In a groundbreaking multi-national study recently published in BMC Psychiatry, researchers have delved into the complex relationship between parenthood and mental health among older adults. Exploring data from over 110,000 individuals aged 50 and above across 20 countries, this investigation sheds new light on how the number of children influences depression risk, revealing striking cultural and regional variances that challenge existing assumptions.
The research leverages six prominent aging cohorts: the Health and Retirement Study (HRS) in the United States, the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the Korean Longitudinal Study of Aging (KLoSA), and the Longitudinal Aging Study in India (LASI). Together, these datasets provide a rich, cross-continental perspective on late-life mental health and familial structures, validating findings with robust epidemiologic tools such as the Center for Epidemiologic Studies Depression Scale (CESD) and the European Depression Scale (EURO-D).
Central to the study is the nuanced assessment of depression’s prevalence, which varied dramatically, with rates as low as 10.7% in the United Kingdom and escalating to nearly half of the population in Poland. Childlessness, defined as having no children, also displayed significant geographic discrepancies. Western countries reported higher proportions of childlessness, with England’s ELSA cohort showing 15.8%, compared to Asian cohorts such as China’s CLHLS with a mere 1.5%. Such disparities underscore profound sociocultural, economic, and policy differences shaping family dynamics worldwide.
A key finding of the analysis lies in the divergent mental health outcomes associated with childlessness in Western versus Asian populations. The data strikingly showed that, in Western countries, being childless bore no significant association with increased depression risk. Odds ratios hovered around neutrality, indicating that older adults without children in the US, England, and much of Europe fare comparably in terms of mental health to their counterparts with children.
Contrastingly, the story sharply differed in Asian contexts. Individuals without children in China, Korea, and India faced notably higher odds of experiencing depressive symptoms. For example, Chinese participants exhibited twice the risk of depression relative to those with children. This marked regional divide was statistically confirmed through random-effects meta-analysis, emphasizing that cultural frameworks, societal expectations, and familial roles heavily influence the psychological implications of childlessness among older adults.
The study’s methodological rigor extended to exploring potential non-linear relationships between the number of offspring and depression risk. In datasets from India and Europe, the researchers observed a curvilinear effect: depression risk initially diminished with the addition of children but increased beyond a certain number, suggesting a threshold beyond which the burden or complexity of parenthood could translate into adverse mental health consequences. This pattern challenges simplistic notions of “more children equals better support” and calls for nuanced interpretations of family size dynamics.
Further subgroup analyses refined these insights by dissecting variation across age groups, gender, and marital status. Remarkably, the association between having children and depression was more pronounced in men and individuals aged 75 or younger in Korean data, highlighting gender-specific and age-dependent vulnerabilities. Additionally, in the US cohort, childlessness was linked to heightened depression risk only among those living alone, underscoring how social isolation may mediate mental health outcomes in the absence of offspring.
These findings carry profound implications for public health and social policy, especially given rapidly aging populations worldwide. The protective role of parenthood in mental well-being appears contextually contingent, shaped by societal values and caregiving expectations inherent in different cultures. In Asia, where filial piety and intergenerational support are culturally embedded, childlessness may precipitate social exclusion or lack of care, thus elevating depression risk. Western societies, in contrast, might provide alternative community supports or promote greater individual autonomy, buffering potential psychosocial impacts.
The research team advocates for recalibrated mental health interventions and aging policies that recognize these cultural gradients. Supporting older adults without children in Asian communities may necessitate innovative social support mechanisms or community integration strategies, while Western approaches might benefit from fostering diverse social networks and addressing loneliness in isolated individuals regardless of parenthood status.
Moreover, these nuanced associations call for further longitudinal research to unravel causality and temporal dynamics. While cross-sectional analyses provide crucial snapshots, understanding how depression trajectories evolve concerning parenthood and social changes will be vital for targeted prevention and care.
To summarize, this extensive multinational inquiry charts a sophisticated landscape where the intersection of family structure and mental health in later life is far from uniform. It challenges monolithic assumptions by revealing how cultural context modulates the psychological significance of childlessness and family size, highlighting the intricate interplay between societal norms, support systems, and individual well-being. As global demographics shift and older adult populations burgeon, such insights are invaluable in crafting tailored, culturally sensitive approaches to promote mental health equity and resilience.
This study not only broadens the epidemiological understanding of depression risk determinants but also elevates the discourse on aging, social connectedness, and mental health policy, marking a milestone in geriatric psychiatry research with immediate relevance for clinical practice and social innovation worldwide.
Subject of Research: Relationship between the number of children and depression in adults aged 50 years and older across multiple countries.
Article Title: Association between the number of children and depression in the population aged 50 years and older: a multi-national cross-sectional analysis.
Article References:
Zhang, J., Feng, P., Chen, X. et al. Association between the number of children and depression in the population aged 50 years and older: a multi-national cross-sectional analysis. BMC Psychiatry 25, 765 (2025). https://doi.org/10.1186/s12888-025-07206-3
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