The gendered nature of filial piety--a study among Chinese Canadians

Daughters and daughters-in-law providing elderly care: a qualitative study from Karachi, Pakistan

BACKGROUND AND CONTEXT

Providing care to the elderly is an emerging area of interest due to the increase in elderly population not only in the developed world but also in low and middle income countries. In Pakistan a country with an overall population of over 200 million, the elderly population amounts to 11.3 million. Caregiving of the elderly tends to occur within the kinship motivated by sociocultural norms as well as absence of government support facilities. While quantitative literature exists in Pakistan describing the "caregiver's burden," an in-depth analysis into the experiences of familial caregivers is missing.

METHODS

The research used qualitative methods with the aim to explore the lived experiences of 7 daughters and 3 daughters-in-law, living in Karachi, Pakistan providing care to the elderly requiring assistance in at least two tasks of daily living.

RESULTS

Five themes were developed inductively through the phenomenological method. All participants were Muslim and belonged to the upper economic strata of the society. Findings reveal that obligations to care are dominant in kinship circles particularly among women. Participants highlighted the importance of elderly in the Pakistani society, especially due to the religious lens that considers them as blessings. Daughter caregivers spoke about caregiving of their parents as a form of role reversal, emphasizing also upon the life-long emotional bond that served as a strong motivator. On the other hand, for daughter-in-law caregivers, motivations to care also stemmed from social expectations and kinship obligations. All participants reported multiple difficulties during the caregiving experience, despite existence of paid formal help, with respect to balancing multiple role demands and the nature of caregiving that requires constant effort. Results also illustrate that despite the desire to care for the elderly within a collectivist and patrilocal society, participants experienced multiple physical and emotional effects. However, a few also reported an increase in self-mastery and self-worth.

CONCLUSION

This study reveals that despite increasing urbanization and more women working outside the home, providing care to the elderly appears to be centered within the kinship circle. The research makes important contributions to the ageing literature in Pakistan with relevance to other South Asian contexts.

Filial Piety and the Development of Independence and Interdependence During Emerging Adulthood: A Longitudinal Study of Taiwanese Adolescents

While filial piety has been widely studied in Confucian-influenced societies, little is known about how it may influence the development of emerging adults' independence and interdependence. Using a population-based longitudinal study in Taiwan (N = 3,149; 49.5% females), this study examined the association between filial piety in adolescence (aged 13-15) and independence and interdependence in emerging adulthood (aged 22). Results show that greater adherence to filial piety in adolescence predicts higher independence in emerging adulthood. Additionally, greater adherence to filial piety predicts higher interdependence for females, but not males, when parents hold traditional gender-role attitudes. This study underscores the significance of cultural norms and parental gender-role attitudes in shaping individuals' development during emerging adulthood.

Influence of intergenerational support on the mental health of older people in China

Today, population aging is the main trend of population development. Home-based care is mainly adopted in Chinese society, and scholars have paid ample attention to the effect of intergenerational support on the mental health of older people. However, research conclusions differ. This study uses data from the 2018 China Health and Pension Tracking Survey (CHARLS), which we analyzed with STATA software to construct least squares regression and two-stage least squares regression models. The regression model included 6,647 respondents to investigate the mental health status of older people based on depression status. Intergenerational support was defined as economic support, emotional support, and daily care provided by the children of older people. We studied the impact of three aspects of intergenerational support on the mental health of the elderly. We performed a robustness test using the variable replacement and propensity score matching methods, and analyzed age, gender, and urban-rural heterogeneity. The results showed that economic support had no significant impact on the mental health of older people, while emotional support and daily care had a positive effect. The heterogeneity results indicated that the relationship between intergenerational support and mental health of older people differed significantly based on age, gender, and urban and rural areas. Therefore, children should raise their awareness of supporting their parents, pay attention to their parents' mental health, and provide emotional support and daily care. Furthermore, community work improves family relations, creates a good social environment, and encourages young people to respect and be filial to older people. The government should improve the medical security system and old-age service system, and provide policy support to help the mental health of older people.

Association of filial attitude, filial behavior and death literacy: implications for development of death system in Guangdong-Hong Kong-Macao Greater Bay Area of China

BACKGROUND

Filial piety, as a major traditional norm in Chinese culture and in Chinese families, affects the attitudes and behaviors of adult children toward their parents and impacts their end-of-life decision-making and the quality of death of their parents. Death literacy is a novel concept aimed at promoting palliative care in the context of public health.

AIMS

To understand attitudes and behaviors related to filial piety and to examine the role of death literacy in filial behaviors toward dying parents among residents in the Guangdong-Hong Kong-Macao Greater Bay Area of China.

METHODS

A cross-sectional online survey that employed the convenient and snowball sampling methods was adopted. Filial Piety Representations at Parents' End of Life Scale and Death Literacy Index were used.

RESULTS

This study identified a significant gap between the filial piety attitudes and behaviors of Chinese adult children. Gender, caregiving experience and death literacy were predictors of filial behaviors in an end-of-life context.

CONCLUSION

Providing truth disclosure support, offering guidance to young adult children and caregivers of terminally ill fathers, and strengthening factual and community knowledge of death are necessary to enhance the reciprocal comfort of both adult children and dying parents in the context of Chinese filiality.

Adverse childhood experiences, emotional distress and dissatisfaction with motherhood among first-time mothers: Mediations and child differences

Despite the challenges associated with motherhood, studies have not consistently identified factors contributing to first-time mothers' dissatisfaction with motherhood in resource-limited regions. To fill this research gap, this study investigates how adverse childhood experiences (ACEs) result in first-time mothers' dissatisfaction with motherhood through emotional distress in Nigeria. Results from the partial least square structural equation model suggests that ACEs are associated with dissatisfaction with motherhood ( = 0.092; p < 0.01) and emotional distress ( = 0.367; p < 0.001). There is also a significant association between emotional distress and dissatisfaction with motherhood ( = 0.728; p < 0.001). Indirect path from first-time mothers' ACEs to dissatisfaction with motherhood through emotional distress shows significance ( = 0.267; 95% CI (0.213, 0.323); p < 0.001). In addition, the indirect path from first-time mothers' ACEs to dissatisfaction with motherhood through child emotional closeness showed significant dampening effects ( = 0.044; 95% CI (0.025, 0.066); p < 0.001). No serial impact of emotional distress and child emotional closeness was found in the study. The findings based on child gender indicated that only among first-time mothers of female children are ACEs predictors of dissatisfaction with motherhood. Trauma-informed interventions should be introduced in primary care settings to screen for ACEs and emotional dysfunctions among first-time mothers.

Effects of filial piety belief on cyberbullying perpetration of Chinese university students

Cyberbullying has become a worldwide phenomenon. Although the topic has drawn decent academic attention and many studies have been conducted on Chinese samples, variable interests in these studies have not captured the thinking and behavioral characteristics of Chinese people. Based on the dual filial piety model and self-determination theory, this study examined the effect of filial piety belief on cyberbullying perpetration and tested the mediation of relatedness need satisfaction. A total of 856 university students completed the questionnaires, including dual filial piety scale, relatedness need satisfaction scale and cyberbullying perpetration scale. The regression results found that reciprocal filial piety negatively predicted and authoritarian filial piety positively predicted cyberbullying perpetration. The SEM results showed that reciprocal filial piety and authoritarian filial piety impacted cyberbullying perpetration through the mediating effect of relatedness need satisfaction. Reciprocal filial piety was positively while authoritarian filial piety negatively correlated with relatedness need satisfaction and relatedness need satisfaction was negatively correlated with cyberbullying perpetration. The results provide a new position to understand the effect of family factors on cyberbullying perpetration by placing the topic within traditional Chinese family value.

The effect of perceived social support on frailty and depression: A multicategorical multiple mediation analysis

The mediating effects of three sources of perceived social support on frailty severity and depression were examined. Conducted in rural China, data on 570 frail older women were studied. Results showed that significant others' support (mainly daughters) (β = 0.177 for frailty score = 3) mediated the relationship between frailty severity and depression, and the 95 % bias-corrected bootstrap confidence intervals did not straddle zero (0.013-0.419), while the mediating effects of family support (mainly sons) and friends support were not observed. Support from daughters contributes to frail mothers' mental health.

Loving Your Parents and Treating Others Well: The Effect of Filial Piety on Cyberbullying Perpetration and Its Functional Mechanism Among Chinese Graduate Students

Although a few studies have investigated the effect of family factors on cyberbullying perpetration, these studies have mainly focused on the roles of parents. Few studies have examined the roles of children. In traditional Chinese culture, the filial piety belief (FPB) refers to the viewpoint that considers the roles of children in a family context. We suggest that how children consider their roles in a family might also influence cyberbullying perpetration. Based on the dual filial piety model and social information processing model, this study examined the effect of FPB on cyberbullying perpetration and tested its mediation of hostile attribution bias. In total, 588 graduate students participated. The participants completed several questionnaires, including the FPB scale, the social information processing-attribution response questionnaire, and the cyberbullying scale. The results were as follows. First, reciprocal filial piety (RFP) was significantly negatively correlated with hostile attribution bias and cyberbullying perpetration, while authoritarian filial piety (AFP) was significantly positively correlated with hostile attribution bias and cyberbullying perpetration. Second, hostile attribution bias mediated the association between FPB (comprising AFP and RFP) and cyberbullying perpetration; RFP decreased hostile attribution bias, while AFP increased hostile attribution bias; and hostile attribution bias increased cyberbullying perpetration. The current study expands our understanding of the influential factors and formation mechanism of cyberbullying perpetration in Chinese culture.

Adult children's achievements and ageing parents' depressive symptoms in China

This study examined the association between adult children's achievements and ageing parents' depressive symptoms in China. The research topic was examined within the contexts of one-child and multiple-children families in rural and urban China. Older adults (aged 60-113, N = 8,450; nested within 462 communities/villages) from the 2013 China Longitudinal Ageing Social Survey provided information about themselves and their adult children (N = 22,738). Adult children's achievements were assessed with educational attainment, financial status and occupational status; older parents' depressive symptoms were assessed with nine items of the Chinese version of the Center for Epidemiological Studies Depression Scale. Multilevel linear regression models were estimated separately for older parents with one child only and multiple children. For older parents with multiple children, both having one or more children with any achievement and the total number of children's achievements were associated with fewer depressive symptoms. For parents with only one child, any achievement of the child and the total number of the child's achievements were associated with fewer depressive symptoms. Our results also indicated that the association between children's achievements and parents' depressive symptoms varied by rural-urban residence and family type. Our findings contributed to the understanding of family dynamics underlying the emotional wellbeing of older adults in China.

"I thought that I had to be alive to repay my parents": Filial piety as a risk and protective factor for suicidal behavior in a qualitative study of Chinese women

Filial piety involves the Confucian view that children always have a duty to be obedient and to provide care for their parents. Filial piety has been described as both a risk and a protective factor in depression and suicide. This qualitative study aimed to explore the role of filial piety in the suicidal behavior of Chinese women. Qualitative interviews were conducted with Chinese women with a history of suicidal behavior living in the Beijing area (n = 29). Filial piety data were extracted and analyzed in accordance with constructivist grounded theory. The women described five specific family and filial piety factors and how they influenced their ability to fulfill family role obligations, which was described as a nexus connecting these factors to depression, suicidal behavior, and recovery. The five factors were: 1) rigidity of parental filial expectations, 2) perception of family relationships as positive/supportive or negative/harsh, 3) whether filial piety is of high or low personal value in the woman's life, 4) any experiences of rebellion leading to punitive consequences, and 5) how much filial piety she receives from her children. These factors could inform suicide risk assessments in this population. They can be harnessed as part of recovery and protect against future suicidal behavior.

Intergenerational support and depressive symptoms among older adults in rural China: the moderating roles of age, living alone, and chronic diseases

Background

While depressive symptoms are recognized as major mental health problems in later life, there is a lack of study in examining potential moderators in the association between intergenerational support and depressive symptoms, especially in social contexts with low socioeconomic status and inadequate formal public support. This study set out to examine the association between intergenerational support and depressive symptoms among older adults in rural Northeast China, and the potential moderating roles of age, living alone, and number of chronic diseases on this link.

Methods

A quota sampling approach was used to recruit 448 respondents aged 60 and above from rural Chinese communities. Depressive symptoms were the dependent variable. Intergenerational emotional, instrumental, and financial support were the main independent variables. Age, living alone, and number of chronic diseases were the moderators. Multiple linear regression models with interaction terms were conducted to test the proposed model.

Results

The results showed that intergenerational emotional support was significantly associated with depressive symptoms in older adults when instrumental and financial support and covariates were controlled (β = -0.196, p < .001). Age was found to have a significant moderating effect on the relationship between intergenerational instrumental support and depressive symptoms (β = -0.118, p < .05). Among older respondents aged 74.51 years and older, instrumental support was positively associated with depressive symptoms, but this association was not significant for younger respondents. Furthermore, living alone and number of chronic diseases suffered moderated the association between intergenerational financial support and depressive symptoms, which was statistically significant only for those living alone and with more chronic diseases (interaction term between living alone and intergenerational financial support: β = -0.082, p < .05; interaction term between number of chronic diseases and intergenerational financial support: β = -0.088, p < .05.

Conclusions

The findings not only highlight the important role of intergenerational support in promoting mental health in later life in rural Chinese contexts, but also identify within-population heterogeneity in the identified associations. Policy and intervention implications are discussed.

Sex Differences in Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

Background: Cerebral small vessel disease (SVD) is a common cause of stroke, mild cognitive impairment, dementia and physical impairments. Differences in SVD incidence or severity between males and females are unknown. We assessed sex differences in SVD by assessing the male-to-female ratio (M:F) of recruited participants and incidence of SVD, risk factor presence, distribution, and severity of SVD features. Methods: We assessed four recent systematic reviews on SVD and performed a supplementary search of MEDLINE to identify studies reporting M:F ratio in covert, stroke, or cognitive SVD presentations (registered protocol: CRD42020193995). We meta-analyzed differences in sex ratios across time, countries, SVD severity and presentations, age and risk factors for SVD. Results: Amongst 123 relevant studies (n = 36,910 participants) including 53 community-based, 67 hospital-based and three mixed studies published between 1989 and 2020, more males were recruited in hospital-based than in community-based studies [M:F = 1.16 (0.70) vs. M:F = 0.79 (0.35), respectively; p < 0.001]. More males had moderate to severe SVD [M:F = 1.08 (0.81) vs. M:F = 0.82 (0.47) in healthy to mild SVD; p < 0.001], and stroke presentations where M:F was 1.67 (0.53). M:F did not differ for recent (2015-2020) vs. pre-2015 publications, by geographical region, or age. There were insufficient sex-stratified data to explore M:F and risk factors for SVD. Conclusions: Our results highlight differences in male-to-female ratios in SVD severity and amongst those presenting with stroke that have important clinical and translational implications. Future SVD research should report participant demographics, risk factors and outcomes separately for males and females. Systematic Review Registration: [PROSPERO], identifier [CRD42020193995].

A Measurement Invariance Investigation of the Polish Version of the Dual Filial-Piety Scale (DFPS-PL): Student-Employee and Gender Differences in Filial Beliefs

Filial beliefs are defined as a cognitive script or even a contextualized personality construct for social exchanges, which shapes the attitudes of individuals. In the given study, we investigate the factorial structure of the Polish version of the Dual Filial Piety Scale (DFPS-PL) and verify whether measurement of filial piety is invariant among students and employees, and among men and women. Two studies were conducted on different age samples: 489 students aged 18-24 and 849 employees aged 25-64. In order to verify the hypotheses, the DFPS-PL was administered. As a result of confirmatory factor analyses (CFA), it has been demonstrated that the structure of filial piety measured by the DFPS-PL among students and employees, and men and women, could be interpreted as two-factorial, and that there is partial scalar measurement invariance for the tested model across these groups (MGCFA). The comparison of the average latent mean scores suggests that employees declare a lower level of AFP (Authoritarian Filial Piety; need of social belonging and collective identity) than students. There were no significant differences between students and employees when RFP (Reciprocal Filial Piety; need of interpersonal relatedness) was compared. In addition, the results showed that women score higher in RFP than men. The given findings are discussed in the context of values transition in non-Asian countries. The main contribution is to confirm the factorial structure of the DFPS-PL and introduce the novel Eastern concept of Filial Piety to Western culture.

Expectation and Evaluation of Spouse's Filial Piety and Marital Satisfaction in China

The present study examined the effect of expectation and evaluation of spouse’s filial piety on marital satisfaction among young Chinese couples. We administered scales assessing gender role attitude, marital satisfaction, and expectation and evaluation of spouse’s filial piety on 422 married participants and explored the relationships among these variables. The results showed the following: (1) gender role attitude mediated the relationship between participants’ gender and evaluation of their spouse’s filial piety. There was no significant gender difference in the evaluation of spouse’s filial piety; however, men were more likely to have a traditional gender role attitude, and a traditional gender role attitude leads to lower evaluation of spouse’s filial piety. Furthermore, it was found that the wife’s sibling condition influenced the participants’ expectation and evaluation of spouse’s filial piety as compared to the husband’s; (2) the evaluation of spouse’s filial piety was significantly positively correlated with marital satisfaction; and (3) women’s expectations of their husband’s filial piety moderated this relationship. The positive effects of the evaluation of spouse’s filial piety on marital satisfaction were significantly stronger when they had high expectations in this regard.

Filial expectation among Chinese immigrants in the United States of America: a cohort comparison

Relying on two unique data-sets on Chinese older immigrants (N = 3,157) and younger immigrants with ageing parents (N = 469) in Chicago, this study compared the level of filial expectation among the two groups and examined the predictors and mental health implications of having high filial expectation among each group. Results of t-tests, logistic regression and negative binominal analyses showed that, regardless of socio-demographic variables, acculturation, physical health and family relations, Chinese adult children had higher filial expectations on themselves than older immigrants' filial expectation on the younger generation. Chinese older immigrants who had less education, lower levels of acculturation, poorer health and closer relationships with children reported higher filial expectation. In the cohort of younger immigrants, high filial expectation was associated with lower income, better health and closer relations with their parents. In addition, having high filial expectation was associated with lower levels of depression and anxiety among the older immigrants, but not among the younger cohort. The results indicated that, whereas Chinese older immigrants seemed to adapt their filial expectation in the new society, the younger cohort still strongly adhere to this traditional family norm. Maintaining strong filial expectation might be a protective factor for older immigrants' mental health. Practice and policy implications of these findings are discussed in the paper.

Effectiveness of palliative care consultation service on caregiver burden over time between terminally ill cancer and non-cancer family caregivers

PURPOSE

The responsibility of taking care of terminal patients is accepted as a role of family members in Taiwan. Only a few studies have focused on the effect of palliative care consultation service (PCCS) on caregiver burden between terminal cancer family caregivers (CFCs) and non-cancer family caregivers (NCFCs). Therefore, the purpose of this study is to address the effect of PCCS on caregiver burden between CFC and NCFC over time.

METHODS

A prospective longitudinal study was conducted in a medical center in northern Taiwan from July to November 2017. The participants were both terminally ill cancer and non-cancer patients who were prepared to receive PCCS, as well as their family caregivers. Characteristics including family caregivers and terminal patients and Family Caregiver Burden Scale (FCBS) were recorded pre-, 7, and 14 days following PCCS. A generalized estimating equation model was used to analyze the change in the level of family caregiver burden (FCB) between CFC and NCFC.

RESULTS

The study revealed that there were no statistically significant differences in FCB between CFC and NCFC 7 days and 14 days after PCCS (p > 0.05). However, FCB significantly decreased in both CFC and NCFC from pre-PCCS to 14 days after PCCS (β = - 12.67, p = 0.013). PPI of patients was the key predictor of FCB over time following PCCS (β = 1.14, p = 0.013).

CONCLUSIONS

This study showed that PCCS can improve FCB in not only CFC but also NCFC. We suggest that PCCS should be used more widely in supporting family caregivers of terminally ill patients to reduce caregiver burden.

Anxiety about aging, resilience and health Status among Chinese older adults: Findings from Honolulu and Wuhan

A growing body of literature found that anxiety about aging is related to health and well-being of older adults. However, very few studies have been conducted on Chinese older adults residing in different countries and examined the role of resilience. Using the Pearlin's Stress Process Model, this study aims to fill in this gap by examining the relationship between anxiety about aging as the stressor and health status among Chinese older adults living in Honolulu, the United States (N = 292) and Wuhan, China (N = 532). The survey data were collected through June 2017 to September 2018, using snowball and convenience sampling strategy. The moderating role of resilience on the focal relationship is also explored. Results showed that for both samples, the negative relationship between anxiety about aging and self-rated health was significantly moderated by resilience (18 % and 13 %, respectively), implying the stress-buffering role of resilience. Although both mean levels of resilience and anxiety about aging were lower for the Honolulu sample, the moderating effect appeared to be stronger, implying that older adults in the Honolulu sample might rely more on psychological resources such as resilience in coping with stressors, compared with their counterparts in Wuhan. However, the moderating effect of resilience did not work for the association between anxiety about aging and number of chronic conditions for both samples. Our findings suggest that future research needs to take into account both social and psychological resources when examining anxiety about aging and health status among Chinese older adults residing in different cultural contexts.

Three-Dimensional Filial Piety Scale: Development and Validation of Filial Piety Among Chinese Working Adults

The aim of this investigation is to develop a three-dimensional filial piety scale and explore its psychometric properties. Two studies are conducted based on Wang's three-dimensional filial piety model. Study 1 consists of a review of the current literature, in-depth interviews, and feedback from the target group and experts. An initial 36-item scale using a bipolar Likert 6-point rating scale is developed. Then exploratory factor analysis is conducted on working adults (n = 617) to explore the dimensions and final items, and a 15-item scale with three factors is obtained. Study 2 confirms the factor structure of the new three-factor scale obtained from Study 1 using a confirmatory factor analysis with sample 1 (n = 585). Next, the criterion validity is tested with sample 2 (n = 248) and test-retest reliability with sample 3 (n = 67). The results support the model on which this scale is based and show three dimensions of filial piety, namely the balance of interests, good affection, and family role norms. As a valid, reliable scale, the three-dimensional filial piety scale can therefore be used in the Chinese context to measure filial piety for working adults of different genders and ages and in different cohabitation situations.

Depressive Symptoms Among Adult Children Aged 55 Years or Older: The Effects of Support Provided to Their Older Parents

Objectives

This study examines the effects of frequency of visits, monetary, and in-kind support provided to older parents on the depressive symptoms of adult children.

Method

This study drew secondary data from the China Health and Retirement Longitudinal Study Follow-up Questionnaire. A total of 629 older children aged 55 years and older ( M = 59.80, standard deviation = 3.90) met the inclusion criteria. The dependent variable—depressive symptoms—was measured with the Center for Epidemiological Studies Depression scale.

Results

Approximately 22% of participants reported clinically significant levels of depressive symptoms. Hierarchical regression analyses found that more frequent visits and monetary support to older parents were related to lower levels of depressive symptoms in older children.

Conclusion

Providing monetary support to parents may help mitigate a major concern of parents: health-care costs. Older children’s altruistic behaviors meet legal and cultural expectations in Chinese society, contributing to family intimacy and thereby their own mental health outcomes.

Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study

BACKGROUND

Although the awareness of mental health problems in late life is rising, the association between financial transfers to the older generations from children and mental health at older ages in China has received little attention. This study examines the association between financial transfers from children and depressive symptoms among the mid-aged and elderly residents (from 45 years of age and older) in China.

METHODS

We used the data from the China Health and Retirement Longitudinal Study (CHARLS, 2013) (n = 10,935) This included data on financial transfers from all non-co-resident children to their parents, and the individual scores on depressive symptoms as measured by the 10-item Center for Epidemiologic Studies-Depression Scale (CESD-10). A two-level - individual and community levels - mixed linear model was deployed to explore their association.

RESULTS

Financial transfers from children to parents was the major component of inter-generational financial transfers in Chinese families. A higher financial support from non-co-resident children was signivicantly and positively related to fewer depressive symptoms (coef. = - 0.195,P-value< 0.001) among both the mid-aged and elderly parents.

CONCLUSIONS

Financial transfers from non-co-resident children are associated with depressive symptoms among mid-aged and elderly residents in the China situation. Taxation and other policy measures should encourage and facilitate these type of financial transfers and prevent a decrease of support from children to parents.

Systematic Literature Review and Meta-Analysis of Filial Piety and Depression in Older People

Background: Studies have indicated that one of the key factors in relieving depression in older people is social network support, especially from the family. In Chinese society, the traditional value of filial piety strongly influences daily interactions and behavior. The purpose of this study was to examine older people’s perceptions of filial piety and to explore the correlation between filial piety and depression in older people. Method: In this systematic literature review of seven databases (CEPS, Cochrane, PubMed/Medicine, OVID, CINAHL, ProQuest, and PsycINFO), eight studies on the correlation between filial piety and depression in older people were selected, six of which were included in the present meta-analysis. Results: The studies included in this review lacked consistency regarding the screening and measurement instruments used. Two groups of meta-analyses (four studies) illustrated that filial piety was negatively correlated with depression in older people ( r = −0.196, p < .001, 95% confidence interval [CI] [−0.283, −0.106] and r = −0.139, p = .006, 95% CI [−0.235, −0.041]), suggesting that an increase in older people’s perception of their children’s filial piety was correlated with a reduction in their depression. Conclusions: Filial piety was correlated with depression in older people. Future studies should focus on clarifying the concept of filial piety to aid in the application of appropriate measurement tools and the development of intervention measures that could enhance the care provided for depression in older people.

The Association Between Filial Discrepancy and Depressive Symptoms: Findings From a Community-Dwelling Chinese Aging Population

Background

The relationship between filial piety and depressive symptoms has been widely discussed, but limited research focused on the gap between filial expectations and filial receipt. This study aims to investigate the association between filial discrepancy and depressive symptoms.

Methods

Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged, population-based epidemiological study of U.S. Chinese older adults aged 60 and older in the greater Chicago area. Depressive symptoms were measured by the Patient Health Questionnaire-9. Overall filial discrepancy was evaluated by filial receipt minus expectations. Levels of overall filial discrepancy divided older adults into four groups based on the medium value of filial expectations and receipt. Logistic regression analyses were performed.

Results

Older adults with greater filial receipt than expectations were more likely to have lower risk of depressive symptoms (odds ratio [OR], 0.95 [0.92-0.97]). The group with high expectations and low receipt has the highest risk of depressive symptoms among the four groups (OR, 1.51 [1.07-2.13]). Greater receipt than expectations in care (OR, 0.83 [0.76-0.92]), make happy (OR, 0.77 [0.69-0.86]), greet (OR, 0.88 [0.79-0.97]), obey (OR, 0.76 [0.68-0.86]), and financial support (OR, 0.80 [0.71-0.89]) was associated with lower risk of depressive symptoms.

Conclusions

This study goes beyond previous research by examining the association between filial discrepancy domains and depressive symptoms. Cultural relevancy of health interventions is important in the context of Chinese communities. Health care professionals are suggested to be aware of the depressive symptoms of U.S. Chinese older adults with high filial expectations and low receipt.

Intergenerational transfers and informal care for disabled elderly persons in China: evidence from CHARLS

Aiming at 'ageing healthier and ageing better', a certain amount of high-quality informal care should be available for elderly persons with physical disability as formal care is barely accessible in China. The demographic transition and family structural changes have dramatically weakened traditional norms of filial piety and the structure of intergenerational transfers. This article employed nationwide representative data from the first wave (2011) of Chinese Health and Retirement Longitudinal Study (CHARLS) in order to identify the duration of informal care provision at home for frail elders (1122 in rural areas and 577 in urban areas, total 1699), measured in monthly hours, before estimating the associations between intergenerational transfers and the received time of informal care with Tobit Model analysis. Results showed that financial support from the younger generation was unexpectedly negatively associated with the monthly hours of care, implying a reduction of caring support along with increasing financial transfers towards older parents. The lack of informal care could not be compensated by having more children, co-residing with children, or increasing the parent-to-child/grandchild transfers. Spouses were shown to replace children as the major caregivers. In addition, the community-based long-term care system needs to be promoted to sustain and develop informal care, as the latter will become increasingly important with changing family dynamics. Finally, the received time of informal care, rather than the severity of physical disability measured by difficulty with ADLs or IADLs, was introduced to identify the actual demand for care by elders. The paper argues that it is important to reconceptualise and re-investigate the duration of care provision in the Chinese context in order to develop standards of payment as part of long-term care policies.

Cultural Differences in Young Adults' Perceptions of the Probability of Future Family Life Events

Most young adults are exposed to family caregiving; however, little is known about their perceptions of their future caregiving activities such as the probability of becoming a caregiver for their parents or providing assistance in relocating to a nursing home. This study examined the perceived probability of these events among 182 young adults and the following predictors of their probability ratings: gender, ethnicity, work or volunteer experience, experiences with caregiving and nursing homes, expectations about these transitions, and filial piety. Results indicated that Asian or South Asian participants rated the probability of being a caregiver as significantly higher than Caucasian participants, and the probability of placing a parent in a nursing home as significantly lower. Filial piety was the strongest predictor of the probability of these life events, and it mediated the relationship between ethnicity and probability ratings. These findings indicate the significant role of filial piety in shaping perceptions of future life events.

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.

Gendered aspects of perceived and internalized HIV-related stigma in China

Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.

Older parents enjoy better filial piety and care from daughters than sons in China

This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey using logistic regression and controlling for various covariates. Our analyses clearly demonstrate that disabled older parents are more satisfied with care provided by daughters than sons and that older parents enjoy greater filial piety from and better relationships with daughters than sons. The daughter-advantages of enjoying greater filial piety from and better relationships with children are stronger among the oldest-old aged 80+ than the young-old aged 65-79, and surprisingly more profound in rural areas than urban areas, while son-preference is much more prevalent among rural residents. We also discuss why China's rigorous fertility policy until October-2015 and much less-developed pension system in rural areas substantially contribute to sustaining traditional son-preference and a high sex ratio at birth (SRB) when fertility is low. We recommend China take integrative public health policy actions of informing the public that having daughter(s) is beneficial for old age care, developing the rural pension system and implementing the universal two-child policy as soon as possible. We believe that these policy actions would help to reduce son-preference, bring down the high SRB, and enable more future elderly parents to enjoy better care from their children and healthier lives.

Strengthening Social Capital Through Residential Environment Development for Older Chinese in a Canadian Context

Among Canada's visible-minority population 65 years of age or older, nearly four out of ten are Chinese. However, little research has been devoted to the examination of the role of the housing environment in building social capital for older Chinese despite the increase in this population and related social issues. The purpose of this paper is to examine Chinese elders' experience of social capital and how it is affected by their residential environment in a Canadian context. In this qualitative study, forty-three Chinese elders in a Canadian context were interviewed with a focus group approach. Findings indicate that the environments in which these older adults lived either hindered or assisted them in building or increasing their social capital. A culturally and linguistically homogeneous residential environment does not necessarily provide positive support to older Chinese for their acquisition of social capital. Adversities in the environment, such as maltreatment or lack of support from their immediate micro environment (family), tended to motivate older adults to improve their social capital for problem-solving. The study offers implications from research findings to social work practice and concludes with an analysis of limitations.

Coresidence with elderly parents in contemporary China: the role of filial piety, reciprocity, socioeconomic resources, and parental needs

This paper examines how adult children's expressed filial piety, receipt of help from parents, socioeconomic resources, and parents' needs are associated with the likelihood of parent-child coresidence in contemporary China. Drawing on the 2002 wave of the Chinese Survey of Family Dynamics and the 2002 wave of the Chinese Longitudinal Healthy Longevity Survey, we used logistic regression to analyze correlates of coresidence with parents of 3,938 married adult children, aged 35 to 65. Results show that the stronger the filial piety expressed by adult children, the higher their likelihood of coresiding with their parents. Married adult children are also more likely to coreside with elderly parents who have provided intensive grandchild care and financial support or with those who need financial, physical, and emotional support. However, adult children who own homes are significantly less likely to live with their parents than are those who do not. These findings suggest that coresidence in contemporary China is influenced not only by parents' needs but also by children's values, socioeconomic resources, and past receipt of parental help.

End-of-Life Family Caregiving for Older Parents in China’s Rural Anhui Province

Cette étude a examiné les corrélats de la prestation de soins de la fin de vie fournis par les enfants adultes à leurs parents âgés et le rôle du sexe des enfants adultes en soins familiaux dans la Chine rurale. Les données proviennent de cinq vagues de l'Étude longitudinale du bien-être des personnes âgées en milieu rural dans la province de l'Anhui, en Chine, pendant 12 ans, et d'une enquête post-mortalité. On a utilisé la modélisation linéaire hiérarchique . Les résultats ont montré que l'ordre de naissance des enfants adultes, la distance géographique antérieure, et l'échange du soutien intergénérationnel antérieur étaient significativement associés à la prestation de soins de famille de la fin de vie. Les enfants les plus âgés, par rapport à d'autres frères et sœurs, fourni les plus grand soins de fin de vie pour leurs parents. Les enfants qui cohabitent avec les parents plus âgés avant leur mort, par rapport à d'autres enfants des mêmes parents, ont offert les plus grands soins. Les enfants adultes qui avaient déjà échangé le soutien instrumental avec les parents âgés avant la mort, en particulier les fils, tendaient à fournir le plus grands soins en fin de vie, par rapport à ceux d'autres.

The perception of social support among U.S. Chinese older adults: findings from the PINE Study

OBJECTIVE

This study examined perceptions and correlates of both positive and negative social support among U.S. Chinese older adults.

METHOD

Data were drawn from the Population Study of Chinese Elderly in Chicago study, a population-based study of U.S. community-dwelling Chinese older adults aged 60 years and above in the Greater Chicago area.

RESULTS

The findings suggested that U.S. Chinese older adults were more likely to perceive positive and negative spouse and family support than friend support. Younger age, being female, higher levels of education, being married, living with a larger number of people, higher health status, better quality of life, and improved health over the past year were positively associated with positive social support. However, younger age, being male, higher levels of education, being married, having fewer children and grandchildren, living with more people, lower health status, and poorer quality of life were positively correlated with negative social support.

DISCUSSION

Chinese older adults perceive a high level of both positive and negative spouse and family support simultaneously. Further longitudinal studies should be conducted to better understand the factors and outcomes associated with perceived positive and negative social support.

The expectation and perceived receipt of filial piety among Chinese older adults in the Greater Chicago area

OBJECTIVE

Filial piety is a key Chinese cultural value that determines children's caregiving obligation to older adults. This study aims to evaluate the expectations and perceived receipt of filial piety from the perspectives of Chinese older adults.

METHOD

Data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) study, a population-based study of U.S. Chinese older adults aged 60 and above in the Greater Chicago area. Filial care was examined in six domains, including care, respect, greeting, happiness, obedience, and financial support. Socio-demographics correlate with expectations and receipt of filial piety were also reported.

RESULTS

Participants reported high level of overall expectations and receipts of filial piety, and highest expectation and perceived receipt were placed on the domain of respect.

DISCUSSION

This study provides insights on the extent to which U.S. Chinese older adults expect and perceive receipt of filial care. Our findings have implications for the provision of culturally appropriate health care services.

Generational juggling acts in midlife families: gendered and ethnocultural intersections

This study draws upon a sociocultural stress and coping perspective to examine generational demands in midlife families. It examines both the predictors and family-related circumstances that contribute to perceptions of greater demand, with a focus on gendered and ethnocultural dimensions. Using mixed-methods, data are based on a sample of 236 parents collected in 2006/2007 from four cultural groups: British-, Chinese-, Southern European-, and South Asian Canadian. Key findings reveal that caregiving experiences remain highly gendered and are mediated by ethnocultural background and other work/family contextual characteristics. Recommendations for those who work directly with culturally diverse "sandwiched" generation families are highlighted.

Intergenerational relations and elder care preferences of Asian Indians in North Carolina

The US older population is growing in ethnic diversity. Persistent ethnic disparities in service use among seniors are linked to structural barriers to access, and also to family processes such as cultural preferences and intergenerational relations. There is sparse information on the latter issue for immigrant ethnic minority seniors. Information on the Asian group (the fastest growing senior sub-population) is extremely scarce, due to this group's diversity in national, linguistic, and cultural origins. We conducted a qualitative study among community-dwelling Asian Indian families (including at least one member aged 60 years and older) in North Carolina to examine preferences of seniors and the midlife generation regarding elder care, and the role of intergenerational relations in desired care for elders, exploring the theoretical perspective of intergenerational relationship ambivalence. Our results suggest that cultural preferences, ambivalence in intergenerational relations, and regulations on health service eligibility among immigrant/transnational seniors and midlife adults influence preferences for elder care.

More than communication skills: experiences of communication conflict in nursing home nurses

CONTEXT

Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes.

OBJECTIVES

The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan.

METHODS

Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method.

RESULTS

Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others.

CONCLUSIONS

The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing).

Parents' preferred care-givers in rural China: gender, migration and intergenerational exchanges

This study examines how intergenerational exchanges affect elders' choice of preferred care-givers in the case of sickness among adult children in rural China. The sample derived from a four-wave longitudinal study in Anhui Province, China, based on which we constructed three time intervals (i.e.2001–2003, 2003–2006 and 2006–2009) and stacked them. Our working sample included 10,181 observations from these three stacked intervals, representing 4,927 children with 1,170 elder parents. We used fixed-effects logistic regression to predict elders' favouritism among their children. Results show that those children who received more help with grandchild care from parents, who provided instrumental support to parents and whose spouses provided instrumental support to parents were more likely to be named the preferred care-givers. On average, parents favoured sons. For mothers, this favouritism was completely explained by proximity and intergenerational exchanges, and even reversed under certain circumstances. For fathers, this favouritism of sons was partially explained by proximity and intergenerational exchanges. Migrant children were less likely to be preferred care-givers. This effect was moderated by elder parents' help with caring for grandchildren. Particularly, mothers favoured daughters over sons if the above moderation effect was considered. We discuss these findings in the context of social changes including increased importance of daughters in elder parents' support networks and the large-scale rural to urban migration.

Australian-Chinese families caring for elderly relatives

Caring for elderly relatives has predominately been explored from the standpoint of the needs and experiences of the hegemonic culture in multicultural countries like Australia, Canada and the United States of America. Australia, in particular, has paid scant attention to cultural and linguistically diverse groups in relation to caring for the aged. In this paper we focus on Chinese-Australian families caring for elderly relatives. We explore the traditional value of filial piety which is said to underpin social norms and beliefs about caring for aged parents in Chinese cultures. Specifically we draw on four in-depth interviews with Chinese-Australian care-givers of elderly relatives to identify meanings of filial piety and practices of filial piety. Findings indicate that while filial piety is still an important value in caring for the aged, meanings about how to practise filial piety are changing and vary across families.

Filial caregivers; diasporic Chinese compared with homeland and hostland caregivers

This paper examines the distinctiveness and similarities of diasporic Chinese Canadian caregivers to older adults compared with Hong Kong Chinese and Caucasian Canadian caregivers. Particular interest lies in whether filial responsibility, actual caregiving behaviours, health and a variety of structural characteristics cluster in ways that suggest these three groups of filial caregivers are distinctive. Data were collected using face-to-face interviews. The findings suggest that the caregivers participating in this study cluster into types that roughly approximate their original cultural groupings. Interestingly, however, the diasporic or immigrant Chinese appear more similar to homeland (Hong Kong) than hostland (in this instance Caucasian) Canadian caregivers - all diasporic Chinese were originally, or their ancestors were, from Hong Kong. Chinese Canadians are not necessarily in the middle in terms of caregiving behaviours, but rather show variability depending on the behaviour examined. In addition, these findings confirm past research that Western culture does not have clear and explicit norms of filial responsibility to the same extent as does Chinese culture.

Filial responsibility: does it matter for care-giving behaviours?

This paper examines the relationship between attitudes of filial responsibility and five different types of care-giving behaviours to parents among three cultural groups. It does so within an assessment of the relative importance of cultural versus structural factors for care-giving behaviours. Face-to-face interviews were conducted with 100 Caucasian-Canadians, 90 Chinese-Canadians and 125 Hong Kong-Chinese. Multiple regression analyses assessed the association of cultural and structural factors with behaviours among the total sample and each of the three cultural groups. Limited support was found for an association between care-giving attitudes and care-giving behaviours. Attitudes are related to emotional support only among the two Chinese groups as well as to financial support among Chinese-Canadian respondents and to companionship among Hong Kong-Chinese respondents. Attitudes are not the strongest predictors and are unrelated to assistance with basic and instrumental activities of daily living. However, cultural group per se is a strong predictor of care-giving behaviours as are: parental ill health, living arrangements, and relationship quality. This study suggests gerontological assumptions about the role of societal norms and personal attitudes in parental care-giving should be questioned. It also suggests the need for further inquiry into unpacking those aspects of ‘cultural group’ that are related to behavioural differences, and the importance of examining multiple types of care-giving behaviours and of distinguishing task-oriented helping behaviour from other types of assistance.

Predicting the filial behaviors of Chinese-Malaysian adolescents from perceived parental investments, filial emotions, and parental warmth and support

The present study examined the mediating role of perceived parental warmth and support in predicting Chinese Malaysian adolescents' filial behaviors from their age, perceived parental investments, and positive filial emotions toward their parents. The effects of these predictors were examined separately for mothers and fathers. Participants included 122 Chinese adolescents (M = 13.14 years; SD = 2.22) in Malaysia. Adolescents' perceived parental investments, filial emotions, and warmth and support from each parent were positively, and age was negatively associated with their filial behaviors. No gender differences were found. Perceived maternal warmth and support significantly mediated the effect of age, perceived investments from, and filial emotions toward mothers on adolescents' filial behaviors, but perceived paternal warmth and support did not have a mediating role. The present study sheds light on the unique maternal versus paternal filial role, and important familial processes in Chinese-Malaysian children and adolescents from a cultural perspective.

Theorising about ageing, family and immigration

This article critically reviews the ways in which theories in social gerontology have been used to explain the influence of ethnicity and immigration on older adults. The purpose of this cursory examination is to explore how these theories can be used for further theory advancement without serious modifications to existing theories. Current theories do not have the capacity to capture the effects of immigration at the structural level and its link to the social, psychological and family levels, let alone the physical ageing of individuals or societies. The overriding complexity of ageing and immigration requires at minimum, a long-term view and an integrating framework with multiple levels that can accommodate a variety of theoretical interests. The conclusions are that a lifecourse perspective, in conjunction with existing theories, can be employed in two different ways to further this theoretical agenda. A lifecourse perspective provides scaffolding for other theories where seemingly incommensurate epistemological positions can be easily accommodated and the principles of the lifecourse can be integrated into existing theories for a more fine-grained analysis of ethnicity and immigration. These approaches leave the theoretical door open to everyone including the positivists, the constructionists and critical and postmodern scholars with the possibility for interdisciplinary theory building to advance the understanding of the lives of immigrant families.