Intergenerational contact and depressive symptoms in midlife and older adults: an analysis of six cohort studies across 33 countries.

Background: Population aging has heightened global concern about mental health in later life. Intergenerational contact, a crucial component of social support, is a modifiable social factor. However, existing evidence is largely derived from single-country studies and there is limited cross-national longitudinal research exploring how these relationships vary across diverse sociocultural and welfare contexts. This study examined the association between intergenerational contact and depressive symptoms among adults aged 50 years and older across 33 countries to address these gaps. Methods: We conducted a cross-national analysis using harmonized data from six population-based cohort studies to ensure cross-national comparability: the Health and Retirement Study (HRS), English Longitudinal Study of Ageing (ELSA), Survey of Health, Ageing and Retirement in Europe (SHARE), China Health and Retirement Longitudinal Study (CHARLS), Korean Longitudinal Study of Aging (KLoSA), and Mexican Health and Ageing Study (MHAS), collected between 2010 and 2019. Intergenerational contact with children was categorized into three categories: co-residence; living apart with frequent (at least weekly) contact; and living apart with infrequent contact. Depressive symptoms were measured by the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D), as appropriate. Logistic regression models with generalized estimating equations were used to estimate associations, adjusting for demographic characteristics, socioeconomic status, health status, and health related behaviors. Findings: The analytic sample included 189,036 participants. The prevalence of depressive symptoms, defined using scale-specific cut-offs, ranged from 20·3% in England to 33·3% in China. Compared with co-residence, living apart with infrequent contact was consistently associated with higher odds of depressive symptoms in most cohorts, including China (odds ratio [OR] 1·19, 95% confidence interval [CI] 1·11-1·27), the US (OR 1·18, 95% CI 1·10-1·28), continental Europe (OR 1·10, 95% CI 1·05-1·16), South Korea (OR 1·24, 95% CI 1·14-1·35), and Mexico (OR 1·43, 95% CI 1·23-1·66). By contrast, living apart with frequent contact was associated with lower odds of depressive symptoms in European cohorts, including England (OR 0·88, 95% CI 0·81-0·96) and continental Europe (OR 0·93, 95% CI 0·91-0·96). Interpretation: The association between intergenerational contact and depressive symptoms among midlife and older adults is context dependent. Residential separation combined with infrequent contact may reflect reduced emotional support and is linked to an increased burden of depressive symptoms across various settings. Conversely, frequent intergenerational contact can help mitigate this risk in certain cultural contexts. Future research is needed to clarify causal pathways across diverse settings. Funding: This study is funded by the National Natural Science Foundation of China.