Childlessness and vulnerability of older people in China

Childlessness and Depressive Symptoms Among Middle-Aged and Older Adults in China: Examining the Role of Partnership Trajectories

OBJECTIVE

Although previous studies have recognized the potential connection between childlessness and increased mental health risks in later life, the diverse pathways leading to childlessness remain unclear. This study thus sought to explore the association between patterns of partnership trajectories and depressive symptoms among childless middle-aged and older adults in China.

METHOD

Utilizing sequence analysis, this research identified distinct partnership trajectory patterns among participants from the China Health and Retirement Longitudinal Study (CHARLS). It then examined the associations between these trajectory patterns and depressive symptoms over a 9-year follow-up period.

RESULTS

Our analysis uncovered 5 distinct partnership trajectories: long-term partnership (64.2%), never partnered (20.1%), re-partnered (6%), divorce/separation (3.6%), and widowhood (9.3%). Childless individuals who never partnered exhibited a higher risk of depressive symptoms compared to those with children.

CONCLUSION

The findings suggest that it is the dynamic interplay between childlessness and partnership trajectories, rather than childlessness alone, that significantly influences depressive symptoms in later life. Adopting a life course perspective provides valuable insights into understanding the mental health disparities among the heterogeneous childless population.

Trajectory patterns and influencing factors of depression due to child bereavement among older adults in China: a 5-year longitudinal study

Objective

As a result of the aging of the world population, a high number of older adults lose their children during their lifetime. Depression due to child bereavement is a significant psychological problem. Therefore, it is necessary to investigate the trajectories of depressive symptoms associated with child bereavement among older adults in China and determine the influencing factors.

Methods

In this study, data from the China Health and Retirement Longitudinal Study were used as the longitudinal data, and 284 women and 117 men aged over 60 years were included. A latent growth mixture model was used to identify trajectory patterns in depression due to child bereavement over time. Multivariate logistic regression analysis was used to determine the influencing factors.

Results

Four trajectory patterns of depressive symptoms associated with child bereavement were identified: a low depression rapidly increasing group (12.0%), a high depression rapidly declining group (12.1%), a high depression slowly increasing group (23.1%), and a low depression stable group (52.8%). The findings of the multivariate logistic regression analysis showed that residence, sleep status, satisfaction with life, and self-report of health were related to the trajectory patterns of depressive symptoms among the participants.

Conclusion

This study revealed heterogeneity in changes in depressive symptoms among older adults with child bereavement in China. The government and medical institutions should consider these trajectory patterns of depression and adopt individualized support measures based on the characteristics of different groups.

Influence of Living Arrangements on Perioperative Cognitive Dysfunction Among Elderly Patients

OBJECTIVE

The authors' aim in this study was to investigate the impact of various living arrangements on the occurrence of perioperative cognitive dysfunction (POCD) (now known as perioperative neurocognitive dysfunction, or PND) among elderly patients.

METHODS

The authors' study cohort consisted of 162 elderly patients who underwent laparoscopic radical surgery for gastrointestinal cancer under general anesthesia. The authors categorized them into the following 5 groups based on their preoperative living arrangements: living with the spouse and children (group A); living with the spouse (group B); living with children (group C); living alone (group D); and living in a nursing home (group E). The authors observed and compared the preoperative and postoperative cognitive functions of the patients in the 5 groups.

RESULTS

There was no statistically significant difference in age, sex, years of education, duration of surgery, duration of anesthesia, or postoperative visual Analog Scale (VAS) scores among the 5 groups of patients. However, the 5 groups of patients differed significantly with respect to preoperative mini-mental state examination (MMSE) scores, the difference between preoperative and postoperative scores, the preoperative rate of cognitive impairment, and the prevalence of postoperative POCD. When the authors examined the Montreal cognitive assessment (MoCA) scale scores, there were statistically significant differences in the preoperative scores, the difference between preoperative and postoperative scores, and the prevalence of postoperative POCD among the 5 groups. The prevalence of preoperative cognitive impairment, as diagnosed by the MMSE and MoCA scales, and the occurrence of POCD at 3 and 5 days post-surgery were similar. Logistic regression analysis of risk factors for POCD prevalence revealed that the living arrangement of elderly patients was a risk factor for the prevalence of POCD on day 3 post-surgery, whereas the living arrangement and the presence of preoperative cognitive impairment were risk factors for POCD on day 5 post-surgery.

CONCLUSION

The authors' study results highlighted the type of living arrangements of elderly patients as one of the factors that influence the prevalence of POCD in the immediate postoperative period. Elderly patients who preoperatively resided in a nursing home or those who lived alone were more likely to be associated with developing POCD.

Relationship between Perceived Family Resilience, Emotional Flexibility, and Anxiety Symptoms: a Parent-Adolescent Dyadic Perspective

Family resilience is crucial for individual's psychological health. Previous studies explored the protective factors of anxiety at the individual level, with less attention paid to the impact of family interaction from a dyadic perspective. This study utilized the Actor-Partner Interdependence Mediation Model to investigate the relationship between family resilience, emotional flexibility, and anxiety symptoms. A sample of 2144 Chinese parent-adolescent dyads (36% upper grades of primary school, 64% secondary school, 49.39% girls; 70.38% mothers) was recruited. Perceived family resilience was inversely related to anxiety symptoms, directly or indirectly, through the mediation of emotional flexibility at the individual level. At the dyadic level, adolescents' perceived family resilience was significantly associated with parents' anxiety symptoms through their own or parents' emotional flexibility. Parents' perceived family resilience was inversely link to adolescents' anxiety symptoms through parents' emotional flexibility. Parents emotional flexibility also mediated the association between adolescents' perceived family resilience and their anxiety symptoms. These findings contribute to understanding the intricate dynamics of family resilience and psychological outcomes in parent-child relationships under adversity, emphasizing the need for child-centered interventions to improve family members' mental health.

Stigma of Losing an Only Child: Implications for Public Perceptions of Bereavement Adversities and Prosocial Tendencies in China

Given the one-child policy (1979-2016), many bereaved parents (mean age ˃ 60 years) in China have lost their only child. Yet, the social environment in which these parents continue their lives is little known. The current study drew on data from 2029 Chinese adults (Mage = 36.62 years, SDage = 10.06, range = 18-71) who anonymously completed questionnaires about their negative attitudes towards the bereaved parents (i.e., stigma of losing an only child), perceptions of adversities faced by these parents, and prosocial tendencies (willingness to provide personal help and expectations for government support). In total, 44% of the participants held moderate to high levels of stigma of losing an only child. Participants with greater stigma reported fewer adversities faced by the bereaved parents and they were less likely to agree that the government should provide resources. Moreover, perceptions of adversities mediated the negative association between public stigma and expectations for governmental support. This study advances our understanding of the unwelcoming environment in which the vulnerable population of parents who have lost their only child live by innovatively revealing perspectives from the public.

Influencing factors of posttraumatic stress disorder in Shidu parents who have lost their only child: a cross-sectional survey

BACKGROUND

In China, parents who have lost their only child are referred to as Shidu parents (SDPs). This study aimed to investigate the prevalence and risk factors of post-traumatic stress disorder (PTSD) and investigate the influence of depressive and anxiety symptoms on the development of PTSD.

METHOD

Four hundred and thirty-six SDPs completed assessments of PTSD (Structured Clinical Interview for DSM-IV Disorders, SCID-IV; The Clinician-Administered PTSD Scale-IV, CAPS-IV), depression (Hamilton depression scale), and anxiety (Hamilton Anxiety Scale) via in-person interviews. Logistic regression and hierarchical multiple linear regression analyses were used to explore the association of demographic characteristics, depression, and anxiety symptoms with PTSD.

RESULTS

The prevalence of PTSD in SDPs was 14.45%. The comorbidity of depression and anxiety symptoms was 87.30% in the SDPs with PTSD. The logistic regression model, which included factors of gender, age, education, depression, and anxiety, which contributed to the development of PTSD, was significant [χ² (11) = 122.47, p < 0.001]. The hierarchical multiple linear regression analysis indicated that female gender and the severity of comorbidities (depression and anxiety) were positively associated with the severity of PTSD.

CONCLUSION

This study found that the severity of depression and anxiety was closely related to the severity of PTSD, supporting that SDPs are highly prone to the co-occurrence of PTSD, depression, and anxiety after bereavement. Our findings may provide more insights into the development of individualized interventions for parents who have experienced the loss of their only child.

Associations between regular physical exercise and physical, emotional, and cognitive health of older adults in China: an 8-year longitudinal study with propensity score matching

Background

The importance of healthy aging is growing in China as it has the largest number of older adults in the world and is one of the fastest-aging countries. This study aimed to examine the predictive value of regular physical exercise in relation to the physical, emotional, and cognitive health among samples of adults aged ≥60 years in China during an 8-year period.

Methods

A total of 10,691 older adults were extracted from two waves of national data from the China Family Panel Studies in 2010 and 2018. To minimize the impact of selection bias on the findings, a longitudinal propensity score matching (LPSM) method was used to examine the relationships between regular physical exercise and emotional health (depression), between regular physical exercise and physical health (instrumental activities of daily living), and between regular physical exercise and cognitive health (cognitive ability) of older adults. After LPSM, 856 older adults were included in the study. In the regular physical exercise group, the average age of participants at baseline year was 65.67 years, with an average age of 65.90 years for 238 men and 65.45 years for 190 women, and in the non-physical exercise group, their average age at baseline year was 65.70 years, with an average age of 65.45 years for 253 men and 65.98 years for 175 women.

Results

LPSM indicated that regular physical exercise has been found to be effective in improving physical function and reducing depressive symptoms in old adults, even after controlling for background differences. However, the sensitivity analysis suggests that the positive association between regular physical exercise and cognitive function may not be sufficiently valid.

Conclusion

The findings of this study indicate that engaging in long-term structured and repetitive physical exercise can have a significant positive effect on reducing depressive symptoms and improving the physical function of older adults. As a result, incorporating regular physical exercise into the lifestyle of older adults is recognized as an effective strategy for promoting healthy aging and reducing the strain on public health resources.

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

The impact of internet use on old-age support patterns of middle-aged and older adults

Background

The trend towards low fertility and low mortality is prominant worldwide. The accelerating ageing and the pressure on public pensions are making the "dependent pattern of old-age support", which relies on family and government, unsustainable. It is urgent for people to change their mindset about ageing and to develop a sense of "relying on themselves for oldage support".

Methods

This study incorporates the commercial pension insurance, formal care and the attitude towards independent old-age support pattern into the framework of "independent pattern of old-age support", using the probit regression model and instrumental variables approach to examine the impact of internet use on old-age support patterns of middleaged and older people based on the CGSS 2012-2018 five-period data.

Results

The more frequent internet use increased the likelihood of purchasing commercial pension insurance, accepting formal care, and endorsing independence in later life. The internet can promote the acceptance of independent pattern of old-age support by delivering information and facilitating social interaction.

Discussion

Consistent with previous research, this study finds that internet use can promote the purchase of commercial pension insurance. There are no relevant studies on the impact of internet use on formal care and attitude towards independent old-age support pattern. Our finding provides important empirical and theoretical references for ageing countries to further transform old-age support patterns.

Exploring urban empty-nesters' using WeChat influencing factors and quality of life: A qualitative descriptive study

OBJECTIVE

To explore urban empty-nesters using WeChat influencing factors and experiences of improving their quality of life.

METHODS

14 registered empty-nesters who had used WeChat in Fuzhou communities were recruited via convenience and purposive sampling methods with a qualitative descriptive design. Data were collected through individual, semi-structured, and face-to-face interviews and analyzed according to content analysis.

RESULTS

The research revealed two primary themes with associated sub-themes: 1) influencing factors of using WeChat, and 2) quality of life experiences.

DISCUSSIONS

Physiological factors, education level, and social support were using WeChat influencing factors by urban empty-nesters. WeChat is a convenient channel to improve empty-nesters' daily lives and a practical platform to meet empty-nesters' needs. Identifying these experiences could help older adults, especially empty-nesters' accept the era of intelligence and provide inspiration and reference for the increasingly normalized empty nest life.

Co-Reasoning With the Significant Other(s): How Childless Older Adults in Rural China Make Residential Decisions

Applying the concept of residential co-reasoning, this research explored the role of the next of kin in the residential decision-making of childless older adults in rural China. We examined research questions regarding who, if anyone, had been the significant other(s) during the residential decision-making, and how they conducted the co-reasoning process. A constructivist grounded theory approach was applied, with 27 childless older adults being interviewed. We found that participants tended to choose to age in place if they had a continuous, reliable, and trustworthy relationship with certain members of next of kin, which they referred to as "I have someone at home." Acquiring care from kin was an ongoing negotiation process. Participants applied three types of negotiations: exchanging properties for care from kin; maintaining relational intimacy with kin; and counting on the filial obligation of kin. Otherwise, if care from kin was unavailable, participants tended to relocate to rural institutions.

Social isolation and health outcomes among older people in China

Background

Social isolation is a serious public health issue affecting a significant number of older adults worldwide. However, associations between different dimensions of social isolation and functional health are unclear. We assessed the varied effects of social isolation on health among a nationwide sample of older adults from China.

Methods

We assessed social isolation among 5,419 people aged 65 and older who took part in both the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Social isolation includes objective social isolation (kinlessness and lack of social contacts) and subjective social isolation. Four functional health outcomes were examined: self-rated health (SRH), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive function measured by the Mini-Mental State Examination (MMSE). We used multivariable regression analyses to examine the associations between social isolation and health outcomes.

Results

Older people who never married or who had recently lost a spouse were more likely to report poor SRH (OR=2.44) and difficulty with IADLs (ORs=1.46) than those who were married and lived with a spouse. Older people who never gave birth were less likely to report cognitive impairment (OR=0.53) than those who had living children, while older people who had recently lost a child were more likely to report poor SRH than those who had living children (OR=1.32). Older people who had no children visiting were more likely to report difficulty with IADLs than those who had children visiting (OR=1.25). In terms of subjective social isolation, older people who felt lonely were more likely to report poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.19, 1.27, 1.28 and 1.21, respectively), and older people who had no one to talk to were more likely to report poor SRH, cognitive decline, and difficulty with ADLs and IADLs (ORs=2.08, 5.32, 2.06 and 1.98, respectively).

Conclusions

Kinlessness, lack of social contacts and subjective social isolation may impact various dimensions of health in older people. Due to the varied health consequences of social isolation, targeted health interventions should be developed to address relevant situations of social isolation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02681-1.

Symptom structure of posttraumatic stress disorder after parental bereavement - a network analysis of Chinese parents who have lost their only child

BACKGROUND

The death of a child is a highly traumatic event and often leads to mental health problems, including posttraumatic stress disorder (PTSD). Previous studies have focused on overall PTSD after the loss of an only child; however, little attention has been given to PTSD at the symptom level. This study aims to identify the network structure of PTSD symptoms in bereaved parents who have lost their only child, known as Shidu parents in Chinese society.

METHODS

A cross-sectional study enrolled 385 bereaved individuals who had lost an only child across 10 cities in China from November 2016 to July 2017. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). Network analysis was implemented by using the R packages qgraph and bootnet.

RESULTS

The PTSD network revealed that diminished interest, exaggerated startle, irritability/anger, and nightmares were the most central symptoms. The strongest connections emerged between the symptoms of recurrent thoughts and nightmares, irritability/anger and reckless/self-destructive behavior, and hypervigilance and exaggerated startle.

LIMITATIONS

We utilized cross-sectional data, and it is therefore not possible to infer the evolution of the symptom network over time. In addition, participants were limited to parents who had lost an only child, and the findings of this study must be interpreted with caution.

CONCLUSIONS

The current study provides further clarity regarding how PTSD symptoms relate to each other in bereaved parents who have lost an only child. Symptoms with high centrality and connectedness may be viable targets for intervention in bereaved parents who have lost an only child.

Vulnerable Older Adults' Identification, Geographic Distribution, and Policy Implications in China

With the population aging and urbanization in China, vulnerable older adults tend to show more complex characteristics, bringing great challenges to public health policies. Using China Longitudinal Aging Social Survey data 2014, this paper builds a comprehensive index system for the identification of vulnerable older adults from three dimensions, including health, economy, and social support, then divides older adults into four support levels and six small classes by using the typological method. The results show that older adults in urgent need of assistance or priority are those poor in health and economic conditions, 1.46% of them are highly vulnerable because of the lack of social support; 12.76% of them obtain a certain social support are moderately vulnerable; and 34.72% of them are slightly vulnerable with disadvantage in only one dimension. The geographic distribution of different types of vulnerable older adults varies significantly. The paper provides evidence to design more feasible and specific policies with comprehensive considerations for different types of vulnerable older adults residing in different regions.

Care willingness and demand of residents under 60 years of age in western China: a cross-sectional study

OBJECTIVES

The objective was to examine care willingness and demand of residents under 60 years of age after retirement.

SETTING

The staged cluster sampling method was used between August and October 2018 in Dujiangyan, Sichuan Province, China.

PARTICIPANTS

2282 participants under 60 years of age were surveyed in 2018 by the staged cluster sampling method in China.

PRIMARY AND SECONDARY OUTCOME MEASURES

The results of care willingness and demand were assessed by multiple comparisons of χ² test and multivariable logistic regression.

RESULTS

The respondents who preferred institution-based care, home-based care and community-based care accounted for 39.5%, 38.3% and 20.2% respectively, whereas only 2.1% preferred home-based self-care. The main reasons for the respondents to choose institution-based care included better medical care (31.9%), better daily care (27.0%), burden reduction for children (26.3%), better accommodation (22.8%), satisfied living environment (21.6%) and low consumption (12.3%). The factors that affected care willingness and demand included age, ethnicity, educational attainment, marital status, occupation and the current type of residence.

CONCLUSIONS

The results revealed the care willingness and demand of residents under 60 years of age after retirement and relevant decision factors. This study provides a certain theoretical and practical significance for the development of the care willingness mode and promotes the cognition of policy-makers and researchers, and also provides the basis for decision-making.

Residential reasoning: how childless older adults choose between ageing in place (AIP) and institutionalisation in rural China

The decision of whether to grow old in one's home (also referred to as ageing in place (AIP)) or relocating to an institution is an ongoing negotiation process, which involves residential decisions and adaptation. This research aims to explore how childless older adults in rural China choose between AIP and institutionalisation. Through a qualitative study conducted in rural China among childless older adults, we explored the reasons why they make certain residential choices and how they adapted during the decision process. Twenty-five childless participants (aged 60–83) were interviewed. Findings suggested that they referred to the term ku (literally meaning ‘bitterness’; and a metaphor referring to ‘conducting farming and farm-related activities’) to explain their residential decisions. If a person could endure ku – sustain food and basic living through farming and farm-related activities, they tended to choose to age in place; otherwise, they chose to relocate to institutions. Ku represents a sense of mastery, encompassing the stressfulness and suffering aspect that requires adaptation. Three adaptive strategies were identified: (a) positive reappraising of the negative aspect of ku, (b) routinising ku, and (c) transcending the narrative of ku into a toughness identity. Our findings suggest that childless older adults struggled to achieve residential mastery while making residential decisions, even though a sense of mastery was shaped by the individual and structural constrictions.

Childlessness and Social Support in Old Age in China

Although previous studies showed that children are the primary source of old-age support in China, much less is known about the availability and sources of social support among childless elders. Also, little research has explored how older adults' social support transitions over time by childless status. Using the 2005 and 2011 Chinese Longitudinal Healthy Longevity Survey (N = 14,575), this study examined the transition of living arrangement and sources of social support by childless status among adults aged 65 and older. A series of multinomial logistic and linear regression models were used to analyze the data. Results show that compared to elders with children, childless elders were more likely to live alone or in an institution at baseline, but their probability of living alone decreased substantially while that of living in an institution increased modestly in the 6-year follow-up. Moreover, childless elders generally had fewer support sources, but this disadvantage became smaller over time. Although childless elders were significantly more likely to depend on nobody, the spouse, grandchildren (or other relatives), or nonrelatives for support at baseline, this pattern disappeared in the follow-up likely due to mortality selection. Findings imply that although the risk of social isolation among childless elders becomes lower as age progresses, garnering more social resources at younger ages may help reduce their premature mortality.

Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries

OBJECTIVES

No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between "childlessness" (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes.

METHODS

Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648).

RESULTS

Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures.

DISCUSSION

We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.

A profile analysis of post-traumatic stress disorder and depressive symptoms among Chinese Shidu parents

BACKGROUND

Due to the one-child policy implemented in China, most families have only one child. When parents experience the death of their only child, these parents receive the label 'Shidu parents'. Shidu is a major public health issue in China. However, the patterns of post-traumatic stress disorder (PTSD) and depressive symptoms that are present in this population remain unclear.

OBJECTIVE

This study aims to identify profiles of PTSD and depressive symptoms among Shidu parents and to explore the predictors of profile membership.

METHODS

A total of 363 participants (M age = 61.5 years, SD = 7.5) were asked to complete questionnaires assessing PTSD, depressive symptoms, perceived social support, and demographic information. Latent profile analyses and multivariate logistic regressions were used.

RESULTS

Three distinct profiles were identified: low (39.4%), moderate (32.8%), and high symptoms (27.8%). Parents who were younger and perceived lower levels of support from family and significant others were more likely to experience higher levels of PTSD and depressive symptoms.

CONCLUSIONS

These results indicate that the severity of PTSD and depressive symptoms tightly cohere, providing evidence for the co-occurrence of PTSD and depressive symptoms after bereavement. The findings provide valuable information for the development of tailored professional interventions for bereaved parents.

Risk factors for PTSD of Shidu parents who lost the only child in a rapid aging process: a cross-sectional study

BACKGROUND

The elderly population is rising globally, especially in China where a large population base causes the largest number of older adults in the world. Notably, Shidu people who are over the age of 60 and have lost their only child have drawn great public attentions as they become more elderly, medically unstable and worse mentally unhealthy. Posttraumatic stress disorder (PTSD) is one of the most common consequences resulted from the loss of the only child. However, few previous studies have examined PTSD in Shidu older aldults, and the risk factors are a relatively understudied area. Our study aims to estimate the prevalence and potential risk factors of PTSD and improve the possibility of early identifying the high-risk Shidu parents with PTSD, and successively provide timely and effective interventions.

METHOD

Based on the register of population statistic information provided by the health family planning commission, 149 participants were enrolled randomly. Data was collected by interviews and questionnaires. Socio-demographic and bereavement-related information and physical health outcomes were obtained. PTSD Checklist-Civilian Version was used to screen for bereavement-related PTSD.

RESULT

The morbidity of PTSD reached 30.9%, while in the group of age over 60 the morbidity reached 31.6%. Stratified by potential demographic risk factors, SDPs have significant between-group differences of PTSD. Specially, being women, higher income, losing the single child at older age, more serious medical conditions and being Shidu for a shorter period indicated higher severity of PTSD in SDPs. The single child dying at a older age and from accidence were also significant indicators. Regression analysis showed the gender of SDPs, hospital visits, and the cause of child death significantly predicted the severity of PTSD.

CONCLUSION

With the accelerate process of aging, especially in China, Shidu older adults become a group deserved more attentions. PTSD is clearly a possible reaction to the loss of the only child. The gender and hospital visits of the Shidu older adults and the causes of their child's death significantly related to the prevalence of PTSD, which could help to improve the possibility of early intervening.

Relationship between neighbourhood social participation and depression among older adults: A longitudinal study in China

Previous research has found a negative linkage between neighbourhood social participation and depressive symptoms in Western countries, but the cross-sectional design of these studies limits the ability to infer causality. Little attention has been paid to socio-psychological pathways linking neighbourhood social participation to depressive symptoms among older adults in China. This study aimed to examine the impact of neighbourhood social participation on depressive symptoms among older adults in China. It also further explored the mediating roles of physical activity, social contact among neighbours, and contact with own children in the relationship between social participation and depressive symptoms. Data obtained through three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study were used. The sample consisted of 10,105 individuals aged 60 and above and 24,623 person-year records captured during these three waves. Depressive symptoms were assessed using the Center for Epidemiology Studies of Depression scale. Results showed that respondents' depression decreased with an increasing level of neighbourhood social participation, more time spent on physical activities, and a higher frequency of contact with neighbours and with own children. These factors were found to partly mediate the relationship between neighbourhood social participation and depression. The negative relationships between social contact and depression and contact with own children and depression were both strengthened by neighbourhood social participation. In conclusion, physical activity, social contact among neighbours and contact with own children are mechanisms through which neighbourhood social participation lowers the risk of depression among older adults in China.

Objective and subjective financial status and mortality among older adults in China

The association between financial status and mortality in older adults is well documented. However, it is unclear whether the association may vary by objective and subjective indicators of financial status. To examine this issue, we used the latest four waves (2005, 2008/2009, 2011/2012, and 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of community-residing adults aged 65 and older (n = 25,954). Financial status was assessed using eight objective, subjective, and culturally-oriented measures to capture various dimensions of financial resources at older ages. Multivariate hazard models were used to examine how different indicators of financial status were associated with subsequent mortality in all older adults and by age, gender, and urban-rural residence. Results showed that higher financial status-either objective or subjective-was associated with lower risks of mortality. Subjective assessments of financial status had stronger associations with mortality than objective assessments. The patterns were generally similar between young-old (aged 65-79) and the oldest-old (aged 80+), between women and men, and between rural and urban areas. Together, the findings offer new evidence to help improve the socioeconomic gradient in mortality among older adults in China.