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Abstract

Grandparenting is becoming increasingly prevalent worldwide, especially in Chinese society. However, the impact of grandparenting on older adults’ health remains unclear. This study examined whether and how grandparenting is associated with depressive symptoms in Chinese older adults and the role of intergenerational support (i.e., financial, emotional, and instrumental support) in this relationship. Using data from the China Longitudinal Aging Social Survey (CLASS) 2018 wave, the researchers employed multivariate linear regression models to investigate variations in depressive symptoms and their associations with grandparenting; the role of intergenerational support was also explored. The results indicated that older adults who engage in grandparenting, particularly in non-intensive care, experience a reduction in depressive symptoms, even after accounting for sociodemographic and health-related factors. Overall, intergenerational support plays a mediating role in the relationship between grandparenting and associated mental health outcomes. Bidirectional emotional and financial support and receiving instrumental support were associated with lower depressive symptoms among Chinese grandparents. In general, the findings of this study suggest that grandparenting, along with intergenerational support, provides certain protective health benefits for Chinese grandparents. With rapid changes in Chinese society, further prospective longitudinal studies are needed to examine family contexts in the relationship between grandchild caregiving and associated health outcomes.

Plain Language Summary

Using data from the China Longitudinal Aging Social Survey (CLASS) 2018 wave, this study examined whether and how grandparenting is associated with depressive symptoms in Chinese older adults and the role of intergenerational support in this relationship. The results indicated that older adults who engage in grandparenting, particularly in non-intensive care, experience a reduction in depressive symptoms, even after accounting for sociodemographic and health-related factors. Overall, intergenerational support plays a mediating role in the relationship between grandparenting and associated mental health outcomes. More prospective longitudinal studies are called to examine the associations between grandparenting and related health outcomes considering culture variations.

Keywords

Chinese grandparents grandparenting depressive symptoms intergenerational support mediating effect

Introduction

China is currently experiencing a rapidly aging population. The most recent census data show that there are now 264 million people over 60 years of age, comprising 18.7% of the country’s population (China National Bureau of Statistics, 2022). As the country grapples with its most evident demographic reality, the health of the older adult population—specifically, their mental health—has become a significant concern for the government. Mental health is a critical component of healthy aging (Tang et al., 2022). The promotion of mental health among older adults can lead to improvements in their quality of life. In contrast, poor mental health may result in mental disorders, such as depression, which are highly correlated with detrimental behaviors, such as suicide, resulting in severe social consequences (Y. Wang et al., 2020).

Recently, grandparenting has become the focus of academic circles in various intergenerational support practices (Carr et al., 2019; Danielsbacka et al., 2022; Hayslip et al., 2015). On the one hand, an increase in average life expectancy allows older adults more opportunities and time to play the role of grandparents. On the other hand, providing childcare can be seen as an essential way to enhance family values and promote functional integrity. These factors, as mentioned above, contribute to the prevalence of grandparenting in some countries, specifically China, where Confucian values and collectivist culture are the mainstream (Pan et al., 2022; Xu, 2019). With the relaxation of China’s fertility control policies, the younger generation may have decided to have a second or third child. However, because of the lack of developed childcare services, most adult children seek help from their families, and older adults are increasingly responsible for caring for their grandchildren. According to a recent study, nearly half (49.59%) of Chinese grandparents provide grandchild care (Choi & Zhang, 2021).

Although grandparenting is becoming more common in China, the mental health impact of grandchild care on older adults remains unexplored and inconsistent, with reports of positive, negative, and null health effects in different studies (Shen & Yang, 2022; Tang et al., 2022; Xu, 2019). One reason for this is that many empirical studies are based on local, small-scale, or convenience-sampled data, limiting the generalization and comparison of conclusions (Cong & Silverstein, 2008). While some studies have used national, cross-sectional, or longitudinal data (Chen & Liu, 2012; Ko & Hank, 2014), their data are not updated and hardly reflect the current profiles of Chinese older adults providing grandchild care. Another explanation is that most studies used living arrangements as a measure of grandparenting, which revealed older adults’ socioeconomic status rather than childcare provision (Choi & Zhang, 2021). Moreover, previous empirical studies rarely controlled for the effects of multidimensional intergenerational support (Ku et al., 2013; Luo et al., 2019; W. P. Wang et al., 2019). In fact, grandparenting may promote frequent contact between older adults and their adult children, and these connections could lead to grandparents receiving and/or providing financial, instrumental, and emotional support from/to the younger generation, which would, in turn, impact their mental health (Tosi & Grundy, 2019).

This study aimed to explore the association between grandparenting and depressive symptoms in Chinese older adults. Unlike existing studies, the researchers first examined whether and how grandchild care affected Chinese older adults’ depressive symptoms based on the latest wave (2018) on the nationally representative China Longitudinal Aging Social Survey (CLASS). Second, the researchers adopted multiple measurements of grandparenting, including grandchild care provision, average grandchild care intensity, and low/high grandchild care intensity levels, to more accurately reflect grandchild care behavior. The researchers also explored the impact of intergenerational support on the relationship between grandparenting and depressive symptoms among Chinese grandparents.

Literature Review

Grandparenting and Mental Health

Investigations into the connection between grandparenting and mental health among older adults have produced divergent results, including positive, negative, and null effects (Kochli-Hailovski et al., 2021; Shen & Yang, 2022; Teerawichitchainan & Low, 2021). According to role strain theory, individuals may encounter adverse outcomes due to a need to rotate between the expectations of different roles (Goode, 1960). In the context of grandchild care, the lack of time, energy, and material and emotional resources may cause role dilemmas and increase stress levels among older adults, leading to adverse mental health outcomes (Danielsbacka et al., 2022; Jennings et al., 2021). For instance, grandmothers in Southern Europe experienced an increase in loneliness levels when caring for their grandchildren (Hajek & König, 2022). In addition, older adults may experience psychological stress and feelings of sacrifice and loneliness due to an overload of caring obligations, inconsistency in childcare philosophy with adult children, and conflicts with family members triggered by providing grandchild care (Danielsbacka et al., 2019; Komonpaisarn & Loichinger, 2019).

However, studies based on role enhancement theory have reached the opposite conclusion, stating that grandchild care benefits older adults’ mental health (Sieber, 1974). Benefits gained from playing an additional childcare role, such as accompanying resources, self-fulfillment, and satisfaction, may outweigh the adverse effects of role strain, thereby helping grandparents achieve self-efficacy (Di Gessa et al., 2016b). A European study showed that providing grandchild care had a protective effect against grandparents’ depressive symptoms compared with non-caregivers (Yang et al., 2022). In addition, by caring for their grandchildren, grandparents can maintain their active social roles and receive company and support from family members (Pruchno & McKenney, 2002). These, in turn, lessen their sense of loneliness and loss from retirement and shrinking social networks in old age, fostering positive life goals and attitudes (Antonucci et al., 2014). However, some empirical studies have found that grandchild care does not significantly affect older adults’ mental health (Ates, 2017; Szinovacz & Davey, 2006). A recent Australian study found no relationship between subjective well-being (i.e., life satisfaction and quality of life) and grandchild care (O’Loughlin et al., 2017). To date, the health consequences of providing intergenerational care have not been clarified.

Grandchild Care Intensity and Mental Health

Owing to data constraints, most studies have adopted a dichotomous measurement of grandparenting (i.e., whether or not grandchild care is provided). Nevertheless, care intensity levels exist and are determined by grandchildren’s characteristics, care content, and care experience (Harrington Meyer & Abdul-Malak, 2020). For example, the time and energy dedicated to caring for infants or children with special needs are considerably higher than those dedicated to typical school-age grandchildren. Most studies on grandparenting, mainly in Europe and the United States, have shown that grandparents assume a high level of care when adult parents are imprisoned, mentally or physically dysfunctional, or deceased. The results often indicated a negative relationship between grandparenting levels and mental health consequences (Danielsbacka et al., 2022; Di Gessa et al., 2016a; Hayslip & Kaminski, 2005; Liu & Cong, 2019).

However, the mental health effects of grandparenting may vary across cultures, even when considering caring intensity levels (Kochli-Hailovski et al., 2021). According to a study conducted among older adults in Europe, an increase of 10 hr of childcare per month could lead to the development of depressive symptoms in grandparents (Brunello & Rocco, 2019). In South Korea, grandparents’ caring stress decreased significantly as their involvement increased (Park, 2018). However, some studies have found no mental health effects of grandparenting. For instance, an analysis of longitudinal data from 15 European countries revealed no significant correlations between grandchild care and depression, life satisfaction, and subjective life expectancy (Sheppard & Monden, 2019). These inconsistent empirical results reflect the complexity of the association between grandparenting and mental health consequences in later life, warranting further empirical examination.

Intergenerational Support and Mental Health

As individuals age, the impact of intergenerational support on older adults’ health becomes increasingly important (Seo & Kim, 2022; Viscogliosi et al., 2022). Intergenerational support encompasses three aspects—financial, instrumental (e.g., household chores), and emotional—and is bidirectional (i.e., top-down or bottom-up) (Antonucci et al., 2014; Cutrona et al., 1986; Wallston et al., 1983). Research has demonstrated that adult children’s financial and emotional support, as well as daily care, can considerably impact the health consequences of grandparents, with the magnitude of support being a key factor (Choi & Zhang, 2021; Krzeczkowska et al., 2021; Teerawichitchainan & Low, 2021; Viscogliosi et al., 2022). For instance, excessive financial support and daily living care may lower self-rated health levels (Song & Li, 2006; P. Wang & Li, 2011). In contrast, a study in the rural area of Chaohu in Anhui, China indicated that higher levels of remittances from adult children were associated with fewer depressive symptoms among grandparents in skipped-generation households (Cong & Silverstein, 2008). Moreover, older adults may regard continuously helping their children as a failure of their part in the education and nurturing of their children, thereby causing psychological stress (Schwarz et al., 2010). Thus, the positive effects of reciprocity on mental health in older adults may be negated by an imbalance in the frequency or manner of exchanges with their adult children (Sun & Ji, 2017).

As an essential family activity, grandparenting enhances contact opportunities between older adults and their children, facilitating intergenerational support and resource exchange (Tosi & Grundy, 2019). However, few studies have considered the role of intergenerational support when investigating how grandparenting affects older adults’ mental health. These findings provide a mixed picture of the role of intergenerational support. For example, a recent empirical study showed that providing financial support to adult children increased the psychological burden of grandchild care in Mexican American older adults, indicating a moderating effect (Liu & Cong, 2019). Tang et al.’s (2022) study found that financial and emotional support from adult children mediated the mental health effects of grandchild care (Tang et al., 2022). However, other studies have found no mediating or modulating effects of intergenerational support on certain dimensions (Landry-Meyer et al., 2005; Zhou et al., 2017). To date, most studies have used intergenerational support as a control variable, leaving its role largely unexplored (Hayslip et al., 2015).

The Present Study

This study aimed to investigate the association between grandparenting and older adults’ mental health and the role of intergenerational support in this relationship. The researchers expect to make the following contributions to the academic field. First, compared with existing literature using regional survey samples or non-probability samples, this study provides a nationally representative profile of older adults’ characteristics and grandchild care behaviors based on the latest data from the 2018 CLASS. Second, owing to data limitations, existing studies have primarily used living arrangements to measure intergenerational care. However, this method may reflect older adults’ socioeconomic and health statuses rather than intergenerational care. Thus, the researchers adopted care intensity as a general measure of grandchild care. The researchers also employed a multidimensional measurement strategy for grandparenting rather than a rough one. Third, the researchers analyzed the role of intergenerational support in the association between grandparenting and older adults’ depressive symptoms by discussing grandchild care behaviors in the family context rather than in isolation. Finally, the study analysis controlled for various demographic and socioeconomic characteristics of older adults, as well as their health status, to reduce the influence of confounding variables.

In accordance with Chinese culture and by referring to theoretical and empirical studies on grandparenting and related mental health outcomes, this study hypothesizes that (1) Chinese grandparents who provide grandchild care have better mental health than those who do not; (2) the association between grandparenting and mental health varies according to the intensity of care, that is, intensive caregivers have better mental health than their non-intensive caregiving counterparts; and (3) intergenerational support plays a role in the association between grandparenting and related mental health outcomes.

Methods

Data and Sample

This study utilized data from the CLASS, a nationally representative longitudinal study of Chinese adults aged 60 years and over that collects data on income, wealth, household, health, etc. The CLASS employs a complex multistage probability sampling method. A baseline survey of 11,511 respondents was conducted in 2014, followed by face-to-face interviews every 2 years. This study used data from the 2018 wave, which included 11,418 respondents. Those who had no grandchildren or did not report childbearing status were excluded (3,460 individuals). The researchers then restricted the analysis to respondents who completed the questions on grandchild care provision, intergenerational support, sociodemographic items, and health status. Finally, 4,128 respondents were included in the analysis. The Research Ethics Committee of Renmin University of China granted ethical approval for all CLASS waves. Before participation, all participants provided informed consent. The CLASS data is accessible to the public through its official website (http://class.ruc.edu.cn/index.htm).

Measures

Depressive Symptoms

The dependent variable was the severity of depressive symptoms, which reflected the grandparents’ mental health status. The researchers measured depressive symptoms in the CLASS sample using the revised version of the Center for Epidemiologic Studies Depression (CES-D) scale, which includes nine items (CES-D9) (Cong & Silverstein, 2008). The CES-D9 has been validated in Chinese older adults (Jin & Liu, 2017; Zhou et al., 2017). The CES-D9 asks about the frequency of respondents’ feelings and behaviors in the previous week, involving three items for positive affect (happiness, enjoyment of life, and pleasure), two for negative affect (loneliness and upset), two for marginalization feelings (loneliness and having nothing to do), and two for somatic symptom (poor appetite and trouble sleeping). The researchers coded the answers as 1 (rarely or none), 2 (sometimes), or 3 (most of the time). After reverse-coding the positive items, the researchers summed the nine items to obtain the depressive symptom total score, ranging from 1 to 27, where 27 implied the highest depressive symptoms level. The Cronbach’s α coefficient for the scale was .72.

Grandparenting

In the 2018 wave, respondents with at least one grandchild among all their adult children were asked whether they had provided grandchild care in the year prior to the interview. If they had (yes = 1), they were asked to rate their grandparenting intensity by reporting how many hours, on a typical day, they spent looking after their grandchildren, from none (0) to less than 1 hr (1) to over 8 hr (5). Using this information, the researchers first calculated the average daily care intensity score as a continuous variable ranging from 0 to 5 and then distinguished between two types of grandparenting status: non-intensive (1; i.e., an average daily care intensity score less than 4) and intensive (2; i.e., an average daily care intensity score more than 4) An average grandparenting intensity score of 4 (i.e., 8 hr on a typical day) was chosen as the threshold based on the literature (Kim et al., 2017). Non-caregivers served as the reference group.

Intergenerational Support

Intergenerational support is conceptualized as the support older adults provide for their adult children and vice versa, including financial, instrumental, and emotional support.

Financial Support

Respondents were asked how much money they had given to or received from their adult children in the past 12 months. They were required to choose among nine categories: “none (Chinese yuan renminbi [CNY] 0),”“CNY 1–199,”“CNY 200–499,”“CNY 500–999,”“CNY 1,000–1,999,”“CNY 2,000–3,999,”“CNY 4,000–6,999,”“CNY 7,000–11,999,” and “CNY 12,000 and above.” This study averaged the median values of the respondents’ chosen categories across their adult children and then used the logged (+1) value as a measurement of financial support, both given to and received from adult children, separately.

Instrumental Support

Respondents were asked to rate the frequency with which they received or provided help from/to their adult children in household chores during the year prior to the interview (hardly ever = 0, several times a year = 1, at least once a month = 2, at least once a week = 3, almost every day = 4). The researchers took the average value of the participants’ responses across their adult children as a measure of instrumental support, both given to and received from adult children.

Emotional Support

The respondents were asked to rate their level of emotional closeness to their adult children (not close = 0; somewhat close = 1; close = 2). The researchers measured instrumental support by averaging the participants’ responses across their adult children, with higher levels indicating stronger emotional support.

Controls

This study controlled for several sociodemographic characteristics of older adults, including gender (male = 1, female = 0), marital status (married = 1, non-married = 0), living arrangements (living with adult children = 1, living without adult children = 0), education (1 = any education, 0 = none), residential area (urban = 1, rural = 0), and the log(+1) of personal income (in CNY). As existing studies indicated, after reaching the age of 75, older adults are likely to develop chronic illnesses, accompanied by the deterioration of a considerable number of physiological functions (Crimmins, 2004). Regarding that health deterioration in older adults could directly affect grandchild care decision-making and care intensity, this study coded age as a dichotomous variable (75 years = 1; 60–75 years = 0).

The researchers also controlled for grandparents’ health conditions by coding four health conditions as dummy variables: (1) activities of daily living (ADL; 1 = at least one functional limit, 0 = no functional limit), (2) instrumental activities of daily living (IADL; 1 = at least one functional limit, 0 = no functional limit), (3) pain (1 = feeling some pain, 0 = feeling no pain), and (4) chronic diseases (1 = at least one, 0 = none). Additionally, the researchers controlled for cognitive function in the analysis as a continuous variable measured using the Mini-Mental State Examination (MMSE). The MMSE assessment protocol in the CLASS was adapted and validated in the Chinese context, including 12 items regarding orientation, registration, attention, calculation, and language, with a summed score ranging from 0 to 12 (Arpino & Bordone, 2014; Pan et al., 2022; Sun & Ji, 2017; Yang, 2020). Higher scores indicated better cognitive function (Cronbach’s α = .70).

Analytic Strategy

The researchers adopted the ordinary least squares (OLS) method to analyze the association between grandparenting and depressive symptoms and then tested the role of intergenerational support to reveal potential mechanisms. Specifically, the researchers estimated three sets of regression models. Models 1, 4, and 7 included grandparenting as a key independent variable (base models). Models 2, 5, and 8 added the control variables of sociodemographic characteristics and health conditions to base models to assess how these potential confounders could affect the relationship between grandparenting and depressive symptoms. Models 3, 6, and 9 further included intergenerational support, aiming to examine the roles of financial, instrumental, and emotional support in the relationship (full models). The OLS regression was performed using STATA 17.0.

Results

Sample Characteristics

Table 1 presents the descriptive statistics for all variables analyzed in this study. The average score for depressive symptoms in the sample 13.36 (out of 27), indicating a moderate level. Less than half of the grandparents provided no care to their grandchildren (41.6%). Most caregivers provided non-intensive grandparenting (34.7%), followed by intensive grandparenting (23.7%). Regarding intergenerational support, older adults maintained high emotional intimacy with their adult children, with a score of 1.88 out of 2 (SD = 0.34). On average, older adults received more financial and instrumental support than they had given to their adult children. Regarding socioeconomic status, most grandparents were male (55.4%), below 75 years of age (85.1%), married (83.6%), living with their adult children (49.8%), and educated (50.2%). The average annual income was CNY 8,433 (log[+1] = 9.04). As for health conditions, most grandparents reported no ADL (96.2%) or IADL limits (76.5%). However, 71.6% of the respondents had at least one chronic illness, and approximately half experienced pain (49%). The mean cognitive ability score was 9.50 (SD = 2.40).

Table 1.

Descriptive Statistics of Grandparents, China Longitudinal Aging Social Survey (CLASS), 2018 (N = 4,128).

Variables	Mean/% (SD)
Dependent variable
Depressive symptoms (1–27)	13.36 (3.53)
Independent variables
Grandparenting
Providing care (ref = no care)	58.4
Average care intensity	1.74 (1.793)
Care intensity level (ref = no care)
None-intensive grandparenting	34.7
Intensive grandparenting	23.7
Intergenerational support
Emotional support (0–2)	1.88 (0.34)
Receiving financial support (log[+1])	6.22 (2.58)
Giving financial support (log[+1])	3.09 (3.49)
Receiving instrumental support	1.42 (1.23)
Giving instrumental support	0.90 (1.27)
Controls variables
Sociodemographic status
Gender (ref = female)	55.4
Age (ref = 60–74 years old)	14.9
Marital status (ref = nonmarried)	83.6
Living arrangements (ref = not living with adult children)	49.8
Residence (ref = urban area)	37.8
Education level (ref = none education)	79.5
Personal income (log[+1])	9.04 (1.88)
Health conditions
Cognitive function (0–12)	9.50 (2.40)
ADL (ref = no limit)	3.80
IADL (ref = no limit)	23.5
Chronic illness (ref = none)	71.6
Physical pain (ref = feeling no pain)	49.0

Note. Standard deviations are given in parentheses. ADL = activities of daily living; IADL = instrumental activities of daily living.

Multivariate Results

Table 2 shows the estimated results of depressive symptoms predicted by grandparenting using OLS regression models. The results of Models 1, 4, and 7 (base models) suggested that grandparenting was significantly negatively associated with depressive symptoms in older adults. Compared to non-caregivers, caregivers had a .641-point lower CES-D score (p < .01) (Model 1). As care intensity increased, older caregivers’ depression symptoms decreased ( $β = - . 203^{* * *},$ Model 4). Intensive grandparenting ( $β = - . 814^{* * *},$ Model 7) brought more psychological benefits for older adults than non-intensive childcaring ( $β = - . 602^{* * *},$ Model 7). Models 2, 5, and 8 added grandparents’ sociodemographic status and health conditions to the basic models. Except for intensive grandparenting, the same findings were observed after controlling for confounders, although the magnitude of estimated coefficients and statistical significance attenuated ( $β = - . 641^{* * *} \to - . 299^{*},$ Model 1 to 2; $β = - . 203^{* * *} \to - . 088^{*},$ Model 4 to 5; $β = - . 602^{* * *} \to - . 293^{*},$ Model 7 to 8). Intensive grandparenting lost its significant effect on older adults after controls were included.

Table 2.

Effects of Grandparenting on Older Adults’ Depressive Symptoms (N = 4,128).

	Model 1	Model 2	Model 3	Model 4	Model 5	Model 6	Model 7	Model 8	Model 9
Grandparenting
Providing care (ref = no care)	−.641*** (0.16)	−.299* (0.16)	−.232 (0.16)
Average care intensity				−.203*** (0.04)	−.088* (0.05)	−.068 (0.05)
Care intensity level (ref = no care)
None-intensive grandparenting							−.602*** (0.17)	−.293* (0.16)	−.223 (0.16)
Intensive grandparenting							−.814*** (0.27)	−.334 (0.26)	−.308 (0.25)
Intergenerational support
Emotional support			−1.299*** (0.24)			−1.300*** (0.24)			−1.301*** (0.24)
Giving financial support (log[+1])			−.039* (0.02)			−.039* (0.02)			−.039* (0.02)
Giving instrumental support			−.018 (0.06)			−.007 (0.06)			−.013 (0.06)
Receiving financial support (log[+1])			−.053* (0.03)			−.054** (0.03)			−.053* (0.03)
Receiving instrumental support			−.153*** (0.06)			−.153*** (0.06)			−.154*** (0.06)
Controls
Gender (ref = female)		.078 (0.16)	.019 (0.15)		.076 (0.16)	.019 (0.15)		.077 (0.16)	.019 (0.15)
Age (ref = 60–74 years old)		−.668*** (0.19)	−.681*** (0.19)		−.662*** (0.19)	−.671*** (0.18)		−.668*** (0.19)	−.680*** (0.19)
Marital status (ref = nonmarried)		−.931*** (0.19)	−.851*** (0.18)		−.927*** (0.19)	−.848*** (0.18)		−.929*** (0.19)	−.847*** (0.18)
Living arrangements (ref = not living with adult children)		−.389**	−.287*		−.373**	−.285*		−.384**	−.280*
Living arrangements (ref = not living with adult children)		(0.15)	(0.16)		(0.15)	(0.16)		(0.15)	(0.16)
Residence (ref = urban area)		.039 (0.17)	.002 (0.17)		.019 (0.17)	−.011 (0.17)		.038 (0.17)	−.001 (0.17)
Education level (ref = none education)		−.142 (0.22)	.001 (0.22)		−.133 (0.22)	.007 (0.22)		−.141 (0.22)	.003 (0.22)
Personal income (log[+1])		−.141*** (0.04)	−.128*** (0.04)		−.139*** (0.04)	−.128*** (0.04)		−.140*** (0.04)	−.128*** (0.04)
Cognitive function		−.239*** (0.03)	−.229*** (0.03)		−.239*** (0.03)	−.229*** (0.03)		−.239*** (0.03)	−.229*** (0.03)
ADL (ref = no limit)		1.581*** (0.50)	1.617*** (0.51)		1.592*** (0.50)	1.627*** (0.51)		1.582*** (0.50)	1.619*** (0.51)
IADL (ref = no limit)		.862*** (0.20)	.825*** (0.19)		.861*** (0.20)	.826*** (0.19)		.862*** (0.20)	.826*** (0.19)
Chronic illness (ref = none)		.593*** (0.14)	.606*** (0.14)		.593*** (0.14)	.607*** (0.14)		.593*** (0.14)	.606*** (0.14)
Physical pain (ref = feeling no pain)		1.396*** (0.15)	1.357*** (0.15)		1.394*** (0.15)	1.355*** (0.15)		1.396*** (0.15)	1.356*** (0.14)
Constant	13.734*** (0.12)	16.826*** (0.55)	19.539*** (0.67)	13.711*** (0.11)	16.785*** (0.55)	19.512*** (0.67)	13.734*** (0.12)	16.824*** (0.55)	19.540*** (0.67)
Adj. R²	.008	.186	.21	.01	.186	.21	.008	.186	.210
F	16.242	40.23	34.413	21.354	40.52	34.634	8.417	37.365	32.649

Note. Robust standard errors are given in parentheses. ADL = activities of daily living; IADL = instrumental activities of daily living.

p < .1. **p < .05. ***p < .01.

Models 3, 6, and 9 (full models) added intergenerational support to Models 2, 5, and 7. The estimated results showed that while grandparenting lowered depressive symptoms among grandparents, its statistical significance disappeared regardless of its measurement. These variations suggest that intergenerational support reduces the mental health impact of childcare, indicating its mediating role in the association between grandparenting and depressive symptoms. The full models suggested that better emotional support $(β = - 1 . 30^{* * *})$ , receiving more financial $(β = - . 053^{*})$ and instrumental support $(β = - . 153^{* * *})$ from adult children, and providing more financial support $(β = - . 039^{*})$ to adult children were inversely associated with depressive symptoms, with relatively stable estimation coefficients and statistical significance.

Last, for controls, the researchers found that being married, living with adult children, earning more, and being aged 75 years or above were significantly associated with lower depressive symptoms. In contrast, a decline in cognitive ability, limits in ADL and IADL, chronic illnesses, and pain were significantly associated with more depressive symptoms. However, no significant variations in depressive symptoms were observed based on gender, living region, or educational status among Chinese grandparents.

Discussion

Despite the worldwide popularity of older adult participation in grandchild care, the relationship between grandparenting and caregivers’ mental health has been scarcely explored, particularly in Asia and China. This study aimed to expand theoretical and practical understanding of the association between grandparenting and depressive symptoms in Chinese older adults by examining the role of intergenerational support. Using nationally representative cross-sectional data from the CLASS 2018, the researchers explored whether and how grandparenting impacts depressive symptoms in older adults and the role of intergenerational support. Unlike previous studies, the researchers measured grandparenting in various ways rather than a single rough one. Using hierarchical linear regression models and controlling for sociodemographic status and health condition confounders, the researchers have more effectively examined the influence of grandparenting on depressive symptoms.

The empirical results of the present study indicate that providing grandchild care is significantly associated with fewer depressive symptoms among older Chinese adults. This finding supports the researchers’ first hypothesis but does not align with previous studies in Europe and the United States that reported adverse health consequences of grandparenting (Hughes et al., 2007). Grandparents providing childcare in the West are generally associated with socioeconomic disadvantages or motivated by the absence of parental childcare due to drug/alcohol misuse, maternal/paternal imprisonment, or financial hardship (Di Gessa et al., 2020, 2022; Glaser et al., 2018). This implies that grandparents may be pressured to support their adult children and grandchildren (Cong & Silverstein, 2008; Teerawichitchainan & Low, 2021). However, based on Confucian culture and collective family values, which emphasize strong family ties and lineage solidarity, Chinese older adults view grandchild care as a normative role rather than a burden (Choi, 2020). When caring for their grandchildren, Chinese older adults consider themselves indispensable “helpers” for their adult children and gain a sense of satisfaction and achievement in care activities (Ko & Hank, 2014; Lai et al., 2021; Xu, 2019). Generally, the results of this study support role enhancement theory and are consistent with previous findings in the Chinese context (Ku et al., 2012; W. P. Wang et al., 2019; Xu, 2019).

The researchers also found that the net health effect on grandparents varied according to childcare intensity levels. Overall, grandparents experienced fewer depressive symptoms as average grandparenting intensity increased. However, when considering grandparents’ characteristics, only non-intensive grandparenting benefited older caregivers’ psychological wellbeing. Thus, the second hypothesis is partly supported. One possible explanation is that non-intensive childcare brings more pleasure to older adults than pressure.

In contrast, intensive childcare may lead to a heavier burden on older adults as intensive grandparenting is more consuming and demanding. In this situation, “role strain” may offset the positive effects of “role enhancement” on older adults’ mental health. Hence, under different levels of care intensity, the consequences on older adults’ mental health depend on the net effect of role-playing. The findings of this study are inconsistent with previous studies in the Chinese context, highlighting the protective role of intensive childcare (Chen & Liu, 2012; Choi, 2020; Choi & Zhang, 2021; Ku et al., 2013). However, it should be noted that previous studies examined living arrangements rather than grandparenting per se (Tang et al., 2022). Indeed, both non-intensive and intensive grandchild care, which are highly associated with the characteristics of grandchildren, may occur across different living arrangements (e.g., skipped-generation households and multigeneration households). In addition, living arrangements reflect grandparents’ socioeconomic status and health conditions more than care intensity (Di Gessa & Grundy, 2014).

Furthermore, the researchers hypothesized that intergenerational support plays a role in the relationship between grandparenting and the associated mental health among Chinese grandparents. Evidence suggests that intergenerational support serves as a mediator in this relationship. Social convoy theory suggests that a more robust family network acts as a shield against the adverse impacts of a shrinking social network as individuals age (Antonucci & Akiyama, 1987). Grandparenting may result in more regular contact between grandparents and their adult children, thus strengthening family convoys by improving the flow of tangible and intangible resources and offering emotional, financial, and instrumental support. This could bring health benefits for older adults.

Furthermore, upward and downward support with a culturally symbolic meaning might enhance the psychological well-being of Chinese grandparents. For older adults, receiving support from adult children is often seen as a sign of filial piety, as emphasized by Confucian values. In China today, the symbolic value of filial piety conveyed through children’s support is more critical to older adults than the actual amount of support. Whereas, because of altruism and collectivism, older adults may spare no effort in supporting their adult children in need of career development. In doing so, older adults may feel a sense of achievement in following cultural norms. Some studies have also argued that close emotional connections with adult children are increasingly valued by older adults (Fu & Ji, 2020). However, the results of this study did not indicate that providing instrumental support significantly affects grandparents’ mental health outcomes. One possible explanation is that caring for grandchildren while providing instrumental support may be beyond the capabilities of older adults because grandparenting is spiritually and physically demanding. This topic merits further study, considering the scarcity of studies on the mediating role of intergenerational support, particularly the instrumental dimension.

Sensitivity analyses were conducted to test the robustness of the current findings. First, the researchers imputed missing values with multiple imputation methods using chained equations in STATA 17, considering that the missing data for the study variables ranged from none to approximately 10%. However, the main estimation results from the 20 imputed datasets remained almost unchanged. Additionally, the researchers tested the moderating role of intergenerational support by including interaction terms with grandparenting. However, none of the interaction terms showed significant results, indicating no moderating effect of intergenerational support. Thus, the findings of this study are robust.

This study has certain limitations. The main limitation is its cross-sectional nature, which made it challenging to identify the causal effect of grandparenting on depressive symptoms in older adults. Although the researchers controlled for multiple confounders, such as socioeconomic status and health conditions, this study did not rule out the possibility of health selection, in which healthier grandparents were more likely to engage in childcare activities. Second, the survey measures used in this study were approximate and may not have accurately captured information on grandparenting. The CLASS survey provided only childcare frequency information that the researchers used to measure grandparenting intensity, thus decreasing the understanding of grandchild care. For example, omissions from the CLASS include care responsibility, care content, care stress, coping strategies, and demographic attributes and health conditions of grandchildren. Similar problems exist in the operationalization of intergenerational support. These data constraints limit the theoretical and practical understanding of the association between grandparenting and health conditions in older adults.

Considering these limitations, future investigations should use longitudinal data to examine the connections between grandparenting and related health outcomes, thereby yielding a more comprehensive understanding of the causal effects of grandparenting. Further investigation is required to obtain more comprehensive measurements pertaining to grandparenting and intergenerational support as well as the specific attributes of grandchildren. It is also imperative to delve deeper into the mechanisms underlying the relationships between intergenerational support, grandparenting, and associated outcomes. Finally, grandparents’ health consequences should be further evaluated based on various micro- and macro-indicators such as sex, residence, marriage, and regional cultural norms in the context of Chinese demographic trends such as declining fertility, increased migration, and rapid urbanization.

Conclusion

In the Chinese setting, grandparenting was associated with fewer depressive symptoms, particularly non-intensive childcare, even after adjusting for socioeconomic and health covariates. Intergenerational support is a critical mediating factor facilitating the potential protective effects of childcare on grandparents’ mental health. Further prospective studies are needed to elucidate the mechanisms underlying the relationship between grandparenting and the associated health outcomes. In summary, the findings of this study contribute to the understanding of cultural contrasts in health outcomes of grandparenting worldwide.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research,authorship,and/or publication of this article: This work was supported by funding from China’s Philosophy and Social Science program (19BRK011) and the major research project of philosophy and social sciences of the Ministry of Education of the People’s Republic of China (23JZD028). None of the authors have a conflict of interest.

Ethical Approval

This study used secondary data (CLASS,2018 wave). Ethical approval for all CLASS waves was granted by the Research Ethics Committees of Renmin University of China. Before participation,all participants gave informed consent. For further information,please see

ORCID iD

Huan Wang

Data Availability Statement

Data available in a publicly accessible repository (China Longitudinal Aging Social Survey,CLASS),

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All in the Family: Does Grandparenting Impact Chinese Grandparents’ Depressive Symptoms?

Abstract

Plain Language Summary

Keywords

Introduction

Literature Review

Grandparenting and Mental Health

Grandchild Care Intensity and Mental Health

Intergenerational Support and Mental Health

The Present Study

Methods

Data and Sample

Measures

Depressive Symptoms

Grandparenting

Intergenerational Support

Financial Support

Instrumental Support

Emotional Support

Controls

Analytic Strategy

Results

Sample Characteristics

Multivariate Results

Discussion

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

Ethical Approval

ORCID iD

Data Availability Statement

References