title: 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.
abstract: BACKGROUND
  The 20th century's rapid industrialization and urbanization brought important social changes to Taiwan, including an increased number of elders living alone, which has increased risk of depression for the elderly. This study aimed to evaluate the changing pattern regarding the effect of intergenerational exchanges on elders' depressive symptoms from 1993 to 2007.
  
  
  METHODS
  Data from the second-, fourth- and sixth-wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were analyzed. This study collected elders' individual sociodemographic characteristics, their self-reported health status and their intergenerational exchanges, including living with partners or with their children and their provision of care for their grandchildren. Information about elders' depression was evaluated using the 5-item Epidemiological Studies Depression Scale (CES-D).Changes in elders' intergenerational exchanges and depressive symptoms were compared during these study periods (chi-square test). Then, logistic regression was performed to determine how significantly elders' intergenerational exchanges were associated with their depressive symptoms across the three years 1993, 1999 and 2007.
  
  
  RESULTS
  The prevalence of elders living with partners decreased from 1993 to 2007 by 19%, and that of living with their children decreased from 1993 to 2007 by 7%. Conversely, the percentage of elders providing care for grandchildren dramatically increased, from 9% in 1993 to 21% in 2007. Elderly people had significantly fewer depressive symptoms in 2007 than in 1993.After adjusting for confounders, those living without a partner, living without children or providing no grandchild care had a greater risk of feeling lonely and being depressed. However, during the period 1993 to 2007, the impact on elders' depression and loneliness of co-residing with a partner or with children decreased at the same time that the impact of their provision of grandchild care increased. In 2007, elders who provided no grandchild care were significantly more likely to feel lonely and sad as well as to have high CES-D scores; these strong associations were not found in 1993 and 1999.
  
  
  CONCLUSIONS
  This study illustrates how taking care of grandchildren protects against depression and loneliness in elderly Taiwanese. We argue the need, in an aging society, for improving intergenerational interaction and recommend careful evaluation of the interaction between population policies and those of social welfare, such as child care.
authors.affiliation: Master program in Global Health and Development, Taipei Medical University, Taipei, Taiwan. jeanfjtsai@tmu.edu.tw
authors.forename: Feng-Jen
authors.initials: FJ
authors.lastname: Tsai
authors.forename: Sandrine
authors.initials: S
authors.lastname: Motamed
authors.forename: André
authors.initials: A
authors.lastname: Rougemont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002654:Child Care / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D016901:Intergenerational Relations; D008132:Loneliness / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D013624:Taiwan