Depression, Social Support, and Mental Health: A Longitudinal Mediation Analysis in African American Custodial Grandmothers

Social support and subjective well-being of noncustodial grandparent caregivers in urban China: The mediating roles of generative acts

While social support is generally beneficial, it remains unclear how it directly and indirectly affects subjective well-being among grandparents via generative acts. Multi-stage cluster random sampling was employed in a city in Eastern China, reaching 1013 noncustodial grandparent caregivers of kindergarten children (mean age = 58.3, range: 40-93, female = 71.9%, non-local = 508). Data were analyzed using structural equation modeling (SEM). The results reveal that social support positively affected three indicators of subjective well-being among noncustodial grandparent caregivers. Also, social support worked through agentic generative acts to positively affect life satisfaction and positive affect, while not through domestic generative acts. The present study contributes to grandparent caregiving research in urban China by advancing an integrated framework that considers the mechanism of generative acts. Policy and practice implications are also discussed.

The impact of grandchild care on depressive symptoms of grandparents in China: The mediating effects of generational support from children

Objectives

Despite extensive studies about the direct effect of grandchild care on caregiver depression in China, understanding of its internal influencing mechanism has been limited. After controlling for socioeconomic factors, this study investigated whether the experience of caring for grandchildren had a long-term impact on the depression levels of grandparents, either directly or indirectly through generational support from adult children.

Methods

The subjects of this study were a total of 9,219 adults over 45 who participated in the China Health and Retirement Longitudinal Surveys in 2015 and 2018. We adopted a lag-behind variable to examine the impact of grandchild care on depressive symptoms of grandparents. The proposed mediation model was analyzed using bootstrap modeling, and the KHB method was conducted further to examine differences in the effects of generational support.

Results

The experience of caring for grandchildren had a significant negative correlation with the depression level of Chinese grandparents. Moreover, children's support significantly mediated the impact of parenting experience on grandparents' depression. Significantly, instrumental support mediated the effect to the greatest extent, while emotional support from children contributed the least. The intermediary effect has urban-rural heterogeneity.

Conclusion

These findings indicated that grandchild care significantly inhibited the depression level of Chinese grandparents through increased intergenerational support from adult children. The implications of the study's findings were discussed.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

"Who is going to take care of these grandkids if I go?": End-of-life planning by caregivers in grandparent-headed households

This qualitative study applied thematic analysis to semi-structured interviews with 15 key informants who self-identified as primary caregivers to at least one grandchild. Using Family Systems Theory and Theory of Planned Behavior as guiding frameworks, this study reports grandparent caregivers' end-of-life planning behaviors while illuminating factors influencing these behaviors. The analysis revealed two themes related to grandparents' communicative behaviors surrounding end-of-life planning (formal and informal behaviors) and four themes related to factors that influence grandparents' end-of-life planning (emotional paradoxes, legal/custodial conundrums, concerns about child wellbeing, and resources needed to plan). Findings extend end-of-life planning literature to often overlooked nontraditional family populations.

Understanding the Relationships between Parenting Stress and Mental Health with Grandparent Kinship Caregivers' Risky Parenting Behaviors in the Time of COVID-19

Grandparent kinship caregivers may experience increased parenting stress and mental distress during the COVID-19 pandemic. It may lead to risky parenting behaviors, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren. This study aims to examine (1) the relationships between parenting stress, mental health, and grandparent kinship caregivers' risky parenting practices, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren during the COVID-19 pandemic, and (2) whether grandparent kinship caregivers' mental health is a potential mediator between parenting stress and caregivers' psychological aggression, corporal punishment, and neglectful behaviors. A cross-sectional survey among grandparent kinship caregivers (N = 362) was conducted in June 2020 in the United States. Descriptive analyses, negative binomial regression analyses, and mediation analyses were conducted using STATA 15.0. We found that (1) grandparent kinship caregivers' high parenting stress and low mental health were associated with more psychological aggression, corporal punishment, and neglectful parenting behaviors during COVID-19; and (2) grandparent kinship caregivers' mental health partially mediated the relationships between parenting stress and their psychological aggression, corporal punishment, and neglectful behaviors. Results suggest that decreasing grandparent kinship caregivers' parenting stress and improving their mental health are important for reducing child maltreatment risk during COVID-19.

Depression, anxiety, and happiness in dog owners and potential dog owners during the COVID-19 pandemic in the United States

Major life events, such as the COVID-19 pandemic, affect psychological and physiological health. Social support, or the lack thereof, can modulate these effects. The context of the COVID-19 pandemic offered a unique opportunity to better understand how dogs may provide social support for their owners and buffer heightened symptoms of stress, anxiety and depression and contribute to happiness during a major global crisis. Participants (768 pet dog owners and 767 potential pet dog owners) answered an online survey, including validated depression, anxiety, happiness psychometric scales, attitude to and commitment towards pet, and perceived social support. Potential pet dog owners were defined as individuals who did not own a dog at the time of the survey but would be very or extremely interested in owning one in the future. Dog owners reported having significantly more social support available to them compared to potential dog owners, and their depression scores were also lower, compared to potential dog owners. There were no differences in anxiety and happiness scores between the two groups. Dog owners had a significantly more positive attitude towards and commitment to pets. Taken together, our results suggest that dog ownership may have provided people with a stronger sense of social support, which in turn may have helped buffer some of the negative psychological impacts caused by the COVID-19 pandemic.

Domestic Generative Acts and Life Satisfaction among Supplementary Grandparent Caregivers in Urban China: Mediated by Social Support and Moderated by Hukou Status

Urban China is witnessing a growth of migrant grandparents apart from the prevalent local grandparent caregiving. However, the health consequences and influencing factors of grandparent caregiving remain largely unknown among migrant and local grandparent caregivers. This study examined informal and formal social support's mediation roles between domestic generative acts and life satisfaction, as well as investigating Hukou's (household registration system) moderation effect. Our sample compromised 1013 grandparent caregivers (Migrant = 508, Local = 505) from 12 kindergartens with a multistage clustered random sampling from Eastern China. Migrant grandparent caregivers had significant lower informal social support (M = 4.000, L = 4.355, p < 0.001), formal social support (M = 1.787, L = 2.111, p < 0.001), and life satisfaction (M = 3.323, L = 3.574, p < 0.001) than local ones. Structural equation modeling results indicated that domestic generative acts positively associated with life satisfaction (b = 0.085, p < 0.05), informal (b = 0.223, p < 0.001) and formal social support (b = 0.080, p < 0.05); informal (b = 0.379, p < 0.001) and formal social support (b = 0.138, p < 0.001) positively associated with life satisfaction. In addition, both informal (β = 0.084, CI [0.039, 0.101], p < 0.001) and formal social support (β = 0.011, CI [0.001, 0.018], p < 0.05) mediated the relationship between domestic generative acts and life satisfaction. Furthermore, Hukou status moderated the indirect path from domestic generative acts to life satisfaction via informal social support (p < 0.01), but not formal social support (p > 0.05). Migrant grandparent caregivers, with limited formal social support resources, were found to be more dependent on informal social support than locals. The findings revealed social support and wellbeing disparities among migrant and local grandparent caregivers in urban China. Theoretical contributions and practical implications are also discussed.

Material hardship and parenting stress among grandparent kinship providers during the COVID-19 pandemic: The mediating role of grandparents' mental health

BACKGROUND

The COVID-19 pandemic has exposed the vulnerability of many families, including grandparent kinship families, to deal with a health/economic crisis. The fear of COVID-19 plus stay-at-home orders have increased individuals' psychological distress. Moreover, school closures and homeschooling further increased parenting stress among caregivers.

OBJECTIVES

This study examined the relationship between material hardship and parenting stress among grandparent kinship providers, and assessed grandparents' mental health as a potential mediator to this relationship during the COVID-19 pandemic in the United States.

PARTICIPANTS AND SETTING

Grandparent kinship providers (N = 362) that took primary care of their grandchildren participated in a cross-sectional survey via Qualtrics Panels in June 2020 in the United States.

METHODS

Descriptive and bivariate analyses, binary logistic regression, and mediation analyses were conducted using STATA 15.0.

RESULTS

Suffering material hardship was significantly associated with higher odds of experiencing parenting stress among grandparent kinship providers, and grandparents' mental health partially mediated this association.

CONCLUSIONS

Addressing material and mental health needs among grandparent kinship providers is critical to decreasing their parenting stress.

Providing regular grandchild care: Grandparents' psychological and physical health

OBJECTIVES

To examine the associations between intensity of providing regular grandchild care and positive affect (PA) and negative affect (NA), heart rate variability (HRV) and somatic symptoms.

METHODS

This was a cross-sectional study involving 104 individuals (aged 59-82) who provide at least 5 h a week of regular care for their grandchildren. The study model was assessed using structural equation modeling.

RESULTS

Intensity of regular care (mean hours per week: M = 14.8, SD = 11.2) was associated with higher PA and lower NA. Higher perceived role overload, higher NA and lower PA were associated with lower HRV and somatic symptoms. The fit indices indicated a good model fit.

CONCLUSIONS

The results suggest that healthcare professionals should be aware of the positive and negative implications of caring for grandchildren on their older patients, including the increased risk of future morbidity, as indicated by lower HRV.

Compounding Complexity: Examining Multiple Factors Leading to Challenges Within Grandfamilies

BACKGROUND AND OBJECTIVES

Grandparents who are raising their grandchildren in the absence of the biological parents, often referred to as custodial grandparents, are prevalent across the United States. The objective of this project was to establish a grounded theory as a tool for practitioners and researchers to understand the experiences of members of grandfamiles.

RESEARCH DESIGN AND METHODS

In-depth, unstructured interviews with custodial grandparents and grandchildren from 15 grandfamilies were conducted. Classic grounded theory was the methodology used to ask the question, "What are the challenges within grandfamilies and how do they respond to these challenges?"

RESULTS

The theory emerging from the data, Compounding Complexity, provides an explanatory framework of three interrelated categories of factors that affect complexity in grandfamilies: situational, relationship, and emotional complexity. Conflict and change were found to be consistent across the categories of Compounding Complexity.

DISCUSSIONS AND IMPLICATIONS

Next steps include adding data from interviews with biological parents to Compounding Complexity and applying the theory. Understanding relationship, situational, and emotional complexity in the context of conflict and change enables practitioners to advance their work with grandfamiies.

Advances in Understanding the Causes and Consequences of Health Disparities in Aging Minorities

PURPOSE OF REVIEW

The purpose was to discuss appropriate methods for advancing our understanding of health disparities or minority aging including life-course perspectives, biological measures, pain measurement, and generational approaches.

RECENT FINDINGS

Life course perspectives provide an orientation for studying older minorities that concomitantly captures exposures and stressors that may lead to earlier onset of disease and premature mortality. The use of biological markers to study health disparities in older minorities is necessary in order to identify pathways between psychosocial factors and health outcomes. Work focusing on pain disparities should include explorations of relationships between psychosocial factors, and subjective and objective measures of pain. Studying families can provide insight into genetic associations and coping styles in older minorities.

SUMMARY

Methodological approaches that take life course, biology, and social factors into account may help identify causal pathways between social determinants of health and health outcomes among older minorities. Once these causal pathways have been identified, more strategies and interventions that strive toward health equity across older adults of all race/ethnic groups can be developed.

Relationship of Perceived Social Support with Mental Health in Older Caregivers

Background: Elderly caregivers present increased physical and mental health problems. These factors can lead to a lack of autonomy and a need for social support. This study aims to analyse the relationships between perceived social support and mental health status in elderly caregivers aged 65 and older. Methods: a cross-sectional study based on data from the Spanish National Health Survey (ENSE-17) carried out on 7023 people. The study population was restricted to 431 caregivers aged ≥65 years. A study of the correlation between the mental health state and the perceived social support was carried out. Both variables were related to the sex of the caregiver. Results: Perceived social support by older caregivers is significantly related to mental health (p = 0.001), and stress (p < 0.001). Also, there is a significant relationship between perceived social support and mental well-being (p = 0.001), self-esteem (p = 0.005) and stress (p = 0.001) in older women caregivers. Conclusions: Older caregivers have adequate mental well-being and perceive high social support. Perceived social support can contribute to improving the mental well-being of older caregivers.

The Influence of Caregiving on the Relation Between Marital Status and Psychological Health in a Grandparent Sample

Grandparent caregivers report poorer psychological and physical health, but relationship status has been shown to influence burden. The current study investigated depressive symptoms of 3288 grandparents who completed the third wave of the National Survey of Families and Households. The study found that those who are unmarried were more likely to be grandparent caregivers, and female participants reported higher depressive symptoms. Marital status and caregiving status were comparable predictors of depression, but marital status did not buffer the effects of caregiving status on depression. Caregiving status accounted for a significant amount of depressive symptom variance for depression, comparable to marital status and gender. There was a significant difference in depressive symptoms of married and unmarried grandparent non-caregivers but with a significantly lower baseline depression rate than grandparent caregivers. Future research should examine whether making social support options available to unmarried grandparent caregivers who lack informal support from a spouse may improve outcomes.

Mental and Physical Health Correlates of Financial Difficulties Among African-American Older Adults in Low-Income Areas of Los Angeles

Background: While financial difficulties correlate with mental and physical health status, less is known about these associations among economically disadvantaged African-American (AA) older adults. Objective: This study explored mental and physical health correlates of financial difficulties among AA older adults in low-income areas of south Los Angeles. Methods: A cross-sectional study on 740 AA older adults (age ≥ 55 years) conducted in South Los Angeles between 2015 and 2018. Independent variable was financial difficulties. Outcomes were depressive symptoms, chronic pain, chronic medical conditions, self-reported health, and sick days. Age, gender, educational attainment, living alone, marital status, smoking, and drinking were also measured. Zero order (unadjusted) and partial (adjusted) correlates of financial difficulties were calculated for data analysis. Adjusted (partial) bivariate correlations controlled for age, gender, education, marital status, living alone, and health insurance. Results: In adjusted analyses, financial difficulties were positively associated with chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. Conclusion: Financial difficulties seem to be linked to chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. The results advocate for evaluation of social determinants of health in providing health care of AA older adults. Addressing financial difficulties may help with the health promotion of low-income AA older adults in urban areas.

Grandparents Raising Grandchildren: What Have We Learned Over the Past Decade?

BACKGROUND AND OBJECTIVES

In this manuscript, we update the literature over the last decade in addressing several new content areas that have emerged in the grandfamilies literature, along with issues that are still important to understanding grandparents raising their grandchildren today.

RESEARCH DESIGN AND METHODS

The social science and gerontological literature since 2004 was accessed, reviewed, organized topically, and integrated, based upon an exhaustive PsychINFO literature search.

RESULTS

Our review indicates an ongoing and/or growing emphasis on (a) the strengths of grandparent raising grandchildren, (b) diversity among grandfamilies along a number of parameters, (c) the social-interpersonal, cultural, and policy-related contexts of grandfamilies, (d) process-focused research, (e) parenting, parenting skills, and family relationships, (f) grandparent psychological distress, (g) targets for and the efficacy of interventions with grandfamilies, and (h) methodological issues relevant to the study of grandfamilies.

IMPLICATIONS

We discuss the implications of our findings in terms of more completely understanding grandfamilies along a number of parameters, as well as presenting specific recommendations for future research and practice.

Social support as a mediator between depression and quality of life in Chinese community-dwelling older adults with chronic disease

The older adults with chronic disease usually show poor mental health and experience low quality of life (QOL). This study aimed to examine the mediating role of social support in the relationship between depression and QOL in community-dwelling older adults with chronic disease. A total of 387 Chinese older adults aged 60 or above with chronic disease were included in this cross-sectional study. Social support was negatively associated with depression and positively associated with physical component scale (PCS) and mental component scale (MCS). Depression and social support were all predictors of PCS and MCS. Mediation analysis suggested that social support partially mediated the impact of depression on PCS and MCS. Understanding the mediating role of social support might be beneficial in reducing the adverse impact of depression on QOL in community-dwelling older adults with chronic disease.

Sobrecarga familiar, apoyo social y salud comunitaria en cuidadores de personas con trastorno mental grave

RESUMEN Objetivo Identificar el nivel de sobrecarga de los cuidadores y analizar los factores asociados con el cuidado familiar en salud mental. Método Se realizó un estudio descriptivo transversal realizado entre los meses de enero y julio del año 2016, en el que se evalúa una muestra de cuidadores de siete dispositivos públicos y una asociación de familiares y pacientes identificando la sobrecarga de los mismos y los factores que contribuyen a reducir estos niveles, a través del instrumento Zarit Burden Inventor y . El estudio se llevó a cabo de acuerdo a las recomendaciones de los comités de ética de las instituciones participantes. Resultados Participaron 107 cuidadores. Las principales aportaciones refieren que la participación activa del cuidador en dinámicas asociativas, la asistencia a actividades psicoeducativas y la vinculación territorial a áreas metropolitanas con recursos comunitarios, disminuyen el nivel de sobrecarga del cuidador. Conclusión Finalmente, destaca la importancia y responsabilidad de la enfermería comunitaria a efectos de prevenir los niveles de sobrecarga e incrementar los de salud; además, se realizan una serie de propuestas en la línea de favorecer redes de apoyo social, combinar tratamientos e incrementar los programas de salud pública en contacto con la comunidad.

Changes in Health Perceptions among Older Grandparents Raising Adolescent Grandchildren

This research study explores health perceptions before and after becoming a primary caregiver among older grandparents raising adolescent grandchildren. Qualitative, in-depth face-to-face interviews were conducted with grandparents age 40 and older (N = 15) who were raising adolescent grandchildren age 12 and older. Most grandparents were female, had some college education, White/Non-Hispanic, were married, had an average age of 65 years, and reported never attending a grandparent support group. Before assuming the primary caregiver role, older grandparents described their physical health as good, filled with physical activity, and reasonably free of health conditions. After entering the primary caregiving role, older grandparents of adolescents described functional restrictions and visible changes in physical health requiring intensive medical interventions. In terms of mental health, older grandparent caregivers experienced anxiety, worry, depression, sadness, and frustration. These findings highlight the complex caregiving circumstances encountered by older grandparents raising adolescents and the need for health education and policy development to increase comprehensive supportive services targeting this population.

Biofeedback in Grandmothers Raising Grandchildren: Evaluating Intervention Parameters

This study examined the six critical parameters for evaluating interventions, including necessity, acceptability, feasibility, safety, fidelity, and effectiveness, of a heart rate variability (HRV) biofeedback training intervention in a sample of 20 grandmothers who were the primary caregivers of their grandchildren. After the grandmothers completed the HRV biofeedback training, they answered open-ended questions to provide data on the six parameters during face-to-face interviews. The findings of the study provided evidence for the necessity, acceptability, feasibility, safety, fidelity, and effectiveness of the HRV biofeedback intervention for reducing the stress experienced by grandmothers in raising their grandchildren.