The findings are published in the journal Aging & Mental Health.

Older adults in China rely heavily on family support, particularly from their adult children. Filial piety--the Confucian idea describing respect for one's parents and responsibility for adult children to care for their parents as they age--is a central value in traditional Chinese culture. In the 1970s, China introduced a one-child policy to slow the population growth, resulting in hundreds of millions of families with only children. While the policy ended in 2016, its consequences will be felt for decades, particularly for families who experience the loss of a child.

"The death of a child has been recognized as one of the most challenging and traumatic events for a parent," said Bei Wu, PhD, Dean's Professor in Global Health at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator, as well as the study's senior author. "Within the cultural context of China, the death of an only child is devastating not only due to the emotional loss, but also the loss of financial and instrumental support that is critical to older adults." The death of a spouse is also recognized as a distressing life event, forcing older adults to navigate both the emotional loss and the shattering of a married couple's social and economic circumstances. In this study, Wu and her colleagues wanted to examine whether the loss of a spouse had a similar impact on psychological well-being as the loss of an only child and whether the presence of one mitigated the absence of the other.

The researchers analysed data from a 2013 survey conducted in Shanghai involving more than 1,100 adults, including 128 parents who lost their only child. The survey evaluated the impact of the loss of a spouse or child on participants' psychological well-being, including depression, loneliness, and life satisfaction. They found that adults who lost their only child but have a living spouse had more psychological distress than those who lost their spouse but have a living child. This effect appeared to be stronger in women than in men.

Losing an only child resulted in 1.37 times the level of loneliness and 1.51 times the level of depression as losing a spouse, and life satisfaction were 1.14 times worse for those who lost an only child vs. their spouse. Adults whose children and spouse were both alive had better psychological well-being than those who experienced loss. "Our findings demonstrate that the loss of an only child carries more psychological weight than the loss of a spouse in Chinese culture," said Wu.

Wu and her colleagues recommend increasing access to professional mental health services for adults who experience loss, as well as developing culturally relevant interventions to address social isolation and loneliness among older Chinese adults.