Aging and Health Research 2 (2022) 100052

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Aging and Health Research

journal homepage: www.elsevier.com/locate/ahr

Physical and mental health of family caregivers of older parents and

grandchildren in China
Yujun Liu a,∗, M. Courtney Hughes b, Karen A. Roberto c, Jyoti Savla d
a
School of Family and Consumer Sciences, Northern Illinois University College of Health and Human Sciences, 1425 W. Lincoln Hwy, DeKalb, IL, USA
b
School of Health Studies, Northern Illinois University, DeKalb, IL, USA
c
Center for Gerontology and the Institute for Society, Culture and Environment, Virginia Tech, Blacksburg, VA, USA
d
Department of Human Development and Family Science, Center for Gerontology, Virginia Tech, Blacksburg, VA, USA

a r t i c l e i n f o a b s t r a c t

Keywords: Background: Families have been recognized as the primary source of care for younger and older family members
Family caregiving in Chinese tradition. The aim of this study was to examine the association between informal caregiving for aging
Mental health parents and/or grandchildren and health outcomes of family caregivers in mainland China.
Physical health
Methods: Using data from the 2013 and 2018 waves of China Health and Retirement Longitudinal Study
China
(CHARLS), we conducted univariate comparisons of demographics characteristics between informal caregivers
Grandparenting
Caregiver health and non-caregivers using t-test and chi square test. We used linear regression and negative binomial regression to
examine the physical and mental health outcomes of family caregivers aged 45 and over living in mainland China.
This cross-sectional study was based on the self-reported measures of caregiving status, demographic factors, and
health outcomes.
Results: Compared to non-caregivers, informal caregivers were more likely to be women, younger in age, married,
living in rural areas, and with less years of education. Older age, being male, being married, living in an urban
area, having a higher level of education, and having better self-reported health were associated with better
mental health outcomes among family caregivers. Being male, younger age, and working, and having better self-
reported health, were associated with better physical function among family caregivers. Caregivers who only
cared for their grandchildren reported greater life satisfaction, fewer depressive symptoms, and a higher level of
physical function than non-caregivers. In addition, caregivers who cared for only their parents reported fewer
depressive symptoms than non-caregivers.
Conclusions: Health practitioners and policymakers should consider the needs for additional resources for family
caregivers of older adults and children. Targeted policies and programs may improve family caregivers’ health,
especially for female family caregivers living in rural areas.

1. Introduction
When faced with illness or disability, families have long been rec-
ognized as the primary source of care for older people [1,2]. In China,
which has over one-fifth of the world’s older population [3], providing
care for the aging population is a strong cultural value. Adult children
are traditionally expected to provide care for their aging parents [4].
However, changes in the demographic characteristics of China’s fami-
lies have resulted in fewer adult children caregivers available to support
their older parents. The “4–2–1″ paradigm, consisting of four grandpar-
ents, two adult children, and one grandchild, represents the anticipated
family structure in China in upcoming decades [5,6]. China’s older adult
support ratio (number of adults aged 25–64 years per number of persons
older than 64 years) is projected to fall from nearly 13 in 2000 to 2.1
by 2050 [7]. As the number of children per family decreases and as life
expectancy increases in China, fewer adult children or children-in-law
will be available to support their older parents [8,9]. Researchers and
practitioners are concerned about the strain on adult children without
siblings to share caring responsibilities [10–12].
Another aspect of Chinese cultural norms, rooted in the Confucian-
ism philosophy which promotes family harmony [3,13], is multigenera-
tional co-residence, or a “networked” family living arrangement. In this
latter situation, relatives live apart but close [6], allowing grandpar-
ents to be involved in their grandchildren’s care daily without claiming
a custodial responsibility. With its cultural reliance on filial piety and
practices focusing on collective family interests [6], China represents an
ideal setting for examining health outcomes when considering multiple
types of family caregiving relationships.

∗
Corresponding author.
E-mail address: lyujun@niu.edu (Y. Liu).

https://doi.org/10.1016/j.ahr.2021.100052
Received 30 August 2021; Received in revised form 15 December 2021; Accepted 26 December 2021
Available online 28 December 2021
2667-0321/© 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Y. Liu, M.C. Hughes, K.A. Roberto et al.
Findings from previous studies conducted in western countries sug-
gested that sociodemographic characteristics such as race/ethnicity, in-
come, education, and marital status differed significantly between fam-
ily caregivers and non-caregivers [4,8,9,14]. For example, using data
from the U.S. Centers for Disease Control and Prevention’s Behavioral
Risk Factor Surveillance System, Anderson and colleagues (2013) re-
ported that caregivers in the U.S. were significantly more likely to be 50
to 64 years of age, female, non-Hispanic black, having some college edu-
cation, and married. In studies that went beyond describing caregiver’s
characteristics, findings suggested that providing care could threaten
family caregivers’ physical and mental health, which may compromise
their ability to continue in their caregiver role [17]. Family caregivers
reported fatigue and sleep disturbances, lower immune functioning, in-
creased insulin levels and blood pressure and greater risk for cardio-
vascular disease [11,17]. Caregiver’s burden and strain also have been
found to be directly associated with caregivers’ engagement in adverse
health behaviors such as smoking and greater alcohol consumption [18].
Furthermore, several studies have demonstrated a relationship between
caregiving and anxiety, stress, and depression [19].
Earlier research in the U.S. reported negative health effects of car-
ing for grandchildren. In particular, extensive and custodial grandpar-
enting (providing primary care for the grandchild) has been associated
with poor health outcomes for grandparents, including elevated depres-
sive symptoms, declined life satisfaction and more functional limita-
tions [20]. In contrast, recent studies conducted in China, Hong Kong,
and Taiwan found health advantages for caregivers who provided oc-
casional, extensive, or even custodial care to grandchildren [21]. Com-
pared to older adult non-caregivers, grandparent caregivers experienced
reduced depressive symptoms, better self-rated health, greater life sat-
isfaction and fewer functional health limitations [22,23].
Although China has the largest and fast growing older population,
and family members are expected to provide care for the older adults
and grandchildren, little is known about the sociodemographic char-
acteristics of family caregivers in mainland China [13,15,16]. Further-
more, to our knowledge, there are no studies in Eastern or Western coun-
tries investigating caregiving for both older parents and grandchildren
and its potential relationship with long-term caregiver’s health.
Our study aimed to describe the characteristics of family caregivers
in mainland China. We aimed to examine the associations between care-
giver demographic characteristics and caregiving roles and long-term
health outcomes of caregivers. Our research based on Pearlin’s stress
process model [5,24], which many researchers in Western countries
have used to examine how providing care could influence caregivers’
physical, emotional, and social health [25,26]. We chose Pearlin’s four
domains (the background and context of stress, the primary and sec-
ondary stressors, the mediators of stress, and the outcomes of stress) to
study caregiver health as a potential consequence of several interrelated
factors [24]. Our goal is to improve knowledge about the long-term
health outcomes of caregivers for older parents and/or grandchildren
while interpeting possible primary and secondary stressors upon which
policymakers and practitioners could consider effective interventions.
2. Methods
2.1. Data source and sample
Data came from the China Health and Retirement Longitudinal Study
(CHARLS), a nationally representative and publicly available longitudi-
nal survey which include a wide range of individual and household in-
formation about people aged 45 years and over and their partners living
in private households in mainland China. CHARLS was designed to be
comparable with the Health and Retirement Study (HRS) of U.S. and
related aging surveys around the world while being sensitive to the spe-
cific conditions of China. The baseline wave of CHARLS was collected
in 2011 and included 17,500 individuals from 10,000 households in 28
provinces, 150 counties/districts, and 450 villages/communities. Older
2
Aging and Health Research 2 (2022) 100052
adults living in nursing homes or care facilities were not sampled, but
the survey followed up with respondents of Wave 1 who later entered
care facilities. The same study procedures were used in 2013, and the
survey followed up with 15,770 respondents (84.8% of the total sample)
from the 2013 wave.
2.1.1. Sampling procedures and data collection
At the provincal level, individuals from 28 provinces were sampled.
On the neighborhood level, the sample used administrative villages
(cun) in rural areas and community (shequ) in urban areas, as primary
sampling units (PSUs). Three PSUs were selected within each unit at
the provincial level, using probabilities proportional to size sampling
procedures. After final sampling work in the PSU completed, a letter
to potential respondents was sent to each selected household to inform
them about the study. In each sampled household, a short screening
form was used to identify whether the household had a member meeting
the age criteria. Individuals aged 45 years and above were selected as
main respondents. If this person was married, his or her spouse was also
interviewed. If an age-eligible person was too frail to answer questions,
a proxy respondent was identified to help him/her to answer questions,
usually a spouse or knowledgeable adult child in the household. Indi-
viduals were interviewed by CHARLS research team members who were
professionally trained for conducting face-to-face interviews.
2.2. Current study sample
We selected the study sample from the combined CHARLS datasets
(N = 11,203), including CHARLS 2013 and CHARLS 2018. We included
all the participants in the combined dataset for the analysis of descrip-
tive statistics. Among all respondents, 3787 participants (about 35% of
the total sample) were identified as caregivers for grandchildren and
1083 were identified as caregivers for older parents (10% of the total
sample). About 3.4% (N = 373) participants were caregivers for both
grandchildren and older parents. When respondents provided care to
parents or grandchildren both at CHARLS 2013 and CHARLS 2018, we
used their data from CHARLS 2018 to examine their recent caregiving
experience.
2.3. Measures
The sample for the regression and binominal analysis included par-
ticipants who had given personal care to their old parents and/or grand-
children for one month or more during the past 12 months. Participants
who responded “Yes” to the question “Did you or your spouse take care
of your parents or parents-in-law during the last year in assisting them
in their daily activities or other activities (e.g., household chores, meal
preparation, laundry, going out, grocery shopping, financial manage-
ment, etc.)” were categorized as caregivers for parents. Participants who
answered “Yes” to the question “During last year, did you/ your spouse
spend time in taking care of your grandchildren” were categorized as
caregivers for grandchildren. Those who answered “Yes” to both ques-
tions were categorized as caregivers for both. We characterized the sam-
ple by two caregiving factors (caregiving status and time spent on care-
giving) and six demographic variables (including age, gender, marital
status, urban/rural residency, education, and working status) (Table 1).
Our dependent variables were four self-reported measures of health sta-
tus, two related to physical health and two related to mental health.
2.4. Statistical analysis
In preparation for conducting the statistical analysis for the current
study, we ran tests and removed outliers and data from respondents
other than the selected participants (data from responses from other
people in the household). We used the full information maximum likeli-
hood (FIML) estimation, a pragmatic missing data estimation approach,
Y. Liu, M.C. Hughes, K.A. Roberto et al.
Table 1
Definitions of study variables used in CHARLS.
Variable Definition
Dependent
Physical health
Physical function Indicated 4-point scale (1 = no difficulty to
4 = absolutely cannot do it) responses to ability to
complete activities of daily living (dressing, bathing or
showering, eating, transferring (getting into or out of
bed), toileting, and continence) and instrumental
activities of daily living (doing household chores,
preparing hot meals, grocery shopping, making phone
calls, and taking medications).
No. of chronic diseases Indicated number of listed chronic diseases ranged from
1 to 14.
Chronic diseases included: hypertension, dyslipidemia,
diabetes, cancer, chronic lung diseases (bronchitis,
emphysema), liver disease, heart diseases, stroke,
kidney diseases, digestive diseases, psychiatric problem,
memory-related diseases, arthritis or rheumatism,
asthma.
Mental health
Life satisfaction Indicated Likert scale response (1 = completely satisfied
to 5 = not at all satisfied) to “Please think about your
life-as-a-whole. How satisfied are you with it? Are you
completely satisfied, very satisfied, somewhat satisfied,
not very satisfied, or not at all satisfied?”
Depression Assessed using the 10-item Center for Epidemiological
Studies Depression Scale [27].
Independent
Caregiving status Caregiving status was categorized into caregiver for
parents only, caregiver for grandchildren only and
caregiver for both parents and grandchildren.
Time spent on caregiving Response to “Approximately how many weeks per year
and how many hours per week did you spend last year
taking care of your parents or parents-in-law?”
Covariates
Age Age of respondent
Gender Gender of respondent
Marital status Indicated yes to married or cohabiting
Urban/rural residency Urban or rural residency status
Education Level of education completed
Working status Indicated yes to earn a wage, run own business, or
unpaid family business work
using Stata 14 (StataCorp LP, College Station, TX, USA) [28,29] to ad-
dress missing data. FIML has been shown to produce unbiased parame-
ter estimates and standard errors under missing at random (MAR) and
missing completely at random (MCAR) conditions. FIML requires that
missing values be at least MAR [29]. For all continuous variables, we
ran tests for skewness and kurtosis, checked for multivariate normality,
and conducted transformations for data not normally distributed.
We described all study variables using means and frequency. We
also conducted univariate comparisons of informal caregivers and non-
caregivers using t-test and chi square test. This cross-sectional study was
based on the self-reported measures of caregiving status, demographic
factors, and health outcomes. We used a negative binomial regression to
determine the association of the independent variable (caregiving sta-
tus) on physical function (i.e., ADL/IADL) and the number of chronic
conditions of the caregivers. This type of analysis is used with skewed
dependent count variables when the variance is larger than the mean
[30]. All analyses were controlled for age, marital status, gender, edu-
cation, residence, working status, and self-reported health. In addition,
we performed linear regression models to examine the associations be-
tween caregiving, depression symptoms, and life satisfaction using the
2018 wave data.
3. Results
Descriptive characteristics of the informal caregivers are provided
in Table 2. There were many consistencies among the characteristics of
the various caregiver status groups. However, some differences existed
3
Aging and Health Research 2 (2022) 100052
between the caregivers for parents only and caregivers for grandchildren
only, namely the caregivers for parents tended to be younger, married,
and with lower education levels than the caregivers for grandchildren.
Compared to non-caregivers, the family caregivers of both parents and
grandparents were more likely to be women, younger in age, married,
living in rural areas, and having less years of education.
3.1. Findings of regression and negative binomial analysis
As shown in Tables 3 and 4, family caregivers caring only for grand-
children reported greater life satisfaction, fewer depressive symptoms,
and a higher level of physical function than non-caregivers. Family care-
givers caring only for parents also reported fewer depressive symptoms.
Overall, the greater the amount of time caregivers spent care provid-
ing, the lower their life satisfaction and higher their level of physical
function. Better mental health outcomes were associated with the fol-
lowing caregiver characteristics: older age, being male, higher level of
education, being married, having better self-reported health, and living
in urban areas. There was no relationship between working and men-
tal health outcomes. Better physical function was negatively associated
with older age but positively associated with being male, working, and
having better self-reported health (Table 4). Additionally, no relation-
ship existed between marital status or urban/rural residency and phys-
ical function and disease status.
4. Discussion
This study expands the growing literature on the health implications
of family caregiving on adults in developing countries. First, it situates
grandparenthood and caregiving in a new context in which family care-
givers are involved in caring for multiple generations. Such dual burden
of caregiving is likely to increase at a population level as older adults’
life expectancy and health status continue to improve [2]. Second, it
highlights the need for effective interventions to improve the health out-
comes of family caregivers. A scoping review found that a wide range
of such interventions exists in high-income countries [31]; however, in-
terventions suitable for lower-income countries are lacking [32]. One
reason may be that lower- and middle-income countries are focused on
chronic disease prevention for the growing number of residents facing
more illnesses than for caregiver interventions [33,34]. Third, we char-
acterized our sample using various independent variables which allowed
us to more precisely identify which factors were associated with caregiv-
ing health outcomes. Our findings are consistent with previous research
in western countries, showing that disparities in mental health outcomes
for family caregivers are based on demographic factors including gen-
der, education, and metropolitan status [19,20].
Unlike previous studies that reported poor physical health among
grandparent caregivers [35], we found that family caregivers who
cared only for their grandchildren had better physical health than non-
caregivers. One explanation for this finding may be that taking care of
children may involve being physically active to “keep up” with them.
To test this hypothesis, The Healthy Grandparenting Project in Belgium, a
clinical trial currently ongoing, is examining physical activity levels in
caregiving grandparents and investigating its health impact compared
to the physical activity levels of non-caregiving grandparents and older
adults without grandchildren [36].
We also found that compared with non-caregivers, family caregivers
who provided care for parents or grandchildren reported lower depres-
sive symptoms and higher life satisfaction. We postulated that the cul-
tural value of filial and family obligation may have served as a buffering
effect, weakening the association between caregiver stress and depres-
sive symptoms. It is possible that by providing care to their parents, the
adult children caregivers in mainland China have achieved the sense of
fulfilling their family obligations and their role as filial children [37],
and consequently not feeling caregiving stress and depressive symp-
toms often reported in studies conducted in western nations [38]. In
 Y. Liu, M.C. Hughes, K.A. Roberto et al.
Table 2
Univariate comparisons of informal caregivers and non-caregivers, CHARLS data, 2013, 2018.

t-test

Group 1 Caregivers for Group 2 Caregivers for Group 3 Caregivers Group 4 Non-Caregivers Group 1 Group 2 Group 3
Continuous Variable Parents (n = 1083) Grandchildren (n = 3787) for Both (n = 373) (n = 6333) vs 4 p value vs 4 p value vs 4 p value

Depressive 20.55 (4.14) 18.89 (3.45) 20.29 (3.90) 19.83 (3.61) 5.93 <0.001 12.88 <0.001 2.38 0.03
Symptoms,
Score, Mean (SD)
Age, Year, Mean (SD) 51.54 (6.04) 58.44 (8.76) 52.43 (6.54) 60.07 (11.63) 23.59 <0.001 7.45 <0.001 12.57 <0.001
Total Caregiving 2.52 (0.80) 2.57 (0.78) 2.36 (0.85) – – – –
Time
(Log-transformed hours),
Mean (SD)
Chi2
Categorical Variable Group 1 p value Group 2 p value Group 3 p value
vs 4 vs 4 vs 4
4

Gender, n(%) 161.28 <0.001 275.77 <0.001 86.22 <0.001

Male 404 (37.30) 1552 (40.98) 125 (33.51) 3675 (58.02)
Female 679 (62.70) 2235 (59.02) 248 (66.49) 2658 (41.98)
Marital Status, n(%) 445.61 <0.001 698.93 <0.001 180.33 <0.001
Married or Cohabiting 1006 (92.89) 3210 (84.76) 352 (94.36) 3369 (59.50)
Single (widowed, divorced, never 77 (7.10) 567 (15.24) 21 (5.64) 2297 (40.50)
married)
Urban/rural 81.57 <0.001 39.25 <0.001 12.51 <0.001
Residency, n(%)
Urban 378 (27.68) 1052 (27.78) 109 (29.76) 1250 (22.01)
Rural 703 (71.33) 2735 (72.22) 264 (70.24) 4399 (77.99)
Education, n(%) 124.72 <0.001 134.34 <0.001 53.46 <0.001
Less than high school 830 (75.31) 3332 (88.00) 300 (80.60) 5509 (87.00)
High school 166 (16.70) 234 (6.20) 41 (11.10) 677 (10.70)
College and above 87 (7.99) 221 (5.80) 32 (8.30) 147 (2.30)

Aging and Health Research 2 (2022) 100052

Note. CHARLS: China Health and Retirement Longitudinal Study; Bonferroni adjustments were used for multiple comparisons.
Y. Liu, M.C. Hughes, K.A. Roberto et al. Aging and Health Research 2 (2022) 100052

Table 3
Results of the regression analysis for the associations between caregiving activities at CHARLS 2013 and life satisfaction and depressive symptoms among
caregivers at CHARLS 2018.

Life Satisfaction Depressive Symptoms

b SE p value b SE p value

Covariates (2013
wave)
Age 0.086 0.002 <0.001 0.049 0.009 0.08
Marital Status (Ref. 0.078 0.050 <0.001 −0.015 0.270 0.06
Not married/in a
relationship)
Gender (Ref. Men) 0.011 0.031 0.07 0.147 0.161 <0.001
Education 0.023 0.009 0.12 −0.112 0.045 <0.001
Urban/rural 0.040 0.038 0.17 0.073 0.198 <0.001
residency (Ref.
Urban)
Working Status (Ref. 0.014 0.037 0.57 −0.020 0.196 0.11
Not working)
Self-reported Health 0.041 0.023 0.008 −0.023 0.011 0.002
Caregiving Status
(Ref. Not caregiving)
Care Only for 0.021 0.008 0.10 −0.033 0.017 0.003
Parents
Care Only for 0.032 0.012 0.001 −0.021 0.003 <0.001
Grandchildren
Care Both 0.019 0.004 0.27 0.028 0.002 0.38
Caregiving Time −0.013 0.090 0.03 0.033 0.252 0.24
(Log transformed)
R2 0.27 0.46

Note. SE: standard error.

Table 4
Results of the negative binomial analysis for the associations between caregiving activities at CHARLS 2013 and physical function and disease status of caregivers
at CHARLS 2018.

Physical Function No. Chronic Conditions

b SE p value b SE p value

Covariates (2013
wave)
Age 0.004 0.002 0.08 0.018 0.003 <0.001
Marital Status (Ref. −0.006 0.041 0.15 −0.128 0.097 0.13
Not married/in a
relationship)
Gender (Ref. Male) −0.069 0.077 <0.001 −0.033 0.055 0.57
Education −0.028 0.012 0.72 −0.022 0.015 0.55
Urban/rural 0.045 0.051 0.96 0.033 0.067 0.77
residency (Ref.
Urban)
Working Status (Ref. −0.129 0.049 0.08 −0.354 0.063 <0.001
Not working)
Self-reported Health 0.031 0.067 0.03 −0.119 0.090 0.06
Caregiving Status
(Ref. Not caregiving)
Care Only for −0.012 0.003 0.10 0.031 0.012 0.12
Parents
Care Only for 0.063 0.013 0.008 −0.017 0.003
Grandchildren
Care Both 0.026 0.006 0.99 0.023 0.006 0.71
Caregiving Time 0.013 0.090 0.02 0.033 0.252 0.08
(Log-transformed)
Model Fit
AIC 10,301.51 8178.40
BIC 10,345.24 8226.51

Note. SE: standard error; Ref., Reference category; AIC, Akaike information criterion; BIC, Bayesian information criterion.

this way, caregivers providing care for their older parents may be rec-
ognized and praised by their parents and others in their social network
as filial and commendable, providing positive encouragement for the
adult children caregivers. Thus, receiving positive psychological affir-
mation and support may moderate or reduce depressive symptoms in
adult children caregivers. Consistent with a previous study from Tai-
wan [21], compared with noncaregivers, multigenerational caregivers
were more likely to report better self-rated health, higher life satisfac-
tion, and fewer depressive symptoms. We postulated the positive finding
could be attributed to the influence of Chinese culture of multigenera-
tional co-residence, or a “networked” family living arrangement [6].
Grandparents could have the support and involvement of the parents
of the grandchildren. Emotional and social support might mediate the
relationship between caregiving and health among caregivers for grand-

5
Y. Liu, M.C. Hughes, K.A. Roberto et al.
children. Our findings underscore the need for future research to clarify
the moderating role of the cultural values of filial obligation for adult
children caregivers for aging parents and the mediating effect of social
and emotional support on the association between caregiving and health
outcomes among grandparent caregivers in China.
4.1. Limitations
Unlike most previous studies about Chinese family caregivers which
rely on regional, non-representative samples, this study draws on pub-
licly available data from a nationally representative longitudinal sur-
vey, making the findings more generalizable, transparent, and replica-
ble. However, the study is not without its limitations. First, the find-
ings are based on self-reported data, which may not be as accurate
as biomedical measurements. However, Ning et al. showed moderate
agreement between self-reported data and biomedical measurements
using the CHARLS dataset [39]. Second, we were limited to the basic
questions about for whom the respondent cared. Thus, we could not
analyze secondary stressors (e.g., work stressors, relationship stressors,
balancing childcare) that earlier studies have shown may combine with
caregiving to impact caregivers’ physical and mental health. Third, work
status was categorized as working or non-working as provided in the
CHARLS dataset. Future studies should include information about vari-
ous types of employment to assess the influence of workload and work-
related stress on caregiving outcomes for persons in mainland China.
Fourth, although the effect of caregiving status on the two mental health
indicators is statistically significant, the effect size is small. We recom-
mend further research examining this relationship by cross-validating
the findings using other datasets and indicators of mental health.
4.2. Implications
Considering the cultural context of caregiving, specifically filial and
family obligation, this study sheds new light on the relevant predispos-
ing and enabling factors that practitioners and policymakers should con-
sider when developing and delivering programs and services for fam-
ily caregivers in mainland China. For example, while there are health-
related benefits related to caregiving for grandchildren or parents, our
study findings suggested that there is also room for improvement in the
health outcomes of family caregivers from certain demographic groups.
For example, females often carry the burden of caregiving roles. Stud-
ies showed that compared with male caregivers, female caregivers may
face higher levels of caregiving stress, have fewer social resources, and
report lower levels of psychological and physical health [33]. Health sys-
tems should consider providing resources, including mental health and
wellness education, to help female caregivers cope with their respon-
sibilities. Another group in need of mental health resources are family
caregivers living in rural areas. Xu et al. described the disparities in
mental health service utilization in China based on metropolitan status
and suggested increasing insurance reimbursement in rural areas would
help increase service uptake [39].
In conclusion, our study contributes to the international literature on
family caregiving for older parents and grandchildren using evidence
from mainland China. We identified both beneficial and determential
effects of caregiving for family caregivers’ physical and mental health.
Future research should consider using longitudinal data to explore the
potential moderating and mediating factors that can account for positive
health consequences of family caregiving.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
6
Aging and Health Research 2 (2022) 100052
Acknowledgements
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article. The authors
had no receipt of funding to declare.
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