The protective effect of taking care of grandchildren on elders’ mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders’ loneliness and depression between 1993 and 2007 in Taiwan

The rapid aging of populations, triggered by low fertility rates and longer life expectancy, is a global phenomenon that requires a research and policy response concerning the potential consequences of this important demographic evolution [1, 2]. One important issue concerning aging is depression in elderly individuals, especially loneliness caused by the evolution of intergenerational contact in a changing society [3, 4].

In the 20th century, studies regarding associations between older adults’ intergenerational exchanges and their mental health mainly focused on elderly persons’ parent–child relationships and noted the importance of contingent exchanges between elders and their adult children in promoting older adults’ psychological well-being [5, 6]. However, in aging societies, attention is being transferred to the impact of intergenerational exchanges between grandparents and grandchildren on elders’ mental health. As grandparents’ provision of grandchild care is central to the model of intergenerational solidarity, this provision was identified as a particularly important form of multigenerational family support [7, 8].

Typical and common arrangements for grandparents’ provision of grandchild care are baby-sitting over the weekend or during the evening, caring for children when their parents are at work, or taking care of grandchildren under other circumstances on a regular or irregular basis. Previous findings, indicating that grandparents provided child care more sporadically when mothers were relatively young and worked nonstandard hours but provided extended full-time grandparent care for mothers with more extensive full-time employment, further reflect parents’ need for assistance from their own parents to take care of grandchildren in this changing society [9].

The majority of studies on the grandparent-grandchild relationship and its effect on elders’ health have emphasized that grandparents are responsible for the care of grandchildren and reported the possible risks of such caregiving on elders’ physical health and depressive symptoms [10–12]. However, a recent study has shown benefits to grandparents who take care of grandchildren, which is supported by the social exchange theory, especially from the perspective of emotional reward [13]. With the emerging nuclearization of both young and old generations brought about by modernization, the importance of grandparent-grandchild intergenerational exchanges in promoting elders’ mental health may be expected to increase, especially in eastern countries.

Taiwan is a typical Chinese society, strongly influenced by the traditional value of filial piety. It is the responsibility of family members to extend family generations and to have frequent intergenerational transfers. Chinese culture not only requires adult children to take care of their elders but also addresses the elders’ wishes and willingness to have and to take care of grandchildren [14, 15]. With a decreasing fertility rate (from 1.81 children per woman in 1990 to 1.68 in 2000 and then to 1.1 in 2006) and an increasing life expectancy (from 71.6 years for men and 77.6 years for women in 1993 to 75.09 years for men and 81.90 years for women in 2007), the aged population will comprise over 20% of the overall Taiwanese population in the near future (2026) [16]. Rapid industrialization and urbanization during the 20th century have brought about a social evolution, including recognition of the government’s responsibility to offer welfare systems [16] as well as more elders living without partners and apart from their children. These changes in intergenerational exchanges and living arrangements present a high risk for loneliness in older people. Our previous study found that, as a form of support for their adult children and an alternative source of company, the prevalence of grandchild care provided by grandparents has increased over time in Taiwan [17]. This finding not only reflected the growing importance of the grandparent-grandchild relationship but also raised the issue of the mental health effects of this changing pattern on elders. Because the impact of the changing intergenerational exchange pattern on elders’ depression and loneliness has not yet been evaluated, we conducted the current study to fill that research gap.

Our study results reveal the changing pattern of associations between elders’ intergenerational exchanges and their depression and loneliness from 1993 to 2007. In general, elders had fewer depressive symptoms in 2007 than they did in 1993. In addition, elders’ intergenerational exchanges, including taking care of grandchildren, co-residing with a partner and co-residing with their children, were all found to be associated with elders’ depression and loneliness. Elders who lived with a partner or children or who provided grandchild care had a lower risk of feeling lonely and a lower risk of having depressive symptoms. However, the impact of elders’ co-residence with partners and children on their depression and loneliness decreased over time, whereas the impact of elders’ provision of grandchild care on their depression and loneliness increased over time. In 2007, elders who did not provide grandchild care had a significantly higher risk of feeling lonely and sad and were significantly more likely to have high CES-D scores; these strong associations were not found in 1993 and 1999.

The changing role of women might be one of the important factors affecting the evolution of family arrangements. The female participation rate in the labor force in Taiwan increased from 36.4% in 1960 to 49.6% in 2010 because of industrialization and urbanization, which resulted in an increased need for child care, especially from grandparents [19]. In the same period, the number of illiterate elders in Taiwan gradually decreased, and a greater number of elderly individuals lived in urban areas than in rural areas. In addition, a greater number of elders lived without partners, and fewer elders lived with their children. Furthermore, elders provided more grandchild care than before, while more of their adult children entered the work force and began having children. These changes show that the daily focus of elderly people transferred from concern for their partners and adult children to care for their grandchildren. The associations between the changing pattern of elders’ intergenerational involvement and its effect on their mental health reflect not only changing relationships within families but also the increasing impact of interacting with grandchildren on preventing depression in the elderly.

Assuming the role of a grandparent has become a normal stage in the family cycle; because of increasing life expectancy and decreasing fertility, most people now have more years to devote to their grandchildren than ever before. This phenomenon might also lead to unexpected side effects, such as healthy, wealthy grandparents competing for the attention of fewer grandchildren [20]. Our finding that grandparents who take care of grandchildren had greater psychological well-being might be a reflection of their desire to interact with their grandchildren. The emotional attachments between grandparents and grandchildren have been described as unique in that the relationship is exempt from the psycho-emotional intensity and responsibility that exist in parent–child relationships. Previous studies on the grandparent-grandchild relationship mainly focused on the perspective of the grandchild and reported children’s feelings of love and acceptance from their grandparents [21, 22]. Our study results also found a positive impact of interacting with grandchildren on elders’ psychological well-being, which reflects the elderly’s need for their grandchildren’s love and company.

In addition, previous studies based on the social exchange viewpoint, in which older people feel unhappy when depending on an imbalanced exchange relationship, highlighted the correlation between elders’ greater life satisfaction and their roles as “givers” [23]. Compared with the need to be supported, the inability to establish a reciprocal relationship could more seriously devastate elders’ morale. Therefore, elders who provide more grandchild care gain emotional rewards from helping their adult children and interacting with their grandchildren.

Our participants were elders aged above 60 years old who were retired or nearly retired. Although elders today report reduced loneliness and sadness and fewer depressive symptoms, owing to advanced communication techniques and social media, most elders in this age group experience serious social losses both within and outside of the family, especially after retirement. In addition, recent studies have reported the strong correlation between elders’ loneliness and poor health outcomes, including death and multiple measures of functional decline, reflecting the fact that loneliness is an emerging issue for elders [24]. Following our study findings of the importance of grandparent-grandchild interactions in preventing elders’ loneliness, more studies are needed for a better understanding of the impact of intergenerational transfers on elders’ mental health.

There were some limitations in this study. First, our finding can only be considered to be an association (rather than a cause) because the information on elders’ intergenerational exchanges and their responses about depression and loneliness were cross-sectional. Second, we did not address the possible inverse causation that people with depression are less likely to perform grandchild care. There may be other potentially explanatory variables beyond the scope of the current study, such as poor mental health or geographic distance from children and grandchildren, that simultaneously increase depression and loneliness and reduce grandchild care. Third, the ages of the grandchildren were not specifically considered because of the lack of that information in this study. Fourth, we believe that we underestimated the impact of providing care for grandchildren on elders’ mental health in Taiwan because of the high “reporting threshold”: in Chinese culture, elders who care for grandchildren for only part of a day might not be considered as taking care of grandchildren.

In conclusion, our study results demonstrate the increasing influence of grandchild care provided by grandparents on the grandparents’ depression and loneliness over time in Taiwan. Our findings indicate that elders who provided more grandchild care had an improved psychological status. However, we also recognize the possible negative effects that grandchildren can have on elders’ physical and mental health. Therefore, further studies are needed to evaluate the changes in intergenerational transfers and their effects on elders’ mental health in an aging society. In addition, we suggest careful evaluation of the link between social welfare and population policies, such as child care policies, to encourage an increase in the interactions between grandchildren and noncustodial grandparent(s). We recommend that policy makers widen the scope of particular social welfare policies to link their specific purposes with other related functions.

Feng-jen Tsai holds a PhD in public health and an LLM degree in law. She is an assistant professor at the Taipei Medical University (Master program in Global Health and Development) and a lawyer in Taiwan.

Sandrine Motamed, MD, MPH is a lecturer at the University of Geneva (Medical Faculty), a chief resident at the University Hospital of Geneva and an adjunct associate professor of the University of Hokkaido, Japan.

Andre Rougemont, MD, MPH is an honorary professor and the former Director of the Institute of Social and Preventive Medicine, University of Geneva.