Title : Family structure and depressive symptoms among older adults in China: A marginal structural model analysis
Abstract:
Background and objectives: Mental well-being in late-life is inevitably connected to families due to the reliance of older adults on family members. The study aimed to investigate the causal relationship between family structure and depressive symptoms among Chinese older adults as well as gender and rural/urban disparities.
Research Design and Methods: We used the longitudinal data from China Health and Retirement Longitudinal Study (CHARLS) which was surveyed 4 times over 7 years. The depressive symptoms were assessed based on Centre for Epidemiological Studies–Depression scale with score of 12 as a cut-off. Family structures were grouped into single-member, couple, nuclear family and extended family. Marginal structural models (MSMs) were performed to estimate the causal effects of family structure on depressive symptoms, accounting for time-varying confounding.
Results: Cumulative exposure to single-member family type increased the odds of depressive symptoms by an average of 33% (95%CI: 1.22-1.44) than counterparts in the couple family after adjusting for confounding. People in the extended family may have 6% higher odds of depressive symptoms (95%CI: 1.00, 1.11). The longitudinal associations between family structure and depressive symptoms were consistent across subgroups of gender and residential area (P for interaction is 0.6638 for gender, and 0.7043 for residential area).
Discussion and Implications: People living alone and living in the extended family have increased risk of depressive symptoms. Early screening for depression in older population is recommended particularly from "at risk" family types to enhance their future psychological wellbeing.
Audience Take Away Notes:
- This study estimated the causal effects of family structure on depressive symptoms in a nationally representative cohort of Chinese older adults, with a biennial follow-up up to seven years
- Marginal Structural Models (MSMs) were used to allow for family dynamics and time-varying confounding
- Chinese older adults living in single-member and extended families were found to have a greater risk of depression than those living in couples. It is essential to enhance psychological support and promote mental health services for the older adults living in "at-risk" families
