Under one roof: The effect of co-residing with adult children on depression in later life.

RATIONALE: The number of older parents living without adult children has increased dramatically over the last decades. However, recent trends exacerbated by the Great Recession have led to an increase in intergenerational co-residing. METHODS: We used three waves of data (2004-2010) from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected around the Great Recession to assess the effects of intergenerational co-residence on mental health in later life (n = 50,043). We used an instrumental variable (IV) approach that exploits changes in employment opportunities of adult children during the Great Recession to examine the impact of co-residing with adult children on depression scores measured using the Euro-D scale of depression. RESULTS: Northern European countries exhibited low levels of both co-residence and depression in older age, while most countries in Eastern and Southern Europe had high levels of both co-residence and depression. In OLS models that controlled for measured characteristics, co-residing with an adult child was not associated with depressive symptoms in older parents (β = -0.0387; 95% CI -0.0892 to 0.0118). By contrast, results from IV models suggest that co-residing with an adult child significantly reduces depressive symptoms by 0.731 points (95% CI -1.261 to -0.200) on the 12-item scale. Results were robust to a series of robustness checks including controls for child characteristics, country-specific time trends, and analyses restricted to homeowners. CONCLUSIONS: Our findings suggest that, in the context of high unemployment rates during the Great Recession in Europe, increased intergenerational exchange between adult children and older parents in the form of co-residence had positive mental health effects on older parents

Do living arrangements affect depression in later life? Evidence from Europe and the United States

Living arrangements of older people in Europe and the US have changed considerably in the last decades. The impact of these changes on mental health in later life is not fully understood. Making use of interdisciplinary ageing datasets (the Survey of Health, Ageing and Retirement in Europe and the Health and Retirement Study in the US), this thesis aims to evaluate how changes in the way older people live influence depressive symptoms in old age – focusing on two types of living arrangements: intergenerational co-residence and housing tenure. Composed of four empirical chapters, this PhD thesis makes four methodological and substantive contributions to the literature. The first chapter sets the stage for a cross-national comparison of the effect of living arrangements on depression. It assesses the comparability of commonly used depressive symptoms measures in the primary ageing datasets (Euro-D and CES-D scales). The second chapter focuses on the effect of early access to homeownership (before the age of 35) and housing stability on later life depression in the US. The findings suggest that accessing the housing ladder early on in the life course and remaining in that home are associated with both lower levels of depressive symptoms and slower progression of depression in later life. The third empirical chapter investigates the association between changes in housing tenure and depression in later life in the US. Using individual fixedeffects models, this analysis assesses whether within-person changes in housing tenure are associated with within-person changes in depressive symptoms. The analyses show that acquiring a home after 50 brings mental health benefits. The fourth empirical chapter evaluates the effects of intergenerational co-residence in 14 European countries. Using an instrumental variable approach to account for reverse causality, the findings suggest that co-residing with an adult child in the context of the 2008 economic crisis can yield mental health benefits for their parents. Taken together, the results presented in this thesis underscore the importance of living arrangements as key life course determinants of depression in old age

Mapping support policies for informal carers across the European Union

Background: At a time when health and social care services in European countries are under pressure to contain or cut costs, informal carers are relied upon as the main providers of long-term care. However, still little is known about the availability of direct and indirect support for informal carers across the European Union. Methods: Primary data collection in all EU member states was supplemented with an extensive review of the available literature. Results: Various forms and levels of support have been implemented across Europe to facilitate the role of informal caregivers. Financial support is the most common type of support provided, followed by respite care and training. Most countries do not have a process in place to systematically identify informal carers and to assess their needs. Policies are often at an early stage of development and the breadth of support varies significantly across the EU. Conclusions: Policy developments are uneven across the member states, with some countries having mechanisms in place to assess the needs and support informal carers while others are only starting to take an interest in developing support services. Given the unprecedented challenges posed by population ageing, further research and better data are needed to capture and monitor information on informal carers, to help design adequate support policies and eventually to evaluate their impact across the EU

The Mental Health Benefits of Acquiring a Home in Older Age: A Fixed-Effects Analysis of Older US Adults.

Homeownership is consistently associated with better mental health, but whether becoming a homeowner in later in life has positive psychological benefits has not, to our knowledge, been examined. We assessed whether acquiring a home after age 50 years was associated with depression in a representative sample of older US adults. We used individual fixed-effects models based on data from 20,524 respondents aged ≥50 years from the Health and Retirement Study, who were interviewed biennially during 1993-2010. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale. Controlling for confounders, becoming a homeowner in later life predicted a decline in depressive symptoms in the same year (β = -0.0768, 95% confidence interval (CI): -0.152, -0.007). The association remained significant after 2 years (β = -0.0556, 95% CI: -0.134, -0.001) but weakened afterward. Buying a home for reasons associated with positive characteristics of the new house or neighborhood drove this association (β = -0.426, 95% CI: -0.786, -0.066), while acquiring a home for reasons associated with characteristics of the previous home or neighborhood, the desire to be closer to relatives, downsizing, or upsizing did not predict mental health improvements. Findings suggest that there are small but significant benefits for mental health associated with acquiring a home in older age

COVID-19 as a Syndemic.

A Perspective on 'A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19' by Logette E, Lorin C, Favreau C, Oshurko E, Coggan JS, Casalegno F, Sy MF, Monney C, Bertschy M, Delattre E, Fonta P-A, Krepl J, Schmidt S, Keller D, Kerrien S, Scantamburlo E, Kaufmann A-K and Markram H (2021). Front. Public Health. 2:27. doi: 10.3389/fpubh.2021.69513

Does schooling attained by adult children affect parents' psychosocial well-being in later life? Using Mexico's 1993 compulsory schooling law as a quasi-experiment

Higher adult child educational attainment may benefit older parents' psychosocial well-being in later life. This may be particularly important in low- and middle-income countries, where recent generations have experienced comparatively large increases in educational attainment. We used data from the 2012 Mexican Health and Aging Study, a nationally representative study of adults aged ≥50 years and leveraged the exogenous variation in adult child education induced by Mexico's compulsory schooling law passed in 1993. We employed two-stage least squares (2SLS) regression to estimate the effects of increased schooling among adult children on parents' (respondents') depressive symptoms and life satisfaction scores, controlling for demographic and socioeconomic characteristics. We considered heterogeneity by parent and child gender and other sociodemographic characteristics. Our study included 7186 participants with an average age of 60.1 years; 54.9% were female. In the 2SLS analyses, increased schooling among oldest adult children was associated with fewer depressive symptoms (β = −0.25; 95% CI: −0.51, 0.00) but no difference in life satisfaction (β = 0.01; 95% CI: −0.22, 0.25). Stratified models indicated differences in the magnitude of association with depressive symptoms for mothers (β = −0.27, 95% CI: −0.56, 0.01) and fathers (β = −0.18, 95% CI: −0.63, 0.26) and when considering increased schooling of oldest sons (β = −0.37; 95% CI: −0.73, −0.02) and daughters (β = −0.05, 95% CI: −0.23, 0.13). No parent and child gender differences were found for life satisfaction. Power was limited to detect heterogeneity across other sociodemographic characteristics in the second stage although first-stage estimates were larger for urban (vs. rural) dwelling and more (vs. less) highly educated respondents. Results were similar when considering the highest educated child as well as increased schooling across all children. Our findings suggest that longer schooling among current generations of adult children, particularly sons, may benefit their older parents' psychosocial well-being

Intergenerational socioeconomic mobility and adult depression:the CONSTANCES study

Socioeconomic mobility from childhood onwards may predict depression risk in adulthood. Using data from the nationally representative CONSTANCES study in France (2012-2014, n=67,057), we assessed the relationship between intergenerational socioeconomic mobility and adult depression (Center for Epidemiological Studies-Depression scale, >=16 in men, >=20 in women) and antidepressant use. Socioeconomic position was ascertained by occupational grade (childhood: maternal and paternal measures prior to age 15 years combined; adult: participant own). Data were analyzed using logistic regression models adjusted for sociodemographic characteristics, parental history of psychiatric disorders and suicide, health behaviors and chronic health problems. Compared to participants who had persistently high socioeconomic circumstances, those who experienced other socioeconomic trajectories had elevated levels of depression (multivariate Odds Ratios: upward mobility: 1.21, intermediate socioeconomic position: 1.28, downward mobility: 1.66, persistently low socioeconomic position: 1.82). Downward mobility and persistently low socioeconomic position were also associated with elevated odds of antidepressant use (multivariate Odds Ratios: 1.24 and 1.36 respectively). In supplementary analyses, socioeconomic mobility was more strongly associated with depression in women than in men and in younger participants (18-29 years) than other age groups. Factors that contribute to depression risk and socioeconomic inequalities in this area appear at play already in childhood; this should be acknowledged by clinicians and policymakers

The Health Effects Of Expanding The Earned Income Tax Credit: Results From New York City.

Antipoverty policies may hold promise as tools to improve health and reduce mortality rates among low-income Americans. We examined the health effects of the New York City Paycheck Plus randomized controlled trial. Paycheck Plus tests the impact of a potential fourfold increase in the Earned Income Tax Credit for low-income Americans without dependent children. Starting in 2015, Paycheck Plus offered 5,968 study participants a credit of up to $2,000 at tax time (treatment) or the standard credit of about$500 (control). Health-related quality of life and other outcomes for a representative subset of these participants (n = 3,289) were compared to those of a control group thirty-two months after randomization. The intervention had a modest positive effect on employment and earnings, particularly among women. It had no effect on health-related quality of life for the overall sample, but women realized significant improvements

Public transport policy, social engagement and mental health in older age:a quasi-experimental evaluation of free bus passes in England

Background Social engagement and social isolation are key determinants of mental health in older age, yet there is limited evidence on how public policies may contribute to reducing isolation, promoting social engagement and improving mental health among older people. This study examines the impact of the introduction of an age-friendly transportation policy, free bus passes, on the mental health of older people in England. Methods We use an instrumental variable (IV) approach that exploits eligibility criteria for free bus passes to estimate the impact of increased public transportation use on depressive symptoms, loneliness, social isolation and social engagement. Results Eligibility for the free bus travel pass was associated with an 8% (95% CI 6.4% to 9.6%) increase in the use of public transportation among older people. The IV model suggests that using public transport reduces depressive symptoms by 0.952 points (95%CI −1.712 to −0.192) on the Center for Epidemiologic Studies Depression Scale. IV models also suggest that using public transport reduces feelings of loneliness (β −0.794, 95%CI −1.528 to −0.061), increases volunteering at least monthly (β 0.237, 95%CI 0.059 to 0.414) and increases having regular contact with children (β 0.480, 95%CI 0.208 to 0.752) and friends (β 0.311, 95%CI 0.109 to 0.513). Conclusion Free bus travel is associated with reductions in depressive symptoms and feelings of loneliness among older people. Transportation policies may increase older people’s social engagement and consequ