Social Support from Adult Children,Parent–Child Relationship,Emotion Regulation Strategy,and Depressive Symptoms Among Chinese Older Adults

Abstract

We examined the association between social support from adult children (SSAC) and depressive symptoms among Chinese older adults, as well as the moderated mediation mechanism with the parent–child relationship as a mediator and with emotion regulation strategies (cognitive reappraisal and expressive suppression) as moderators. With a cross-sectional design, 356 Chinese older adults completed our questionnaire survey. Results revealed the negative association between SSAC and depressive symptoms among Chinese older adults, and the parent–child relationship mediated this association. In addition, the indirect effect of SSAC on depressive symptoms through the parent–child relationship depended on emotion regulation strategies. Specifically, the parent–child relationship mediated the association between SSAC and depressive symptoms only for older adults with less cognitive reappraisal or more expressive suppression. Our study highlighted the complementary role of family and individual factors in ameliorating older adults’ depressive symptoms.

Keywords

social support from adult children depressive symptoms parent–child relationship emotion regulation strategy older adults

Improvements in living conditions and medical treatment have contributed to longevity, which has resulted in an increasing number of older adults in China. In the context of successful aging, older adults’ mental health has gradually attracted the attention of Chinese society. Depressive symptoms, one of the most common mental health problems in older adults, have led to a high elderly suicide rate and have been a significant cost to society (Wu et al., 2018). One study found that the prevalence of self-reported depressive symptoms in Chinese older adults was 39.86% in 2008 (Yu et al., 2012), and this number keeps growing (Yu et al., 2012). It has become critical to examine the factors that can reduce older adults’ depressive symptoms and promote successful aging in China. According to Wu et al. (2018), social support from adult children (SSAC) is a key factor for relieving older adults’ depressive symptoms. In China, the traditional Confucian culture highly values filial piety and adult children’s filial behaviors toward their parents (Shek, 1999). It is a shared consensus that children should provide a wide range of support to their parents (Zeng et al., 2013). SSAC, as an act of filial piety, governs not only caregiving responsibility, but also the parent–child relationship and dynamics (Guo et al., 2015). Thus, the parent–child relationship might play a mediating role between SSAC and depressive symptoms. Therefore, in this study, we focused on the association between Chinese older adults’ SSAC and their depressive symptoms, and we further examined the mechanism of this link.

Theoretical Background

Social Support from Adult Children and Depressive Symptoms

According to the socioemotional selectivity theory (Carstensen et al., 1999), older adults focus more on the people closest to them, such as children, as their remaining lifespan decreases. SSAC has become the focus of elderly social support research (Yang, 1989). In China, under the influence of Confucian culture, providing support for older adults is considered to be a necessity to show reverence and filial piety (Shek, 1999). Chinese family culture emphasizes that Chinese adult children are embedded in the family (Bedford & Hwang, 2003), and it is adult children’s natural obligation to provide their elderly parents with both financial assistance and emotional support (Zeng et al., 2013).

Some studies conducted in China have indicated a link between SSAC and reduced depressive symptoms (Wu et al., 2018; Yu et al., 2012). For example, Chao (2011) found that receiving instrumental, emotional, and financial support was a powerful predictor of Chinese older adults’ depressive symptoms. Peng et al. (2019) indicated that emotional SSAC was positively associated with life satisfaction among Chinese older parents. Other studies also noted the association between Chinese older adults’ SSAC and reduced depressive symptoms (Poulin et al., 2012; Wu et al., 2018). Based on the above review, we hypothesized a negative association between SSAC and depressive symptoms in Chinese older adults.

Social Support from Adult Children and Depressive Symptoms: The Mediating Role of the Parent–Child Relationship

The parent–child relationship is one of the most important dyadic relationships for older adults, and a harmonious parent–child relationship has always been taken for granted in China (Lee et al., 2012). The key features of a positive parent–child relationship are concordance and mutuality between the older parents and adult children, which is specifically embodied in effective communication, mutual respect, a lack of conflict, and a close connection (Lam et al., 2012; Lee et al., 2012; Man & Bond, 2005). Previous studies have indicated that the parent–child relationship was closely related to older adults’ emotional symptoms. This meant that positive parent–child relationships contributed to older adults’ better mental health, whereas negative parent–child relationships had detrimental effects (Ward, 2008). For instance, Li et al. (2019) found that older adults enjoying positive relationships with their children likely had few depressive symptoms. A study in Korea also demonstrated that harmonious family relationships were significantly related to reduced suicidal ideation and attempts (Bagalkot et al., 2014). Conversely, conflicting family relationships could inhibit older adults from seeking family members’ help, thus breaking the family protection systems on which Chinese older adults rely to address emotional issues, which would increase the depressive symptoms (Sun et al., 2018).

Previous studies have indicated that SSAC and the parent–child relationship were correlated with each other (Guo et al., 2015; Li et al., 2019). For example, older adults who received more help from children reported more emotional closeness with their children (Burholt & Dobbs, 2010). Rook and Ituarte (1999) reported that SSAC, especially emotional support from children, could improve the quality of the parent–child relationship. In addition, Peng et al. (2019) found that elderly parents receiving emotional support from adult children reported higher satisfaction with their parent–child relationships, which was beneficial for their life satisfaction. In another example, Song (2015) indicated that satisfaction with the family relationship was the mechanism underlying the association between SSAC and depressive symptoms. In summary, we inferred the possible effects of SSAC on the parent–child relationship, as well as the possible association between the parent–child relationship and depressive symptoms, based on previous findings. Thus, we hypothesized that the parent–child relationship might mediate the association between older adults’ SSAC and depressive symptoms.

Social Support from Adult Children and Depressive Symptoms: A Moderated Mediation Model of Parent–Child Relationship and Emotion Regulation Strategy

Depressive symptoms are mainly reflected as emotional experiences, and depressed older people are bound to experience painful feelings such as sadness, emptiness, and anxiety (Rottenberg, 2017). Emotion regulation has been conceptualized as the process by which individuals moderate their emotions consciously or unconsciously to respond appropriately to environmental demands (Aldao et al., 2010). Thus, emotion regulation in older adults can affect their depressive states. Previous researchers indicated that individuals exert considerable control over their emotions by using a variety of strategies (Gross, 1998). Gross and John (2003) suggested two emotion regulation strategies: cognitive reappraisal and expressive suppression. Cognitive reappraisal is an antecedent-focused strategy that involves explaining a potential emotion-inducing situation before the emotion response tendencies have been fully generated (Gross & John, 2003). Expressive suppression is a response-focused strategy that involves inhibiting ongoing emotion expression late in the emotion generation process (Gross & John, 2003). When older adults simply and purely want to change their mood to feel happier, they would use cognitive reappraisal to regulate their emotion (English et al., 2017); whereas if older adults want to achieve some instrumental goals, such as making others feel better, or the goals are uncontrollable, they would choose expressive suppression (Brummer et al., 2014; English et al., 2017). In conclusion, research on aging has paid close attention to older adults’ emotion regulation strategies, and previous studies have indicated that older adults made great use of emotion regulation strategies, including cognitive reappraisal (Nowlan et al., 2015) and expressive suppression (Brummer et al., 2014).

The influences of cognitive reappraisal and expressive suppression on mental outcomes are complex and inconsistent. Most studies indicated that cognitive reappraisal was accompanied by good mental health outcomes. For example, individuals who habitually used cognitive reappraisal showed fewer depressive symptoms (Aldao et al., 2010; Zhao & Zhao, 2015). For Chinese older adults, previous studies have also found that cognitive reappraisal was beneficial for reducing negative emotions (Yeung & Wong, 2020; You et al., 2019). However, Troy et al. (2010) found that cognitive reappraisal was protective against depressive symptoms only for individuals with high levels of stress. A recent study across four continents also found that the effectiveness of cognitive reappraisal in ameliorating depressive symptoms was not significant (Chahar Mahali et al., 2020). This suggested that the effect of cognitive reappraisal on depressive symptoms was complex. Expressive suppression has long been seen as a maladaptive response to negative emotions (Aldao et al., 2010), and habitual expressive suppression users have generally been reported as having high levels of depressive symptoms (Chahar Mahali et al., 2020; Zhao & Zhao, 2015). For older adults, a study conducted in Thailand indicated a positive association between expressive suppression and a low level of emotional well-being (Tuicomepee et al., 2018). However, several studies indicated different findings. For instance, Brummer et al. (2014) found that the association between older adults’ expressive suppression and their psychological distress was not significant. One possible explanation for this is that many difficulties were hardly controllable or manageable for older adults, and in such situations, expressive suppression was more adaptive. In conclusion, the effects of cognitive reappraisal and expressive suppression on mental outcomes are complicated and inconsistent. Therefore, it is necessary to further explore the effect of emotion regulation strategies on depressive symptoms in Chinese older adults.

For older adults, family factors, such as the parent–child relationship, and individual factors, such as emotion regulation strategies, may combine to influence depressive symptoms rather than acting alone. However, few studies have examined the joint effects of family and individual factors on older adults’ depressive symptoms. In previous relevant studies, family function combined with emotion regulation to deter nonsuicidal self-injury related to mental health (Kelada et al., 2016). In addition, emotion regulation moderated the association between family tension and personal health: as family tension increased, individuals using more cognitive reappraisal showed better health compared with individuals using less cognitive reappraisal (Jones et al., 2018). Thus, we hypothesized that the indirect effect between SSAC and depressive symptoms through the parent–child relationship would depend on older adults’ emotion regulation strategies. More specifically, the parent–child relationship would mediate the association between SSAC and depressive symptoms for older adults with less cognitive reappraisal or more expressive suppression.

Hypothetical Research Model

In this study, we focused on the role of SSAC in Chinese older adults’ depressive symptoms. In addition, we examined the mediating role of the parent–child relationship in the link between SSAC and older adults’ depressive symptoms. Moreover, we incorporated emotion regulation strategies (cognitive reappraisal and expressive suppression) as moderators to expand the mechanism to a moderated mediation model. We hypothesized the following (Figure 1):

SSAC will be negatively associated with older adults’ depressive symptoms.

The parent–child relationship will mediate the association between SSAC and older adults’ depressive symptoms.

Figure 1.

The hypothesized moderated mediation model. Note. “a,” “b,” “c,” and “c’” represent the regression coefficients in Table 3.

The indirect effect of SSAC on depressive symptoms through the parent–child relationship depends on the emotion regulation strategy (cognitive reappraisal or expressive suppression). Specifically, the parent–child relationship will mediate the association between SSAC and depressive symptoms for older adults with less cognitive reappraisal or more expressive suppression.

Method

Participants and Procedure

We implemented this research with the assistance of social work undergraduates in [redacted for blind review] to conduct the survey. All of the interviewers received professional training in conducting a psychological survey. We selected 19 communities in the Sichuan province of China in which to conduct research. These communities were selected because they have collaborations with [redacted for blind review]. After obtaining the neighborhood committees’ permission, we recruited older adults aged above 60 in these communities to participate in our survey. We compensated each participant with 20 RMB (approximately 3 USD) for their consumption of time and energy in this study. The participants completed the questionnaire at senior centers in their communities, taking about 30 minutes. Most participants (n = 316) were able to complete the questionnaire independently, and some (n = 40) with vision diseases answered questions orally through an question-and-answer procedure conducted by an interviewer. When participants had any problems or questions during the survey, the interviewers provided timely and effective assistance. This study obtained ethics approval from [redacted for blind review].

Measures

Social support from adult children

Social support from adult children was assessed with six items by Fung et al. (2009). The six items included whether the children (a) were willing to help with chores, (b) provided assistance in difficult situations, (c) gave me good advice, (d) showed appreciation for me, (e) cheered me up when I was down, and (f) could be confided in about personal matters. Participants indicated their responses on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). If participant had two or more children, they would be asked to give a comprehensive assessment of each item based on the support from all children. We added up the scores of the six items. Higher scores indicated higher levels of SSAC. This measurement demonstrated good psychometric properties for Chinese participants (Fung et al., 2009). In this study, the α value for the SSAC scale was .88.

The parent–child relationship

The parent–child relationship was assessed using a lexically derived measure of relationship (Man & Bond, 2005). The measurement contained 12 phrases to describe the parent–child relationship. Five of them were positive phrases: (a) “We crossed the knee and talked from the heart (cu xi chang tan),” which means we had heart-to-heart talks; (b) “We relied upon each other like tooth and lip (chun chi xiang yi),” meaning that we had mutual dependence; (c) “We were closely related (mi qie),” which means we had emotional closeness; (d) “My things were yours, and vice versa (bu fen bi ci),” which means everything was shared between us; and (e) “Our hearts were connected at a single point (zhi qu xiang tou),” which indicates that we were like-minded. Seven of them were negative phrases: (a) “The other could not fit in (ge ge bu ru),” which means we were incompatible with each other; (b) “Water in the well did not disturb water in the river (jing shui bu fan he shui),” meaning that each one was going his or her own way; (c) “We were superficial (biao mian guan xi),” which means the relationship had little emotional depth or similar; (d) “Each swept the snow in front of his own door (ge ren zi sao men qian xue),” which means each one minded his or her own business; (e) “We were full of conflicts (man shi chong tu),” which means we experienced disagreements without compromise; (f) “We could not stand the test (jing bu qi kao yan),” which means a vulnerable relationship existed between us; and (g) “We were just casual acquaintances (fan fan zhi jiao),” which means we communicated infrequently. Participants were instructed to answer the questions with response options of 1 (strongly disagree) to 5 (strongly agree) based on their current relationship with their children, and if they had more than one child, they would combine their experiences with all children to give a comprehensive response. We reversed the scores of the seven negatively phrased items, then totaled the scores for all items. Higher scores indicated more harmonious parent–child relationships. This scale showed good psychometric properties in Chinese adults (Lee et al., 2012). In this study, the α value for the parent–child relationship scale was .86.

Emotion regulation strategy

Emotion regulation strategies were measured using the Emotion Regulation Questionnaire (Gross & John, 2003). The measurement contained 10 items, six for cognitive reappraisal (e.g., “I control my emotions by changing the way I think about the situation I’m in”) and four for expressive suppression (e.g., “I control my emotions by not expressing them”). Items were rated on a five-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree). We added the cognitive reappraisal and expressive suppression scores separately. Higher scores in each factor indicated more cognitive reappraisal or expressive suppression, respectively. Previous studies demonstrated that this questionnaire had generally satisfactory reliability and validity in investigating Chinese participants’ usage of emotion regulation strategies (Li & Wu, 2018). In this study, the α reliability for the cognitive reappraisal subscale and expressive suppression subscale were .84 and .77, respectively.

Depressive symptoms

Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10; Boey, 1999). The scale contained eight positive-scored items (e.g., “My sleep was restless”) and two reverse-scored items (“I felt hopeful about the future” and “I was happy”). Participants responded to the CESD-10 within the time frame of “during the past week” with response options of 0 to 3 (0 = Rarely or none of the time, less than 1 day; 1 = Some or a little of the time, 1–2 days; 2 = Occasionally or a moderate amount of the time, 3–4 days; 3 = Most or all of the time, 5–7 days). After reversing the scores of the two reverse-scored items, we totaled the scores of all items. Higher scores indicated more depressive symptoms. The CESD-10 had good psychometric properties for Chinese older adults (Cheng & Chan, 2005). In this study, the α value for the CESD-10 was .80.

Sociodemographic variables

The questionnaire gathered participants’ sociodemographic information including gender, age, marital status, education, income, number of children, and living arrangement. Participants reported their physical health from 1 (much worse than my peers) to 5 (much better than my peers).

Statistical Analysis

We computed Pearson correlations to determine the bivariate associations among the study variables. We used interaction terms to test the moderating effect, and the variables needed to be Z-standardized so that the interaction terms followed a normal distribution (Dawson, 2014). Thus, we used Z-scores for the study variables. In regression analysis, we reported unstandardized coefficients. We treated gender, age, marital status, education, income, number of children, living arrangement, and physical health as covariates. We regarded p < .05 as statistically significant. In addition, bootstrapping procedures can be used in non-normal distribution situations and can perform well in reducing type I error rates (Preacher & Hayes, 2008). Because the values of a x b did not necessarily follow the normal distribution, we estimated the indirect effects with a bootstrapping procedure 5,000 times for the bias-corrected confidence intervals (Preacher & Hayes, 2008). Specifically, this process involved 5,000 instances of resampling with replacement. From this, an empirical approximation of the sampling distribution of a × b was built and used to construct the confidence intervals for the indirect effect. The confidence intervals that excluded zero indicated significant indirect effects.

We first tested the direct effect of SSAC on depressive symptoms with linear regression using SPSS 21.0 after controlling all covariates (Hypothesis 1; c in Figure 1). Then, we conducted the mediation analysis with PROCESS version 2.13 for SPSS 21.0 (Model 4 in PROCESS; Hayes, 2013) to estimate the indirect effect of SSAC on depressive symptoms through the parent–child relationship (Hypothesis 2; a × b in Figure 1) after controlling covariates.

Moderated mediation was performed with PROCESS version 2.13 for SPSS 21.0 (Model 14 in PROCESS; Hayes, 2013) to test the conditional indirect effect related to Hypothesis 3. We expected emotion regulation strategies to moderate the association between the parent–child relationship and depressive symptoms (b in Figure 1) and the indirect effect to depend on the level of cognitive reappraisal and expressive suppression (Hypothesis 3). To further interpret the interaction results, we graphed the interaction effects separately and presented the slopes of the parent–child relationship on depressive symptoms at higher and lower levels of emotion regulation strategies in Figure 2 and Figure 3. Higher and lower values of moderators were defined as one standard deviation above and below the mean, respectively. We also reported the indirect effect at various levels of the moderator (1 SD below the mean, the mean, and 1 SD above the mean). We tested the moderated mediation index to formally estimate the moderated mediation effect (Hayes, 2015). The significance of the moderated mediation index implied that any two conditional indirect effects defined based on the moderator’s various values were statistically different.

Figure 2.

The association between the parent–child relationship and depressive symptoms with cognitive reappraisal as a moderator. Note. PR = Parent–child relationship, CR = Cognitive reappraisal. Higher and lower values of CR were defined as one standard deviation above and below the mean, respectively.

Figure 3.

The association between the parent–child relationship and depressive symptoms with expressive suppression as a moderator. Note. PR = Parent–child relationship, ES = Expressive suppression. Higher and lower values of ES were defined as one standard deviation above and below the mean, respectively.

Results

A total of 356 individuals participated in our survey. The participants had an average age of 71.50 ± 8.63 (range: 60–94) years, and 41.6% of them were male. In addition, 27.5% of the participants had one child, 35.4% of the participants had two children, and 37.1% of the participants had three or more children. Participants’ sociodemographic information is described in Table 1.

Table 1.

Sociodemographic Information of the Participants.

Variable	Mean ± SD (range)N (%)
Age	71.50 ± 8.63 (60–94)
Gender
Male	148 (41.6%)
Female	208 (58.4%)
Marital status
With a spouse	260 (73.0%)
Single (unmarried/divorced/ widowed)	96 (27.0%)
Education
Primary education or below	234 (65.7%)
Secondary education	60 (16.9%)
Tertiary education	62 (17.4%)
Monthly income (RMB)
<1,000	55 (15.4%)
1,000-2,000	122 (34.3%)
2,001–3,000	90 (25.3%)
>3,000	89 (25.0%)
Number of children
1	98 (27.5%)
2	126 (35.4%)
>2	132 (37.1%)
Living arrangement
With children	155 (43.5%)
Not with children	201 (56.5%)
Physical health	3.70 ± .90
Social support from adult children	22.93 ± 3.81
Parent–child relationship	46.10 ± 6.28
Cognitive reappraisal	21.55 ± 3.28
Expressive suppression	11.99 ± 3.07
Depressive symptoms	8.30 ± 4.63

Note. Sample size, n = 356. SD = Standard deviation, 1USD = 6.5RMB.

The correlations of study variables are presented in Table 2. SSAC (r = −.32, p < .001), the parent–child relationship (r = −.32, p < .001), and cognitive reappraisal (r = −.18, p < .001) were negatively associated with depressive symptoms, whereas expressive suppression was not significantly associated with depressive symptoms (p > .05). In addition, SSAC (r = .61, p < .001), cognitive reappraisal (r = .44, p < .001), and expressive suppression (r =−17, p < .01) were significantly associated with the parent–child relationship. SSAC showed a significant effect on depressive symptoms in the regression model (c = −.34, p < .001; see Table 3), which verified Hypothesis 1.

Table 2.

Descriptive Statistics and Bivariate Correlations of the Study Variables (n = 356).

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13
1. Social support from adult children	—	.61***	.35***	−.11*	−.32***	.01	.06	−.07	.14**	.01	.06	−.10	−.03
2. Parent–child relationship		—	.44***	−.17**	−.32***	−.05	.04	−.03	.14*	−.00	.01	−.18**	.05
3. Cognitive reappraisal			—	−.05	−.18***	.03	.03	−.03	.22***	.07	−.12*	−.15**	−.01
4. Expressive suppression				—	.08	.14**	−.02	−.09	−.04	−.00	−.00	.06	.20***
5. Depressive symptoms					—	−.07	−.10	.07	.03	−.11*	−.13*	.12*	−.13*
6. Gender						—	.00	−.19***	.27***	.22***	−.13*	−.06	.04
7. Age							—	.33***	−.19***	.10	.63***	−.16**	−.11*
8. Marital status								—	−.17**	−.06	.20***	.21***	−.12*
9. Education									—	.53***	−.30***	−.10	.03
10. Monthly income										—	−.10	−.09	.11*
11. Number of children											—	−.01	−.00
12. Living arrangement												—	.06
13. Physical health													—

Note. SD = Standard deviation.

*p < .05. **p < .01. ***p < .001.

Table 3.

The Indirect Effect of Social Support from Adult Children on Depressive Symptoms through the Parent–Child Relationship (n = 356).

Variable	Parent–child relationship	Depressive symptoms
Intercept	−.52	.28
Gender	−.15	−.17
Age	.00	.00
Marital status	.10	.08
Education	.08	.20**
Income	−.05	−.15**
Number of children	−.03	−.07
Living arrangement	−.26**	.14
Physical health	.10*	−.12*
Social support from adult children	.60*** (a)	−.22*** (c’)
		(c = −.34***)
Parent–child relationship		−.20** (b)
Indirect effects [95% bootstrap CI]		−.12 [−.1975, −.0455]
R ²	.41***	.20***

Note. Unstandardized coefficients are presented. CI = Confidence intervals. Bootstrap = 5000.

* p < .05. **p < .01. ***p < .001.

Table 3 presents the indirect effect of SSAC on depressive symptoms through the parent–child relationship. After we controlled for sociodemographic variables in the regression model, SSAC had a positive direct effect on the parent–child relationship (a = .60, p < .001), the parent–child relationship had a significant direct effect on depressive symptoms (b = −.20, p < .01), and SSAC had an indirect effect on depressive symptoms through the parent–child relationship (a x b = −.12, 95% CI [−.1975, −.0455]). The direct effect of SSAC on depressive symptoms (c = −.34, p < .001) decreased but remained significant (c’ = −.22, p < .001) after we added the parent–child relationship as a mediator. Thus, our results supported Hypothesis 2.

Hypothesis 3 predicted that emotion regulation strategies would moderate the indirect effect in Hypothesis 2. The indexes of moderated mediation were significant (index _{cognitive reappraisal} = .07, 95% CI [.0169, .1337]; index _{expressive suppression} = −.07, 95% CI [−.1365, −.0118]; see Table 4), which indicated that the indirect effect of SSAC on depressive symptoms through the parent–child relationship varied with the value of emotion regulation strategies. Additionally, the interaction terms of the parent–child relationship and emotion regulation strategies were significant in the moderated mediation models (β _{cognitive reappraisal} = .12, β _{expressive suppression} = −.12, both p < .05; see Table 4). To further interpret the results, we graphed the interaction effects for cognitive reappraisal and expressive suppression in Figures 2 and Figure 3, respectively. Compared with individuals with higher cognitive reappraisal, the association between the parent–child relationship and depressive symptoms was stronger for individuals with lower cognitive reappraisal. However, the opposite was true for expressive suppression. The association between the parent–child relationship and depressive symptoms was stronger for individuals with higher expressive suppression. Furthermore, to illustrate the presence of moderated mediation, we reported the indirect effect at various levels of the moderator (1 SD below the mean, the mean, and 1 SD above the mean). For individuals with lower and average levels of cognitive reappraisal, the indirect effects were significant (depressive symptoms _{lower level of cognitive reappraisal} = −.18, 95% CI [−.2845, −.0794]; depressive symptoms _{average level of cognitive reappraisal} = −.11, 95% CI [−.1881, −.0284]; see Table 4), whereas for individuals with higher level of cognitive reappraisal, the indirect effect became nonsignificant (depressive symptoms _{higher level} _{of cognitive reappraisal} = −.03, 95% CI [−.1272, .0613]; see Table 4). However, the variation trend of the indirect effects for individuals with different levels of expressive suppression was contrary to the results for cognitive reappraisal. Specifically, for individuals with average and higher levels of expressive suppression, the indirect effects were significant (depressive symptoms _{average level of expressive suppression} = −.12, 95% CI [−.1993, −.0460]; depressive symptoms _{higher level of expressive suppression} = −.19, 95% CI [−.2967, −.0924]; see Table 4), but for individuals with lower level of expressive suppression, the indirect effect was not significant (depressive symptoms _{lower level} _{of expressive suppression} = −.05, 95% CI [−.1459, .0456]; see Table 4). These results indicated that the indirect effect of SSAC on depressive symptoms through the parent–child relationship was contingent on emotion regulation strategies, such that the parent–child relationship mediated the association between SSAC and depressive symptoms for older adults with less cognitive reappraisal or more expressive suppression. Based on these results, Hypothesis 3 was verified.

Table 4.

The Moderated Mediation Model with the Parent–Child Relationship as a Mediator and with Emotion Regulation Strategies (cognitive reappraisal and expressive suppression) as Moderators (n = 356).

Moderator	Variable	Depressive symptoms
Cognitive reappraisal	Index of moderated mediation [95% CI]	.07 [.0169, .1337]
	Direct effects
	Social support from adult children	−.21***
	Parent–child relationship	−.18**
	Cognitive reappraisal	−.08
	Parent–child relationship × Cognitive reappraisal	.12*
	Conditional indirect effects [95% CI]
	Lower cognitive reappraisal	−.18 [−.2845, −.0794]
	Average cognitive reappraisal	−.11 [−.1881, −.0284]
	Higher cognitive reappraisal	−.03 [−.1272, .0613]
	R ²	.22***
Expressive suppression	Index of moderated mediation [95% CI]	−.07 [−.1365, −.0118]
	Direct effects
	Social support from adult children	−.20**
	Parent–child relationship	−.20**
	Expressive suppression	.12*
	Parent–child relationship × Expressive suppression	−.12*
	Conditional indirect effects [95% CI]
	Lower expressive suppression	−.05 [−.1459, .0456]
	Average expressive suppression	−.12 [−.1993, −.0460]
	Higher expressive suppression	−.19 [−.2967, −.0924]
	R ²	.22***

Note. Unstandardized coefficients are presented. CI = Confidence intervals. Bootstrap = 5000.

* p < .05. **p < .01. ***p < .001.

Gender, age, marital status, education, income, number of children, living arrangement, and physical health were controlled in all the regression models.

Discussion

In this study, we examined the association between SSAC and older adults’ depressive symptoms, as well as the potential moderated mediation mechanism with the parent–child relationship as a mediator and with emotion regulation strategies as moderators. We found that SSAC was negatively associated with older adults’ depressive symptoms (Hypothesis 1). In addition, SSAC could relieve depressive symptoms by improving the parent–child relationship (Hypothesis 2). Moreover, the parent–child relationship mediated the association between SSAC and depressive symptoms only for older adults with less cognitive reappraisal or more expressive suppression (Hypothesis 3). These findings contribute to the theoretical understanding of the role of SSAC in depressive symptoms and have implications for developing family-based intervention programs to ameliorate older adults’ depressive symptoms.

We found a negative association between SSAC and older adults’ depressive symptoms, which is consistent with most previous studies (e.g., Phillips et al., 2008; Wu et al., 2018). With China’s accelerated urbanization process, nuclear families are becoming more widespread, which has resulted in more severe situation of older adults living alone (Zeng et al., 2013). Support from the government for older adults is still limited in China, and a gap exists between the need for support from the government and its supply (Zhu & Walker, 2018). Therefore, the main responsibility of providing support for older adults rests with families. We stressed the importance of SSAC in relieving older adults’ depressive symptoms, which indicated that children should actively build strong support systems for their older parents. Furthermore, SSAC in this study mainly referred to emotional support, and previous studies have also suggested that with a change in social structure and cultural values, children should focus more on providing emotional support (Peng et al., 2019). Therefore, in contemporary China, children should actively pay attention to the emotional needs of their elderly parents and provide emotional support to maintain older adults’ mental health as much as possible.

In this study, we further found the parent–child relationship to be a possible mechanism for linking SSAC and depressive symptoms. On the one hand, elderly parents receiving more support from adult children tended to get along better with their children, which was associated with more harmonious relationships. On the other hand, harmonious parent–child relationships established a family protective system for older adults’ mental health, which was negatively related to depressive symptoms in older adults. Based on our findings, we suggest that effective communication and close connections between adult children and elderly parents can effectively promote harmony in their relationships. Moreover, empathy thinking and mutual respect are also conducive to avoiding conflict and establishing concordant parent–child relationships. In addition, our mediation analyses showed that the direct effect of SSAC on depressive symptoms was still significant after adding the parent–child relationship as a mediator, indicating that other mechanisms might be able to explain the effect of SSAC on depressive symptoms. For example, SSAC might promote psychological resilience (Li et al., 2015), and thus relieve older adults’ depressive symptoms.

Our study showed that the parent–child relationship mediated the association between SSAC and depressive symptoms only for older adults with lower cognitive reappraisal or higher expressive suppression, but not for older adults with higher cognitive reappraisal or lower expressive suppression. We defined the more adaptive emotion regulation strategy as more cognitive reappraisal or less expressive suppression according to the study findings, emphasizing the impact of older adults’ emotion regulation strategies on depressive symptoms. Cognitive reappraisal could effectively alter the entire subsequent emotion trajectory and reduce the experiential and behavioral components of depressive symptoms. However, expressive suppression might create an awareness of discrepancy between inner experience and outer expression, and this incongruence could exacerbate depressive symptoms (Gross & John, 2003). This study highlighted the combination of the parent–child relationship and emotion regulation strategies to alleviate depressive symptoms among older adults. Older adults using adaptive emotion regulation strategies might be able to rely on themselves to reduce depressive symptoms. Crucially, however, when older adults’ emotion regulation strategies were maladaptive, the SSAC was significantly associated with depressive symptoms through promoting the positive parent–child relationship. Therefore, interventions for facilitating SSAC and improving the parent–child relationship should focus more on older adults with maladaptive emotion regulation strategies.

In summary, this study combined family and individual factors to expand the interpretation of the association between SSAC and depressive symptoms. On the one hand, SSAC could increase close communication and connections, as well as decrease conflict and arguments between adult children and their older parents, which resulted in more harmonious parent–child relationships. On the other hand, a harmonious parent–child relationship could build the family protection system on which Chinese older adults rely to address emotional issues to help older adults relieve their depressive symptoms effectively. Beyond that, SSAC could decrease depressive symptoms by promoting the parent–child relationship only for older adults with less cognitive reappraisal or more expressive suppression.

Limitations and Future Studies

We must acknowledge some limitations of this study. First, a cross-sectional design in this study cannot infer the temporal ordering among study variables, which could be examined in future longitudinal or experimental studies. Second, self-reporting bias is a limitation of the study design; besides older adults, other family members such as children, could be invited to evaluate the variables in this study to obtain more comprehensive data in the future. Third, the findings of this study are based on a sample in the Sichuan province of China; whether the results can be generalized to the entire nation of China or to Western countries requires further examination. Fourth, convenience sampling might have restricted the generalizability of our findings. Fifth, considering that the association between SSAC, the parent–child relationship, and older adults’ depressive symptoms may differ for each specific parent–child relationship, future studies could distinguish the association differences between these variables in different forms of parent–child relationship, such as whether they are only-child families, or whether they live with their children. Last, in addition to the parent–child relationship, other mechanisms such as psychological resilience could link SSAC to older adults’ depressive symptoms, which can be further explored in the future studies.

Implications

This study combined family and individual factors to provide some implications for reducing depressive symptoms in older adults. Children should proactively bear the primary obligation of providing support to their older parents, especially when it comes to providing caring and emotional support. Strengthening the parent–child relationship and improving the interactions between adult children and older parents are also important for reducing depressive symptoms. In addition, it is important to help older adults develop more adaptive emotion regulation strategies and guide them in reassessing and reinterpreting negative situations, as well as in making an active effort to repair their bad moods, rather than suppressing their emotions when they face negative emotional experiences. Family factors and individual factors should be combined when interventions are designed. Family-based interventions should more target older adults with maladaptive emotion regulation strategies.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from National Natural Science Foundation of China (No. 71704017), Social Science Foundation of Chongqing, China (No. 2017YBSH051), and Fundamental Research Funds for the Central Universities (2019GGXY00).

ORCID iD

Yan Wang

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