Restricted accessResearch articleFirst published online 2025-4
The Associations Between Social Support From Adult Children (SSAC) and the Risk of Later-Life Depression (LLD) Among Rural Older Individuals: A Longitudinal Study Based on 2011 to 2018 China Health and Retirement Longitudinal Study Data
This study was designed to investigate the implications of perceived social support from adult children (SSAC) on the incidence of later-life depression (LLD) among rural older adults in China. A total of 1762 participants without depressive symptoms and aged ≥60 years at baseline were recruited from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study (CHARLS) and followed up until 2018. After following-up for 2–7 years (average 4.6 years), a total of 746 participants (43.2%) were identified with LLD and the overall incidence of LLD was 128.5 per 1000 person-years. Univariate and multiple Cox regression analysis consistently indicated that receiving living care support was the sole form of SSAC that may significantly reduce the risk of LLD in rural older adults in China (HR: 0.81, 95% CI: 0.70–0.95, p = .008). These results may be of assistance in comprehensively understanding the role of SSAC in the mental health of older adults.
BaiW.ZhangJ.SmithR. D.CheungT.SuZ.NgC. H.ZhangQ.XiangY. T. (2023). Inter-relationship between cognitive performance and depressive symptoms and their association with quality of life in older adults: A network analysis based on the 2017-2018 wave of Chinese longitudinal healthy longevity survey (CLHLS). Journal of Affective Disorders, 320(9), 621–627. https://doi.org/10.1016/j.jad.2022.09.159
3.
BeckerO. A.HankK. (2022). Adult children’s estrangement from parents in Germany. Journal of Marriage and Family, 84(1), 347–360. https://doi.org/10.1111/jomf.12796
4.
BiY.WangL.XuY.JiangY.HeJ.ZhangM.ZhouM.LiY.XuM.LuJ.WangT.DingL.DaiM.ZhangD.ChenC. S.LaiS.WangW.WangL.NingG.2012 China Noncommunicable Disease and Risk Factor Surveillance in Migrant Workers Study Group. (2016). Diabetes-related metabolic risk factors in internal migrant workers in China: A national surveillance study. Lancet Diabetes & Endocrinology, 4(2), 125–135. https://doi.org/10.1016/S2213-8587(15)00366-6
5.
ChanD. Y. L.LeeS. W. H.TehP. L. (2023). Factors influencing technology use among low-income older adults: A systematic review. Heliyon, 9(9), Article e20111. https://doi.org/10.1016/j.heliyon.2023.e20111
6.
ChaoS. F. (2011). Assessing social support and depressive symptoms in older Chinese adults: A longitudinal perspective. Aging & Mental Health, 15(6), 765–774. https://doi.org/10.1080/13607863.2011.562182
7.
ChappellN. L.KuschK. (2007). The gendered nature of filial piety--a study among Chinese Canadians. Journal of Cross-Cultural Gerontology, 22(1), 29–45. https://doi.org/10.1007/s10823-006-9011-5
8.
ChengS. T.ChanA. C. M. (2006). Filial piety and psychological well-being in well older Chinese. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(5), P262–P269. https://doi.org/10.1093/geronb/61.5.P262
9.
DijkstraP. A.KalmijnM. (2006). Differentials in face-to-face contact between parents and their grown-up children. In DijkstraP. A.KalmijnM. (Eds.), Family solidarity in The Netherlands (pp. 63–88): Dutch University Press.
10.
FangE. F.Scheibye-KnudsenM.JahnH. J.LiJ.LingL.GuoH.ZhuX.PreedyV.LuH.BohrV. A.ChanW. Y.LiuY.NgT. B. (2015). A research agenda for aging in China in the 21st century. Ageing Research Reviews, 24(Pt B), 197–205. https://doi.org/10.1016/j.arr.2015.08.003
11.
FengZ.LiQ.ZhouL.ChenZ.YinW. (2021). The relationship between depressive symptoms and activity of daily living disability among the elderly: Results from the China health and retirement longitudinal study (CHARLS). Public Health, 198(5), 75–81. https://doi.org/10.1016/j.puhe.2021.06.023
12.
FuH.SiL.GuoR. (2022). What is the optimal cut-off point of the 10-item center for epidemiologic studies depression scale for screening depression among Chinese individuals aged 45 and over? An exploration using latent profile analysis. Frontiers in Psychiatry, 13(3), 820777. https://doi.org/10.3389/fpsyt.2022.820777
13.
GaoK.CaoL. F.MaW. Z.GaoY. J.LuoM. S.ZhuJ.LiT.ZhouD. (2022). Association between sarcopenia and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study. EClinicalMedicine, 44(1), 101264. https://doi.org/10.1016/j.eclinm.2021.101264
14.
GariépyG.HonkaniemiH.Quesnel-ValléeA. (2016). Social support and protection from depression: Systematic review of current findings in western countries. British Journal of Psychiatry, 209(4), 284–293. https://doi.org/10.1192/bjp.bp.115.169094
GrigoryevaA. (2017). Own gender, sibling’s gender, parent’s gender: The division of elderly parent care among adult children. American Sociological Review, 82(1), 116–146. https://doi.org/10.1177/0003122416686521
17.
GrundyE.HenrettaJ. C. (2006). Between elderly parents and adult children a new look at the intergenerational care provided by the ‘sandwich generation’. Ageing and Society, 26(5), 707–722. https://doi.org/10.1017/S0144686x06004934
18.
HeG.XieJ. F.ZhouJ. D.ZhongZ. Q.QinC. X.DingS. Q. (2016). Depression in left-behind elderly in rural China: Prevalence and associated factors. Geriatrics and Gerontology International, 16, 638–643. https://doi.org/10.1111/ggi.12518
19.
HossainB.YadavP. K.NagargojeV. P.JosephK. J. V. (2021). Association between physical limitations and depressive symptoms among Indian elderly: Marital status as a moderator. BMC Psychiatry, 21, 573. https://doi.org/10.1186/s12888-021-03587-3
20.
HuA. (2018). The diversification of children’s support for their parents in the context of an aging society: Concepts and behavior. Social Sciences in China, 39(4), 114–136. https://doi.org/10.1080/02529203.2018.1483106
21.
HuH.CaoQ.ShiZ.LinW.JiangH.HouY. (2018). Social support and depressive symptom disparity between urban and rural older adults in China. Journal of Affective Disorders, 237, 104–111. https://doi.org/10.1016/j.jad.2018.04.076
22.
HuangW.ZhuW.ChenH.LiF.HuangJ.ZhouY.SunX.LanY. (2022). Longitudinal association between depressive symptoms and cognitive decline among middle-aged and elderly population. Journal of Affective Disorders, 303(4), 18–23. https://doi.org/10.1016/j.jad.2022.01.107
23.
HungJ. (2022). Hukou System Influencing the Structural, Institutional Inequalities in China: The Multifaceted Disadvantages Rural Hukou Holders Face. Social Sciences, 11(5), 194. https://doi.org/10.3390/socsci11050194
24.
IrwinM.ArtinK. H.OxmanM. N. (1999). Screening for depression in the older adult: Criterion validity of the 10-item center for epidemiological studies depression scale (CES-D). Archives of Internal Medicine, 159(15), 1701–1704. https://doi.org/10.1001/archinte.159.15.1701
25.
JiguangZ.YuncanW.YunxingS. (2022). Raising sons or daughters for old age? Influence of children’s gender on intergenerational family support in rural families. Frontiers in Public Health, 10(1), 1063390. https://doi.org/10.3389/fpubh.2022.1063390
26.
JinX.GuoQ.FeldmanM. W. (2015). Marriage squeeze and intergenerational support in contemporary rural China: Evidence from X county of Anhui province. International Journal of Aging and Human Development, 80(2), 115–139. https://doi.org/10.1177/0091415015590304
27.
KimK.BirdittK. S.ZaritS. H.FingermanK. L. (2020). Typology of parent-child ties within families: Associations with psychological well-being. Journal of Family Psychology, 34(4), 448–458. https://doi.org/10.1037/fam0000595
28.
LeeS. R.KimL. S. (2022). Coresidence of older parents and adult children increases older adults’ self-reported psychological well-being. International Journal of Alzheimer’s Disease, 2022(1), 5406196. https://doi.org/10.1155/2022/5406196
29.
LinK.YinP.LoubereN. (2014). Social support and the ‘left behind’ elderly in rural China: A case study from Jiangxi province. Journal of Community Health, 39(4), 674–681. https://doi.org/10.1007/s10900-014-9864-4
30.
LorcaM. B. F.PonceM. S. H. (2015). Normative, structural, and individual factors that predispose adult children to provide social support to their elderly parents. Journal of Comparative Family Studies, 46(4), 517–540. https://doi.org/10.3138/jcfs.46.4.517
31.
ManningK. J.ChanG.SteffensD. C.PierceC. W.PotterG. G. (2021). The interaction of personality and social support on prospective suicidal ideation in men and women with late-life depression. American Journal of Geriatric Psychiatry, 29(1), 66–77. https://doi.org/10.1016/j.jagp.2020.03.018
32.
PengC.KwokC. L.LawY. W.YipP. S. F.ChengQ. (2019). Intergenerational support, satisfaction with parent-child relationship and elderly parents’ life satisfaction in Hong Kong. Aging & Mental Health, 23(4), 428–438. https://doi.org/10.1080/13607863.2017.1423035
33.
PerryG. (2017). Going home how mothers maintain natal family ties in a patrilocal society. Human Nature-An Interdisciplinary Biosocial Perspective, 28(2), 219–230. https://doi.org/10.1007/s12110-016-9282-7
34.
RosengrenA.SmythA.RangarajanS.RamasundarahettigeC.BangdiwalaS. I.AlHabibK. F.AvezumA.Bengtsson BostromK.ChifambaJ.GulecS.GuptaR.IgumborE. U.IqbalR.IsmailN.JosephP.KaurM.KhatibR.KrugerI. M.LamelasP.YusufS. (2019). Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: The prospective urban rural epidemiologic (PURE) study. Lancet Global Health, 7(6), e748–e760. https://doi.org/10.1016/S2214-109X(19)30045-2
35.
SilversteinM.CongZ.LiS. Z. (2006). Intergenerational transfers and living arrangements of older people in rural China: Consequences for psychological well-being. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(5), S256–S266. https://doi.org/10.1093/geronb/61.5.S256
36.
SofaA. (2019). Happiness in elderly: Contribution of health’s perception and filial piety. In Proceedings of the 4th ASEAN conference on psychology, counselling, and humanities (ACPCH 2018) (pp. 338–341). Atlantis Press.
37.
SolomonovN.LeeJ.BanerjeeS.FluckigerC.KanellopoulosD.GunningF. M.SireyJ. A.ListonC.RaueP. J.HullT. D.AreanP. A.AlexopoulosG. S. (2021). Modifiable predictors of nonresponse to psychotherapies for late-life depression with executive dysfunction: A machine learning approach. Molecular Psychiatry, 26(9), 5190–5198. https://doi.org/10.1038/s41380-020-0836-z
38.
SunX.ZhouM.HuangL.NuseB. (2020). Depressive costs: Medical expenditures on depression and depressive symptoms among rural elderly in China. Public Health, 181(2), 141–150. https://doi.org/10.1016/j.puhe.2019.12.011
39.
SunY. Z. (2017). Among a hundred good virtues, filial piety is the first: Contemporary moral discourses on filial piety in urban China. Anthropological Quarterly, 90(3), 771–799. https://doi.org/10.1353/anq.2017.0043
40.
TeerawichitchainanB.PothisiriW.LongG. T. (2015). How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand. Social Science & Medicine, 136-137(4), 106–116. https://doi.org/10.1016/j.socscimed.2015.05.019
41.
TurnerS. T.CarmelS.O'RourkeN.RaveisV. H.TovelH.Cohn-SchwartzE. (2022). Social support and symptoms of depression in late life: Bidirectional associations over time. International Journal of Environmental Research and Public Health, 19(23), 16065. https://doi.org/10.3390/ijerph192316065
42.
WangG.JiaC.MaZ.ZhouL. (2022). Physical diseases and elderly suicide in rural China: A case-control psychological autopsy study. Australian and New Zealand Journal of Psychiatry, 56(5), 560–568. https://doi.org/10.1177/0004867421998804
43.
WangF. L. (2005). Brewing Tensions While Maintaining Stabilities: The Dual Role of the Hukou System in Contemporary China. Asian Perspective, 29(4), 85–124.
44.
WangJ.ChenT.HanB. (2014). Does co-residence with adult children associate with better psychological well-being among the oldest old in China?Aging & Mental Health, 18(2), 232–239. https://doi.org/10.1080/13607863.2013.837143
45.
WangY.ZhangJ.WangB.FuH. (2020). Social support from adult children, parent-child relationship, emotion regulation strategy, and depressive symptoms among Chinese older adults. Research on Aging, 42(9-10), 281–290. https://doi.org/10.1177/0164027520930973
46.
WolffJ. L.MulcahyJ.HuangJ.RothD. L.CovinskyK.KasperJ. D. (2018). Family caregivers of older adults, 1999–2015: Trends in characteristics, circumstances, and role-related appraisal. The Gerontologist, 58(6), 1021–1032. https://doi.org/10.1093/geront/gnx093
47.
WongD. F. K.LiC. Y.SongH. X. (2007). Rural migrant workers in urban China: Living a marginalised life. International Journal of Social Welfare, 16(1), 32–40. https://doi.org/10.1111/j.1468-2397.2007.00475.x
48.
WuM. H.ChangS. M.ChouF. H. (2018a). Systematic literature review and meta-analysis of filial piety and depression in older people. Journal of Transcultural Nursing, 29(4), 369–378. https://doi.org/10.1177/1043659617720266
49.
WuY.DongW.XuY.FanX.SuM.GaoJ.ZhouZ.NiessenL.WangY.WangX. (2018b). Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study. BMC Public Health, 18(1), 882. https://doi.org/10.1186/s12889-018-5794-x
50.
YamadaK.TeerawichitchainanB. (2015). Living arrangements and psychological well-being of the older adults after the economic transition in Vietnam. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(6), 957–968. https://doi.org/10.1093/geronb/gbv059
51.
YangF. (2021). Aging in the context of urbanization: Social determinants for the depression of the Chinese older population (1st ed.). Routledge.
52.
YinH.ZhangW. (2022). Study on the Spiritual Pension of the Rural Elderly. Proceedings of the 2022 8th International Conference on Humanities andSocial Science Research (ICHSSR2022). pp 689-692. Atlantis Press.
53.
ZhangJ.ChandolaT.ZhangN. (2023). Understanding the longitudinal dynamics of rural-urban mental health disparities in later life in China. Aging & Mental Health, 27(7), 1419–1428. https://doi.org/10.1080/13607863.2022.2098912
54.
ZhaoY.HuY.SmithJ. P.StraussJ.YangG. (2014). Cohort profile: The China health and retirement longitudinal study (CHARLS). International Journal of Epidemiology, 43(1), 61–68. https://doi.org/10.1093/ije/dys203
55.
ZhengX. Q.LiH. F. (2022). How Chinese children’s filial piety beliefs affect their parents’ life satisfaction and loneliness. PsyCh Journal, 11(6), 863–872. https://doi.org/10.1002/pchj.558
56.
ZhengZ.ChenH. (2020). Age sequences of the elderly’ social network and its efficacies on well-being: An urban-rural comparison in China. BMC Geriatrics, 20(1), 372. https://doi.org/10.1186/s12877-020-01773-8
57.
ZunzuneguiM. V.BelandF.OteroA. (2001). Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain. International Journal of Epidemiology, 30(5), 1090–1099. https://doi.org/10.1093/ije/30.5.1090
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
