The relationship between taking care of grandchildren and grandparents’ depression

Abstract

Evidence shows that grandchild care can affect grandparents’ mental health. However, whether the grandparent’s age, grandchild’s age, continuity of care, number of grandchildren, and number of hours per caregiving can be involved in this connection is unclear. The present study investigated the relationship between grandparents’ depression and dimensions of grandchild care. The present study was a cross-sectional study, where the studied population included grandparents aged 50–70 and having at least one grandchild aged 12 years or less. 432 cases were included in the study by multi-stage random sampling method. Demographic information questionnaire, which includes demographic questions and questions related to grandchild care, the Geriatric Depression Scale (GDS-15), and the short form of the Beck Depression Inventory (BDI-S) were used to collect information. Data analysis was done using non-parametric tests and SPSS version 26 software. The average age of the participants was 60.00 ± 5.416. In the age group of 50 to 59 years, no significant relationship was observed between taking care of a grandchild and depression, while this relationship was significant in the age group of 60 to 70 years (p = 0.022); the average depression scores in the group that took care of a grandchild was significantly higher. Furthermore, a significant relationship was found between the age of each grandchild under care and the depression status of the participants. Further investigations in the age group of 50 to 59 years old revealed that the average scores of depression in the group who cared for a grandchild of three to six years old were significantly higher (p < 0.001). Long-term care of grandchildren in non-elderly grandparents is less threatening to their mental health. However, it can be associated with depression in older adults.

Introduction

Intergenerational relationships are lifelong, continuous, dynamic relationships between parents and children and family-based interpersonal relationships throughout the generation [1]. Increasing empirical research shows the essential role of intergenerational interactions in maintaining the health of older people [2]. Family members, especially descendants, are essential sources of social support for the older people. Intergenerational relationships are vital in improving mental and physical health [3]. Social isolation and loneliness are associated with negative consequences such as poor cognitive function, sleep problems, reduced physical activity, depression, and even mortality [4]. A study showed that social isolation increases anxiety associated with depressive symptoms in older adults, and depressive symptoms were more common in older adults who felt lonely and lacked social support [5]. Family and friends and the relationship between grandparents and grandchildren are considered a source of happiness and optimism in the life of the older people, which causes pleasure, attention, and love [6]. In the 2015 Survey of Health, Aging, and Retirement in Europe (SHARE), almost half (45%) of grandparents reported caring for grandchildren, and nearly a fifth (18.5%) of those caregivers reported doing so almost daily [7]. Besides, this informal care of grandchildren for working parents is common in Asia and the United States, varying between 40 and 60% [8]. The relationship between grandchildren and grandparents is significant and worthy of attention and sensitivity for various reasons [9]. Therefore, the relationship between grandchild care and grandparent depression depends on transitory factors. Among the influential factors are the intensity of care, the presence of children’s parents, the number and age of children under care, the cohabitation of grandparents and grandchildren, the financial status of the family, And similar considerations [10].

On the one hand, previous research in the United States has reported adverse health effects of grandchild caregiving, particularly grandparent custodial care, with poorer health outcomes, including increased depressive symptoms, decreased life satisfaction, and more significant functional limitations. Nevertheless, these health hazards may already exist [11]. This distress may arise from stressors associated with raising grandchildren, as well as other intersecting sources of disadvantage, such as being poor, being female, and being a racial/ethnic minority [12]. On the other hand, a study showed that grandparents’ regular assistance to grandchildren is associated with greater life satisfaction and lower risk of depression, and grandparents who care for their grandchildren for four or more hours a week have a lower risk of depression [13]. Therefore, contradictory evidence of the relationship exists between grandchild care and depression. One of the main reasons for these contradictions seems to be different dimensions of grandchild care, such as the age, number, and gender of grandchildren, the underlying diseases of grandchildren, the frequency and average hours per time of care, as well as the age of the grandparent. Caring for the grandchild alone cannot be a valuable variable, but its dimensions should also be studied. Therefore, the present study was analyzed and investigated to determine the relationship between taking care of grandchildren and depression of grandparents taking care of and not taking care of grandchildren in Tehran in 2022.

Methods

The current research is a cross-sectional study investigating the relationship between grandchild care and depression of grandparent and non-caregiver grandparents in 2022. The sampling method was a multi-stage random method. The studied population was people aged 50 to 70 covered by health care centers under the supervision of Shahid Beheshti University of Medical Sciences who had at least one grandchild 12 years old or younger. The North Health Centers, the East Health Center, and the Shemiranat Health Network have seventy-eight, seventy-three, and twenty-three comprehensive health service centers and health centers covered by Shahid Beheshti University, respectively. In this part of the research, in the first stage of sampling, 10% of the centers of each region were selected as the investigated clusters, of which eight were selected from North Health Centers, seven from East Health Center, and three from Shemiranat Health Center. The selection of clusters was utterly random, and the number of selected samples in each cluster was twenty-four people. Additionally, the number of samples from each cluster was chosen randomly.

After visiting each health center, the necessary arrangements were made with the head of the center. Then, with the guidance of the relevant expert, the target community was invited by phone to come to the center on a specific day and time to complete the questionnaires. It is worth mentioning that all participants in the study met the inclusion criteria and, before entering the study, the purpose of the research and its steps were first explained fully and clearly to each of the eligible individuals. Then, informed and written consent was obtained from all participants and they were assured that their information would remain confidential and that they could be excluded from the study if they did not wish to continue their cooperation.

In the present study, the ratio of depression scores in two groups of grandparents (taking care of grandchildren: have/do not have) is compared. Therefore, the formula for comparing two ratios was used. The confidence value and power of the study group were 95% and 80%, respectively, and the corresponding values of these indicators were 1.96 and 0.84, respectively. Considering the lack of access to a similar study inside the country, to obtain the ratio values of depression in two caregiver and non-caregiver groups, the authors referred to the study by Feng Jen Tsai entitled “The effect of maintaining and improving the care of grandchildren on the mental health of the elderly - evidence from a longitudinal study in Taiwan,” and found that the prevalence of depression in two caregiving and noncaregiving groups was 5.06 and 6.46, respectively [14] and the acceptable difference was considered 3.5.

According to Formula 1, the sample size of 216 people was calculated for each group. A total of 432 people were calculated for both caregiver and non-caregiver groups.

The inclusion criteria were being between 50 and 70 years old, being covered by health care centers of Shahid Beheshti University of Medical Sciences, the ability to communicate and answer questionnaires, the ability to perform daily tasks, not suffering from severe depression, having at least a grandchild of 12 years old or younger. The criteria for exclusion from the study included participants’ unwillingness to continue their participation and incomplete questionnaire responses.

It is worth noting that to ensure that any differences observed in the study results were due to differences in grandchild care, and not differences in group size, a random sample matching method was used after collecting the samples to ensure that the number of samples in both groups was 216.

Measurements

Data were collected by demographic questionnaire, short form of the Beck Depression Inventory (BDI-S), and the Geriatric Depression Scale (GDS-15). The BDI-S scale was used to measure the depression of grandparents between the ages of 50 and 60, and the GDS-15 scale was used for participants 60 and older.

It is important to consider that the use of the Beck questionnaire can also be appropriate for both groups, but to more accurately assess the level of depression in the older people, the GDS-15 scale, which was specifically designed for this population, was preferably used.

Demographic questionnaire

This questionnaire of demographic characteristics contains information such as age, gender, marital status, level of education, life composition, and employment status. It also includes researcher-made questions about grandchild care, which include regular or occasional care of a grandchild 12 years old or less during the recent year, the number of times the grandchild was taken care of in the last year, the average hours of taking care of the grandchild per care, the condition of the grandchild’s illness or disorder, as well as the age, sex, and number of grandchildren under care.

Beck depression scale

To measure the depression of the age group of 50 to 59 years old, BDI-S was used, which has already been standardized by Gholamreza Rajabi, and the Cronbach’s alpha coefficient and halving for the whole questionnaire are respectively 0.89 and 0.82, and the correlation coefficient between the short form and the 21-question form of the BDI is 0.67 [15]. BDI-S is designed with 13 questions and four options.

Quantitative values of each item are determined from 0 to 3, and the scores can fluctuate from 0 to 39. A negative score is not considered [16]. Scores above 10 indicate moderate and severe depression [17, 18].

Geriatric depression scale

The GDS-15 questionnaire with a cut-off point of 8 was used to measure the depression of grandparents aged 60–70, which has already been standardized by Seyyed Kazem Malakouti et al., which has good validity and reliability (90% sensitivity and 84% specificity) [19]. The minimum score of this scale is zero, which indicates a normal mood, and the maximum score is 15, which indicates the lowest mood [20]. The answers to the questions are “yes” and “no” closed answers. The score of each answer is zero or one and changes depending on each question. For example, in one question, the answer “no” may have a score of one, and in another, the answer “yes” may have a score of one. If the answers to questions 1, 5, 7, 11, and 13 are no, each of them will get a positive mark, and if they answer yes to the rest of the questions, they will get a positive mark. A score greater than 7 means susceptibility to severe depression [21, 22].

It should be noted that the questionnaires were completed by the participants themselves. However, for individuals with insufficient literacy, their companions were asked to read the questionnaire to them and record their responses. If a participant did not have a companion present, the researcher themselves read the questionnaire to the participant and recorded their responses. Throughout all stages of data collection, the principles of confidentiality were upheld, and information was kept confidential. The data collection process took approximately three months in 2023.

Data analysis

In analytical statistics, Kolmogorov-Smirnov and Shapiro-Wilk tests were used to determine the distribution of quantitative variables in terms of normality, and Mann-Whitney and Kruskal-Wallis tests were used to investigate the relationship between grandchild care variables and grandparents’ depression. Finally, SPSS version 26 software was used for statistical analysis. Furthermore, the significance level was considered 0.05 in all tests.

Results

According to the reported information, the average age of the participants was 60.00, with a standard deviation of 5.416. Grandparents aged 50 to 59 and 60 to 70 comprise 48.6% and 54.4% of the participants. Out of the total of 432 participants in the research, 46.5% are women, 53.5% are men, and most are married (82.9%). In addition, according to the findings, participants with middle school/high school education have a maximum frequency of 26.6, and illiterate participants, with 2.8%, have the lowest frequency among the participants. Regarding the life composition, the participants who live with their spouse and children have a maximum frequency of 44.9%. Additionally, according to the findings, 38.2% of the participants of this study were retired. Furthermore, 47% of the participants answered that they had a chronic disease (Table 1).

Table 1.

Frequency distribution of grandchildren care questionnaire variables

Variable	Items	Total		50 to 59 years old		60 to 70 years old
		n*	%**	n*	%**	n*	%**
Grandchild care status	Yes NO	216 216	50.0 50.0	99 111	22.9 25.7	117 105	27.1 24.3
Grandchild Care Days (Year)	Almost every day 3 to 6 days a week 1 to 2 days a week Less than 5 days a month Occasionally a year	64 31 74 24 23	14.8 7.2 17.1 5.6 5.3	33 18 30 10 8	7.65 4.15 6.95 2.3 1.85	31 13 44 14 15	7.2 3.0 10.2 3.25 3.45
Mean Hours of Grandchild Care	More than 6 h Between 1 and 6 h Less than 1 h	74 102 40	17.1 23.6 9.3	37 42 20	8.55 9.7 4.65	37 60 20	8.55 13.9 4.65
Grandchild’s illness/disorder	Yes No	22 410	5.1 94.9	6 204	1.4 47.2	16 206	3.7 47.7
Grandchild’s age	Less than 3 years 3 to 6 years More than 6 years	157 135 140	36.3 31.3 32.4	117 71 22	27.1 16.4 5.1	40 64 118	9.3 14.8 27.3
Grandchild’s gender	Girl Boy Both sexes	120 171 141	27.8 39.6 32.6	63 89 58	14.6 20.6 13.4	57 82 83	13.2 19.0 19.2

* Number

** Percent

As seen in the above table, caring and non-caring grandparents comprise 50% of the participants, 22.9% of grandparents aged 50 to 59, and 27.1% of grandparents aged 60–70 take care of their grandchildren (Table 2).

Table 2.

Specific findings of participants’ depression status

age category	Items	Number	Percent
50 to 59 years old	Healthy Depressed	144 66	33.3 15.3
60 to 70 years old	Healthy Depressed	60 162	13.9 37.5

According to the above table, the majority of participants aged 50 to 59, with 33.3%, have a non-depressed state of mind. Moreover, 37.5% of 60-70-year-old participants declared they have a depressed mind.

As shown in Table 3, all the participants were divided into two groups with and without depression, and then the significant relationship between depression status with demographic information and the grandchild care questionnaire was measured. Among the demographic information, a significant relationship was found between the participants’ age, life composition, and chronic disease with the state of depression (p < 0.05). In addition, in the grandchild care questionnaire, a significant relationship was found between the care status of the grandchild and the age of each grandchild under care with the state of depression (p < 0.05). Furthermore, no significant relationship was found between the number of times (days) of taking care of a grandchild in a recent year and the depression of the participants. However, the relationship between the average hours of taking care of the grandchild per time (intensity) and the depression of the participants was close to significance (p = 0.062). Additionally, no significant relationship was observed between the rest of the grandchild care items with depression, such as the state of disorder or disease or gender of the grandchild.

Table 3.

Findings related to the state of depression in different demographic items and grandchild care questionnaire

Variable	Items	Depression percentage	P-value
Age	50 to 59 years old 60 to 70 years old	15.3 37.5	< 0.001*
Sex	Man Female	26.2 26.2	0.215*
Marital status	Married Widow Never married Divorced	43.3 5.6 0.0 3.9	0.304*
Education	Illiterate Elementary Middle or high school Diploma University	1.6 8.3 15.0 13.9 13.9	0.304*
living arrangement	Loneliness With wife With wife and children Only with children Other	4.6 19.2 21.8 6.0 1.2	0.003*
Employment status	Employed Retired Jobless Housekeeper	10.9 22.0 2.5 17.4	0.257*
Chronic disease	Yes No	28.0 24.8	0.01*
Grandchild care status	Yes No	29.2 23.6	0.021*
Grandchild Care Days (Year)	Almost every day 3 to 6 days a week 1 to 2 days a week Less than 5 days a month Occasionally a year	16.7 7.9 20.8 7.4 5.6	0.826*
Mean Hours of Grandchild Care	More than 6 h Between 1 and 6 h Less than 1 h	17.1 31.5 9.7	0.061*
Grandchild’s illness/disorder	Yes No	3.5 49.3	0.205*
Grandchild’s age	Less than 3 years 3 to 6 years More than 6 years	13.4 18.3 21.1	< 0.001*
Grandchild’s gender	Girl Boy Both sexes	14.1 20.6 18.1	0.747*

* Chi-Square

Finally, to deal with more details, the relationship between the state of depression and the items of the grandchild care questionnaire was investigated separately in two age groups, 50 to 59 years old and 60 to 70 years old.

According to Table 4, in the age group of 50 to 59 years, no significant relationship was found between taking care of a grandchild and the average depression scores, while in the age group of 60 to 70 years, the average depression scores in the group that took care of a grandchild was significantly higher (p = 0.022). In addition, in the age group of 50 to 59, the mean depression scores were significantly higher in the group that cared for a 3 to 6-year-old grandchild (p < 0.001).

Table 4.

Findings related to the state of depression in the various items of the grandchild care questionnaire

Variable	Items	50 to 59 years old				60 to 70 years old
		median	IQR***	Rank mean	P-value	median	IQR***	Rank mean	P-value
Grandchild care status	Yes No	6.00 6.00	7.00 8.00	6.75 7.45	0.628*	11.00 9.00	5.00 8.00	10.41 9.00	0.022*
Grandchild Care Days (Year)	Almost every day 3 to 6 days a week 1 to 2 days a week Less than 5 days a month Occasionally a year	5.00 8.00 6.50 4.00 3.50	8.50 8.25 6.25 10.00 4.50	6.69 8.83 7.03 4.70 3.87	0.068**	10.00 11.00 11.00 9.50 11.00	5.00 8.00 5.75 3.25 6.00	10.09 9.76 10.79 10.14 10.80	0.795**
Mean Hours of Grandchild Care	More than 6 h Between 1 and 6 h Less than 1 h	5.00 6.00 8.00	5.50 7.00 9.00	6.18 6.73 7.85	0.510**	12.00 10.00 10.00	5.00 5.00 4.50	10.91 10.56 9.05	0.133**
Grandchild’s illness/disorder	Yes No	9.50 6.00	5.50 7.00	10.16 7.03	0.068*	9.50 10.00	3.75 6.00	9.62 9.75	0.568*
Grandchild’s age	Less than 3 years 3 to 6 years More than 6 years	5.00 9.00 6.50	7.00 7.00 10.00	5.85 9.00 7.81	< 0.001**	12.00 10.00 10.00	6.00 5.75 6.00	10.40 9.76 9.51	0.334**
Grandchild’s gender	Girl Boy Both sexes	5.00 6.00 6.50	9.00 8.00 7.00	6.90 7.21 7.22	0.724**	12.00 10.00 10.00	7.50 6.00 6.00	10.52 9.74 9.21	0.087**

* Mann–Whitney test

** Kruskal–Wallis test

*** Interquartile Range

Discussion

According to the findings, a significant relationship was found between taking care of a grandchild and the depression of the caregivers. With further analysis and dividing the group of participants into two age groups of 50–59 years and 60–70 years, it was concluded that this relationship is not significant for the age group of 50 to 59 years, but in the age group of 60 to 70 years, the mean depression scores were significantly higher in the group that took care of grandchildren. The results of the study by Lindsey E. Baker and Meryl Silverstein and the study by Meredith Minkler et al. were in line with this study. The data obtained from these researches showed that caregiver grandparents are more susceptible to suffering from depression symptoms, although this result was general and did not provide any classification for the age of the caregivers. Notably, findings do not consider other roles that the participants may have. When considering these factors, the impact of caregiving on a grandparent’s depression can vary [23, 24]. Meredith Minkler et al. have justified this issue as increasing social isolation, loss of a job or economic security due to caregiving, loss of a grandparent’s fundamental role as a surrogate parent, and related stressors. Caring for children with special needs, infants, preschoolers, and adolescents has also been observed among such caregivers and may contribute to the development of experienced depression [24]. Therefore, this meaningful relationship in the age group of 60–70 years may happen for several reasons: taking care of grandchildren may put more emotional and physical pressure on them and take a lot of time and energy from them. Meanwhile, as a person ages, he or she becomes prone to physical, psychological, and social problems.

Additionally, caring for a grandchild may burden the caring grandparents financially, while the older people face financial problems due to retirement and reduced income. Conceivably, the older people cannot care for their grandchildren well due to lack of ability or physical problems, which can also aggravate depression. On the other hand, role strain theory suggests that people may face different types of role conflict when required to perform certain obligations. When the pressure associated with a particular role surpasses an individual’s physical and mental capabilities, it results in role stress, damaging one’s health. Hence, providing care for a grandchild may limit grandparents’ time and opportunities for self-care [25].

In this study, no significant relationship was found between the number of times (days) of taking care of a grandchild in a recent year and the participants’ depression, but the relationship between the average hours of taking care of a grandchild per time (intensity) and the participants’ depression is close to significance, indicating that what affects the mental health of grandparents is the intensity of the care burden and not the duration of caring for the grandchild. This part of the study was consistent with the results of Dantong Zhao et al. [26].

In addition, this study found no significant relationship between the grandchild’s health condition and the grandparents’ depression, inconsistent with the study of Matthew P. Janicki et al. [27]. They concluded that symptoms of depression are more common among grandparents who care for grandchildren with disabilities. The lack of significance observed in this study may be attributed to the small sample size, potentially resulting in the failure to detect meaningful existential relationships.

Additionally, in this study, no significant relationship was observed between the number of grandchildren under care and the depression of the participants. However, a significant relationship was observed between the average age of grandchildren under care and the depression of grandparents, so that in the age group of 50 to 59 years, the average depression scores were significantly higher in the group that cared for a 3- to 6-year-old grandchild. This significance may be due to the following reasons: the age group of three to six years is in a stage of development where they are just starting to practice social, academic, and self-sufficiency skills. They may need more help and guidance in daily activities, increasing care. On the other hand, the age group under three may need less care due to their greater dependence on parents and caregivers and less educational and educational needs. In addition, in the age group above six, some grandchildren may have become more self-sufficient and need less care. George Brunello et al. concluded in their study that the intensity of caring for grandchildren decreases from age five and above [28].

Furthermore, this study revealed no significant relationship between the grandchild’s gender and grandparents’ depression, and the reason for this lack of significance in this study may be due to the small sample size, which can cause non-recognition of meaningful existential relationships. Similarly, Chiachih DC Wang et al. concluded in their study that the gender of the grandchild is not related to any of the health variables of the grandparents [29]. However, in their study, Emer G. Dunne et al. concluded that stress, anxiety, and depression of grandparents are strongly related to challenging behaviors in granddaughters and challenging emotional concerns in grandsons [30].

Conclusion

The results indicate that taking care of grandchildren affects grandparents’ depression. However, further analysis reveals that taking care of the grandchild alone does not significantly affect the depression of grandparents, but the intensity of taking care of the grandchild and the age of the grandchild can have an impact. However, it should be noted that grandchild care and grandparents’ depression have a complex relationship that has not yet been thoroughly investigated. According to the literature review, taking care of a grandchild has different effects on the depression of caregivers, and the main reason for this difference in results is probably related to cultural differences in different parts of the world. For example, in some cultures, caring for grandchildren is considered a sacred and expected duty for grandparents. In these societies, accepting this role and feeling useful can prevent the onset of depression. In contrast, in cultures that emphasize individual independence, being forced to care for grandchildren can lead to feelings of restriction and dissatisfaction, and thus increase depression. This study has not discussed the grandparents’ economic status and satisfaction with caring for the grandchild. It is easier to explain the relationship between caring for the grandchild and the depression of the grandparent by having information about these two variables. Surprisingly, the study was conducted only in the urban population, and due to the differences in the context of urban and rural life, the study may only be generalizable to some of the society. Therefore, similar studies should be conducted in rural life.

The number of studies that have examined the relationship between grandchild care and depression of grandparents in Iran is limited. The authors suggest paying more attention to the relationship between grandchild care not only with depression but with other dependent variables. Additionally, using cohort and interventional studies in future studies can increase the generalizability of the results to all Iranian grandparents, and participants should be followed up during the investigation process.

Abbreviations

SHARE

Survey of Health, Ageing and Retirement in Europe

GDS

Geriatric Depression Scale

WHO

World Health Organization

SPSS

Statistical package for social science

BDI

Beck’s Depression Inventory

Author contributions

Study concept and design: Safa Kheirkhah Chobqlou; analysis and interpretation of data: Ali Ramezankhani; drafting of the manuscript: Safa Kheirkhah Chobqlou; critical revision of the manuscript for important intellectual content: Parisa Taheri Tanjani; statistical analysis: Mojtaba Azadbakht.

Funding

The authors received no funding from an external source.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to the sensitive nature of the questions asked in this study, survey respondents were assured raw data would remain confidential and would not be shared, but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This research was reviewed and approved by the ethics ID IR.SBMU.PHNS.REC.1401.125 in the Faculty of Health and Neuroscience Research Center of Shahid Beheshti University of Medical Sciences. It should be noted that informed and written consent was obtained from all the participants before entering the study, and they were also assured that their information would remain confidential and if they did not wish to continue their cooperation, they could be removed from the study. In addition, all the participants were aware of the research process, and the objectives were fully explained. Finally, indicatively, the ethical principles of the Declaration of Helsinki have been observed.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.