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Compared to their urban counterparts, Chinese rural elderly have a larger average household size 3. In China, there are strong social expectations towards parenthood, which perhaps is the most important responsibility inherent to the marriage. According to Chinese traditional values, childlessness was perceived as a shame or a curse on the family, particularly for women K.

Couples would be embarrassed if they were infertile, for not being able to continue the family line. Childless women are especially stigmatized, often experiencing disapproval and discord relationships with husband and in-laws, and even marriage breakdown W. From the functional perspective, children are of particular significance as old age security in China, especially in rural areas Jiang, In China, filial responsibility of adult children to their parents entails a complex series of duties including coresidence, food provision, and physical and emotional care of parents Zhan, The Chinese Constitution of and the Marriage Law of both clearly mandate supporting aging parents as a legal obligation of adult children R.

Support from adult children is especially crucial for Chinese rural elders who often have very limited personal resources and formal services. The average per capita annual income for rural residents was less than one third of that of urban residents National Statistics Bureaus of China, The lack of protection of formal services makes adult children the most available and reliable source of old-age support for Chinese rural elders. While the previous work on Chinese older adults have either focused on economically developed regions K. The questions addressed in the study include:.

Given that a major negative consequence of childlessness among Chinese rural elders is lack of monetary support from children in later life, the third question asked:. The sample of this study was derived from Anhui province, which is an underdeveloped province, with GDP per capita ranked 26th among the 31 provinces in China National Statistics Bureaus of China, The baseline survey was conducted in A multistage cluster sampling method was used to recruit 1, respondents aged 60 and older from the administrative records of 72 randomly selected villages in 6 rural townships in Chaohu region.

Respondents discussed each child at length in terms of living arrangement, frequency of contact, and support exchanges. Follow-up surveys were administered to the original respondents in , , and , with attritions of The survey also used systematic sampling method to select elders aged between 60 and 67 7 elders in each 72 village to replenish the sample. Among them, older adults completed the survey. The data used in the current study was derived from the most recent survey — the survey — which consisted of a total of 1, older adults who provided information on 4, children.

Psychological well-being was operationalized as life satisfaction and depression to index both positive and negative well-being. The life satisf action scale assessed cognitive judgments regarding the current quality of life. The sum score of life satisfaction ranged from 0 to seven, with higher scores reflecting higher levels of life satisfaction.

The depression scale had nine items, among which three indicated feelings of positive affect happiness, enjoyment, pleasantness , two indicated feelings of negative affect lonely, upset , two indicated feelings of marginalization useless, nothing to do , and two indicated somatic symptoms poor appetite, has trouble sleeping. After reversely coding positive affect items i. Family relations were assessed by fiver indicators that captured the living arrangement, intergenerational contact, and family support received by the older adults.

Living arrangement included two dichotomous variables: Intergenerational contact was assessed by the variable: Family support included monetary and instrumental support. Monetary support was assessed by the total amount of money received from all children during the past year. Natural log of the RMB value was used because of the skewed distribution of this variable.

Instrumental support was assessed by a dichotomous variable assessing whether the respondent had received hands-on help from any family members e. The variables living with children , having monthly contact with at least one child , and monetary support from children were coded 0 for childless elders due to the absence of such family relations. Income was indicated by the total income that the respondent and spouse, if married had received from work or pension in the past year. The natural log of the RMB value was used to represent this variable given its skewed distribution.

Descriptive data were presented to provide a profile of the older adults in the study. A series of T-tests, ANOVA tests, and Chi-square tests were carried out to compare the three groups of older adults in their individual attributes and family relations. To answer the first research question, ANOVA tests were carried out to compare the three groups in their level of depression and life satisfaction, respectively. To answer the second and the third research questions, multiple regression analyses were carried out to predict the depression and life satisfaction respectively, with four sets of variables entered sequentially in each regression: The last step of the regressions tested whether childlessness is more consequential in certain groups of older adults.

Table 1 presents the sample characteristics.

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About half of them were females and the majority were married The mean annual income of the respondents was 2, RMB USD and the average functional health difficulty score was 3. The average respondent had about four children. Among them, 50 4. More than two thirds of the parents had monthly contact with at least one child. ANOVA tests were conducted to compare group differences in age, income, and functional health difficulties.

T-tests were conducted to compare elder with one child and elders with multiple children in the amount of monetary support from children. Chi-square tests were conducted to compare group differences in the rest of the variables. The sample is comparable to Chinese rural elderly in general in gender composition women: The share of the childless in the sample is also comparable to the national figure 4. However, the respondents in the sample had much lower education illiterate: Overall, the sample represents a group of economically deprived older adults, even compared to Chinese rural elderly in general who have relatively low economic status.

Table 1 also compares the three groups in their individual and family attributes. The three groups differed significantly in all domains except for education, functional health difficulties, and the likelihood of receiving instrumental support.

An examination of the raw data showed that the nature of being unmarried was quite different between the childless and the older parents. In other words, childless elders in this study were mainly males who had never married. It is likely that these men in rural China were too poor to get married in early years and thus remain single and childless in later life. Childless elders also had lower income and higher likelihood to living alone.

Among older parents, having more than one child was associated with greater likelihood of having monthly contact with children and significantly more monetary support from children. To address the first research question, two ANOVA tests were carried out to compare the three groups in levels of depression and life satisfaction.

Figure 1 illustrates the results, showing that childless elders had the highest level of depression and the lowest level of life satisfaction, followed by elders with one child and elders with multiple children. Post-hoc analyses revealed that the significant differences in depression were between older adults with multiple children and the two other groups.

The differences in life satisfaction were significant across all the three groups. To understand what factors account for such group differences and to answer the second and the third research questions, multiple regressions were carried out to predict depression and life satisfaction by sequentially entering parental status, personal attributes, family relation variables, and the interaction terms. Table 2 presents the results of regressions predicting depression. Consistent with the results of ANOVA tests, the Model 1 showed that only having more than one child was associated with lower level of depression.

When controlling for personal attributes in the Model 2, the difference between the childless and elders with multiple children remained, suggesting that individual attributes such as higher income of elders with multiple children did not fully account for their lower level of depression than the childless.

Having one child became a significant predictor in the Model 2, showing that, given similar individual attributes, older adults with one child would also be less depressed than the childless. Model 2 revealed that older adults who were illiterate, who had lower income, and who had more functional health difficulties had higher level of depression.

Specifically, living alone and lack of monetary support from children were associated with higher level of depression. In the Model 4, interactions between monetary support and other significant predictors were added to further understand whether the negative influence of lack of monetary support from children was particularly detrimental to certain groups of rural elders. The results of Model 4 revealed a significant interaction between income of older adults and monetary support form children. The benefit of monetary support from children was minimal among elders with 90 th percentile income, evidenced by the relatively flat line.

In other words, with high level of income, lack of monetary support from children was not very detrimental for older adults. I repeated the same regression analyses on life satisfaction Table 3. Several notable differences in the life satisfaction regressions emerged. First, parents with one child also had a higher level of life satisfaction than childless elders. Such a difference was not associated with individual attributes Model 2 , and seemed to be resulted from the differences between the two groups in whether the participants lived with and received monetary support from children Model 3.

Second, even after controlling for all the individual and family relation variables, parents with multiple children still enjoyed higher level of life satisfaction compared to the childless Model 3. This suggests that the mere fact of having multiple children may yield a greater sense of satisfaction among Chinese rural elders.

Overall, older adults who were married, educated, who had higher income, less functional difficulties, who lived with children, and who received greater monetary support from children had greater life satisfaction. As for depression, the interaction between income and monetary support from children was statistically significant predictor Model 4. Figure 3 shows that elders who had no income benefited most from monetary support from children, followed by those with average income, and then those with 90 th percentile income. To revolve the puzzling findings in the previous studies that Chinese elders tend to be more negatively affected by childlessness than their Western counterparts, this study used a sample of Chinese rural elders to examine potential differences among childless elders, elders with one child, and elders with multiple children in their levels of depression and life satisfaction, and the mechanism behind the potential differences.

The empirical analysis suggests several important conclusions. As a matter of fact, childless elders in the sample did have poorer psychological well-being than older parents. They also demonstrated vulnerabilities in other domains of personal and social lives such as lower income and a greater tendency to live alone.


These findings contrast those in the U. Childlessness in rural China is a risk factor and is likely to leave those with no child in destitute and poor psychological status in later life. The reasons for such a risk go beyond the mere fact that one has no child.

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Instead, the risk is likely to be attributable to low income, living alone, and not receiving monetary support from children in this population. As discussed below, having higher income can buffer against this risk. It is worth noting that the adverse conditions of the childless in the sample may be the very reason explaining their childlessness in the first place.

The childless in the study were older men who had never married. This is an interesting finding that reflects poor marital prospects for Chinese men living in poor rural regions. The findings reveal that the primary mechanism underpinning the unfavorable psychological outcomes of childlessness in rural China was lack of monetary support from children in later life.

Children is an important source of comfort to Chinese rural elders for a very practical reason: While Western elders often have savings, pensions, retirement benefits, and health care, children might be the only source of income for older adults in rural China. The availability of social services in rural China is also minimum. The joint effect of low income and lack of monetary support from children is particularly detrimental, demonstrated by the significant interactions between the two variables in predicting both depression and life satisfaction. As observed in Figure 2 and Figure 3 , among those who had a high level of income, the benefit of monetary support from children was negligible, with older adults receiving different levels of monetary support having comparable levels of depression and life satisfaction.

I argue that this pattern resembles the findings in most Western studies, that is, given sufficient financial protections, whether having children or receiving momentary support from them would have a very limited impact on individual well-being. The significant results of income and monetary support from children by no means indicate that other factors such as health, in-person contact, and instrumental support from children are not important for Chinese rural elderly. Second, the measures of contact and instrumental support were aggregated values at the family level.

Finally, it is possible that greater monetary support from children reflects closer parent-child relationships which benefit late-life wellbeing but is not captured in this study. Other things being equal, older parents with multiple children still enjoyed a higher level of life satisfaction than childless elders. In other words, the mere presence of multiple children boosted the sense of life satisfaction among Chinese rural elders. Such a relationship was not found in depression.

This is an important finding because it demonstrates that depression and life satisfaction may represent conceptually distinctive domains of subjective well-being that are affected by the childless status differently Umberson et al. Unlike many Western societies, childlessness still represents a disruption of the expected life course for most Chinese. In contrast, only about 4. Being a childless in China, thus may lead to a sense of failure to meet normative expectations, which in turn, would depress positive self-evaluations and create lower life satisfaction Hansen et al.

It is reasonable to assume that parents with multiple children in rural China may view their fortunes and achievements in life more favorably than the childless and parents with only one child, and consequently enjoying greater sense of life satisfaction. This study is limited in its generalizability. The very low socioeconomic status of the respondents needs to be borne in mind when interpreting the findings related to income and monetary support from children.

These findings may not be applicable to Chinese elders in urban areas or more affluent rural areas. Although the proportion of the childless in the sample is comparable to the national figure, the predominantly high percentage of unmarried males in the group is unusual and may reflect the characteristics of the childless in economically deprived areas only.

More studies using national samples are needed. The relationships found in this study need to be validated using larger representative samples of elders who fall into these less common but more vulnerable status groups. The small sample size of subgroups also prevented additional analysis testing interactions with gender and marital status. The negative impact of childlessness may be greater in Chinese rural women due to the stronger stigma of infertility associated with women than with men.

A study showed that marital status rather than parental status is a more salient factor influencing loneliness and depression in old age Z. Future studies with larger samples and a greater variation in marital status among the childless would help to discern the relative importance of the two conditions on individual well-being. Other limitation of the study relates to the measures. Limited by the nature of secondary data analysis, many variables were measured by single items, and as discussed earlier, some family relation variables were aggregated information at the family level.

Variables using multiple items and taking into account within-family variations may have a greater predicting power. The findings presented support to the old myth that children make people happier and that not having children jeopardizes wellbeing in later life. Parenthood also contributes to life satisfaction of Chinese rural elders, independently of economic status and personal resources, which may be largely due to the strong social expectations and social rewards of parenthood in rural China. Comparing to relative findings from the Western studies, the findings of this study demonstrates how socioeconomic, cultural, and institutional factors may all play a role in shaping the consequences of childlessness in later life.

I argue that, it is the different local contexts between the West and the East that explain the inconsistent findings in the current literature about childlessness and late life well-being. Parental status represents a background factor that reflects other aspects of personal, family, and social conditions which may be more influential to individual well-being than the status itself. Future studies need to look beyond structural indicators such as parental status and to examine the mechanism through which there factors work in the local settings.

They are likely to require greater income support, health care, and social services compared with older parents. It is critical that social programs developed to address the needs of this group of particularly vulnerable older populations. I thank Merril Silverstein, Shuzhuo Li, and Iris Chi for their leadership in the larger research project and Dongmei Zuo for her contribution to data collection. I also thank Yawen Li and Jay I. Chok for their helpful feedback to the manuscript.

National Center for Biotechnology Information , U. Author manuscript; available in PMC Jan 1. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Aging Ment Health. This not only omitted migrant workers living in distant cities, but also may have excluded locals who worked day-jobs away from home. Our study was cross-sectional, thus precluding mechanistic or causal analyses, even as we examined the data in ways that can provide direction for future prospective investigations.

Nonetheless, the link between perceived social support and depression is consistent with the buffer theory [ 15 ]. There were two concerns we needed to address. First was that as we applied CES-D that was not a diagnostic tool with a cutoff point at 16, which was set to screen for distress and depressed symptoms. Second was that even though the CES-D has been widely adopted in China, its cut-off points have not been established in China. However, there was a large epidemiological study focusing on the validation of CES-D in China that reported that the Chinese version of CES-D showed good reliability and validity, and this study recommended that the cut-off point at 16 was applicable in China as well [ 63 ].

However, appropriate formal validations of the cut-off point of CES-D against a golden-standard diagnostic psychiatric interview have still not been completed. Hence, the high prevalence of depression in this study, compared to other studies applying diagnostic tools, could be a result of adopting the cutoff at 16 for the CES-D. We also note that our study depended on self-report measures, where perceptions of well-being or depression are subject to reporting biases [ 64 ]. Recent evidence suggests that perceived social support is more important than received social support; however, mindful of our concern [ 65 - 67 ], we cannot discern cause from effect.

For example, we found that women who reported worse economic or health status were more likely to be depressed, with ORs of 1. Without a prospective longitudinal study, it is not possible to define independent and dependent variables or explore possible bi-directional relationships.

This study demonstrates that women in rural China are facing significant symptoms of depression. Among these women, individuals with higher levels of social support were less likely to be depressed. Our results suggest that future studies on preventing or overcoming depression and distress will benefit from enhancing perceived and instrumental social support. The authors declared no potential competing interests with respect to the authorship and publication of this article.

FH designed the survey instruments, implemented the field survey, monitored data collection, cleaned the data, developed the plan for analysis, analyzed the data, drafted and revised the paper. CC designed the survey instruments, trained interviewers, developed the plan for analysis, revised the paper, and supervised FH.

MNW designed the survey instruments, trained interviewers, and revised the paper. EDC initiated the project, revised the paper, and supervised FH. PQ designed the survey instruments, monitored data collection, cleaned the data, and revised the paper. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript. Marsha N Wittink, Email: Eric D Caine, Email: National Center for Biotechnology Information , U.

Parental status and late-life well-being in rural China: The benefits of having multiple children

Published online Mar Author information Article notes Copyright and License information Disclaimer. Received Sep 17; Accepted Feb This article has been cited by other articles in PMC.

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Abstract Background Few studies have focused on depression and social support in Eastern populations, especially women in rural China. Results The final sample included 1, participants with a mean age of Conclusions This study provides insights on the psychological health of women in rural China and potential directions for future research. Depressive mood, Social support, Females in rural China, Mental health. Background We report findings from a study of the relationship between distress, depression, and social support among women residing in rural China.

Methods Sample and sampling We conducted a cross-sectional study focused on the towns and areas surrounding Guangyuan City, in northern Sichuan Province near the border with Shaan Xi Province. Instruments and measurements Demographic information We collected demographic information, such as: Duke social support index The Duke Social Support Index DSSI; [ 31 ] was originally a item scale used to explore the interactive effects of life events and social support on major depressive episodes and depressive symptoms. Procedure We conducted the field survey in July Analysis We applied bivariate logistic regression to analyze demographic characteristics, social support, and the results of the CES-D test, and chose multi-stage logistic regressions to explore the fit model among depression, social support and other factors.

Results We recruited 1, consenting participants from whom we obtained 1, completed surveys for the current analyses. Table 1 Bivariate logistic regression of depression. Open in a separate window. Social support in depressed and non-depressed groups We assessed social support by examining social interaction, perceived social support, and instrumental social support, and compared social support levels between depressed and non-depressed groups based on CES-D results. Table 2 Subgroups of social support and depression.

Table 3 Multi logistic regression model between social support and depression. The analysis included cases. Discussion This study focused on women from rural Sichuan where social and economic conditions are much less developed compared with many provinces in Eastern China. Limitations Despite the importance of these findings, we recognize that our study had several limitations. Conclusions This study demonstrates that women in rural China are facing significant symptoms of depression.

Footnotes Competing interests The authors declared no potential competing interests with respect to the authorship and publication of this article. Contributor Information Fengsu Hou, Email: Murray C, Lopez A. The global burden of disease: Murray C, Lopez A, editors. Harvard University Press; Epidemiological survey of depression prevalence in Jiangxi Province. Major depression in Kunming: Prevalence, treatment, and associated disability of mental disorders in four provinces in China during — Risk factors for suicide in China: Qin P, Mortensen PB.

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What do we know about the link between marriage and health?

Parental status and late-life well-being in rural China: The benefits of having multiple children

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