Family Care, Economic Stress, and Depressive Symptoms Among Chinese Adults During the COVID-19 Outbreak: Difference by Urban and Rural Areas.

Background: Although several studies have shown an association of family care with a high level of depressive symptoms, the relationship between them remains indistinguishable. Objective: This study aims to examine the associations between family care, economic stress, and depressive symptoms among Chinese adults in urban and rural areas during the COVID-19 outbreak. Methods: Based on cross-sectional data collected through online surveys from February 1st to 10th 2020 in China the present study recruited 2,858 adults. It used multiple linear regression to examine the association between family care and depressive symptoms, while economic stress was examined as moderators on the above relationship. Results: The results showed that caring for both the elderly and children was significantly associated with higher depressive symptoms compared with non-caregivers (B = 2.584, 95%CI: 1.254, 3.915), and a similar result was also found in urban areas. Also, caring for the elderly only was also had a higher level of depressive symptoms than non-caregivers in rural areas (B = 3.135, 95%CI: 0.745, 5.525). Meeting the care needs was significantly associated with lower depressive symptoms compared with unmet care needs, while for rural caregivers, the results were not significant. Besides, economic stress strengthened the effect of family care needs on depressive symptoms for sandwich-generation caregivers who provide care to both the elderly and children (B = 0.605, 95%CI: 0.077, 1.134). While in rural areas, the moderation effects of economic stress were only found for elderly caregivers (B = 1.106, 95%CI: 0.178, 2.035). Conclusion: These findings suggest that we should pay more attention to the family caregiver's mental health during the COVID-19 outbreak. In addition, more effective policies should be developed to provide financial support for family caregivers, especially for sandwich-generation caregivers and rural elderly caregivers.