Family Conflict, Substance Use, and Mental Health Among Older Adults in South Korea during the COVID-19 Pandemic

Background and Purpose

Social distancing measures were strictly required during the COVID-19 pandemic in South Korea (Kim et al., 2023). These measures, caregiving burden, financial insecurity, and challenging health situations heightened family conflict regardless of age and gender. Family conflict also increased loneliness and anxiety during the pandemic (Yoon & Mahapatra, 2024). Loneliness caused by family conflict has been reported to increase substance use, including alcohol and drugs, and anxiety (Gezinski et al., 2019). In addition, alcohol and drug use to cope with family-related stress has been associated with negative mental health outcomes (Devoto et al., 2022). Given South Koreans’ collectivist values, family conflict among older adults during the pandemic may have had a more significant impact on mental health (Yoon & Choi, 2022). However, limited research has investigated family conflict and mental health, along with loneliness and substance use among older adults in South Korea (hereafter Korea) during the pandemic. Therefore, this study investigated the direct association between family conflict and anxiety and the indirect effects on the association through loneliness and substance use among the study population.

Methods

This study employed data from 336 older adults (aged 51-81) during the COVID-19 pandemic in Korea. The data were collected in February 2021 in Korea as a part of the second wave of an international study about family well-being and COVID-19 (Mohanty et al., 2022). An independent variable, family conflict (α = .795), was measured using five items from the Brief Family Relationship Scale (Fok et al., 2014). The dependent variable, anxiety (α = .943), was measured using the sum of seven items from GAD-7 (Spitzer et al., 2006). For intervening variables, loneliness (α=.888), was measured by summing three items from Hughes et al. (2004), and substance use (α =.878) was measured by summing two items from the Brief COPE instrument (Carver, 1997). Covariates were income, health, gender, marital status, and age. Maximum likelihood estimation was employed to impute missing values (Enders, 2022). Serial mediation analysis using PROCESS macro (model 6) was employed. For the analysis, 95% confidence intervals were estimated using bootstrapping (sample of 5,000).

Results

For direct effects, family conflict during the pandemic was positively associated with loneliness (b=.1914, p=.000) and substance use (b=.1438, p<.001). Loneliness was positively associated with substance use (b=.1455, p=.01) and anxiety (b=1.3606, p=.000). Substance use was also positively associated with anxiety (b=.8563, p=.000). For indirect effects, family conflict was associated with anxiety through loneliness (b=.2604, CI [1434, 3980]) and substance use (b=.1231, CI [.0493, 2119]). Additionally, family conflict was associated with anxiety through loneliness and substance use serially (b=.239, CI [.0033, 0560]).

Conclusions and Implications

Family conflict may directly increase the level of loneliness and substance use among older adults during challenging times. Family conflict may increase levels of anxiety indirectly through loneliness and substance use. Programs and services to support family relationships, appropriate communications, coping strategies, and counseling services are necessary for older adults and their family members during difficult times like the pandemic.