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

The Association Between Family Support and Changes in Self-Rated Health Among Chinese Older Adults: How Living Arrangements Moderate the Association?

OBJECTIVES

The study intends to investigate the association between family support and older adult health as well as the interaction between family support and living arrangements on their health.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Samples included in the final analysis (N = 11,430) come from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

Multiple logistic regression analysis was used to analyze the associations between family supports, multiplicative interaction of family supports and living arrangements, and self-rated health change. Subgroup analysis on disabled older adults was supplemented.

RESULTS

Older adult individuals who received functional support, provided financial support, and had frequent emotional communication with their children in the past year reported better self-rated health. Moreover, having frequent emotional communication with children could bring better self-rated health for the older adults living with spouses and children (ORbetter vs same = 2.765, P < .01) and empty nesters who lived without children (ORbetter vs same = 1.551, P < .05).

CONCLUSIONS AND IMPLICATIONS

Our findings imply that functional support and emotional support may play an increasingly important role in the health of Chinese older individuals. The interaction between emotional support and 2 living arrangements mentioned above is relevant to better health of older individuals. We advocate for culturally tailored Age-Friendly Communities augmenting the geriatric health care framework. While bolstering social support for seniors, prioritizing fundamental needs is paramount for those with disabilities.

Unraveling the Impact of Widowhood Duration on Depression: Does Time Heal All Wounds?

China's aging population has witnessed a surge in widowed older adults, raising concerns about their mental health. Losing a spouse is a profoundly distressing experience with enduring effects on well-being. Despite the proverbial belief in time's healing power, existing studies often neglect the potential decline in depressive symptoms during widowhood. Drawing data from the 2015 and 2018 China Health and Retirement Longitudinal Study, this study delves into the impact of widowhood duration on depression among 8370 older adults and uncovered significantly higher depression scores among widowed individuals, particularly in the initial 3 years. The research reveals that widowhood contributes to heightened depression levels even after accounting for sociodemographic factors. Although the depressive impact lessens over time, it persists beyond 3 years, underscoring the need for heightened awareness and support for this vulnerable population.

Estimating the Sex Gap in Depression-Free Life Expectancy Among Widowed Americans Aged 50 and Older: An Application Using the Interpolated Markov Chain Approach

OBJECTIVES

Using Interpolated Markov Chain software, we compare the length of life with and without depression among married individuals and widowers, and the related sex differences.

METHODS

We applied a multi-state life table approach to estimate depression-free life expectancy among recent cohorts of older married and widowed women and men in the United States, using data from the Health and Retirement Study over a 7-year period (2012-2018).

RESULTS

The study revealed that the difference in life expectancy between sexes widens in the context of widowhood. At age 50, the sex gap in depression-free life expectancy is 0.8 years among married people, whereas the gap almost doubles to 1.7 years among widowed people.

DISCUSSION

By quantifying disparities in the duration of life affected by depression between married and widowed women and men, policymakers could properly allocate resources specifically to address the mental health needs of these groups.

Predictive variables of depressive symptoms and anxiety in older adults from primary care: a cross-sectional observational study

BACKGROUND

By 2050, the number of people aged 60 years and older will have doubled worldwide and the most common mental disorders in this age group are currently depressive symptoms and anxiety. This study aimed to analyze the Basic and Instrumental Activities of Daily Living (BADLs and IADLs, respectively) in older adults; socio-demographic, clinical, lifestyle, and environmental variables; and cognitive impairment related to the appearance of depressive symptoms and anxiety.

MATERIAL AND METHODS

A cross-sectional observational study was conducted with 327 participants aged ≥65 years in primary care. The variables were Yesavage's Geriatric Depression Scale, the Goldberg Anxiety Subscale, socio-demographic, clinical, lifestyle, environmental variables, BADLs, IADLs, and the Spanish version of the Mini-Mental State Examination.

RESULTS

An analysis of variance was carried out for the predictive multiple linear regression models. '≥ 1 chronic pathology' and 'low dependency' in BADL are negatively associated with anxiety, while 'physical activity' and 'low dependency' in BADL are associated with positive factors for depressive symptoms.

CONCLUSIONS

Predictor variables could improve the early detection of anxiety and depressive symptoms by general practitioners and serve as a basis for future studies and personalised-adapted cognitive stimulation programs.

Marital transitions and frailty among middle-aged and older adults in China: The roles of social support

Background

This study explored the association of marital transitions and frailty among Chinese middle-aged and older people and whether this association differs by social support.

Methods

We used a sample of 12,388 adults aged ≥45 years who participated in the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2018. Between-wave changes in marital status ("married at both times", "unmarried to married", "married to unmarried", "unmarried at both times") were used to explore the changes in frailty measured by the frailty index (FI), which was constructed from 55 health variables. Social support was evaluated based on social engagement and intergenerational support. The associations among marital transitions, social support and frailty were analyzed using generalized estimating equations (GEEs).

Results

The mean FI of 12,388 participants was 0.23 (SD = 0.13). Participants who were married to unmarried (β = 0.014, B = 0.005, P = 0.012) and unmarried at both times (β = 0.022, B = 0.003, P < 0.001) had significant a positive impact on FI compared with participants who were married at both times. Social engagement, financial support by children and providing care to grandchildren had an interactive effect with marital transitions in influencing FI.

Conclusions

Being unmarried may increase frailty among Chinese middle-aged and older adults. Financial support by children may mitigate the adverse effects of being unmarried on frailty.

A study on the impact of the number of family generations on intergenerational support for centenarians: a study in a Chinese 'longevity city'

BACKGROUND

As a natural source of support for the elderly, the family is an important channel for achieving a sense of security, happiness, and worthiness in old age. In this study, we analysed the characteristics of intergenerational support in families of centenarians and explored the impact of the number of family generations on intergenerational support.

METHODS

We conducted a cross-sectional survey between April 2020 and January 2021 among 62 elderly people aged 99+ in Rugao, China, one of six 'longevity cities' in the world. Assisted by the researchers, centenarians completed questionnaires with details pertaining to general demographics, intergenerational support, and other aspects. We used a logistic regression model to analyse the influence of the number of family generations on intergenerational support that the centenarians received with respect to economic, living, and emotional aspects.

RESULTS

Centenarians were primarily recipients of care in their families, and received intergenerational support mainly for their declined physical functions and limited self-care ability. The study results revealed that the greater the number of generations comprising the family, the greater was the intergenerational life care and emotional comfort provided for centenarians by the family.

CONCLUSIONS

In this study, we found a positive effect of the number of family generations on intergenerational support for centenarians. The government and society should promote the tradition of respecting, caring for, and honouring the elderly while paying close attention to the dynamic changes in the family structure of centenarians in promoting high-quality and sustainable development of the people, economy, and society.

Examining sociocultural factors in widowhood and cognitive function among older Chinese immigrants: findings from the PINE study

Objectives: Although there is growing evidence on widowhood and cognitive function, existing studies have shown mixed results. Little is known about protective factors that may contribute to resilience, thereby ameliorate the adverse effect of widowhood on cognition among older Asian immigrants. This study explored potential moderators (i.e. social support, acculturation, leisure activities) in the association between widowhood and cognitive function among older Chinese immigrants.Method: The study sample included 2,515 adults aged 60 or older who completed two waves (2011-2013 and 2013-2015) of the Population Study of Chinese Elderly in Chicago. Cognitive function was indexed by global cognitive function and episodic memory. Linear regression analyses were conducted with interaction terms.Results: Our results show that social support moderated the relationship between widowhood and global cognitive function, and acculturation moderated the relationship between widowhood and episodic memory. The adverse effect of widowhood on cognitive function was more pronounced at lower levels of social support and acculturation.Conclusion: Our findings indicate buffering roles of social support and acculturation in cognitive health among older Chinese immigrants who experience widowhood. Providing supportive programs and interventions to increase social support and acculturation is suggested to promote cognitive function in this population.

The impact of pension insurance types on the health of older adults in China: a study based on the 2018 CHARLS data

Introduction

Pension insurance is an essential safeguard for the quality of life and health of older adults because it provides a stable and dependable source of income after retirement. China has constructed a multi-level social security system to accommodate the diverse needs of older adults, and offers various levels of pension insurance to maximize their interests.

Methods

This study uses propensity score matching and ordinary least squares techniques to analyze 7,359 data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) in order to explore the relationship between different pension insurance categories and the health of older individuals.

Results

The research findings reveal that advanced insurances greatly benefit the health of older adults more than basic pension insurances, and the findings pass the robustness test. In addition, the effect was found to be heterogeneous, depending on the location of retirement and the marital status of older adults.Our findings suggest that both material and non-material consumption may be potential mechanisms by which pension insurance affects the health of older adults, providing new evidence for the causal mechanism between pension insurance and the health of older adults.

Discussion

This study expands the scope of research on the health effects of pension insurance by covering a large representative sample across the country. The results show the important impact of the level of pension insurance on the health of older adults and can contribute to the development of social policies to promote the physical and mental health of older adults.

Understanding the Effects of Widowhood on Health in China: Mechanisms and Heterogeneity

This paper analyzes the impact of widowhood on the health of mid-aged and older individuals in China using data from the China Health and Retirement Longitudinal Study (CHARLS) data. Our results show that widowhood significantly increases the risk of depression, chronic diseases, and body pain while reducing cognitive function, sleeping time, and daily activity functions. The effects on depression and daily functions are immediate, that on chronic diseases is lagged, and the effects on cognitive function and sleeping hours persist over time. We find that rural widows are particularly vulnerable to negative health outcomes due to their weaker economic positions, for whom widowhood leads to more grandchild care responsibility and corresponding workforce and social withdrawals. Moreover, rural widows' income loss is not compensated by children, either by co-residence or financial transfers, leading to reduced living standards. Overall, our findings suggest that China needs to strengthen economic security for older people, especially among rural women, in order to avoid significant negative consequences of widowhood.

Widowhood, social networks, and mental health among Chinese older adults: The moderating effects of gender

Objectives

This study aimed to examine the three-way interaction between widowhood, social ties, and gender and its effects on older adults’ mental health, including depressive symptoms and life satisfaction, in the context of China.

Methods

Participants were 7,601 Chinese older adults. Their social network was divided between family and friendship ties, and their mental health was measured by depressive symptoms and life satisfaction. Linear regression was employed to analyze the associations between widowhood, social networks, and mental health, as well as to explore the moderating effect of gender.

Results

Widowhood is associated with more depressive symptoms, but not with life satisfaction, while family and friendship ties are associated with less depressive symptoms and greater life satisfaction. Furthermore, the lack of family ties is associated with more depressive symptoms for widowed men compared to married older men, while it is associated with lower life satisfaction for widowed women compared to married older women.

Conclusion

Family ties are the most important social support resource for Chinese older adults, especially for the widowed group. The vulnerability of older widowed men who lack family ties in China deserves public concern and attention.

Childhood Bereavement, Adverse and Positive Childhood Experiences, and Flourishing among Chinese Young Adults

Childhood bereavement (CB) resulting from a parent or primary caregiver death is associated with a range of adverse outcomes. Little is known about the association between CB and adult flourishing in the context of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs). In a cross-sectional observational study, we examined how ACEs, PCEs, and adult flourishing differs by self-reported CB history among 9468 Chinese young adults (18-35 years), of which 4.3% experienced CB (n = 409). Data collection included convenience sampling among university students in Mainland China. Respondents voluntarily completed an online survey between August and November 2020. Descriptive statistics, chi-square tests, and logistic regressions examined frequencies and differences in ACEs, PCEs, and flourishing by the history of CB controlling for a few demographic covariates. Bereaved individuals reported significantly higher ACEs and lower PCEs. The odds of experiencing emotional, physical, and sexual abuse as well as household substance abuse, parental mental illness, and parental incarceration ranged from 2.0-5.2 times higher for bereaved individuals. Bereaved participants also reported significant negative relationships with Flourishing Index (β = -0.35, t = -4.19, p < 0.001) and Secure Flourishing Index (β = -0.40, t = -4.96, p < 0.001). Consistent with previous research, our findings demonstrate the lasting effects of CB on well-being. We discuss study implications for ACEs and PCEs screening and surveillance as well as grief counseling to promote flourishing among bereaved youth in China and beyond.

Home Alone: Widows' Well-Being and Time

Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-17) and time diaries from Poland (2013), the U.S. (2006-16), the U.K. (2014-15) and France (2009-10), we examine differences between widowed and partnered older women in well-being and its development in widowhood. Most importantly, our analysis accounts for time use, an aspect which has not been studied previously. We trace the evolution of well-being of women who become widowed by comparing them with their matched non-widowed 'statistical twins' and examine the role of an exceptionally broad set of potential moderators of widowhood's impact on well-being. We confirm a dramatic decrease in mental health and life satisfaction after the loss of partner, followed by a slow partial recovery over a 5-year period. An extensive set of controls recorded prior to widowhood, including detailed family ties and social networks, provides little help in explaining the deterioration in well-being. Unique data from time-diaries kept by older women in several European countries and the U.S. tell us why: the key factor behind widows' reduced well-being is increased time spent alone.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-023-00622-w.

Prevalence of and Factors Associated with Negative Psychological Symptoms among Elderly Widows Living Alone in a Chinese Remote Sample: A Cross-Sectional Study

(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.

The impact of son or daughter care on Chinese older adults' mental health

RATIONALE

The traditional cultural norm in China is that eldercare should be offered by a son and his family. However, several decades of family planning policies and rapid economic growth have led to low fertility rates, urbanisation, and cultural change, resulting in both reduced household size and the availability of sons. The traditional eldercare system is thus being challenged, especially in urban areas, with an increasing number of daughters supporting their parents, enabled by rising female empowerment, formal economic employment and improved financial capacities. Existing studies examine and compare the amount and types of support provided by sons and daughters, but very little is known about the differential health outcomes of parents experiencing eldercare offered by sons and by daughters.

OBJECTIVE

This study investigates the difference in mental health outcomes of parents who receive eldercare from their sons and from their daughters.

METHOD

We analyse waves 2013, 2015, and 2018 of the China Health and Retirement Longitudinal Study, with mental health measured by a 10-item Center for Epidemiological Studies-Depression (CES-D-10) score. We compare the CES-D-10 score between parents with different sources of care - son's family, daughter's family or other - with multivariate statistical analysis.

RESULTS

Receiving regular care from a son (or a daughter-in-law) is associated with a lower CES-D score than from a daughter (or a son-in-law). The difference mainly exists amongst those with a stronger son preference and those who are heavily deponent on their children, in particular rural parents, mothers, and those with less wealth.

CONCLUSION

Our study explores the evidence on mental health inequalities among parents with different sources of care, highlighting that lack of son care creates an apparent mental health disadvantage. Lowering older adults' dependency on their children may alleviate this inequality by improving their financial independence. We also suggest the development of a long-term care system and greater facilitation of older adults to take-up supplementary services for family care.

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians

Background

Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection.

Methods

Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease.

Results

Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households.

Conclusions

Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Negative Life Events, Social Ties, and Depressive Symptoms for Older Adults in China

Although it is widely acknowledged that older adults who have gone through negative life events are more likely to develop depression, there is limited evidence on whether and which type of social ties moderate this perceived relationship. Based on 2016 and 2018 waves of Chinese Longitudinal Aging Social Survey (4,466 individuals, 8,932 observations), we apply linear fixed effects models and confirm that negative life events are associated with depressive symptoms for older adults (Coef. = 0.35; 95% CIs 0.11–0.61), and social ties are negatively associated with depression (Coef. = −0.08; 95% CIs −0.10 to −0.07). Our study further suggests that the association between negative life events and depressive symptoms is significantly moderated by friendship ties (Coef. = −0.18, 95% CIs −0.30 to −0.07), rather than family ties (Coef. = −0.03, 95% CIs −0.09 to 0.15). Moreover, the buffering effects of friendship ties are more prominent for the less resilient and less privileged groups, namely male, rural, and less educated older adults. Our findings point to the importance of expanding and strengthening social networks for Chinese older adults in promoting their psychological health.

Grief and growth among Chinese parents who lost their only child: the role of positive and negative experiences of social support from different sources

BACKGROUND

In China, bereaved parents who have lost their only child are known as Shidu parents, and they tend to present high levels of prolonged grief reactions. To date, a widespread focus has been placed on positive social support, while potential negative experiences have been relatively neglected. Additionally, the role of social support from different sources (i.e. close family members [partner, siblings, grandchildren], peers, and others [relatives, friends, colleagues]) has not been examined thoroughly.

OBJECTIVE

The present study investigated whether social support from different sources has a differential impact on postloss adaptation (i.e. prolonged grief and growth). The loss-orientated and restoration-orientated coping strategies of the dual process model were also tested for their mediating roles.

METHODS

A total of 277 Chinese Shidu parents were recruited to complete a series of questionnaires including social support from different sources, prolonged grief symptoms, posttraumatic growth, and dual process coping strategies. Correlation analyses, paired sample t tests and structural equation modelling were conducted.

RESULTS

More positive support were related to less prolonged grief symptoms and more posttraumatic growth, while more negative support was only related to more prolonged grief. Positive support from close family members and others was significantly related to prolonged grief/growth, and negative support from these sources was significantly positively associated with prolonged grief. Positive or negative support from people who shared a similar experience was unrelated to prolonged grief/growth. Positive and negative support were related to prolonged grief and growth through loss-oriented coping strategies.

CONCLUSION

Overall, the present study indicated that positive and negative support experiences from different sources functioned differently in the recovery of Chinese Shidu parents and that loss-oriented coping played a mediating role. These findings highlight the importance of differentiating social support by traits in coping with grief and the crucial mediating role of loss-oriented coping.

HIGHLIGHTS

More positive support correlated with less prolonged grief and more growth, while more negative support correlated with more prolonged grief.Support from family members and friends was more potent than that from peers.Social Support correlated with prolonged grief/growth through loss-oriented coping.

Widowhood, widowhood duration, and loneliness among older adults in China

BACKGROUND

Widowhood is a distressful life event that is associated with loneliness in older adults. However, widowhood is not a binary event, and little is known about the role of widowhood duration in loneliness and about the relationship between widowhood duration and loneliness in different age and sex groups. Given the increases in aging population and in widowed older adults in China, we examined whether and how widowhood and widowhood duration were associated with loneliness in different age and sex groups among Chinese older adults.

METHODS

Five waves of Chinese Longitudinal Healthy Longevity Survey 2002-2014 were used. The analysis included 34,440 sampled individuals aged 65 and above. Random intercept ordered logistic models were used to examine relations between widowhood, its duration and loneliness in the entire sample and by age and sex groups.

RESULTS

Results show that with a wide set of covariates controlled for, widowhood was a significant correlate of loneliness in older adults (OR = 2.34, p < .001); and those who were remarried after widowhood were less likely to be lonely compared to their not-remarried counterparts (OR = 0.47, p < .001). In addition, widowhood was associated with more than twice greater odds of loneliness in the first couple of years following bereavement of spouse (OR = 3.09, p < .001) compared to the currently married older adults. The increased odds ratio of loneliness slightly decreased with the length of widowhood, but it was still significant, even after 40 years of bereavement (OR = 1.96, p < .001).

CONCLUSIONS

These findings are mostly consistent across age and sex groups. In conclusion, this study sheds light on the relationship between widowhood duration and loneliness and the role of remarriage in widowed older adults' loneliness based on a nationwide survey in China. Widowhood has an acute and long-lasting effect on loneliness in older adults. Remarriage after widowhood could largely reduce or offset the risk of loneliness.

Life Satisfaction during the Transition to Widowhood among Japanese Older Adults

INTRODUCTION

The loss of a spouse is among the most stressful life events. Whilst grief and mourning vary across cultures, most longitudinal studies have been conducted in Western societies. Adding to prior research, this study examines the role of resources available prior to spousal bereavement and changes therein for trajectories of well-being in an Eastern society, namely, Japan.

METHODS

Data were derived from a nationally representative panel survey of Japanese older adults aged 60 years and above. We used data from married participants at baseline who experienced spousal loss during the 19-year follow-up period (N = 481). Well-being was indexed as life satisfaction.

RESULTS

The multiphase growth model revealed that life satisfaction typically deteriorated surrounding spousal loss and remained stable 1 year after the event. Compared with individuals coresiding with a child before and after loss, those who did not continuously coreside with a child showed lower levels of postloss life satisfaction, but better recovery. Perceiving better financial status prior to loss was related to higher levels of preloss life satisfaction and, conversely, lower levels after loss. Changes in resources were not associated with life satisfaction following widowhood.

DISCUSSION

Our results show that spousal bereavement has, on average, an initial negative impact on well-being with substantial individual differences in recovery 1 year later. When designing interventions to promote adaptation after spousal loss, it is important to consider the bereaved individual's cultural background and preloss resources.

Offspring's labor migration and its implications for elderly parents' emotional wellbeing in Indonesia

Population ageing and labor out-migration are increasingly challenging normative intergenerational support systems and familial welfare in parts of Asia. Extant studies look at how migration affects the material wellbeing of sending-households, but less is known about how migration shapes the emotional health of non-migrants as origin and destination conditions evolve. This study examines how labor migration among adult children shape the emotional health of elderly parents in Indonesia, and how observed implications are modified by alternative care arrangements and different migrant destinations. Using panel data from 2101 respondents age 50+ in the 2007 and 2014 Indonesia Family Life Survey, and individual-level fixed effects regressions, this study finds that offspring's migration is associated with increased parental depression, net of covariates. Depressive outcomes are abated if resulting care deficits are offset by co-residence or daily interactions with adult children, or if children move to economically lucrative international destinations; however, having a child in Malaysia - a destination characterized by high informal labor employment - increased parental depression. These findings draw attention to the non-economic implications of migration and the distress experienced specifically by parents who lack intergenerational support and who have concerns about child's wellbeing at destination.

Gender convergence or divergence in the relationship between late-life depression and multiple stressors: evidence from a national survey in China

This study aimed to investigate gender convergence or divergence among older adults in China, a Confucian society with strong persistence of gender role differentiation. We examined how multiple stressors influence depression simultaneously, with gender comparison approach. The data were drawn from the China Longitudinal Aging Social Survey study (N = 8,097). Results indicated that older women reported significantly higher levels of depression than men, yet overall depressive symptoms showed many gender similarities. Surprisingly, our analyses supported the hypothesis of gender convergence in stressors predicting late-life depression. Recommendations for practice and further research priorities based on findings are discussed.

Sociodemographic, health-related, and social predictors of subjective well-being among Chinese oldest-old: a national community-based cohort study

BACKGROUND

There is still a lack of systematic investigation of comprehensive contextual factors of subjective well-being (SWB) among Chinese oldest-old. This study aimed to explore sociodemographic, health-related, and social predictors of SWB among Chinese oldest-old using a large and representative sample.

METHODS

The study included 49,069 individuals aged 80 and older from the Chinese Longitudinal Healthy Longevity Survey, a prospective, nationwide, community-based study conducted from 1998 to 2014. SWB was measured by eight items covering life satisfaction, positive affect (optimism, happiness, personal control, and conscientiousness), and negative affect (anxiety, loneliness, and uselessness). Generalized estimating equation models were used to explore the predictors of SWB.

RESULTS

We found that age, gender, ethnic group, education, primary occupation before retirement, current marital status, and place of residence were sociodemographic predictors of SWB among the Chinese oldest-old. The health-related predictors included self-rated health, visual function, hearing function, diet quality, smoking status, drinking status, and exercise status. SWB was influenced by some social factors, such as the number of biological siblings, the number of children, leisure activities, financial independence, and access to adequate medical service. In particular, self-rated health, access to adequate medical services, exercise status, and place of residence exert a stronger effect than other factors.

CONCLUSIONS

SWB in the oldest-old is influenced by a large number of complex sociodemographic, health-related, and social factors. Special attention should be paid to the mental health of centenarians, women, rural residents, widowed, physically disabled, and childless oldest-old people. Relevant agencies can improve physical activities, leisure activities, financial support, and medical services to promote the well-being of the oldest-old.

Difference of depression between widowed and non-widowed older people in China: A network analysis approach

BACKGROUND

In this study, the difference of depression network structures between the widowed and non-widowed older people and the associations of family capital, neighborhood cohesion, and neighborhood built environment with depressive symptoms were explored by using network analysis.

METHODS

This study fitted network models to two subsamples extracted from a nationally representative and cross-sectional data from China Family Panel Studies (CFPS). Depressive symptom levels and the effect of the three possible influencing factors related on depression were compared.

RESULTS

The network structures of depression across the widowed and the non-widowed older people were different to some extent but significantly associated with one another. Neighborhood cohesion were significantly related to severe depressive symptoms in both subsamples. Neighborhood built environment mattered for the non-widowed older people, but not for their counterparts. Family capital also functioned in a different way for the two subsamples.

LIMITATIONS

Investigation was carried out using cross-sectional data, and changes in contents could alter the network structure. In addition, grief-related variables were not included. New studies replicating the current findings with a wider range of contents, multiple time points and a larger sample are warranted.

CONCLUSIONS

This study added evidence to a growing body of literature on depressive symptom patterns for the widowed older people and their counterparts. Tailored service and treatment could be developed for the widowed and non-widowed older people based on their features of depression. The contextual factors including family, neighborhood, and physical environment could be taken into account when considering their association with depressive symptoms.

Gender differential impact of bereavement on health outcomes: evidence from the China Health and Retirement Longitudinal Study, 2011-2015

BACKGROUND

Bereavement is the experience of an individual following the death of a person of significance to the individual, most often referring to the spouse. Increased morbidity, health care utilization, and mortality are known to be associated with bereavement. Given China's growing population of older adults, there is a critical need to assess the health consequences of bereavement.

METHOD

We use data from the China Health and Retirement Longitudinal Study to examine the impact of bereavement on mental health and quality of life among a sample of mid- and older-aged adults. We use propensity score matching to construct a matching sample and difference-in-differences method to estimate the impact of bereavement on mental health and self-assessed health.

RESULTS

We find bereavement is associated with increased depression symptoms among women (1.542 point or 0.229 standard deviations of Center for Epidemiologic Studies Depression (CES-D) 10 score) but not consistently for men over time. No statistically significant effect of bereavement on self-assessed health is found.

CONCLUSIONS

Our results show a harmful impact of bereavement on mental health among older women in China and point to the need for a comprehensive policy on survivor benefits in China, particularly for rural older women.

Trajectories of depression symptoms in Chinese elderly during widowhood: a secondary analysis

Objectives: This study aims to identify heterogeneous depressive symptom trajectories among the widowed elderly in China, to explore predictive variables of latent class membership, and to detect between-classes differences in life satisfaction across time.Method: Data of 198 individuals widowed between 2011 and 2013 were drawn from The China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. Latent class growth analysis was employed to identify depressive symptom trajectories across 2011, 2013, and 2015, and a three-step auxiliary approach was applied to detect predictive variables of latent class membership. Mixed Analysis of Variances was followed to make between-class comparisons on life satisfaction across time.Results: Four grieving trajectories were identified: resilient (54.6%), chronic grief (23.7%), depressed-improved (11.6%), and chronic depression (10.1%). Older age, living exclusively with spouse before widowhood, and agricultural Hukou were significant predictors of depressed-improved, chronic grief, and chronic depression patterns, respectively. Life satisfaction in all groups except for the resilient one remained stable across time, and that of the chronic depression group was significantly lower than those of all the remaining groups.Conclusion: Consistent depressive symptom trajectories during late-life widowhood exist across nations while the specific culture, values, and resources in the Chinese context may have contributed to a particularly high proportion of the chronic grief trajectory. More efforts should be made to identify patterns with predictors before support are provided, and interventions need to be tailored to target specific needs in each subgroup of the elderly during their transitions to widowhood.

Associations between older adults' parental bereavement and their health and well-being: Evidence from the China health and retirement longitudinal study

OBJECTIVES

Few studies have investigated the association between losing a child and parental health and wellbeing, especially among older Chinese bereaved parents. This study examined depressive symptoms, life satisfaction, and self-rated health of older Chinese bereaved parents to estimate the health and well-being of this group.

METHODS

This research used data from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A total number of 11,507 participants age 45 and older were enrolled in the analysis, including 1,758 bereaved adults who had experienced a child's death and 9,749 non-bereaved counterparts. Multivariate linear and logistic regression models were used to examine the effect of bereavement and its interaction effect by sex and age.

RESULTS

Multivariate analyses revealed that the death of a child is associated with an increasing likelihood of experiencing depressive symptoms (adjusted OR = 1.425, p < 0.001), and a reduced probability of a high level of life satisfaction (adjusted OR = 0.725, p < 0.05), whereas experiencing a child's death is not significantly associated with self-reported health status. The effects of bereavement on health and well-being were found to have a much greater impact among participants who were males (compared to females) and who aged<60 years (compared to those ≥60 years).

DISCUSSION

Future longitudinal prospective research is expected to examine the causal relationship and explore the attributes of child death and its effects on parental health. Interventions to improve the health and well-being of the older bereaved population are warranted, particularly for those who are male and under 60 years of age.

Kinship bereavement and psychological well-being of U.S. Chinese older women and men

This study examined the relationship of kinship bereavement with the psychological well-being of Chinese American older women and men. Data from the Population Study of ChINese Elderly were used. Respondents were asked if their spouse, children/grandchildren, siblings, close relatives, and friends had died. Widowhood was associated with more loneliness for both genders. For women, close relative/friend loss was associated with more stress, and children/grandchildren loss was linked to stronger anxiety. Only coefficients for close relative in the stress model were significantly different between genders. The variation in patterns of kinship bereavement may be attributed to Chinese cultural attitudes toward death.

Widowhood and depression: a longitudinal study of older persons in rural China

Using six waves of longitudinal data (2001-2015) collected in Anhui, China (N = 2,131) and generalized estimating equations (GEE) models, this study fulfilled several objectives. First, the study compared the widowed to the married to examine if the transition to and duration of widowhood contributes to changes in depression. Second, the study examined if the bereavement-depression relationship is a process that precedes widowhood or is an abrupt change following the death of a spouse. Third, the study examined if social resources influence the bereavement-depression relationship. The study found that there is pre-widowhood effect on depression and that the widowhood event also contributes to increases in depression. Levels of post-widowhood depressive symptoms peak during the first six months bereavement and taper off within 25 months. Controlling for social support, contact with children, and living arrangements does not change the bereavement-depression relationship. The findings support Attachment Theory, which suggests that the loss of a spouse leads to emotional isolation that cannot be overcome with kin-based social support and social integration.

Social media usage, social support, intergenerational relationships, and depressive symptoms among older adults

Many older adults are unable to use social media, which may affect their social support and intergenerational relationships and cause depression. To examine this impact on older Taiwanese adults, we used purposive sampling, a cross-sectional, correlational study design, and a structured questionnaire to collect data on participants' characteristics, social media usage, social support, intergenerational relationships, and depressive symptoms. We studied 153 older adults (aged 60 years and above) and found higher levels of depressive symptoms among participants who took medication, did not exercise regularly or participate in leisure activities, experienced poor health and sleep quality, and had poorer functional ability compared to their counterparts. Depressive symptoms were significantly associated with social media usage, social support, and intergenerational relationships. We recommend considering risk factors and offsetting depressive symptoms by promoting the use of social media and regular exercise to increase social interactions, social support, and intergenerational relationships among older adults.

Health and marital status of older Chinese couples and implications for intergenerational co-residence

Older individuals who are in poor health or who lack spousal support are in many ways vulnerable in contemporary China. Declines in family size, combined with improvements in life expectancy and the out-migration of young adults from rural areas, have reduced the pool of potential care-givers for a growing number of older individuals. At the same time, state support for elderly people remains inadequate, further emphasising families’ role in care provision. This paper uses couple-level panel data from the 2012, 2014 and 2016 China Family Panel Studies to examine whether older couples with health-care or other needs receive help in the form of intergenerational co-residence. Multinomial logistic regressions are used to examine factors associated with the intergenerational solidarity framework from the older parents’ perspective that could motivate co-residence. Results show that when mothers report activity limitations or poor word recall at baseline, or when at least one parent has activity limitations in both waves, the probability of co-residence in both waves increases. Further, when both parents have depression at baseline, or when a parent loses a spouse, the probability of transitioning to co-residence increases. Findings suggest that adult children in present-day China do respond to parental needs by living together. Nevertheless, going forward, the state will likely have to play a greater role in old-age care provision.

Subjective wellbeing of Chinese elderly: a comparative analysis among Hong Kong, Urban China and Taiwan

This study investigates the relative importance of living with adult children and social participation for the elderly's subjective wellbeing (happiness) in three Chinese societies (Hong Kong, urban China and Taiwan). We use data from the 2011 wave of the Hong Kong Panel Study of Social Dynamics (N = 1,658), the 2010 China Family Panel Studies in mainland China (N = 3,198) and the 2010 wave of the Taiwan Social Change Survey (N = 790). The ordinary least squares regression shows that, as the family value of society moves forward on a traditional–modern continuum, the elderly benefit more psychologically from social participation and less from living with children. The older people in Hong Kong who live independently with a spouse are in a significantly better emotional state than those living with adult children. Social participation is positively associated with subjective wellbeing among the aged in Hong Kong but not among those in urban China and Taiwan. The findings suggest that encouraging social involvement is important for effective public policy to tackle rapid population ageing in Chinese societies.

Who Are the Beneficiaries of China's New Rural Pension Scheme? Sons, Daughters, or Parents?

By applying a fuzzy regression discontinuity design, this study investigates whether sons, daughters, or parents are the beneficiaries of China’s New Rural Pension Scheme. Using data drawn from the China Health and Retirement Longitudinal Survey, our results indicate that pension income crowds out approximately 27.9% of the monetary support from adult sons and decreases the likelihood that adult sons live with their parents by 6.5%. However, we do not find a significant effect of pension income on the likelihood that adult daughters live with their parents. In regards to the well-being of parents, which is measured by consumption and health outcomes, the results show that pension income increases food and non-food consumption by 16.3 and 15.1%, respectively, and improves the psychological health of the elderly. Accounting for the different effects of pension income for those with different income levels, our results show that the New Rural Pension Scheme only has a significant effect on the poor elderly.

Widowhood and Depression in a Cross-National Perspective: Evidence from the United States, Europe, Korea, and China

Objectives

We explore marital and depression trajectories over time for men and women, and distinguish between mood and somatic depression across contexts.

Method

We use longitudinal data from 2002 to 2013 from the United States, England, Europe, Korea, and China to explore depression among individuals married at baseline and follow their trajectories into widowhood with married as the reference group. We use random effects models to estimate these trajectories using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D scales for men and women.

Results

Depression peaks within the first year of widowhood for men and women, but women recover to levels comparable to married counterparts in all countries. Men sustain high levels of depression even 6-10 years post-widowhood everywhere except Europe. Widowed women have higher somatic depression compared to men, who have higher mood depression. Family plays differential roles in mediating depression across countries.

Discussion

Our research shows the complex global relationship between widowhood and depression. Studies that do not compare depression trajectories over time may make incorrect inferences about the persistence of depression by gender and country. Interventions should target different components of depression: mood-related symptoms for men and somatic-related symptoms for women for most effective recovery.

Informal care provision across multiple generations in China

With increasing life expectancy, changes in family structure and, most recently, the relaxation of the hitherto strict family planning policies, understanding how mid-life individuals support multiple generations, particularly their older parents and younger grandchildren, is of increasing research and policy significance in China. This paper analyses data from the 2011 China Health and Retirement Longitudinal Study (CHARLS) to examine the characteristics of Chinese mid-life individuals aged 45–64 who are potentially being ‘sandwiched’ between providing care to older parents/parents-in-law and/or younger grandchildren (under age 16). Binary logistic and multinomial regression models shed light on the factors associated with providing support to one generation or multiple generations. The results highlight that amongst the Chinese mid-life sandwich generation, 58 per cent only provide care to their young grandchildren, 23 per cent only provide care to their parents/parents-in-law, whilst 15 per cent are simultaneously supporting both generations. Rather than acting as competing demands upon the mid-lifers’ time, the multivariate analysis provides evidence that the provision of intergenerational care is complementary, with caring for grandchildren increasing the probability of also supporting one's parents/parents-in-law, and vice versa. However, an increase in the number of younger grandchildren has a negative impact on the care provided to older parents/parents-in-law, indicating that at higher care intensities there may be competing demands across the generations.

Widowhood and mortality risk of older people in rural China: do gender and living arrangement make a difference?

Increased mortality after spousal bereavement has been observed in many populations. Few studies have investigated the widowhood effect in a traditional culture where the economy is underdeveloped. The reasons for the widowhood effect and its gender dynamic are not well understood. In this study, we assessed whether the widowhood-associated excess mortality exists and differs by gender and living arrangement in rural China. We used a six-wave panel of data derived from rural people over 60 years old in the Chaohu region of China. Cox regression analyses suggest that there was a positive effect of spousal loss on mortality for older rural Chinese and this effect was gender different. Our findings also suggest that living with adult children after spousal loss played a protective role in reducing the risk of older men's death, though it tended to increase older men's mortality risk in general.

Does widowhood affect cognitive function among Chinese older adults?

There is growing evidence from Western countries that widowhood may affect cognitive health in later life. However, little is known about whether widowhood is associated with cognitive health in Eastern Asian countries such as China and what factors may explain the association between widowhood and cognitive health. We add to this line of research by investigating the effect of widowhood on 2-year change in cognitive function among Chinese adults ages 55 and older from 2011 to 2013, using data from the China Health and Retirement Longitudinal Study. Cognitive function was measured by episodic memory and mental intactness (i.e., attention and time orientation). Our results showed that Chinese older adults who were continually widowed at both waves had significantly lower episodic memory scores at Wave 2 than their continually married counterparts, controlling for episodic memory at Wave 1, age, gender, education, and other sociodemographic variables. This suggests that the continually widowed experienced greater decline in episodic memory than the continually married over the 2-year period. After further controlling for economic resources, health, and social engagement, the difference in memory decline between the continually widowed and the continually married barely changed. The effect of widowhood on memory decline was similar for men and women. However, the continually widowed were not significantly different from the continually married in the decline of mental intactness. In addition, newly widowed adults were not significantly different from the continually married in the change of episodic memory and mental intactness. We conclude that staying widowed for 2 years or more may be an independent risk factor for episodic memory decline in China. More research is needed to investigate the mediating and moderating mechanisms underlying the association between widowhood and memory decline.

Disability, Psychological Well-Being, and Social Interaction in Later Life in China

Many studies show that disability predicts lower social participation and poorer psychological well-being. However, few have examined how disability, social interaction, and psychological well-being interrelate with one another. We use diary data from World Health Organization's Study on Global AGEing and Adult Health, 2007-2010 ( N = 8,771) and mediation analysis to examine the links between disability, daily social interaction, and the momentary and global well-being of older adults in China. We find suggestive support for the hypothesis that psychological well-being predicts social interaction in the context of disablement, but little evidence for the converse. Specifically, in a cross-sectional analysis, disability predicts lower levels of momentary affect, happiness, and life satisfaction, which are linked to spending more time alone and participating in fewer activities with grandchildren, friends, and coworkers. These findings are consistent with the hypothesis that a less active social life is explained by poor functional performance and compromised psychological vibrancy.

Migration of adult children and mental health of older parents 'left behind': An integrative review

Background

Although a number of studies have examined the effect of the out-migration of children on the mental health of ‘left behind’ elderly parents, research on the consequences of children’s migration on the mental health and well-being of elderly parents left behind is inconclusive and a systematic review is warranted.

Objectives

To identify the association between the left behind or empty nest status and the mental health of older parents, and to identify common risk factors for poor mental health among those left behind.

Methods

Online databases CINAHL, PsycINFO, PubMed, Scopus and ProQuest were searched for research (2000-September 2017) that focused on the relationship between the migration of adult children and the mental health of the older parents (≥50 years) left behind. The JBI Checklist for Analytical Cross Sectional Studies was used to assess the methodological quality of the articles.

Results

25 articles met the inclusion criteria. The studies identified that left behind older parents had higher levels of mental health problems compared to non-left behind. Left behind parents had higher depressive symptoms, higher levels of loneliness, lower life satisfaction, lower cognitive ability and poorer psychological health. A number of risk factors were identified for mental health disorders among the left behind parents, which included living arrangements, gender, education, income, physical health status, physical activity, family and social support, age, rural residence and frequency of children’s visit.

Conclusions

This review synthesised the various studies related to the mental health of left behind parents, advancing the theoretical and empirical understanding of the implications of out-migration of adult children on the psychological health and well-being of older parents. More responsive preventive measures and effective management approaches are required for this vulnerable cohort.

Living arrangements and older People's labor force participation in Hong Kong, 1986-2016

Using the 1% random sample of Hong Kong population census and by-census data (1986, 1991, 1996, 2001, 2006, 2011, 2016), we examine labor force participation (LFP) of older adults (aged 65+) and its association with living arrangements over a thirty-year span. Despite the large time period and the cohort variations in LFP, our cross-classified multilevel models (CCMM) showed a remarkably consistent linkage between the family context and older persons' LFP. Co-residence with adult children accompanies a lower level in older adults' LPF, compared with living alone or with the spouse only, but the extent of the reduction depends on the marital status of the children. Those living with married children have the lowest LFP, but living with unmarried children, sons in particular, increases the likelihood of employment compared with living with married children. We discuss the findings in light of changing macroeconomic conditions, marriage trends, and Chinese cultural traditions in Hong Kong.

The moderating effect of social support on the relationship between physical health and suicidal thoughts among Chinese rural elderly: A nursing home sample

Suicide rate is relatively high among Chinese rural elderly. While there has been some exciting work on reporting and preventing suicide among community-dwelling elderly, only a few published studies have addressed the issues of rural nursing homes in China. This study aimed to investigate the relationship among perceived social support, physical health, and suicidal thoughts of the elderly living in Chinese rural nursing homes. It also examined the moderating effects of social support on the path from physical health to suicidal thoughts of the rural institutional elderly in China. This study investigated 205 participants aged 60 years and above in Chinese rural nursing homes. Participants' suicidal thoughts, perceived social support, and physical health were assessed. This study conducted descriptive analysis, Student's t-test, and Pearson's chi-square test to test how physical health and social support predicted suicidal thoughts, as well as the moderating effects of family's, friends', and others' social support on physical health and suicidal thoughts. Both physical health and perceived social support were significantly related to suicidal thoughts. Perceived social support from family, friends, and significant others moderated the relationship between physical health and suicidal thoughts. Findings of this study suggested that increasing social support and improving physical health would be effective in both suicide prevention and intervention for the residents in Chinese rural nursing homes.

An Arabic Version of the Geriatric Depression Scale (30 Items): Psychometric Properties and Some Findings in a Lebanese Elderly Sample

BACKGROUND/AIM

Although the rates of depression and anxiety disorders have been shown to be higher in older people, especially those living in institutional settings, most of this population remains undiagnosed and untreated. The objective is to translate the full-scale Geriatric Depression Scale (30 items, GDS) into Arabic for use in elderly patients in Lebanon, to check its validity and reproducibility in comparison to the original version of the questionnaire, and assess the risk factors associated with depression in the Lebanese geriatric population.

METHODS

This case-control study was conducted between June and August 2016 and included 500 patients aged more than 60 years (250 living inside and 250 outside a nursing home).

RESULTS

Strongly positive correlations (p < 0.001 for all items of the scale) were found between each item of the scale and the total scale. The mean inter-item correlation for our scale was 0.51, higher than that of the original scale (0.36), with an excellent internal consistency (Cronbach α = 0.901). Living in a nursing home, stress, anxiety, being married, age, and the primary level of education would significantly increase depression (β = 2.211, β = 0.223, β = 0.041, β = 0.902, β = 0.118, and β = 3.533, respectively). A normal nutritional status and a university level of education would significantly decrease depression (β = -0.732; β = -1.961).

CONCLUSION

The Arabic version of the GDS can be used to estimate the severity of depression in the Lebanese elderly population. Periodic screening for anxiety, nutritional status, and stress is also recommended among geriatric people living in Lebanon.

Factors affecting the physical and mental health of older adults in China: The importance of marital status, child proximity, and gender

Evidence is accumulating about the association between strong family ties and the emotional and physical welfare of older adults, and researchers have identified negative consequences of being unmarried, being childless, and/or living alone. These associations have been recognized in multiple contexts, including in Asia where living with a spouse and/or grown children has been shown in some studies to improve elderly well-being. Social support, especially family support, is expected to continue to be important where populations are aging and social safety nets are weak. Using longitudinal data from the 2010 and 2012 waves of the China Family Panel Studies, we focus on the effects of marital status at times 1 and 2, changes in marital status between the two surveys, and other family-related indicators of social connectedness on ratings of depression, levels of life satisfaction, and self-reported physical health among those aged 50 and over. Our sample includes 9831 respondents who have valid data on wellbeing indicators for Wave 1 and Wave 2, as well as complete information on the other covariates controlled in our analysis. In analyses of the full sample, those who were married at both points in time reported lower depression scores than those who were never-married, divorced, or widowed at both time points, and those whose unions dissolved in the interval. Those who were married at both times also generally reported greater levels of life satisfaction than those who were never married at both time points and those who became divorced during the interval. Important underlying gender differences are observed both for life satisfaction and depression. In addition, those who were married at both time points reported being in better physical health than those who became widowed during the interval (significant primarily for women), and those who had never been married (significant primarily for men). Our study contributes to the literature on social ties and the wellbeing by highlighting the importance of marital status and changing marital status, net of child co-residence and proximity, in China.

Worry about not having a caregiver and depressive symptoms among widowed older adults in China: the role of family support

OBJECTIVES

Using the stress-coping framework, this study examined whether worry about not having a caregiver in old age was associated with depressive symptoms among widowed Chinese older adults, including the moderating effects of self-perceived family support.

METHOD

Using a sample of 5331 widowed adults aged 60 years old or older from the 2006 National Sample Survey of the Aged Population in Urban/Rural China, we regressed measures of depressive symptoms on worry about not having a caregiver. We also tested moderation effects of family support.

RESULTS

Individuals who were worried about not having a caregiver reported significantly higher levels of depressive symptoms. Feeling that their children are filial, having instrumental support from children, and having only daughters moderated the effects of worry about not having a caregiver on depressive symptoms.

CONCLUSION

Our findings indicate the detrimental effects of worry about not having a caregiver on the psychological well-being of widowed older adults. This study also highlights some forms of family support that may help reduce such negative effects of widowhood.

Psychological vulnerability of widowhood: financial strain, social engagement and worry about having no care-giver as mediators and moderators

This study examined how financial strain, worry about having no care-giver and social engagement modify the association between widowhood and depressive symptoms among older adults in China. Using national representative data from older adults in China in 2006, we ran structural equation models and ordinary least square regressions to investigate the mediating and moderating effects of financial strain, worry about having no care-giver and social engagement on the association between widowhood and depressive symptoms. All three variables significantly mediated the association between widowhood and depressive symptoms. Compared to their married counterparts, widowed older adults showed more worry about having no care-giver, increased financial strain and lower social engagement, which were significantly associated with depressive symptoms. Higher level of worry about having no care-giver and lower social engagement significantly exacerbated the adverse effects of widowhood on depressive symptoms in the moderation analyses. Our finding of mediating effects suggests that widowhood is negatively related to psychological wellbeing via financial strain, social engagement and care resources. The results regarding moderating effects suggest that alleviating worry about having no care-giver and increasing social engagement may buffer the deleterious effect of widowhood on psychological wellbeing in later life.

Anticipated support from children and later-life health in the United States and China

Past research has shown that anticipated support, the belief that someone will provide support if needed, benefits health. Few studies considered whether the relationship between anticipated support and health depends on the source of such support. This project addresses this gap and examines how anticipated support from children is related to older parents' health and whether such support can be replaced by anticipated support from other relatives and friends. Ordered logit and negative binomial regression models with lagged health outcomes were estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study and the 2011 and 2013 China Health and Retirement Longitudinal Study. Results suggest that anticipated support from children is related to older parents' better self-rated health and fewer depressive symptoms in both countries. In the U.S. where filial norms are relatively weak, anticipated support from others is no less important for health than anticipated support from children. However, in China where filial norms are relatively strong, parents anticipating support only from others are no different in health from those anticipating support from no one.

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.