The experiences of married and single mothers were compared in an investigation of psychosocial vulnerability, stress and depression in a community-based study of Moslem mothers in Malaysia. For the first time, a model of vulnerability-provoking agent originally developed by Brown et al. in the UK was tested in a Malaysian context.

METHODS

A cross-sectional study was carried out in the district of Johor Bahru, Malaysia. Of the 1,200 women approached from membership of community associations, 1,002 (84%) completed the questionnaires. Severe life events Recent Life Events Questionnaire (Brugha and Cragg in Acta Psychiatr Scand 82:77-81, 1990) and psychosocial vulnerability (VDQ) (Moran et al. in Br J Clin Psychol 40:411-427, 2001) were used to measure vulnerability factors. Depression was measured by the General Health Questionnaire (GHQ-30) (Havenaar et al. in Soc Psychiatry Psychiatr Epidemiol 43:209-215, 2008).

RESULTS

Single mothers had significantly higher rates of depression than those married (60.5 vs. 39.5%), as well as higher rates of severe life events and Negative Elements in Close Relationships (lack of support and conflict with children). However, married mothers had greater Negative Evaluation of Self. The two vulnerability factors were correlated to each other and to severe life events and social adversity. Logistic regression showed an interaction between severe life events in the material and relationship domains and joint vulnerability for depression outcome. The results are discussed in relation to the low recognition of psychosocial risks for depression in single mothers in Malaysia, as well as lack of appropriate services.

Sex Differences in Medication and Primary Healthcare Use before and after Spousal Bereavement at Older Ages in Denmark: Nationwide Register Study of over 6000 Bereavements

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark.

Revisiting widowhood in later life: changes in patterns and profiles, advances in research and understanding

This analysis reviews the ways in which both the experience of widowhood in old age and the nature of research on widowhood have changed since the publication of the book Widowhood in Later Life in 1991. Patterns of decline in widowhood in both its duration and incidence in later life are examined. Widowhood research has advanced conceptually by moving beyond understanding widowhood solely in terms of role loss. Life course perspectives, and concepts of multiple narratives and of resilience, have also contributed to the field. New methodologies, including prospective and longitudinal designs involving larger data sets, and more in-depth qualitative studies, have advanced our understanding of complexities and variations in widowhood. These include issues of gender and ethnocultural diversity, as well as the intersection of wealth, health, and class. This article also examines how patterns of labour force affiliation, social policy, and the changing nature of marriage shape widowhood in later life.

Gender Differentials in Disability and Mortality Transitions

Objective: This study has two aims: (a) to examine gender differentials in disability transitions and active life expectancies among older adults in Japan and (b) to determine whether these gender differentials vary by age, socioeconomic characteristics, and disease profile. Method: Active and inactive states are defined as living with and without disabilities using activities of daily living. Expected years of life and active life are examined by constructing multistate life-tables, which employ probabilities of health and mortality transitions derived from hazard models. Results: Results indicate that older women in Japan live longer than older men and spend a proportion of these extra years with and without disability. Discussion: The discussion highlights a projected increase in the number of years that individuals, in particular women, will need long-term care. Policy implications include the need to bolster long-term care services in Japan.

A longitudinal study of family conflicts, social support, and antenatal depressive symptoms among Chinese women

Little is known about the causal factors of antenatal depressive symptomatology in the Chinese population. A total of 1,527 pregnant women were recruited to investigate the predictors of antenatal depressive symptoms using a stress process model in a prospective longitudinal study. The Edinburgh Postnatal Depression Scale, the Dyadic Adjustment Scale, the Stryker Adjustment Checklist, and the Interpersonal Support Evaluation List were used. Multiple linear regression analysis revealed that marital conflict, parent-in-law conflict, and social support predicted antenatal depressive symptoms. Psychiatric nurses can identify predictors to help initiate preventive intervention.

Gender differences in depressive symptoms among older Korean American immigrants

Despite consistent reports over many years of a greater prevalence of depression among women, mechanisms underlying the gender difference remain unclear. Mechanisms relevant to immigrant elderly populations are virtually unexplored. The present study examined gender variations in depressive symptoms using a community sample of 230 older Korean American immigrants (M(age) = 69.8; standard deviation = 7.05) in Florida. We were interested in examining not only mean differences but gender differences in the impact of demographic variables (age, marital status, and education), health constraints (chronic conditions and functional disability), and personal resources (sense of control, social network, and acculturation) on depressive symptoms. Consistent with previous literature, women scored higher on depressive symptoms than men. In a hierarchical regression model, women and those with more chronic conditions, greater functional disability, and lower sense of control were found to have more depressive symptoms. The interaction of gender-by-chronic conditions was found to be significant, and further analysis indicated that the association of chronic conditions with mental well-being was stronger for women. The findings suggest that among older Korean immigrants, women are at particular risk of declining psychological well-being in the face of physical health problems and call attention to the need for interventions designed to promote their physical and mental health.

Sex differences in prevalence and risk indicators of geriatric depression: the Shih-Pai community-based survey

BACKGROUND/PURPOSE

Information about sex difference is important for the development of better prevention and intervention strategies for geriatric depression. We investigated sex differences in prevalence and risk indicators associated with geriatric depression among community-dwelling elderly people in Shih-Pai, Taipei, Taiwan.

METHODS

A cross-sectional community-based survey was conducted from June 1999 to November 2002 among non-institutionalized residents aged =65 years in Shih-Pai community. Trained interviewers collected data through home visits. Geriatric depression was defined as a score of = 5 on the Geriatric Depression Scale-Short Form.

RESULTS

The prevalence of geriatric depression was 9.8% in 3970 participants, with a higher rate in women (12.4%) than men (7.8%). Geriatric depression was significantly associated with women [odds ratio (OR) =1.49, 95% confidence interval (CI) =1.07-2.07), separated/divorced marital status (OR =3.29, 95% CI = 1.51-7.18), living alone (OR = 2.56, 95% CI = 1.38-4.77), past history of stroke (OR = 3.63, 95% CI = 2.09-6.31), and cognitive impairment (OR =2.83, 95% CI =1.96-4.09). Living alone (OR = 3.56, 95% CI = 1.48-8.57), living with children (OR = 1.97, 95% CI = 1.02-3.78), and past history of gouty arthritis (OR =2.46, 95% CI = 1.27-4.79) were significantly associated with depression in women, but not in men.

CONCLUSION

Women have a higher prevalence of geriatric depression than men. Our data support the differential exposure hypothesis and the differential vulnerability hypothesis of sex difference in geriatric depression.

Health among the oldest-old in China: which living arrangements make a difference?

This study aims to (1) examine the association of living arrangements and health among oldest-old Chinese, and (2) investigate gender differences in the association of living arrangements and health. Data were from the first two waves of the Chinese Longitudinal Healthy Longevity Survey, which included 9093 Chinese averaging 92 years old. Living arrangements had six mutually exclusive categories: living alone, with spouse, with children, with spouse and children, with others and in institutions. Using multinomial logistic regression, we found that baseline living arrangements are significantly associated with mortality, activities of daily living (ADL) disability, and self-rated health at Wave 2, controlling for baseline health, sociodemographic characteristics and availability of children. Further, the linkages between living arrangements and mortality vary by gender. Among the different living arrangements, having a spouse in the household (either with a spouse only or with both a spouse and children) provides the best health protection. Living alone and living with children are associated with both health advantages and disadvantages. Institutional living lowers mortality risk for men but not women. Living with others provides the least health benefits. Our study has extended the research on living arrangements and health to a unique population-the oldest-old in China-and clarified the health advantages and disadvantages of different living arrangements. Future research should examine the mechanisms linking living arrangements and health, and the experience of institutional living for men and women in China.

Household Context and Subjective Well-Being Among the Oldest Old in China

This article investigates the importance of household context to subjective well-being among the oldest old (aged 80 years and older) in China. Using data from the Chinese Longitudinal Healthy Longevity Survey, the authors find that living arrangements have strong implications for elderly emotional health. First, living alone is associated with lower subjective well-being. Second, coresidence with immediate family (spouse or children) is associated with positive subjective well-being. Third, compared to living with a son, the traditionally dominant type of living arrangement, coresidence with a daughter appears positively linked to the emotional health of the oldest old. Results highlight the importance of family and cultural context to subjective well-being of the oldest old. They also suggest that the gendered nature of caregiving merits further attention in China and other patrilineal societies.