Multidimensional Intergenerational Support and Self-Rated Health Among Older Chinese Immigrants: The Mediating Effects of Depressive Symptoms

Background and Purpose: Despite the increasing number of ethnic older immigrants in the United States, few studies have examined the psychological pathways between intergenerational support and self-rated health within the context of immigration. Intergenerational support may operate on health-related outcomes in later life through its influences on emotions, moods, and perceived well-being. Depressive symptoms are an important pathway to consider in this relationship. This study investigated the relationship between multidimensional intergenerational support and self-rated health and to what extent depressive symptoms mediate the relationship between intergenerational support and self-rated health among older Chinese immigrants.

Methods: Data came from a regional study using purposive sampling to recruit older Chinese immigrants from senior centers, adult day care centers, and Chinese churches in the Los Angeles area. Older adults aged 60 or older, born in mainland China, and who had at least one child living in the Los Angeles area were eligible participants. Human subject research approval was obtained from the Institutional Review Board. 236 eligible older Chinese immigrants participated in the study between 2010 and 2012. Trained bilingual interviewers administered structured survey instruments using one-on-one, face-to-face interviews. Informed consent was obtained before the interviews.

Self-rated health was measured by how you assess your current health status with a 4-point response set. It was recategorized based on the skewness (1= poor, 2= fair, and 3= good). Intergenerational support included: weekly-face-to-face contact with at least one child, weekly phone contact with at least one child, received financial support from at least one child, provided financial support to at least one child, received household chore help from at least one child, and received personal care from at least one child with yes or no (referent) as responses. Emotional support was the maximal score across all children, ranging from 0 to 6.  Higher scores indicate stronger emotional support. Depressive symptoms were measured by nine questions from the Center for Epidemiologic Studies-Depression (0 = rarely/none of the time, 1 = some of the time, 2 = most of the time). A summated score was calculated. Higher scores indicate more depressive symptoms. Sociodemographics and acculturation factors were covariates. Path analysis with categorical dependent variable using Mplus 6.12 was conducted and model INDIRECT was used to study mediation.

Results: Good model fit was demonstrated (χ²= 57.606, df = 57, p = .453; CFI = .962; TLI = .941; RMSEA = .007; WRMR = .765). Receipt of personal care was significantly, directly associated with better self-rated health. Stronger emotional support was significantly associated with fewer depressive symptoms. Subsequently, fewer depressive symptoms were significantly associated with better self-rated health.

Conclusions and Implications: Different dimensions of intergenerational support influenced health differently. Receipt of personal care had direct positive effects on health. Depressive symptoms served as the mediator in the relationship between emotional support and health. This full mediation helps explain the mechanism by which intergenerational support affects self-rated health. To promote health, interventions need to focus on preventing and reducing depressive symptoms besides encouraging and strengthening social support among older Chinese immigrants.