Explaining gender differences in the associations between care network type and depressive symptoms of older adults in the Netherlands

Abstract

The association between long-term care use and mental health is ambiguous: informal care is generally negatively related to depressive symptoms, while formal care use is positively associated. As both care use and mental health are highly gendered, this study explored gender differences in the association between care network types and depressive symptoms and examined two potential explanatory mechanisms based on Self-Determination Theory: loneliness (indicating relatedness) and care sufficiency (indicating autonomy). The data are from ten observations of the Longitudinal Aging Study Amsterdam (N = 18,954 observations from 4,925 older Dutch adults, between 1992 and 2022). Six types of care networks are considered (partner, informal, formal, institutionalised, privately paid and no care). A mixed-model hierarchical regression analysis was applied across care network types, stratified by gender, using hybrid models that disentangle between inter-individual differences (context related) and intra-individual changes. Results from between and within effects show that, for both men and women, users of partner, privately paid and no care reported fewer depressive symptoms than formal care users. This also applied to informal care for women, but not for men. These differences between care network types were (partly) explained by loneliness (both between- and within-person effects) and care sufficiency (only between-person effects), for both men and women. Changes in loneliness and care sufficiency impacted women’s depressive symptoms more than men’s. Results that formal care users have more depressive symptoms are very robust and imply that formal care must align more with the needs for emotional support.