Association between elderly parents’ health status and adult children’ depression level among different caregiver roles in China: A multi-level mediation analysis

Objective : This study examines the association between the health status of elderly parents and depression levels of their adult children, with a focus on differences in caregiving roles. It also investigates the mediating effect of social isolation among adult children, aiming to inform targeted mental health interventions. Methods : Utilizing data from the 2018, 2020, and 2022 China Family Panel Studies,this study employed multilevel linear models to investigate the relationship between the health status of elderly parents and the depression levels of their adult children. The multilevel mediation analysis was used to test the potential mediating role of social isolation. Results : Findings indicate that poor health status in elderly parents was associated with higher levels of depression in their adult children. This relationship differs depending on whether the adult children serve as caregivers, with a stronger and statistically significant association observed in the caregiver subgroup. Furthermore, social isolation was found to mediate the relationship between parental health status and depression only among caregivers. Conclusion : These results underscore the need to prioritize mental health support for adult children who serve as caregivers. Expanding and diversifying caregiver support services could help mitigate depressive symptoms, improve the balance between caregiving and social life, and promote the sustainability of family-based eldercare system.