Death of a child and parental wellbeing in old age: Evidence from Taiwan
Introduction
Almost everyone encounters the death of a loved one, but the death of a child is rare, particularly in developed countries. The impact of losing a child is devastating and can last for decades, resulting in intense grief (Fletcher, 2002), poor psychological and physical health (Rogers, Floyd, Seltzer, Greenberg, & Hong, 2008), and high rates of both natural and non-natural death (e.g., suicide) (Rostila, Saarela, & Kawachi, 2012). Mounting research has indicated that a parent's sex is a key predictor of adjustment and long-term wellbeing after the death of a child. Bereaved mothers report higher levels of grief and psychiatric symptoms and are at greater risk of death than bereaved fathers (Li et al., 2005, Wijngaards-de Meij et al., 2005). However, few studies have examined how the sex of the deceased child affects parental wellbeing.
We investigate this question in the context of Taiwan, where particular social and cultural factors may affect how parents respond to the death of a son versus a daughter. In Taiwan, older generations have followed Confucian patriarchal ideals, preferring sons over daughters and investing more household resources in their sons. In return, an adult son—most often the oldest married son and his family—is expected to take care of his parents until their death (Chu and Yu, 2009, Lee et al., 1994). Conversely, when daughters marry, the demands of their new family take precedence over their obligations to their biological parents (Greenhalgh, 1985, Lundberg, 2005). Given that older parents depend mainly on the financial resources of their sons, a son's death may be more distressing to parents than a daughter's death. Taiwanese mothers may be especially vulnerable to a son's death because, among older cohorts, women are more socially disadvantaged (e.g., less education, lower income, and their lack of inherited property). Mothers are more likely than fathers to rely on the financial support of their children (Gupta et al., 2003).
Using data from the Taiwanese Longitudinal Study of Aging (TLSA), we test whether the sex of a deceased adult child differentially affects maternal and paternal wellbeing in old age, and discuss socioeconomic and cultural factors that might account for the observed differences. Our results contribute to the literature on gender and health inequality by identifying a significant link between negative major life events and wellbeing in later life.
Section snippets
Death of a child and parental wellbeing
Few events have a bigger emotional impact than losing a loved one and research has shown that the death of a child is particularly devastating (Fletcher, 2002, Sanders, 1979). Losing a child adversely affects multiple domains of parental wellbeing, including health and marital quality (Bolton et al., 2013). For instance, parents who outlive their children are more likely to have poorer self-reported health than those who do not experience the death of a child (Murphy et al., 1999). They are at
Sample
The current study includes participants in the Taiwanese Longitudinal Study of Aging (TLSA), a nationally representative survey designed to assess the health of older people in Taiwan. The first wave of data collection began in 1989 with a nationally representative random sample of 4049 persons aged 60 and older; in 1996, an additional sample of 2462 near-elderly persons (aged 50–66) was added. Follow-up interviews were conducted every 3 or 4 years. By the 2007 survey, 3041 respondents from the
Results
Descriptive statistics for all variables in the analyses are shown by the period of observation (Table 1). At baseline (1996), the average age of respondents is about 65 years. Men comprise 53% of the sample because of the selective migration of men from mainland China in 1949. The vast majority of the sample has no formal education (38%) or only a primary education (40%); only 22% of respondents received secondary or higher levels of education. About 73% of the respondents are married or
Discussion
This study has several important advantages over previous studies that have examined the link between the death of a child and parental wellbeing. First, previous studies have lacked a control group of non-bereaved parents (e.g., Werthmann et al., 2010), have used community-based or otherwise geographically-limited samples (e.g., Rogers et al., 2008), or have failed to include an extensive set of potentially confounding variables, including the respondent's health condition before their child
Acknowledgments
This work was supported by the Demography and Epidemiology Unit of the Division of Behavioral and Social Research at the National Institute on Aging (grant numbers R01AG16790, R01AG16661) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R24HD047879). Funding for the TLSA came from the Taiwan Department of Health, the Taiwan National Health Research Institutes (grant number DD01-86IX-GR601S) and the Taiwan Provincial Government. We gratefully
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