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Published in: BMC Geriatrics 1/2022

Open Access 01-12-2022 | Research

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

Authors: Qian Sun, Youwei Wang, Nan Lu, Shiyan Lyu

Published in: BMC Geriatrics | Issue 1/2022

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Abstract

Background

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

Methods

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

Results

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

Conclusions

The findings not only highlight the important role of intergenerational support in promoting mental health in later life in rural Chinese contexts, but also identify within-population heterogeneity in the identified associations. Policy and intervention implications are discussed.
Literature
1.
go back to reference United Nations: World Population Prospects 2019: Highlights. In.; 2019. United Nations: World Population Prospects 2019: Highlights. In.; 2019.
2.
go back to reference China’s Ministry of Civil Affairs: Statistics bulletin of social service development. In.; 2019. China’s Ministry of Civil Affairs: Statistics bulletin of social service development. In.; 2019.
3.
go back to reference Lu N, Xu L, Lou VWQ, Chi I. Intergenerational relationships and the trajectory of depressive symptoms among older Chinese adults in rural migrant families. Aging Mental Health. 2018;22(3):389–96.CrossRef Lu N, Xu L, Lou VWQ, Chi I. Intergenerational relationships and the trajectory of depressive symptoms among older Chinese adults in rural migrant families. Aging Mental Health. 2018;22(3):389–96.CrossRef
4.
go back to reference Qin X, Wang S, Hsieh C. The prevalence of depression and depressive symptoms among adults in China: Estimation based on a National Household Survey. China Economic Review. 2016;51:271–82.CrossRef Qin X, Wang S, Hsieh C. The prevalence of depression and depressive symptoms among adults in China: Estimation based on a National Household Survey. China Economic Review. 2016;51:271–82.CrossRef
5.
go back to reference Chen Y, Hicks A, While AE. Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China. Quality Life Res. 2014;23(5):1593–602.CrossRef Chen Y, Hicks A, While AE. Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China. Quality Life Res. 2014;23(5):1593–602.CrossRef
6.
go back to reference Wang CW, Chan CL, Yip PS. Suicide rates in China from 2002 to 2011: an update. Soc Psychiatry Psychiatric Epidemiol. 2014;49(6):929–41.CrossRef Wang CW, Chan CL, Yip PS. Suicide rates in China from 2002 to 2011: an update. Soc Psychiatry Psychiatric Epidemiol. 2014;49(6):929–41.CrossRef
7.
go back to reference Zhang C. Prevalence and related influencing factors of depressive symptoms among empty-nest elderly in Shanxi, China. J Affective Disorders. 2018;245:750–6.CrossRef Zhang C. Prevalence and related influencing factors of depressive symptoms among empty-nest elderly in Shanxi, China. J Affective Disorders. 2018;245:750–6.CrossRef
8.
go back to reference Xie Y, Ma M, Wu W, Zhang Y, Zhang Y, Tan X. Factors associated with depressive symptoms among the elderly in China: structural equation model. International Psychogeriatrics. 2021;33(2):157–67.CrossRef Xie Y, Ma M, Wu W, Zhang Y, Zhang Y, Tan X. Factors associated with depressive symptoms among the elderly in China: structural equation model. International Psychogeriatrics. 2021;33(2):157–67.CrossRef
9.
go back to reference Mjelde-Mossey LA, Chi I, Lou VWQ. Relationship between adherence to tradition and depression in Chinese elders in China. Aging Mental Health. 2006;10(1):19–26.CrossRef Mjelde-Mossey LA, Chi I, Lou VWQ. Relationship between adherence to tradition and depression in Chinese elders in China. Aging Mental Health. 2006;10(1):19–26.CrossRef
10.
go back to reference Lin JP, Yi CC. Filial norms and intergenerational support to aging parents in China and Taiwan. Int J Soc Welfare. 2011;20:S109–20. Lin JP, Yi CC. Filial norms and intergenerational support to aging parents in China and Taiwan. Int J Soc Welfare. 2011;20:S109–20.
11.
go back to reference Chappell NL, Kusch K. The gendered nature of filial piety—A study among Chinese Canadians. J Cross-Cultural Gerontol. 2007;22(1):29–45.CrossRef Chappell NL, Kusch K. The gendered nature of filial piety—A study among Chinese Canadians. J Cross-Cultural Gerontol. 2007;22(1):29–45.CrossRef
12.
go back to reference Chen X: Social Support, Social Change, and Psychological Well-being of the Elderly in China: Does the Type and Source of Support Matter?: University of Southern California; 2001. Chen X: Social Support, Social Change, and Psychological Well-being of the Elderly in China: Does the Type and Source of Support Matter?: University of Southern California; 2001.
13.
go back to reference Wu B, Cohen MA, Cong Z, Kim K, Peng C. Improving care for older adults in China: Development of long-term care policy and system. Res Aging. 2021;43(3–4):123–6. Wu B, Cohen MA, Cong Z, Kim K, Peng C. Improving care for older adults in China: Development of long-term care policy and system. Res Aging. 2021;43(3–4):123–6.
14.
go back to reference Guo M, Chi I, Silverstein M. Intergenerational support and depression among Chinese older adults: Do gender and widowhood make a difference? Ageing Soc. 2017;37(4):695–724.CrossRef Guo M, Chi I, Silverstein M. Intergenerational support and depression among Chinese older adults: Do gender and widowhood make a difference? Ageing Soc. 2017;37(4):695–724.CrossRef
15.
go back to reference Antonucci TC. Social Support and Social Relationships. New York: Academic Press; 1990. Antonucci TC. Social Support and Social Relationships. New York: Academic Press; 1990.
16.
go back to reference Chen X, Silverstein M. Intergenerational social support and the psychological well-being of older parents in China. Res Aging. 2000;22(1):43–65.CrossRef Chen X, Silverstein M. Intergenerational social support and the psychological well-being of older parents in China. Res Aging. 2000;22(1):43–65.CrossRef
17.
go back to reference Bai X, Lai DW, Guo A. Ageism and depression: Perceptions of older people as a burden in China. J Soc Issues. 2016;72(1):26–46.CrossRef Bai X, Lai DW, Guo A. Ageism and depression: Perceptions of older people as a burden in China. J Soc Issues. 2016;72(1):26–46.CrossRef
18.
go back to reference Koelmel E, Hughes AJ, Alschuler KN, Ehde DM. Resilience mediates the longitudinal relationships between social support and mental health outcomes in multiple sclerosis. Arch Physical Med Rehabil. 2017;98(6):1139–48.CrossRef Koelmel E, Hughes AJ, Alschuler KN, Ehde DM. Resilience mediates the longitudinal relationships between social support and mental health outcomes in multiple sclerosis. Arch Physical Med Rehabil. 2017;98(6):1139–48.CrossRef
19.
go back to reference Murayama Y, Ohba H, Yasunaga M, Nonaka K, Takeuchi R, Nishi M, Sakuma N, Uchida H, Shinkai S, Fujiwara Y. The effect of intergenerational programs on the mental health of elderly adults. Aging Mental Health. 2015;19(4):306–14.CrossRef Murayama Y, Ohba H, Yasunaga M, Nonaka K, Takeuchi R, Nishi M, Sakuma N, Uchida H, Shinkai S, Fujiwara Y. The effect of intergenerational programs on the mental health of elderly adults. Aging Mental Health. 2015;19(4):306–14.CrossRef
20.
go back to reference Lendon JP, Silverstein M, Giarrusso R. Ambivalence in older parent–adult child relationships: Mixed feelings, mixed measures. J Marriage Fam. 2014;76(2):272–84.CrossRef Lendon JP, Silverstein M, Giarrusso R. Ambivalence in older parent–adult child relationships: Mixed feelings, mixed measures. J Marriage Fam. 2014;76(2):272–84.CrossRef
21.
go back to reference Weinstein M, Glei DA, Yamazaki A, Chang MC. The role of intergenerational relations in the association between life stressors and depressive symptoms. Res Aging. 2004;26(5):511–30.CrossRef Weinstein M, Glei DA, Yamazaki A, Chang MC. The role of intergenerational relations in the association between life stressors and depressive symptoms. Res Aging. 2004;26(5):511–30.CrossRef
22.
go back to reference Chen J, Jordan LP. Intergenerational support and life satisfaction of young-, old-and oldest-old adults in China. Aging Mental Health. 2018;22(3):412–20.CrossRef Chen J, Jordan LP. Intergenerational support and life satisfaction of young-, old-and oldest-old adults in China. Aging Mental Health. 2018;22(3):412–20.CrossRef
23.
go back to reference Lu N, Spencer M, Sun Q, Lou VWQ: Family social capital and life satisfaction among older adults living alone in urban China: The moderating role of functional health. Aging & Mental Health 2020:1–8. Lu N, Spencer M, Sun Q, Lou VWQ: Family social capital and life satisfaction among older adults living alone in urban China: The moderating role of functional health. Aging & Mental Health 2020:1–8.
24.
go back to reference Chan A, Malhotra C, Malhotra R, Østbye T. Living arrangements, social networks and depressive symptoms among older men and women in Singapore. Int J Geriatric Psychiatry. 2011;26(6):630–9.CrossRef Chan A, Malhotra C, Malhotra R, Østbye T. Living arrangements, social networks and depressive symptoms among older men and women in Singapore. Int J Geriatric Psychiatry. 2011;26(6):630–9.CrossRef
25.
go back to reference Kim J, Choi Y, Choi JW, Nam JY, Park EC. Impact of family characteristics by marital status of cohabitating adult children on depression among Korean older adults. Geriatrics Gerontol International. 2017;17(12):2527–36.CrossRef Kim J, Choi Y, Choi JW, Nam JY, Park EC. Impact of family characteristics by marital status of cohabitating adult children on depression among Korean older adults. Geriatrics Gerontol International. 2017;17(12):2527–36.CrossRef
26.
go back to reference Zhang Y, Liu Z, Zhang L, Zhu P, Wang X, Huang Y. Association of living arrangements with depressive symptoms among older adults in China: a cross-sectional study. BMC Public Health. 2019;19(1):1–10.CrossRef Zhang Y, Liu Z, Zhang L, Zhu P, Wang X, Huang Y. Association of living arrangements with depressive symptoms among older adults in China: a cross-sectional study. BMC Public Health. 2019;19(1):1–10.CrossRef
27.
go back to reference Cheng S, Chan ACM. Filial piety and psychological well-being in well older Chinese. J Gerontol Series B: Psychol Sci Soc Sci. 2006;61(5):262–9.CrossRef Cheng S, Chan ACM. Filial piety and psychological well-being in well older Chinese. J Gerontol Series B: Psychol Sci Soc Sci. 2006;61(5):262–9.CrossRef
28.
go back to reference Cong Z, Silverstein M. Caring for grandchildren and intergenerational support in rural China: A gendered extended family perspective. Ageing Society. 2012;32(3):425–50.CrossRef Cong Z, Silverstein M. Caring for grandchildren and intergenerational support in rural China: A gendered extended family perspective. Ageing Society. 2012;32(3):425–50.CrossRef
29.
go back to reference Hatfield JP, Hirsch JK, Lyness JM. Functional impairment, illness burden, and depressive symptoms in older adults: does type of social relationship matter? Int J Geriatric Psychiatry. 2013;28(2):190–8.CrossRef Hatfield JP, Hirsch JK, Lyness JM. Functional impairment, illness burden, and depressive symptoms in older adults: does type of social relationship matter? Int J Geriatric Psychiatry. 2013;28(2):190–8.CrossRef
30.
go back to reference Birk JL, Kronish IM, Moise N, Falzon L, Yoon S, Davidson KW. Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases. Health Psychology. 2019;38(9):802.CrossRef Birk JL, Kronish IM, Moise N, Falzon L, Yoon S, Davidson KW. Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases. Health Psychology. 2019;38(9):802.CrossRef
31.
go back to reference Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: A systematic review and meta-analysis. J Affective Disorders. 2017;221:36–46.CrossRef Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: A systematic review and meta-analysis. J Affective Disorders. 2017;221:36–46.CrossRef
32.
go back to reference Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatrics Soc. 1975;23(10):433–41.CrossRef Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatrics Soc. 1975;23(10):433–41.CrossRef
33.
go back to reference Cheng ST, Chan AC. The Center for Epidemiologic Studies Depression Scale in older Chinese: Thresholds for long and short forms. Int J Geriatric Psychiatry. 2005;20(5):465–70.CrossRef Cheng ST, Chan AC. The Center for Epidemiologic Studies Depression Scale in older Chinese: Thresholds for long and short forms. Int J Geriatric Psychiatry. 2005;20(5):465–70.CrossRef
34.
go back to reference Mangen DJ, Bengtson VL, Landry PH Jr, editors. Measurement of intergenerational relations. Beverly Hills: Sage Publications; 1988. Mangen DJ, Bengtson VL, Landry PH Jr, editors. Measurement of intergenerational relations. Beverly Hills: Sage Publications; 1988.
35.
go back to reference Mahoney R, DW B: Barthel index (BI). Surya Shah, PhD, OTD, MEd, OTR, FAOTA, Professor Occupational Therapy and Neurology, Visiting Professor Neurorehabilitation, University of Tennessee Health Sciences Center 1965, 930(1). Mahoney R, DW B: Barthel index (BI). Surya Shah, PhD, OTD, MEd, OTR, FAOTA, Professor Occupational Therapy and Neurology, Visiting Professor Neurorehabilitation, University of Tennessee Health Sciences Center 1965, 930(1).
36.
go back to reference Belsley DA, Kuh E, Welsch RE. Regression Diagnostics: Identifying Influential Data and Sources of Collinearit. New York: John Wiley; 1980.CrossRef Belsley DA, Kuh E, Welsch RE. Regression Diagnostics: Identifying Influential Data and Sources of Collinearit. New York: John Wiley; 1980.CrossRef
37.
go back to reference White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48(4):817–38.CrossRef White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48(4):817–38.CrossRef
38.
go back to reference Durbin J, Watson GS: Testing for serial correlation in least squares regression. I. In: Breakthroughs in Statistics: Methodology and Distribution. Edited by Kotz S, Johnson NL. New York: Springer New York; 1992: 237-259. Durbin J, Watson GS: Testing for serial correlation in least squares regression. I. In: Breakthroughs in Statistics: Methodology and Distribution. Edited by Kotz S, Johnson NL. New York: Springer New York; 1992: 237-259.
39.
go back to reference Tabachnick B, Fidell L: Using Multivariate Statistics (5th Edition). New York: Harper Collins; 2007. Tabachnick B, Fidell L: Using Multivariate Statistics (5th Edition). New York: Harper Collins; 2007.
40.
go back to reference Brambor T, Clark WR, Golder M. Understanding interaction models: Improving empirical analyses. Political Analysis. 2006;14(1):63–82.CrossRef Brambor T, Clark WR, Golder M. Understanding interaction models: Improving empirical analyses. Political Analysis. 2006;14(1):63–82.CrossRef
41.
go back to reference Hayes AF, Matthes J. Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods. 2009;41(3):924–36.CrossRef Hayes AF, Matthes J. Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods. 2009;41(3):924–36.CrossRef
42.
go back to reference Johnson PO, Neyman J. Tests of certain linear hypotheses and their application to some educational problems. Statistical Research Memoirs. 1936;1:57–93. Johnson PO, Neyman J. Tests of certain linear hypotheses and their application to some educational problems. Statistical Research Memoirs. 1936;1:57–93.
43.
go back to reference Bauer DJ, Curran PJ. Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate Behav Res. 2005;40(3):373–400.CrossRef Bauer DJ, Curran PJ. Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate Behav Res. 2005;40(3):373–400.CrossRef
44.
go back to reference Field A. Discopering Statistics Using SPSS. Thousand Oaks, CA: Sage Publications; 2009. Field A. Discopering Statistics Using SPSS. Thousand Oaks, CA: Sage Publications; 2009.
45.
go back to reference Carden SW, Holtzman NS, Strube MJ: CAHOST: An Excel Workbook for Facilitating the Johnson-Neyman Technique for Two-Way Interactions in Multiple Regression. Front Psychol. 2017; 8(1293). Carden SW, Holtzman NS, Strube MJ: CAHOST: An Excel Workbook for Facilitating the Johnson-Neyman Technique for Two-Way Interactions in Multiple Regression. Front Psychol. 2017; 8(1293).
46.
go back to reference Jacobson NC, Lord KA, Newman MG. Perceived emotional social support in bereaved spouses mediates the relationship between anxiety and depression. J Affective Disorders. 2017;211:83–91.CrossRef Jacobson NC, Lord KA, Newman MG. Perceived emotional social support in bereaved spouses mediates the relationship between anxiety and depression. J Affective Disorders. 2017;211:83–91.CrossRef
47.
go back to reference Li C, Jiang S, Zhang X. Intergenerational relationship, family social support, and depression among Chinese elderly: a structural equation modeling analysis. J Affective Disorders. 2019;248:73–80.CrossRef Li C, Jiang S, Zhang X. Intergenerational relationship, family social support, and depression among Chinese elderly: a structural equation modeling analysis. J Affective Disorders. 2019;248:73–80.CrossRef
48.
go back to reference Walther A, Philipp M, Lozza N, Ehlert U. Emotional support, depressive symptoms, and age-related alterations in male body composition: cross-sectional findings from the men’s health 40+ study. Front Psychol. 2017;8:1075.CrossRef Walther A, Philipp M, Lozza N, Ehlert U. Emotional support, depressive symptoms, and age-related alterations in male body composition: cross-sectional findings from the men’s health 40+ study. Front Psychol. 2017;8:1075.CrossRef
49.
go back to reference Qiu X, Sit JWH, Koo FK. The influence of Chinese culture on family caregivers of stroke survivors: A qualitative study. J Clin Nurs. 2018;27(1–2):e309–19. Qiu X, Sit JWH, Koo FK. The influence of Chinese culture on family caregivers of stroke survivors: A qualitative study. J Clin Nurs. 2018;27(1–2):e309–19.
Metadata
Title
Intergenerational support and depressive symptoms among older adults in rural China: the moderating roles of age, living alone, and chronic diseases
Authors
Qian Sun
Youwei Wang
Nan Lu
Shiyan Lyu
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-021-02738-1

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