Understanding Depression in a Family Context: Evidence from the China Health and Retirement Longitudinal Study

Background and Purpose:China is rapidly becoming an aging society. It is estimated that the number of older adults aged 60 and above will reach 487 million in 2050, which represents nearly 35% of China’s total population (Chen & Han, 2016). With a drastic increase in China’s aging population, the number of older adults who experience mental health problems will also increase. Indeed, a meta-analysis study revealed that the prevalence of depressive symptoms in Chinese older adults was 23.6% (Li, Zhang, Shao, Qi, & Tian, 2014). Although research has been done to examine depression among older adults, most studies focused on the individual as the unit of analysis and failed to explore depression among older adults within an interdependent relationship. Because individuals are nested in families, it is important to understand depression within a family context to see how older couples may affect each other’s psychological wellbeing. Therefore, to address this gap, the current study examined the degree to which individual and dyad-level characteristics were associated with the severity of depression among older couples in China.

Methods:This cross-sectional study utilized data from wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). The total sample in the study was 2,560 heterosexual couples aged 60 and above. Each individual’s severity of depression was measured by the 10-item Center for Epidemiological Studies Depression Scale. A multilevel model was used to analyze the dyadic data.

Results:Our preliminary findings suggested the partial intraclass correlation between a dyad’s depression scores was 0.32, controlling for individual and family factors. This provided evidence of nonindependence and suggested that a couple’s depression scores were similar to one another. Four significant factors were identified: women, on average, had a higher depression score than men (ß = .93, p < .001); older adults living in rural areas tended to have a higher depression score compared to older adults living in urban areas (ß = 1.41, p < .001); older age was a predictor of lower depression scores (ß =-.05, p < .01); and self-cognition (ß = -0.25, p < .001) and spouse’s cognition (ß = -0.11, p < .001) were negatively associated with the severity of depression.

Conclusions and Implications: The results of this study provide important implications for social welfare interventions regarding how to serve the growing older population in China. As spousal cognition was negatively correlated with depression, services to support older couples in which one spouse has dementia are needed. Moreover, the findings provided empirical evidence to support the argument that more community mental health resources should be allocated to rural areas in China.In addition, given that female older adults are more vulnerable to depression compared to male older adults, it is imperative to develop tailored services to support the psychological wellbeing of women.