Do multigenerational living arrangements influence depressive symptoms in mid-late life? Cross-national findings from China and England

Highlights

• Living arrangements influenced depressive symptoms similarly in China and England.

• Men and women living alone had a greater risk of elevated depressive symptoms.

• Living with children/grandchildren but with no partner also increased the risk.

• Male disadvantage in depressive symptoms was more evident in England than in China.

Abstract

Background

While living alone predicts depression in diverse ageing populations, the impact of multigenerational living is unclear. This study compared mid-late life depressive symptoms by living arrangements between societies with distinct kinship ties.

Methods

Repeated data on depressive symptoms and living arrangements over 4 years from 16,229 Chinese (age≥45) and 10,403 English adults (age≥50) were analyzed using multilevel mixed-effects logistic regression. Elevated depressive symptoms were identified using the Center for Epidemiological Depression Scale criteria in each study.

Results

Higher odds ratios (ORs) of elevated depressive symptoms were found in both Chinese and English adults aged<60 living with no partner but with children/grandchildren, compared to those living with a partner only. These ORs were greater for men (Chinese men: 3.09, 95% confidence interval: 2.00–4.78; English men: 3.44, 1.36–8.72) than for women (Chinese women: 1.77, 1.23–2.56; English women: 2.88, 1.41–3.67), after controlling for socioeconomic position, health behaviors, and health status. This male disadvantage was also observed for English, but not for Chinese, adults aged<60 living alone. For adults aged 60+, the increased odds among those living with no partner but with children/grandchildren and those living alone were smaller in both countries.

Limitations

Bias may exist because depressed participants are more likely to experience divorce or separation prior to baseline.

Conclusions

The relationship between living arrangements and depressive symptoms appears robust and consistent across social contexts, although the mechanisms differ. The protective role of partners in both China and England supports targeting those who do not live with partners to reduce depression.

Introduction

Population aging has resulted in an increased share of older adults living only with their spouse or partner or living by themselves in high-income countries (Beard and Bloom, 2015; Grundy, 2006). Similar shifts have also begun in low- and middle-income countries due to more recent population aging dynamics (Reher and Requena, 2018). Older adults’ changing living arrangements pose considerable long-term social and public health challenges given the rapidly increasing need for high-quality elder care and support (Galiana and Haseltine, 2019), which must include targeted interventions at multiple levels to ameliorate high rates of mid-late life mental illness (Briggs et al., 2018).

Much of the evidence linking living arrangements with mental health in mid-late life has focused on living alone (Hays, 2002). Having a co-residential spouse/partner may help secure more economic resources, social ties, and social support into the household, provide better monitoring of one's health and social control of one's behaviors, and encourage help-seeking behaviors at early stages of illness; all of which have positive impacts on one's health (Carr and Springer, 2010; Clouston et al., 2014; Wong et al., 2018; Young and Grundy, 2009). These mechanisms appear important for mental health as well, given findings showing detrimental effects of living alone on common mental disorders (Dean et al., 1992; Russell and Taylor, 2009; Weissman and Russell, 2018), and on psychological distress and wellbeing (Michael et al., 2001) at older ages.

Since multigenerational living is much less common among older adults in high income countries than in emerging economies (Reher and Requena, 2018), its relationship to mental health has been less studied. However, more recently attention has been re-directed to the upswing in adult children moving back to their parental home due to the Great Recession in high income countries and its impact on their parents’ mental health (Aranda, 2015; Caputo, 2019; Courtin and Avendano, 2016). In other words, multigenerational residence may be driven by economic necessity rather than preference. Health benefits of multigenerational living may operate through additional economic resources brought in by household members who share domestic responsibilities and help defray living costs, enable greater access to structural social capital, and provide emotional and instrumental support generated by living together under one roof. While these mechanisms may buffer against stress and loneliness among older adults, multiple generations sharing one house may also lead to lack of space and exacerbate interpersonal conflicts that undermine one's mental health (Muennig et al., 2018). Two European-wide studies of adults aged 50+ demonstrated that co-residing with adult children had positive impacts on their older parents’ depressive symptoms (Buber and Engelhardt, 2008; Courtin and Avendano, 2016), but it appeared that spouse/partner played a more protective role than the children (Buber and Engelhardt, 2008). A cross-sectional study also showed that co-residing with adult children brought benefits to emotional well-being for widowed but not for married Chinese adults aged 80+ (Wang et al., 2014). On the other hand, Caputo (2019) found that US parents aged 50+ with a newly co-residential adult child experienced an increase in depressive symptoms compared to their counterparts with no co-residential adult children. Nevertheless a study from Spain found no differences in depressive symptoms by co-residing with children or not (Zunzunegui et al., 2001).

As the abovementioned studies have focused on single societies, the mixed findings may reflect cross-cultural differences in older adults’ preferences and resources for residential options, intertwined with their expectations of support from their family and community. A comparative perspective is therefore needed. In order to unravel these uncertainties, this study compared the relationship between living arrangements, multigenerational living arrangements in particular, with the risk of elevated depressive symptoms in middle-aged and older adults living in China and England.

We choose China and England for several reasons. First, depression ranks as the fourth leading cause of disability in both countries (Vos et al., 2017). This will demand more policy action as this burden is likely to grow with population aging (United Nations, 2017). Second, a comparative case study of China and England – each with its own unique set of preferences and resources for aging in place alongside very distinctive cultural norms – provides a vital opportunity to advance our understanding on the relationship between living arrangements and mental health. Citizens of the two countries have very different expectations and practices regarding kinship ties and filial piety, and the two countries are also at different stages of economic development. These two macro-level determinants may influence household preferences and living arrangements (Reher and Requena, 2018) and their associations with mental health, given that living alone among adults aged 60+ was much rarer in China (8%) than in the UK (21%) in 2000/1, whereas multigenerational living was the dominant arrangement in China (60%) (United Nations, 2018). As the social, cultural and economic context may modify the effects of particular living arrangements on depression symptoms, the present study examined whether and how much such variation exists between China and England.