Self-rating Depression Status Among Adult-child Caregivers And Its Predictors In Part Of Jinan Communities

BackgroundCulture of filial piety, that the children take care of their own parents, is a unique culture of the Chinese nation, which reflects the Chinese people’s own intergenerational emotional patterns. The traditional way of support characterized by culture of filial piety, which has been directly undertaken by the family unit for two thousand years, is firmly entrenched in the thinking among the people."Bring their children for old age","Elders are treasures","Don’t stray far from home you’re your parents are there","Filial piety is the most important of all virtues" and so on. Filial Piety is reflected in people’s daily life, and embodies the family network of senior-citizen support over the years. Family pension is a way that family members assume pension obligations especially their children and provide pension resources, including the basic economic support, life care, health care and spiritual solace.The old age is the final stage of a general life, which requires special needs and the targeted care. Psychological and emotional needs of the elderly will become more complex and varied with age aging. Over the age of80has become one of the fastest growing groups in Chinese population age structure. The trend of the population aging means that human, financial and material expenditures to the elderly will continue to increase in family and social resources and that the allocation of human resources will also have higher requirements. The result of the family planning policy and the elderly population aging may directly lead the "4-2-1"family structure to the "8-4-2-1" structure. The adult-child caregivers, who are in three generations or four generations, not only bear the responsibility to take care of their parents, their children, grandchildren, even their spouses but also have to deal with kinds of problems from their jobs and daily life. Their burden is so heavy and their mental health easily breaks down over time.Domestic studies about adult-child caregiver burden mainly focused on those caregivers who took care of the parents that had stroke, dementia, Disability and so on. There are few studies that on the psychological problems of caregivers of ordinary family pension. But psychological problems caused by the family pension on child caregivers have been widely taken into account. They found that caregivers will obtain negative emotions and psychological problems in the process of caregiving.Objectives1.Investigate the self-rating depression status among adult-child caregivers and its severity in part of Jinan Communities.2.Analyze the main predictors that may affect the self-rating depression status of adult-child caregivers and provide theoretical support for exerting effective interventions and improving the level of adult-child caregivers’ mental health in the communities.MethodsThis was a cross-sectional descriptive study. The participants were recruited from three communities by convenience sampling in this study. The participants must meet the inclusion criteria: resident population of Jinan; were aged40years or above; cared for their parents who lived in Jinan over one year; were free from any mental illness. Participants were evaluated using three assessment tools: the Self-Rating Depression Scale (SDS), general questionnaire survey of child caregivers and general questionnaire survey of the elderly. Database was built by Epidata3.1software for data entry. Data arrangement and data analyses were carried out using the SPSS (version22.0) statistical software. Statistical description was used to describe the socio-demographic characteristics of the adult-child caregivers and the elderly. T-test or one-way analysis of variance test was used to compare the differences in mean depression scores between subgroups in terms of socio-demographic characteristics of the sample. Non-parameter test was used if the depression scores didn’t meet the homogeneity of variance between subgroups. Pearson’s correlation was conducted between continuous variables. The generalized linear regression analysis was conducted to determine the predictors that may affect the depression scores. The significant level of statistical tests was set at P<0.05.Results1. Comparison of the self-rating depression scores between subgroupsSamples’ self-rating depression score was significantly higher with the increase of perceived burden of supporting the elderly and after adjusting for age, marital status, educational level of cases and the numbers of diseases, participants who had heavy perceived burden of supporting the elderly got higher scores than the ordinal people and the difference was statistically significant (P<0.001).2. Self-rating depression states of the samples770samples surveyed were evaluated by the self-rating depression scale. Samples were positive for depression was24.8%in all participants. There were191samples experienced mild to severe depressive symptoms, accounting for24.8%of all770cases surveyed. The degree of samples’self-rating depressive symptoms was mainly in mild. The proportion of mild, moderate, severe self-rating depression symptoms were17.3%,6.5%and1.0%, respectively in the group.3. Statistical analysis of participants who supported one old-age familyThere were five variables ultimately retained in the model at the level of a=0.05. In the case of other independent variables remained unchanged, the caregivers in the group of less than50-year-old got2.68,3.10,4.11self-rating depression scores higher than that in the group of50-54-year-old,55-59-year-old,60-64-year-old; the caregivers in the group of general job stress, higher job stress, heavy job stress got about3.19,2.18,3.71self-rating depression scores higher than that in the group of no job stress. Who suffered one disease and more than two diseases got1.32and1.97scores higher than those who were healthy. Caregivers whose family had old man with general and poor self-care ability got1.53and3.20scores higher than those whose family had old man with good self-care ability. Caregivers whose family had old man with general, poor and very poor thinking ability got1.59,2.91and6.33scores higher than those whose family had old man with normal and mild impaired thinking ability respectively. And two groups were apt to depression:who suffered heavy job stress+the elderly whose self-care ability was poor and who suffered heavy job stress+the elderly whose thinking ability was poor.4. Statistical analysis of participants who supported their own parentsThere were five variables ultimately retained in the model at the level of a=0.05. Under the condition of the other variables remained unchanged, the caregivers get the lower self-rating depression scores with age. The caregivers in the group of less than50-year-old got2.90,4.29.5.26self-rating depression scores higher than that in the group of50-54-year-old,55-59-year-old,60-64-year-old; the caregivers in the group of general job stress and heavy job stress got about2.49and5.12self-rating depression scores higher than that in the group of no job stress. Who suffered one disease got2.77scores higher than those who were healthy. Caregivers whose family had old man with poor self-care ability got3.07scores higher than those whose family had old man with good self-care ability. Caregivers whose family had old man with general and very poor thinking ability got1.68and6.49scores higher than those whose family had old man with normal and mild impaired thinking ability respectively. And two groups were apt to depression: who suffered heavy job stress+the elderly whose self-care ability was poor and who suffered diseases+those who were young.5.Statistical analysis of participants who supported their parents-in-lawThere were three variables ultimately retained in the model at the level of a=0.05. Caregivers in the group that the literacy level of the elderly was senior got4.88scores higher than that in the group that the literacy level of the elderly was low. Caregivers whose family had old man with general and poor self-care ability got2.67and4.63scores higher than those whose family had old man with normal self-care ability. Caregivers whose family had old man with general, poor and very poor thinking ability got3.48,4.36and6.01scores higher than those whose family had old man with normal thinking ability. And the people who supported the elderly that had poor thinking ability and poor self-care ability and had high educational level were apt to depression.6. Statistical analysis of participants who supported two old-age familiesThe participants got higher scores when their family had to support two old man in different families and four old man. and the difference had statistical significance(P=0.043). The participants also got higher scores when their family had two old men who had poor self-care ability in different families and four old men who couldn’t take care of themselves and the difference had significance(P=0.029).Conclusions1.Samples’ self-rating depression score was significantly higher with the increase of perceived burden of supporting the elderly. The degree of samples’ self-rating depressive symptoms is mainly in mild and moderate. There are few samples have severe self-rating depressive symptoms.2.The relationship between the caregivers and the elderly may result in different influences on children’s mental health in the process of taking care of the elderly. The cases will be apt to depression if they are younger, or ill, or have severe job stress, or the elderly have poor self-care ability, or the elderly have more confused thinking than the normal conditions in the group that caregivers support their own parents. In the group that caregivers support their parents-in-law, cases will be apt to depression if the elderly have higher educational level than the normal conditions, or the elderly have poor self-care ability and thinking ability.3. These findings indicate that these factors that samples’age, job stress, number of disease, the educational level of the elderly, the self-care ability of the elderly and the thinking ability of the elderly may affect caregivers’mental health mainly. We can implement some targeted interventions to these factors and seek the best elderly-supporting pattern which can propel the active aging and alleviate the mental burden of adult-child caregivers to improve the level of mental health in the communities.