Cross-National Differences in Mental Health Impact of Intergenerational Caregiving: Social Pathways Among Older Women in China and the US

OBJECTIVES: This study examined cross-national differences in how multiple intergenerational caregiving roles affect depressive symptoms among middle-aged and older women in China and the United States. METHODS: We analyzed longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and U.S. Health and Retirement Study (HRS). Depressive symptoms were measured using harmonized CES-D scales. Analytical strategies included regression, panel fixed-effects models, and causal mediation analyses. RESULTS: In the U.S. multiple caregiving significantly increased depressive symptom severity (β = 0.208, 95% CI:0.155-0.261). Reduced social participation mediated 47.1% of this effect. Conversely, in China, multiple caregiving showed no significant direct association with elevated depressive symptoms (β = -0.225, 95% CI:-0.856 to 0.406), though a significant indirect pathway emerged via reduced social participation (ACME = -0.358, p < .001). CONCLUSIONS: The psychological impact of intergenerational caregiving among older women varies significantly across cultural contexts. CLINICAL IMPLICATIONS: Mental health interventions and support programs for caregivers should consider cultural contexts and target modifiable pathways such as health status and social participation.