Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China

Abstract

ObjectiveGlobally, depression has become a major health issue among older adults, who experience poor physical health and high medical expenditures. In Asian countries, older adults are greatly dependent on their children. This study assessed the impact of different types of intergenerational support and medical expenditures on depression among older adults in rural China.MethodA three-phase balanced panel was constructed based on data from 1,838 rural older adults with comparable scores on the Center for Epidemiologic Studies Depression Scale (CES-D) from the China Family Panel Studies in 2012, 2016, and 2018. A fixed-effects model was used to analyze the impact of intergenerational support and medical expenditures on CES-D score and of intergenerational support on medical expenditures. The propensity score-matching model was used to test the regression results' robustness.ResultsThe findings were as follows. First, different types of intergenerational support had a heterogeneous impact on depression among rural older adults. Emotional support had a significantly negative impact on CES-D score, although too much care-based support had a positive impact on CES-D score. Low-level economic support had no significant effect on CES-D score. Second, medical expenditures impacted depression; among these, non-inpatient medical expenditure had a significant and positive impact on CES-D score. Third, CES-D scores among rural older adults were associated with chronic diseases and per capita family income. Fourth, care-based support was associated with reduced non-inpatient medical expenditures, and the sub-sample regression results indicated that the impact was significant for older adults with no chronic diseases and those younger than 75 years.ConclusionIntergenerational emotional support and non-inpatient medical expenditures directly affected rural older adults' CES-D scores. The mediating role of medical expenditures between intergenerational support and CES-D score was not significant. Measures should be taken to encourage intergenerational emotional support and reduce the pressure on children's economic and care-based support. Further, the medical insurance reimbursement policy, as formal support, should be improved to alleviate depression among rural older adults when children's support is limited.

Financial well-being, family financial support and depression of older adults in China

“…This finding was consistent with the findings in some previous studies (e.g. Li et al ., 2022; Xue et al ., 2020). One possible reason is that low financial assistance may not play a significant role in reducing depression (Pan and Dong, 2020).…”

The impact of grandparenting on mental health among rural middle-aged and older adults in China: exploring the role of children’s support

“…The involvement of grandchildren often amplifies interactions and emotional care from children ( 57 ). This enhanced emotional and economic support from adult children is possibly pivotal in mitigating depression risks among rural middle-aged and older adults ( 58 , 59 ). In rural China, the traditional Confucian ideals of ‘raising children to care for you when you are old’ and filial piety are still accepted by most people, so older parents usually have high expectations for their children’s support ( 60 ).…”

Self-Rated Health and Life Satisfaction among Elderly Migrants in China: A Moderated Mediation Model of Resilience and Upward Intergenerational Support

“…However, excessive financial support may pose a psychological burden on the elderly. Therefore, appropriate financial support is needed to strengthen the ability of elderly migrants to acquire medical services [ 58 ] and improve their physical health. In general, the negative effects of age and migration on the self-rated health of elderly migrants can be buffered by upward generational support, either financial or emotional.…”