The protective effect of taking care of grandchildren on elders’ mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders’ loneliness and depression between 1993 and 2007 in Taiwan

BMC Public Health, Jun 2013

Background The 20th century’s rapid industrialization and urbanization brought important social changes to Taiwan, including an increased number of elders living alone, which has increased risk of depression for the elderly. This study aimed to evaluate the changing pattern regarding the effect of intergenerational exchanges on elders’ depressive symptoms from 1993 to 2007. Methods Data from the second-, fourth- and sixth-wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were analyzed. This study collected elders’ individual sociodemographic characteristics, their self-reported health status and their intergenerational exchanges, including living with partners or with their children and their provision of care for their grandchildren. Information about elders’ depression was evaluated using the 5-item Epidemiological Studies Depression Scale (CES-D). Changes in elders’ intergenerational exchanges and depressive symptoms were compared during these study periods (chi-square test). Then, logistic regression was performed to determine how significantly elders’ intergenerational exchanges were associated with their depressive symptoms across the three years 1993, 1999 and 2007. Results The prevalence of elders living with partners decreased from 1993 to 2007 by 19%, and that of living with their children decreased from 1993 to 2007 by 7%. Conversely, the percentage of elders providing care for grandchildren dramatically increased, from 9% in 1993 to 21% in 2007. Elderly people had significantly fewer depressive symptoms in 2007 than in 1993. After adjusting for confounders, those living without a partner, living without children or providing no grandchild care had a greater risk of feeling lonely and being depressed. However, during the period 1993 to 2007, the impact on elders’ depression and loneliness of co-residing with a partner or with children decreased at the same time that the impact of their provision of grandchild care increased. In 2007, elders who provided no grandchild care were significantly more likely to feel lonely and sad as well as to have high CES-D scores; these strong associations were not found in 1993 and 1999. Conclusions This study illustrates how taking care of grandchildren protects against depression and loneliness in elderly Taiwanese. We argue the need, in an aging society, for improving intergenerational interaction and recommend careful evaluation of the interaction between population policies and those of social welfare, such as child care.

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The protective effect of taking care of grandchildren on elders’ mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders’ loneliness and depression between 1993 and 2007 in Taiwan

Feng-Jen Tsai 0 Sandrine Motamed 1 Andr Rougemont 1 0 Master program in Global Health and Development, Taipei Medical University , Taipei , Taiwan 1 Institute of Social and Preventive Medicine, University of Geneva , Geneva , Switzerland Background: The 20th century's rapid industrialization and urbanization brought important social changes to Taiwan, including an increased number of elders living alone, which has increased risk of depression for the elderly. This study aimed to evaluate the changing pattern regarding the effect of intergenerational exchanges on elders' depressive symptoms from 1993 to 2007. Methods: Data from the second-, fourth- and sixth-wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were analyzed. This study collected elders' individual sociodemographic characteristics, their self-reported health status and their intergenerational exchanges, including living with partners or with their children and their provision of care for their grandchildren. Information about elders' depression was evaluated using the 5-item Epidemiological Studies Depression Scale (CES-D). Changes in elders' intergenerational exchanges and depressive symptoms were compared during these study periods (chi-square test). Then, logistic regression was performed to determine how significantly elders' intergenerational exchanges were associated with their depressive symptoms across the three years 1993, 1999 and 2007. Results: The prevalence of elders living with partners decreased from 1993 to 2007 by 19%, and that of living with their children decreased from 1993 to 2007 by 7%. Conversely, the percentage of elders providing care for grandchildren dramatically increased, from 9% in 1993 to 21% in 2007. Elderly people had significantly fewer depressive symptoms in 2007 than in 1993. After adjusting for confounders, those living without a partner, living without children or providing no grandchild care had a greater risk of feeling lonely and being depressed. However, during the period 1993 to 2007, the impact on elders' depression and loneliness of co-residing with a partner or with children decreased at the same time that the impact of their provision of grandchild care increased. In 2007, elders who provided no grandchild care were significantly more likely to feel lonely and sad as well as to have high CES-D scores; these strong associations were not found in 1993 and 1999. (Continued on next page) - (Continued from previous page) Background The rapid aging of populations, triggered by low fertility rates and longer life expectancy, is a global phenomenon that requires a research and policy response concerning the potential consequences of this important demographic evolution [1,2]. One important issue concerning aging is depression in elderly individuals, especially loneliness caused by the evolution of intergenerational contact in a changing society [3,4]. In the 20th century, studies regarding associations between older adults intergenerational exchanges and their mental health mainly focused on elderly persons parentchild relationships and noted the importance of contingent exchanges between elders and their adult children in promoting older adults psychological wellbeing [5,6]. However, in aging societies, attention is being transferred to the impact of intergenerational exchanges between grandparents and grandchildren on elders mental health. As grandparents provision of grandchild care is central to the model of intergenerational solidarity, this provision was identified as a particularly important form of multigenerational family support [7,8]. Typical and common arrangements for grandparents provision of grandchild care are baby-sitting over the weekend or during the evening, caring for children when their parents are at work, or taking care of grandchildren under other circumstances on a regular or irregular basis. Previous findings, indicating that grandparents provided child care more sporadically when mothers were relatively young and worked nonstandard hours but provided extended full-time grandparent care for mothers with more extensive full-time employment, further reflect parents need for assistance from their own parents to take care of grandchildren in this changing society [9]. The majority of studies on the grandparent-grandchild relationship and its effect on elders health have emphasized that grandparents are responsible for the care of grandchildren and reported the possible risks of such caregiving on elders physical health and depressive symptoms [10-12]. However, a recent study has shown benefits to grandparents who take care of grandchildren, which is supported by the social exchange theory, especially from the perspective of emotional reward [13]. With the emerging nuclearization of both young and old generations brought about by modernization, the importance of grandparent-grandchild intergenerational exchanges in promoting elders me (...truncated)


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Feng-Jen Tsai, Sandrine Motamed, André Rougemont. The protective effect of taking care of grandchildren on elders’ mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders’ loneliness and depression between 1993 and 2007 in Taiwan, BMC Public Health, 2013, pp. 567, 13, DOI: 10.1186/1471-2458-13-567