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. Author manuscript; available in PMC: 2026 Jan 28.
Published before final editing as: Curr Dir Psychol Sci. 2026 Jan 26:10.1177/09637214251410195. doi: 10.1177/09637214251410195

Historical Change in Midlife Development from a Cross-National Perspective

Frank J Infurna 1, Yesenia Cruz-Carrillo 1, Nutifafa E Y Dey 1, Markus Wettstein 2,3, Margie E Lachman 4, Denis Gerstorf 2
PMCID: PMC12841945  NIHMSID: NIHMS2129325  PMID: 41608078

Abstract

The objectives of our overview are threefold. We first summarize empirical evidence documenting (a)that U.S. middle-aged adults have displayed historical trends of elevations in loneliness and depressive symptoms and declining memory and physical health, and (b)this pattern is largely confined to the U.S. and not observed in peer nations. Second, we provide a conceptual model to detail possible explanations for these historical trends. Third, we discuss future directions to explore whether similar historical trends are transpiring across population subgroups and low- and middle-income nations, and identify psychosocial resources for promoting resilience. This timely review sheds light on midlife development from a cross-national and historical perspective.

Middle-aged adults (ages 40–65) form the backbone of society by comprising most of the workforce and constituting family leadership through bridging younger and older generations (Infurna et al., 2020; Lachman, 2004). Recent conceptual models of midlife development have discussed how midlife is defined by four key features (Infurna et al., 2020; Lachman et al., 2015). First, middle-aged adults juggle multiple roles by balancing work, family, community, and social commitments. Second, they face significant life transitions in their career (e.g., advancement, retirement planning), family (e.g., divorce, remarriage, [grand]parenthood), and health (e.g., chronic illness incidence; Lachman et al., 2015). Third, midlife offers opportunities and involves gains in crystallized cognitive abilities, control beliefs, social relationship quality, and well-being. Fourth, given the integral role that middle-aged adults play in society and family, they are vulnerable to stressors and challenges. Middle-aged adults experience time constraints as they juggle caregiving for aging parents, parenting demands, and the challenges of supporting adult children transitioning into independence (Fingerman et al., 2020; Luthar et al., 2020). Over the past decades, rising childcare, education, and healthcare costs, compounded by labor market instability, have increased financial vulnerabilities among middle-aged adults (Infurna et al., 2020). The significance of midlife is further exemplified by empirical evidence demonstrating that better midlife health foreshadows better health and finances in old age (Infurna et al., 2020).

The vitality of middle-aged adults is critical for societal success. The objectives of our overview are threefold. We first summarize empirical evidence documenting that (a)U.S. middle-aged adults from the Silent Generation to early Generation X (birth years studied: 1930s to early 1970s) have displayed troubling historical trends across key outcomes and (b)this pattern is largely confined to the U.S. and not observed in peer nations. Second, we provide a conceptual model that details potential reasons underlying these historical trends. Third, we discuss future directions that explore whether similar historical trends are transpiring across population subgroups and low- and middle-income nations and identify psychosocial resources for promoting resilience.

Midlife Development: Historical Trends

Our research has compared middle-aged adults from the Silent Generation to early Generation X (birth years studied: 1930s to early 1970s) and documented that later-born cohorts (i.e., those born in the 1960s and 1970s) have shown elevations in loneliness and depressive symptoms and declines in episodic memory and physical health, compared to earlier-born cohorts, and this pattern is largely confined to the U.S (Infurna et al., 2025). Our findings have focused on pertinent indicators of mental, cognitive, and physical health, which expands upon previous research documenting that U.S. life expectancy declined/stagnated in the 2010s (due to increasing mortality rates among working-age adults; Harris et al., 2021). To examine historical change in midlife development, we used longitudinal panel surveys from across the World that have been harmonized by the Gateway to Global Aging initiative (https://g2aging.org). The harmonized surveys consist of nationally representative samples that typically assess participants biennially. Harmonization involved combining datasets from different sources into a consistent, standardized, and comprehensive format for analysis. The surveys assess the variables of interest using similar measures. Furthermore, each study longitudinally assesses large samples of middle-aged adults born in different historical times and includes refresher samples—an approach that maintains sample size and heterogeneity, thereby strengthening the statistical power to detect and quantify historical change. We apply multilevel models to the harmonized longitudinal data to distinguish historical changes in midlife development within and across nations, which also allows for subsequent papers to test questions pertaining to mediation and moderation.

Figure 1 provides an overview of our key findings from the U.S., Europe, South Korea, China, and Mexico. Figure 1A illustrates that middle-aged adults in the U.S. report elevated levels of loneliness compared to their same-aged peers in Europe and that loneliness has historically risen in the U.S. (Infurna et al., 2025). Focusing on episodic memory (Figure 1B), later-born cohorts of U.S. middle-aged adults exhibited poorer memory compared to earlier-born cohorts and peer nations in Europe and Mexico (Wettstein et al., 2025). Later-born cohorts of middle-aged adults in the U.S. reported elevated depressive symptoms (Figure 1C; Gonzalez Avilés et al., 2025) and exhibited poorer grip strength (Figure 1D; Cruz-Carrillo et al., 2025), and these historical trends differ across Europe, South Korea, China, and Mexico. This complements research showing that U.S. middle-aged adults post-Great Recession, compared to pre-Great Recession, reported poorer mental and physical health (Kirsch et al., 2019) and, at the daily level, reported more stressors and lower well-being (Almeida et al., 2020). The evidence is mixed regarding historical trends in midlife physical health beyond that of grip strength; some studies show an increasing prevalence of chronic illnesses, and others show historical declines in functional limitations (Gimeno et al., 2024; Infurna et al., 2021).

Figure 1: Historical change in midlife loneliness, memory, depressive symptoms, and grip strength across nations and regions.

Figure 1:

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Empirical findings pertaining to historical changes in midlife loneliness, memory, depressive symptoms, and grip strength that has utilized harmonized longitudinal panel survey data from the U.S., England, Continental (France, Austria, Belgium, Germany, Switzerland, and Israel), Mediterranean (Italy, Spain, and Greece), and Nordic (Denmark, Netherlands, and Sweden) Europe, South Korea, China, and Mexico. The pattern of findings is displayed for a typical 50-year-old participant by birth year, and the parameter estimates from each of the following papers were used to create the figures (loneliness: Infurna et al., 2025; episodic memory: Wettstein et al., 2025; depressive symptoms: Gonzalez Avilés et al., 2025; grip strength: Cruz-Carrillo et al., 2025). The outcomes displayed in panels A, B, and C are in a T-score metric (M = 50, SD = 10), and grip strength in panel D is displayed in kilograms (kg). In panel D, the dotted lines are findings for women, and the solid lines are findings for men. See Figure S1 in the supplemental materials for the pattern of findings for a typical 60-year-old participant by birth year.

Overall, later-born cohorts of U.S. middle-aged adults are faring worse on each outcome than earlier-born cohorts (loneliness shows a quadratic trend, but overall levels are higher compared to other nations). The U.S. showed historical declines in episodic memory, whereas most other nations exhibited improvements. This finding runs counter to rising educational attainment and the Flynn Effect observed in other age groups. Possible reasons include daily life being more stressful (Almeida et al., 2020), less accumulated wealth, which is more strongly associated with cognition in the U.S. as compared to other nations (Cho et al., 2023), and the prevalence of risk factors for poorer cognition (i.e., obesity, high blood pressure, and high cholesterol) being higher in the U.S. compared to other nations (Gimeno et al., 2024).

Mediterranean Europe showed a similar pattern of worsening outcomes over historical time to that of the U.S.; later-born cohorts reported elevations in loneliness and depressive symptoms and declining grip strength, but unlike the U.S., showed historical improvements in episodic memory. Nordic Europe showed consistent historical improvements; later-born cohorts reported fewer depressive symptoms and lower levels of loneliness, and improvements in episodic memory and grip strength. Later-born cohorts in Mexico reported fewer depressive symptoms and improvements in episodic memory. The findings for England, Continental Europe, South Korea, and China were mixed. Later-born cohorts in England exhibited stability in loneliness, but improvements in memory, depressive symptoms, and grip strength (for women). Later-born cohorts in Continental Europe reported lower levels of loneliness, improvements in memory, but increases in depressive symptoms and declines in grip strength. Later-born cohorts in South Korea showed increases in depressive symptoms, but improvements in grip strength. Later-born cohorts in China reported fewer depressive symptoms, stability in grip strength, and declines in episodic memory.

Multilevel Conceptual Framework

Figure 2 illustrates our guiding conceptual framework for better understanding cross-national differences in historical change of midlife mental, cognitive, and physical health. Factors that are distal and structural (upstream) to proximal and individual (downstream) potentially shape midlife development. Socio-demographics and psychosocial resources can mitigate or amplify historical changes in midlife development. Associations between upstream and downstream factors are multidirectional. For example, in the context of the U.S., being a caregiver for an aging parent or a parent could lead to families moving to a state that has a more favorable policy towards accessibility to caregiving help and greater investment in primary and secondary education. Figure 2 serves as a conceptual basis for testing research questions aimed at determining reasons for similarities and differences in historical change of midlife development across nations. It illustrates the complexity involved by showcasing the interplay among these various levels of influence. We next discuss facets that are most pertinent, and the research community is positioned to study next, with an emphasis on nation-level and individual-level factors.

Figure 2: Multilevel conceptual framework for understanding midlife development of cognitive, mental, and physical health across historical time and nations.

Figure 2:

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Our series of studies has examined midlife development across historical time as a function of birth year or cohort; alternative ways of examining historical time could be through period or year of assessment. The nations that we have included in our studies are the U.S., Europe (England, Continental Europe [France, Austria, Belgium, Germany, Switzerland, and Israel], Mediterranean Europe [Italy, Spain, and Greece], and Nordic Europe [Denmark, Netherlands, and Sweden]), South Korea, China, and Mexico. Upstream factors that are considered distal and structural, such as those that pertain to policy and culture at the national, state, and community levels, shape midlife development. Individual-level factors of intergenerational relationships, financial vulnerabilities, health behaviors, and psychological factors (e.g., personality) are more proximate and likely operate as mechanisms of the link between historical change and midlife development of cognitive, mental, and physical health. Community-level factors that pertain to one’s surrounding environment (e.g., urban versus rural, walking accessibility, pollution, and workplace culture) can also shape midlife development across historical time. The impact of upstream and downstream factors is differentially shaped by socio-demographics and psychosocial resources. For example, historical change in midlife development of cognitive, mental, and physical health could differ between men and women, across years of educational attainment, and by race/ethnicity, and be shaped by psychosocial resources (e.g., control beliefs, social support, and views on aging). Future research should further disentangle upstream and downstream factors driving historical change, as well as the role of socio-demographics and psychosocial resources that may exacerbate or dampen changes in midlife development. These questions can now be directly tested using harmonized longitudinal panel surveys. The different levels can interact or act synergistically. For example, psychological factors, such as personality, could impact how likely people are to move to another community or the type of work environment that they prefer. At the population level, declines in midlife health could place an increased burden on the healthcare system and lead to more investment in upstream factors from policymakers. This figure was adapted from and influenced by Figure 6.1 in Harris et al. (2021) and Figure 1 in Infurna et al. (2020).

Upstream nation-level factors predict midlife development.

The series of studies that we have published has included harmonized longitudinal panel survey data from the U.S., Europe, South Korea, China, and Mexico. These nations differ in the investment of upstream (structural) factors highlighted in Figure 2 (e.g., provision of universal healthcare and extensiveness of family and work benefits). Research suggests that there are historical changes in upstream factors that align with the individual-level findings. For example, since the early 2000s, public spending on family benefits has risen in Europe, whereas it has remained stagnant in the U.S. (Neef & Sodano, 2022; OECD, 2025). Conversely, income inequality has risen in the U.S. during this same period, whereas income inequality has stabilized or narrowed in most European nations (Neef & Sodano, 2022; OECD, 2025). We detail how these upstream factors could differentially shape midlife development of mental, cognitive, and physical health across historical time.

The U.S. does not have extensive family policy programs, such as cash transfers to families with children (e.g., income support during parental leave) or public spending services for families (e.g., subsidized childcare), as compared to European nations (e.g., Germany and Sweden). More generous family and work policies promote health and well-being for both parents and nonparents (Glass et al., 2016). In our own research, we have combined nation-level data on family benefits spending (% of GDP) with individual-level data on loneliness from the U.S. and Europe. In nations that invest more in family benefits, middle-aged adults report lower levels of and less steep within-person increases in loneliness, and this effect is stronger for later-born cohorts (Infurna et al., 2025). For middle-aged adults, family programs are highly relevant because insufficient support for children beyond the period of infancy and childhood could contribute to poorer health outcomes through increasing parenting and financial stress and workplace insecurity (Glass et al., 2016).

The U.S. spends heavily on healthcare (as % of GDP), but ranks poorly on accessibility, efficiency, and equity (Case & Deaton, 2020). Large out-of-pocket costs associated with attaining healthcare strain household budgets by impacting one’s ability to put money in savings and retirement accounts, utilize preventive treatments, and pay monthly bills (Infurna et al., 2020). Increasing rates of out-of-pocket spending, coupled with rising prescription costs, lead to anxiety, substantial debt problems, and disruptions of medical care (Case & Deaton, 2020).

Income inequalities and cultural factors pertaining to norms, values, and residential mobility could also contribute to cross-national differences. Relative to peer nations, the U.S. has higher rates of residential mobility that could lead to people not living close to family and moving frequently, which makes it difficult to establish enduring community connections and increases the likelihood of long-distance caregiving (Holt-Lunstad et al., 2015). Cultural beliefs in Europe, such as friluftsliv in Nordic Europe that emphasizes a physically active outdoor lifestyle and connection to nature, coupled with comprehensive welfare policies, could contribute to better midlife health (Sapir, 2006). Our research has explored the effect of income inequality on midlife loneliness; in nations with greater income inequality (indexed via the GINI coefficient), middle-aged adults report higher levels of loneliness and stronger within-person increases over time (Infurna et al., 2025). Income inequality exacerbates poverty rates, reduces the possibility of moving up the SES ladder, and impacts access to education, jobs, and social services, each of which has downstream effects on health (Case & Deaton, 2020).

Downstream individual-level mechanisms predict midlife development.

At the individual-level, changing intergenerational relationships, financial vulnerabilities, and health behaviors could be driving historical changes in midlife mental, cognitive, and physical health within and between nations. The nature of intergenerational relationships of middle-aged adults with their children and aging parents has undergone substantial changes over the past decades. Middle-aged parents are contending with increasing parental pressures for their children to succeed, combined with a prolonged dependency of their adult children (Luthar et al., 2020). Adult children’s more limited opportunities for job security, rising levels of education and health insurance costs, and inability to meet material needs (e.g., insufficient income to support housing costs) all contribute to higher levels of anxiety and depressive symptoms in middle-aged parents (Fingerman et al., 2020). The past decade has seen parents experiencing high levels of stress compared to other adults because of strained finances, increasing time demands, and parental isolation (Office of the U.S. Surgeon General, 2024), which is exacerbated by the absence of robust policy and community support systems in the U.S. More middle-aged adults are involved with caregiving-related duties for aging parents and relatives while having to juggle full-time work. Such added responsibilities often lead to heightened work-family conflicts, psychological distress, poor sleep quality, and greater utilization of health services.

Later-born cohorts of U.S. middle-aged adults have accumulated less wealth and more financial vulnerabilities, compared to earlier-born cohorts, due to wage stagnation and the Great Recession (Case & Deaton, 2020). Findings obtained following the Great Recession illustrate that U.S. middle-aged adults are most vulnerable to economic failures and hardships (e.g., mortality risk from job loss and home foreclosure rate; Harris et al., 2021), whereas stronger social safety nets in European nations helped buffer middle-aged adults from negative health effects (Margerison-Zilko et al., 2016). Difficulty paying bills, managing monthly expenses, and saving enough for retirement have cascading effects on mental, cognitive, and physical health (Harris et al., 2021). Empirical evidence suggests that historical declines in wealth accumulation are associated with historical increases in midlife loneliness in the U.S. (Infurna et al., in press).

Engagement in health-promoting behaviors contributes to midlife mental, cognitive, and physical health. Physical activity is an important health-promoting behavior in midlife because it has short- and long-term benefits (Lachman et al., 2018). Cross-national research documents how a greater proportion of middle-aged Americans are physically inactive and report more chronic illnesses compared to middle-aged adults in Europe (Gimeno et al., 2024). Various types of physical activity are likely beneficial, capable of promoting positive midlife mental, cognitive, and physical health, and providing individuals with a sense of belonging, community, and opportunities for social engagement if done in a group setting (Lachman et al., 2018).

Future Directions

We note three sets of promising routes for future inquiry. First, substantial differences in historical change across mental, cognitive, and physical health are presumably shaped by socio-demographics, but few studies have tested this empirically. Our research has primarily focused on ages 50–65 and birth years representing the Silent Generation up to early Generation X. The verdict is still out for individuals earlier in midlife (i.e., ages 40–49), as well as later-born individuals among Generation X and from the Millennials. We have also observed that the protective effect of education is diminishing for later-born cohorts (Infurna et al., 2021; Wettstein et al., 2025). Among the foreign-born, a health advantage has been observed compared to the native-born population in the U.S. and other countries (Markides & Rote, 2019), but less is known regarding whether this advantage is maintained across cohorts. Midlife development is presumably also shaped by early-life factors. For example, childhood adversity is associated with poorer midlife health, and recent research observed that this association is mediated by unhealthier behaviors, more perceived stress, and negative emotionality (Bourassa et al., 2023). However, less is known about whether the effects of early life factors are transpiring differently across historical time.

Second, our research has primarily used harmonized data from high-income nations. It would be informative to investigate similarities and differences in the historical trends observed among middle-aged adults from nations that span the entire income spectrum, which promises to provide additional insights into nation-level factors that contribute to historical changes in midlife health. For example, the last 50 years in Sub-Saharan Africa have brought rapid population growth and increased life expectancy, but also historical increases in chronic illnesses that have coincided with pressures on healthcare systems and changes in traditional family structures (Gouda et al., 2019). Major shifts in demographics, policy, and social and economic opportunities have made the region prime to understand whether and how midlife health is historically changing.

Lastly, there is a need to identify resources that middle-aged adults could rely upon to promote resilience and examine whether they mitigate historical declines in midlife health in the U.S. and other nations/regions. Psychosocial resources, including social support, control beliefs, and positive views on aging, are malleable through web-based or in-person interventions, further signifying their potential to combat the U.S. midlife disadvantage (e.g., Castro et al., 2023). During times of need, individuals can draw upon network members for emotional, informational, or instrumental support, each showing unique protective benefits across different contexts (Holt-Lunstad et al., 2015). Empirical evidence shows that higher levels of control beliefs are linked to better overall health and longevity (Lachman et al., 2018). Control beliefs are a resource that mitigates the effect of low SES on health and well-being and the detrimental consequences of the Great Recession on health (Kirsch et al., 2019). Views on aging have relevance for health, well-being, and longevity in midlife because middle-aged adults become increasingly aware of age-related changes and could be more prone to negative age self-stereotyping (Diehl et al., 2020). Promoting positive views on aging in midlife (and other stages of life) through societal level age-friendly initiatives (e.g., https://www.reframingaging.org/), as well as at the individual-level is promising, given empirical evidence showing that individuals’ views on aging are malleable (Diehl et al., 2020).

Conclusion

Our research has documented that later-born cohorts of U.S. middle-aged adults are grappling with unprecedented levels of loneliness, depressive symptoms, and poor physical and cognitive health. Such historical trends have largely been confined to the U.S. and are not observed among most peer nations. Our review provides an overview of empirical and historical perspectives on midlife development from a cross-national perspective, provides a conceptual model for targeting upstream and downstream factors driving such differences, and discusses avenues for future research.

Supplementary Material

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Acknowledgments

The authors gratefully acknowledge the support provided by the National Institute on Aging (R01 AG079523). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

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