Background
Since the 21st century, the proportion of the older adults population in China has been on the rise, and the degree of aging is getting higher [
1‐
3]. According to China’s latest national census, people over 60 accounted for 18.7% of China’s total population, and this is an increase of 5.44% compared to the previous census [
4]. For many countries, the older adults are the main consumers of medical resources, and the health problems of older adults have become a hot spot of the whole society and the main targets of various countries’ health policies[
3] [
5,
6]. The older adults are the high-risk group of mental health, and depression is the most common mental illness in the older adults, which will increase the risk of suicide and death of them [
7‐
9]. In today's call for healthy aging, the problem of depression of the older adults has become a major research area, and alleviating the depression of the older adults has become one of the ways to achieve healthy aging [
10].
Grandchild care is an important factor that affects depression of the older adults, and its situation differs in different cultural backgrounds and countries [
11,
12]. Hank, K found from a survey on Europe that the ten European countries are highly involved in grandchild care, but there are significant differences in the prevalence and intensity of their grandchild care due to different policies for child care and (mother or female) employment systems [
13]. Laughlin’s research pointed out that in the United States, one out of four children under the age of five is taken care of by grandparents [
14]. However, grandparents provide care mostly because their children are in special periods such as divorce, poverty, and drug abuse, or grandchildren are abused and neglected by their children, namely the older adults' children [
15]. In East Asian countries with heavy family concepts, it is more common for the older adults to provide grandchild care. They do not regard caring for their grandchildren as a burden, but as a way to realize their self-worth [
16]. In China, social child care services are not yet complete. Taking care of children has become the task of grandparents. Especially since the implementation of the relaxation of the fertility policy, whether grandparents provide grandchild care services will greatly affect the childbirth decision of adult children [
17].
Grandchild care and depression of older adults
Academia has not yet reached a consensus on the impact of grandchild care on depression of older adults, but the relationship between grandchild care and the health of the older adults is mostly explored from the Role Strain Theory and Role Expansion Theory. The role strain theory believes that individuals will experience the negative effects of multiple roles, especially when the individual’s multiple roles conflict with each other, which will cause pressure [
18]. From this research perspective, providing grandchild care will squeeze the time of their own health investment, will increase the physical burden, and will lose the older adult's own activity arrangements, which makes the older adults who provide grandchild care have a depressive tendency [
19,
20]. On the contrary, the role expansion theory believes that individuals can obtain social integration and satisfaction from multiple roles, adding color and vitality to life [
21]. According to this theory, providing care will increase the chances of grandparents’ social participation, makes the grandparents obtain more social support, especially from their adult children, improves the relationship with children, and enhances the subjective health and life satisfaction of grandparents [
22,
23]. These are beneficial to the mental health of older adults and achieve the effect of improving depression.
Taking care of grandchildren is a social participation with Chinese cultural character, one of the important family characters of the older adults in China [
24]. The actual impact of care behavior on the mental health of older adults is related to the characteristics of the older adults, the characteristics of the grandchildren, and the characteristics of the family, and it is necessary to conduct further empirical tests with national large-scale public data.
Grandchild care and depression in different older adults groups
Previous scholars had explored the influence of grandchild care on the physical and mental health of the older adults, but did not consider the difference between different older adults groups [
25,
26]. According to the previous studies about grandchild care, we can find that female older adults were more frequently involved in the grandchild care, and male older adults usually act as auxiliary role in taking care of grandchildren. Affected by Chinese traditional concepts, generally women do housework and bring their children, while men work outside, women bear more care responsibility in their families [
27]. So will this kind of gender difference of grandchild care will lead to the different effects of grandchild care on the depression of the older adults? Is female older adults more likely to be affected by grandchild care?
The rate of widowhood of older adults is relatively high. In life and emotionally, the older adults who don’t have a spouse, especially widowed, lack a spouse as the object of confession in life, often face a higher risk of depression than the older adults with a spouse [
28,
29] . Grandchild care as a two-way emotional exchange between grandparents and grandchildren, reduces the loneliness of the grandparents, increases the opportunities for the grandparents to participate in society. For those older adults who do not have a spouse, grandchild care can make up for the lack of a spouse to a certain extent. This raises the question, compared to older adults with spouses, does grandchild care have varying impact on the depression of the older adults who don’t have a spouse? Therefore, this research further explores the effect of grandchild care on the depression of older adults of different genders and different marital status on the basis of previous studies.
Grandchild care, intergenerational support from children and Chinese older adults depression
Taking care of grandchildren as a kind of social participation provides grandparents with stronger and more frequent contact with adult children, and make them have more opportunities to obtain the support of adult children [
30]. Chinese grandparents also rely on caring their grandchildren in exchange for intergenerational support from their children in old age [
31]. In other words, taking care of grandchildren increases the likelihood that the older adults will receive more intergenerational support from their adult children.
In previous studies, scholars have explored the influence of intergenerational support from children on the older adults depression . With the development of China’s economy, there are more ways for the older adults in China to obtain social support. However, influenced by Confucianism and traditional Chinese filial piety culture, intergenerational support from children is still the main source of life for the older adults in their later years [
32]. And this family idea makes the intergenerational support from children have a very important protective effect on the mental health of the older adults [
33].
According to the existing literature, scholars often only study the relationship between grandchild care and depression of the older adults, the relationship between intergenerational support from children and depression of the older adults, the relationship between grandchild care and intergenerational support from children [
17] [
34]. No scholar has ever discussed the combination of these three, and explored the relationship and action path among them. This article combines these three to propose a hypothesis: In the context of China's unique social and cultural environment and closely-connected intergenerational relationships, will grandchild care affect the depression of older adults by affecting the intergenerational support from their children?
Therefore, this research will explore the effect of grandchild care on the depression of Chinese older adults from two paths. One is whether the effect of grandchild care on the depression of Chinese older adults is different between different genders and marital status. The other is whether grandchild care affects the depression of the older adults through intergenerational support from children.
Discussion
Based on the CHARLS2018 database, this paper studies the effect of grandchild care on the depression of Chinese older adults, and uses the Bootstrap method to analyze the mediating effect of intergenerational support from children. The regression results of the full sample show that providing grandchild care has a significant postive effect on the depression of Chinese older adults. After adding intergenerational support variables, whether to provide grandchild care has a weaker effect on the depression. The regression results of different genders show that grandchild care has a significant impact on the depression of female older adults. The regression results of different marital status show that grandchild care has a significant impact on the depression of the older adults who don’t have a spouse.
The mediating effect of intergenerational support from children is tested on the full sample. The results show that intergenerational support from children has a significant mediating effect between grandchild care and the depression of the older adults. Providing grandchild care affects the depression of Chinese older adults through increasing their intergenerational support from children.
According to the research in this paper, depression is one of the health threats of Chinese older adults. The average depression score of Chinese older adults has reached the level of mild depression, and taking care of grandchildren can help older adults resist some of the risks of depression. Jing Zhang also used the CHARLS database to conduct research and explored the relationship between caring for grandchildren and the loneliness of the older adults, and found that caring for grandchildren can reduce the possibility of Chinese older adults feeling lonely [
46]. Fengyan Tang's research found that compared with those who did not take care of their grandchildren, the older adults who provided grandchild care in China had fewer depressive symptoms, but the intensity of care should be moderate [
47]. Seung-won Emily Choi considered the characteristics of family structure when studying grandchild care and depression of the older adults in China, and found that taking care of grandchildren in intergenerational families has a lower degree of depressive symptoms than the older adults who do not take care of their grandchildren [
48]. The results of this study and previous studies on grandchild care and health status of Chinese older adults tend to the role expansion theory, that is, grandparents have obtained significant positive benefits by participating in grandchild care. In the context of China’s aging society, grandchild care effectively relieves the pressure on adult children, taps the human resources of the older adults. The caregiver of grandchildren is an important social role of the older adults and enhances the sense of mission of the older adults [
31]. Taking care of grandchildren can increase the chances of social interaction, contacting with relatives and friends, and communication with children, reduce the loneliness of grandparents. At the same time, raising grandchildren is also a very fulfilling thing, which brings self-confidence to grandparents. These are all conducive to reducing their risk of depressive symptoms.
Di Gessa, Giorgio and Bordone, Valeria used the SHARE to study the relationship between European grandchild care and mental health. The results also point to the role expansion theory, that is, taking care of grandchildren have a positive effect on mental health. In the United States, according to the results of Jan Blustein's research, grandparents whose grandchildren are at home are more likely to have symptoms of depression than those whose grandchildren are not at home [
49]. Minkler, M found that the older adults who provided primary care for their grandchildren are twice as likely to suffer from depression as those who do not [
50]. Whether the relationship between caring for grandchildren and depression points to role strain theory or role expansion theory, perhaps there is a great correlation between cultural background.
Our research finds that the effect of grandchild care on the depression of Chinese older adults of different genders is different, and it has a significant effect on the depression of female older adults, but it does not have a significant effect on the depression of male older adults. Previous studies on the social participation of the older adults in China have shown that male older adults in China are more involved in public sphere activities than females, and less involved in family care and housework activities. Female older adults usually focus on family life [
51,
52] . Based on traditional Chinese concepts, scholars have explored the relationship between family responsibilities and depression from the perspective of gender differences. The results show that females are more likely to bear family responsibilities, and they also appear to be more likely to suffer from depression [
53]. Grandchild care is a kind of family responsibility, although many male older adults participate, they take less responsibility, and often play a supporting role. Less taking care of responsibilities leads to the result that taking care of grandchildren does not have a significant effect on depression. Therefore, whether to provide grandchild care is not one of the influencing factors of the depression of Chinese male older adults.
The effect of grandchild care on the depression of Chinese older adults is also different among the older adults with different marital status. Marriage is the most important interpersonal relationship for adults in China, and widowed, divorced or never married means the absence of this important social network [
54]. Marital status is an important factor affecting depression in the older aduts. Without the company of a spouse, they face a greater risk of depression [
55]. Compared with the older adults with a spouse, not having a spouse means insufficient emotional comfort and lack of access to care in old age. Taking care of grandchildren brings about emotional interactions between grandparents and grandchildren, makes the older adults broaden social networks and have more opportunities for social participation. More social activities, for those who don’t have a spouse, to a certain extent make up for the lack of emotional comfort and social networks, which has a positive impact on the mental health of widowed, divorced and never married older adults. However, grandchild care does not have a significant impact on the depression of married Chinese older adults. Previous research have proved that the protection mechanism of marriage plays a positive role in coping with depression during old age [
17,
29]. The presence of a spouse can resist some potential risks of depression of the older adults and it can also weaken the effect of some factors that improve depression. Providing grandchild care as a potential factor in improving depression does not have a significant improvement effect on older adults with spouses. Therefore, whether to provide grandchild care can not have a significant impact on the depression of married older adults.
Qinghong He pointed out that parents provided grandchild care, and children also provided more support to their parents according to intergenerational exchange theory [
30]. However, the role of intergenerational support from children due to grandchild care had not been further explored in previous studies. Our research finds that intergenerational support from children plays an intermediary role between grandchild care and the depression of the older adults. Grandchild care for the older adults is not only social participation in the ordinary sense, but also assistance to children, which can reduce the burden of care for adult children and allow them to work with peace of mind. Children visit their parents with economic support because they are grateful for their help in taking care of grandchildren. Grandparents may think it is better than no visit and no economic support from their children. This kind of emotional and economic support helps to make up or even strengthen the intergenerational bond, thereby enhancing the intergenerational relationship between children and the older adults, allowing the older adults to have a sense of happiness, and achieve the improvement of depression of the older adults. It is a win-win for children’s families and grandparents’ families.
In recent years, China has gradually liberalized childbirth, and social support is seriously insufficient in childcare. Raising children has caused considerable pressure on the family and society. The grandchild care in China should be paid attention to and valued. At present, more and more women in China are participating in social labor. For many women of the right childbearing age, the contradiction between family and work is prominent, and the willingness to bear children is low [
31]. On the basis of the older adults have the ability to take care and full respect for their willingness to provide grandchild care, society and families should encourage the older adults to participate in taking care of their grandchildren, encourage the older adults to raise their grandchildren scientifically, and provide training related to infant and childcare. This not only eases the burden of care for the children's family, increases women's willingness to bear children, but also makes the grandparents enjoy the family happiness of children and grandchildren. At the same time, for the older adults caring for their grandchildren, adult children should give them more intergenerational support. By increasing intergenerational connections and economic support, depression of the older adults can be improved to a greater extent, and the children can play the role of filial children better.
The innovation of this paper is to use a large national database to verify the effect of grandchild care on the depression of the older adults in China, and then classify the older adults by gender and marital status, and explore the effect of grandchild care on the depression of different older adults groups. On this basis, we further explored the mediating role of intergenerational support from children between grandchild care and the depression of the older adults, and finds that grandchild care can improve depression of the older adults by increasing intergenerational support from their children.
At the same time, this research also has certain limitations. First of all, this research uses cross-sectional data and cannot explore the causal relationship between grandchild care and the depression of Chinese older adults. Secondly, when exploring the impact of grandchild care on the depression of the older adults, the measurement and definition of the intensity of grandchild care has not yet been unified. Therefore, we only consider whether grandchild care is provided, but not consider the intensity of grandchild care. Finally, the characteristics of grandchildren are also important factors that affect the depression of the older adults. However, our research haven’t include the characteristics of grandchildren as control variables in the model due to the inability to obtain information about the grandchildren.
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