Elsevier

Social Science & Medicine

Volume 101, January 2014, Pages 166-173
Social Science & Medicine

Death of a child and parental wellbeing in old age: Evidence from Taiwan

https://doi.org/10.1016/j.socscimed.2013.08.007Get rights and content

Highlights

  • This study examines how the death of an adult son or daughter affects parental wellbeing in Taiwan.

  • Wellbeing is measured by self-reports of overall health status and depressive symptoms.

  • A son's death is associated with a decline in wellbeing for mothers but not fathers.

  • A daughter's death is not related to the wellbeing of either parent.

  • These findings reflect gender inequality and the cultural preference for sons in Taiwan.

Abstract

The death of a child is one of the most traumatic events that a parent can experience. The psychological and physical consequences of bereavement are well established, and the consequences are more severe for mothers than fathers. However, little is known about how the death of an adult child affects parental wellbeing in old age or how the deceased child's sex may moderate the association. We use data from the Taiwanese Longitudinal Study of Aging (TLSA) to investigate how the death of a son or a daughter differentially affects the wellbeing of older parents, measured by depressive symptoms and self-rated health. We find that for mothers, a son's death is associated with an increase in depressive symptoms and a decline in self-rated health, but fathers' health is not adversely affected by a son's death. There is little evidence that a daughter's death has a negative effect on either maternal or paternal wellbeing. We situate these findings within their social and cultural contexts and discuss social policies that would reduce gender and health inequality.

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

References (51)

  • C.-C. Chen et al.

    Death of a son is associated with risk of suicide among parous women in Taiwan: a nested case–control study

    Journal of Epidemiology

    (2012)
  • S.-T. Cheng et al.

    The Center for Epidemiologic Studies depression scale in older Chinese: thresholds for long and short forms

    International Journal of Geriatric Psychiatry

    (2005)
  • C.Y.C. Chu et al.

    Understanding Chinese families: A comparative study of Taiwan and Southeast China

    (2009)
  • W. Chung et al.

    The decline of son preference in South Korea: the roles of development and public policy

    Population and Development Review

    (2007)
  • J.A. Cook

    DAD'S DOUBLE BINDS. Rethinking fathers' bereavement from a men's studies perspective

    Journal of Contemporary Ethnography

    (1988)
  • Department of Health, Taiwan. (2012). 2011 Statistics of causes of death. Retrieved 02.21.13....
  • P.N. Fletcher

    Experiences in family bereavement

    Family and Community Health

    (2002)
  • N. Goldman et al.

    Measuring subjective social status: a case study of older Taiwanese

    Journal of Cross-Cultural Gerontology

    (2006)
  • S. Greenhalgh

    Sexual stratification: the other side of “growth with equity” in East Asia

    Population And Development Review

    (1985)
  • M.D. Gupta et al.

    Why is son preference so persistent in East and South Asia? A cross-country study of China, India and the Republic of Korea

    Journal of Development Studies

    (2003)
  • S.-W. Ho et al.

    Cultural influences on parental bereavement in Chinese families

    Omega

    (2007)
  • H.-C. Hsu

    Gender disparity of successful aging in Taiwan

    Women and Health

    (2005)
  • E.L. Idler et al.

    Self-rated health and mortality: a review of twenty-seven community studies

    Journal of Health and Social Behavior

    (1997)
  • U. Kreicbergs et al.

    Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

    Psychological Medicine

    (2004)
  • Y.-J. Lee et al.

    Sons, daughters, and intergenerational support in Taiwan

    American Journal of Sociology

    (1994)
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