Family Care, Economic Stress, and Depressive Symptoms Among Chinese Adults During the COVID-19 Outbreak: Difference by Urban and Rural Areas

Abstract

Background: Although several studies have shown an association of family care with a high level of depressive symptoms, the relationship between them remains indistinguishable.Objective: This study aims to examine the associations between family care, economic stress, and depressive symptoms among Chinese adults in urban and rural areas during the COVID-19 outbreak.Methods: Based on cross-sectional data collected through online surveys from February 1st to 10th 2020 in China the present study recruited 2,858 adults. It used multiple linear regression to examine the association between family care and depressive symptoms, while economic stress was examined as moderators on the above relationship.Results: The results showed that caring for both the elderly and children was significantly associated with higher depressive symptoms compared with non-caregivers (B = 2.584, 95%CI: 1.254, 3.915), and a similar result was also found in urban areas. Also, caring for the elderly only was also had a higher level of depressive symptoms than non-caregivers in rural areas (B = 3.135, 95%CI: 0.745, 5.525). Meeting the care needs was significantly associated with lower depressive symptoms compared with unmet care needs, while for rural caregivers, the results were not significant. Besides, economic stress strengthened the effect of family care needs on depressive symptoms for sandwich-generation caregivers who provide care to both the elderly and children (B = 0.605, 95%CI: 0.077, 1.134). While in rural areas, the moderation effects of economic stress were only found for elderly caregivers (B = 1.106, 95%CI: 0.178, 2.035).Conclusion: These findings suggest that we should pay more attention to the family caregiver's mental health during the COVID-19 outbreak. In addition, more effective policies should be developed to provide financial support for family caregivers, especially for sandwich-generation caregivers and rural elderly caregivers.

Lifetime and 1-Month Prevalence of Mental Disorders in Hebei Province, China: A Community-Based Cross-Sectional Study

“…All of these findings were consistent with previous studies in China and other countries (7,20,48). Comparing with the rural region, people who live in the urban region have heavier work-load and life stress (49,50), and they may be at higher risk of mental disorders. Substance use disorders, one way to deal with stress, maybe also in higher-level for rural residents.…”

Unpaid caregiving and mental health during the COVID-19 pandemic—A systematic review of the quantitative literature

“…Two studies categorised carers as new carers or continued/existing carers [ 41 , 46 ], one study had a very broad definition of caregiving [ 46 ], whilst the other restricted their caring exposure to out-of-home caregiving [ 41 ]. One study divided carers into short-term and long-term (>12 months) caregivers [ 44 ], whilst another examined childcare and eldercare separately as well as together (sandwich care) [ 54 ]. Two studies inferred caregiving based on family/household composition.…”

“…Every included study utilised a validated measure of MH (in line with the review criteria), all of which were self-reported via survey-based instruments. Seven studies examined depression and anxiety as two separate MH outcomes [ 43 , 47 – 49 , 52 , 53 , 60 ], whilst twelve studies examined only depression/physiological distress [ 41 , 42 , 44 – 46 , 50 , 54 – 59 ], and one study examined only anxiety [ 51 ]. A descriptive summary and main findings of included studies (including effect estimates and confidence parameters where reported) can be found in Table 1 .…”

“…Overall, in evaluating the relationship between informal unpaid caregiving and MH in the context of the COVID-19 pandemic, the quality of evidence was found to be moderate. Five studies were deemed to be at low risk of bias (RoB) [ 41 , 42 , 44 , 46 , 47 ], twelve studies at moderate RoB [ 43 , 45 , 49 – 52 , 54 , 56 – 60 ], and three studies rated as high RoB [ 48 , 53 , 55 ]. Domains most likely to dampen quality (limit star allocations) were those relating to non-response, comparability, and temporality.…”

Profiles of activity engagement and depression trajectories as COVID-19 restrictions were relaxed.

“…For example, retrenchment following the economic fallout of the pandemic may be particularly stressful for middle-aged adults, who may struggle with reemployment (e.g., Chiu & Ho, 2006; Oh, 2020) with retirement still some time away. Further, middle-aged adults may be tasked with demanding caregiving responsibilities of their elderly parents (e.g., Liu et al, 2021; Putro & Riyanto, 2020), which have been made more challenging by the pandemic (Liu et al, 2021; Phillips et al, 2020). For older adults, they are likely to live alone due to factors such as widowhood or their adult children moving away (Tang et al, 2019).…”