Mental Health and Well-being of Empty-nesters: A

Chinese Urban Case Study

HuiYang 
Minzu University of China School of Ethnology and Sociology
Aaron Hagedorn 
University of Arlington
Honglin Chen  (  chl@fudan.edu.cn )
Fudan University https://orcid.org/0000-0001-6625-989X
Ronghua Zhang 
Minzu University of China

Research article

Keywords: Mental health and well-being, empty nester, positive ageing, social work, urban China

DOI: https://doi.org/10.21203/rs.3.rs-88892/v1

License:   This work is licensed under a Creative Commons Attribution 4.0 International License.  
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Abstract
The research examined the mental health and well-being of a sample of empty-nesters in Jinan City,
Shandong Province. An in-depth individual interview approach, with document analysis and participant
observation was performed on three types of interviewees (N = 33) recruited via purposive sampling. The
empty-nesters faced many unique problems, especially a sense of being disjointed from the family,
community and society. In uencing factors included Chinese traditional lial piety culture, lagging
implementation of relevant policies and development of community ageing services, as well as the loss
of productive roles for the empty nesters. Implications for social work services are identi ed.

Introduction
Empty Nest refers to a phase in the family life cycle when all children have left home leaving only an
older couple or individual living alone (Bouchard, 2014; Chen, Yang, & Aagard, 2012; Duvall, 1957; Mount
& Moas, 2015). Cross-cultural studies, which highlighted diversity in empty nest experiences by ethnic
background and regional locale, pointed out that the empty nest applied mainly to white families rather
than African American, Hispanic, or Asian families (Mitchell, 2016), thus existing literatures are mainly
about the empty-nest experiences and responses in Western countries.

In the 21st century, China encountered rapid population ageing. The older population aged 60 years and
above increased from 132 million (10.3%) in 2000 to 254 million (18.1%) in 2019, and people aged
65 years and above are anticipated to increase from 176 million (12.6%) in 2019 to 210 million (15.0%) in
2025 (China Development Research Foundation, 2020). The growth of empty nests over the past decade
is a new phenomenon in Chinese culture, which historically emphasized large and close
multigenerational families. Along with the rapid urbanization which has been a global phenomenon, the
traditional extended family is less common as children study or work far from home and the tradition of
being supported by children has been challenged (Chen, Yang, & Aagard, 2012) leading to the empty nest
concept recently appearing in China. The 2010 Population Census showed there were 18.24 million
empty-nesters 60 years old or above who lived alone in China and an additional 21.89 million empty-
nesters living as couples. Compared to the 2000 Census, the empty-nest population grew 84.3% among
single empty nesters and 73.9% among couples in just a decade (Population Census O ce of the State
Council &National Bureau of Statistics, 2012). The China Family Development Report (National Health
and Family Planning Commission, 2015) shows that 10% of the older Chinese population are single
empty nesters, and 41.9% are empty-nest couples. It is anticipated that there will be 118 million empty
nesters in 2020, and the old-age dependency ratio will increase to 28% (The State Council, 2017). Thus
recent sharp increases in the number of empty-nesters led to the advent of related social problems such
as isolated elders without caregiver support and those who commit suicide (Xu & Yu, 2015).The current
policies and services in China focus on material needs of empty-nesters, but studies show that they are
often in need of support that addresses mental health and well-being in terms of psychological,
emotional and social items (Bai, 2015; Lu & Guo, 2013; Mu, 2004).

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Mental health and well-being is de ned in the current paper as a general state of being content with life
as it is, and not feeling depressed or anxious about current circumstances. It exists when one perceives
respect for individuality, feels emotional comfort, and a capacity for social achievements that contribute
to the realization and ful llment of self-worth (Mu, 2004), in Chinese “ ” (jingshen yang lao). Respect
for individuality is represented by items such as self-respect, desire for respect from others, and
autonomy. Emotional comfort can be a positive affective state, and social achievements of the older
people is linked with social participation. To improve the mental health and well-being of older people is a
policy-relevant issue for more effective community-based care. What are the barriers to achieving mental
health and well-being among empty-nesters in China? What kinds of social work services could be
provided? This study offers some preliminary answers to these questions through a case study in Jinan,
Shandong Province.

Literature Review and Theoretical Framework

Western studies on the empty nest started in the 1950s, mainly focused on the determinants of nest
leaving and in uences of empty nest on marital quality, relationships with children, physical and
psychological well-being of the parent(s), as well as gender differences (Bouchard, 2014). To enhance the
life quality of empty nesters, not only family but also government policies and social organizations are
involved (Chen, Yang, & Aagard, 2012). In the early 1980s, the US and European countries began to adopt
policies and programs of supportive housing and personal care service need services, as well as mental
health needs, of older people (Zhou, 2005). For instance, the US Program to Encourage Active, Rewarding
Lives for Seniors (PEARLS) (National Council on Ageing, n.d.) encourages input from the society to ful ll
the older people’s sense of self-actualization and emotional ful llment. Mental health needs have only
recently been directly addressed in social policies in China, whereas policies and programs addressing
housing and personal care needs have been in place since 1990s. Since 2004, scholars have started
research on the mental health issue of this population (Chen, 2014; Fang, 2009; Liang, 2013; Shao, 2006;
Zuo & Gao, 2004). For example, the prevalence of depressive symptoms is higher among an empty nest
group than that among intergenerational families in China, especially among those who are not willing to
participate in group and social activities (Zhai, 2015). Resilient empty nesters have higher quality of life
because they tend to adopt positive coping skills and are more active and e cient in social activities
(Cao, Qian, & Yang, 2020). Many studies (e.g. Jiao, Zhang, Xie, & Peng, 2010; Tong, Lai, Zeng, & Xu, 2011;
Zhai, 2015) identify that empty nesters with higher levels of education have better mental health than
those with fewer years due to more social resources for adaption. Some empty nesters are entirely
neglected by the children (Liu & Deng, 2012). A combination of home and community-based care may be
needed, with institutionalized care likely for some needs (Liu, et al, 2015).

Role loss theory, which predicts a loss in sense of accomplishment as parental roles wane might lead to a
decrease in well-being, as well as role relief theory, whichsuggests the empty-nest stage could lead to an
improvement in parental well-being due to reduced exposure to stressors, provided two contradictory
explanations of the empty-nest effect (Bouchard, 2014; Umberson, Pudrovska., & Reczek, 2010; White &
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Edwards,1990). Both theories emphasize the importance of social participation to the personal identity of
empty-nesters. Social participation is the most pivotal character of positive ageing (Bowling, 2006). In
1999, the World Health Organization called for “positive ageing” and in 2002, this was o cially included
in the Political Declaration at the Second World Assembly on Ageing (United Nations, 2002). Thus,
positive ageing was formally proposed as an active response to population ageing in the 21st century. It
is the product of the interaction between people and social cultural elements, and the older people could
actively and creatively construct meaning and opportunities for this part of the life course (Burr, Caro &
Moorhead, 2002; Guo & Shi, 2006). The positive ageing perspective proactively creates conditions that
promote social engagement rather than social exclusion, so that people could feel a sense of joy and
ful llment in old-age (Bass & Caro, 2001; Jiang, 2011). Positive ageing helps identify latent ability to self-
advocate and pursue hobbies and interests, as well as to access services and care and social bene ts in
the process (Chen, 2015). Positive and adaptive meaning making helps empty nesters manage the
transition more effectively, nding new meaning in life can extend their social relationships and roles
outside the home (Mount & Moas, 2015). Social activities play a key role in maintaining life satisfaction
for those in an empty nest, and it is critical for communities or local governments to assist empty nesters
to maintain engagement in social environments (Chen, Yang, & Aagard, 2012).

Positive ageing theory will be adopted to analyze the current conditions of mental health and well-being
of empty nesters in a Chinese urban community. This study focuses on two important factors affecting
life quality of older adults in the empty nest: personality and level of social participation (Chen, Yang, &
Aagard, 2012). Cultural and social policy perspectives are not often addressed in relation to outcomes of
those in an empty nest, thus the causes of negative reports of mental health and sense of well-being will
be explored.

Methods
This study was conducted in one community in Jinan city, Shandong Province. In 2018, the population
above 60 years old in Shandong Province was 22.40 million, accounting for 22.29% of the total
population in the province, of whom 58.36% were empty nesters (Health Commission of Shandong
Province, 2019). The sample was drawn from a traditional community of Jinan City where there are 2,055
families and 3,200 permanent residents, among whom 20.2% were above the age of 60. There were 52
empty-nest families, de ned as all children having left home permanently for at least six months, in this
community, and almost 70% lived alone and were thus classi ed as single empty nesters. The
community was staffed with a liaison coordinator who collected information on the community residents,
including empty-nest families, and then reported to the community cadres.

Sampling and Data Collection

The study employed an in-depth individual interview method, with document analysis and participant
observation to add supplemental data. National and local policies on elderly care, study reports, working
papers, and the records of the community cadres were reviewed during document analysis. For six
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months, our study team paid regular visits to this community, collecting facts on the community service
development process, daily life, and participation of the older people in community activities through
participant observation. These data were recorded as diary, photos and videos with the consent from the
community residents. In the semi-structured individual interviews, 25 empty-nesters in the community
were purposively screened and sampled to ensure their health status enabled them to participate in the
interview process and they were willing to participate in the interviews. Four sections of questions were
developed specially for them: (1) the basic living status of the family (e.g. gender, age, education level,
living pattern, number of children, where they live now, frequency of meeting children, pension or medical
insurance status, children currently offering any support, any di culty in satisfying basic living needs);
(2) their mental health and well-being (e.g. feeling of everyday life, satisfaction with your life after
children left, current situation of communication with children and other people, daily activities, types of
community participation, expectations of life, evaluation of mental health and well-being situation); (3)
the causes of problems of their mental health and well-being (e.g. problems encountered affecting well-
being, whether need help with these problems, awareness of relevant social policies concerning the
mental health and well-being at the national or provincial level, assessment of community services in
satisfying their mental health and well-being; and (4) participant feedback about what could be done to
satisfy their needs (e.g. factors that could be improved to satisfy mental health and well-being; ides on
government, community, and family roles to improve mental health and well-being). Interviews were
conducted in the interviewee’s home and each interview lasted for about one hour. If the participant’s
children happened to be present (n = 2), the interviewer also asked their perception of their parents’ elderly
life. Examples of questions asked to adult children include: What kinds of support have you provided to
your parent(s)? How do you evaluate the relationship between you and your parent(s)? What could be
done to improve their mental health and well-being?

The information concerning interviewed empty nesters in the community is presented in Table 1. The
sample is representative in terms of empty-nest type. with 68% (N = 17) single empty nesters. Most
participants were retired and only one person out of 25 had no pension. Moreover, all of them received
some money from their children, so they were not without income. Some of the older people offered their
own savings to subsidize their children. All participants were quali ed for the Basic Medical Insurance for
Urban Employees. About 70% were able to take care of themselves, while the othera needed some
assistance with activities of daily living.

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 Table 1
Basic Information of the Interviewed Empty Nesters
Gender Male Female        

number 11 14        

percentage 44% 56%        

Age distribution 70—75 76—80 81—85 86—90 Above 90  

number 5 9 3 4 4  

percentage 20% 36% 12% 16% 16%  

Empty-nest type Single Spousal        

number 17 8        

percentage 68% 32%        

Pension Yes No        

number 24 1        

percentage 96% 4%        

Residence of children Abroad China Shandong Jinan City    

Outside Outside
Shandong Jinan

number1 9 20 19 21    

percentage2 13% 29% 28% 30%    

Frequency of meeting Daily Weekly Monthly Every half A year or Others

with children a year above

number 2 5 4 5 8 1

percentage 8% 20% 16% 20% 32% 4%

1
note “Number” here refers to the number of children who live abroad or outside Shandong Province;
“number” in other columns refers to the number of the elderly.

2
note The 25 empty nesters who were interviewed have altogether 69 children, and the percentage refers
to the ratio between the number of children living in different locations and the total number of children.

Further interviews were conducted among three community cadres and ve social workers. Five social
workers from “Jicheng Community Service Centre” conducted a needs assessment of the residents in this
community and all of them were invited to participate in the interviews. Suggestions were also sought
with regard to their understanding of the mental health and well-being of empty nesters in this

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community. Examples of questions asked are: Do you have regular interaction with the empty nesters in
this community? Do you have any special concerns about the mental health and well-being of this group
of people? What kinds of community services (social work services) have you provided to the empty
nesters? What problems have you encountered in providing these services? Do you know relevant social
policies concerning the mental health and well-being of old people in China as well as in Shandong
Province?

Interviews with community cadres and social workers were conducted in the community committee o ce
and each interview lasted for about 1.5 hours.

Data Analysis
All the interviews were recorded with the consent of the interviewees, and the transcripts were analyzed
via content analysis by the researcher. Regarding the phenomenon of unmet mental health and well-
being, the macro, meso and micro levels of contextual conditions, causal conditions, and actions were
identi ed as main themes. The macro level included social, cultural and policy dimensions (i.e., the
Chinese traditional lial piety culture and relevant elderly-care policies), and the community dimension
(community ageing services) constituted the meso level. The family and individual dimensions (the
empty nesters and their family) were categorized into the micro level. The reports about the mental health
and well-being of the empty nesters as well as the causal conditions will be presented in the next section
at three levels.

The validity of the data analysis was rstly veri ed by checking the interview transcripts with the
interviewees and discussing the analysis results for their feedback. After further clari cation from the
participants, more detailed constructs were identi ed for individuals. Any coding result not veri ed by
participants was revised integrating their clari cation and noting the old and new information. A second
team of researchers experienced in qualitative study reviewed the content analysis process and results
and suggested minor modi cations.

Findings
Research ndings are presented in two parts: The participants’ current situation of mental health and
well-being, and the barriers to achieving better mental health and well-being. In both parts, the family and
individual dimensions, the community dimension and the social, cultural and policy dimensions are
included.

The Mental Health and Well-being of Empty Nesters

The interviewers’ observations and interview responses demonstrated relatively little general optimism
among the empty nesters about life. For example, one of the interviewees said:

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“I stay in the building all day and feel I am separate from the outside world; I myself am useless and my
life is absolutely meaningless” (Case No. 2).

The empty nesters’ generally negative attitude towards their own mental health and well-being
demonstrated a low level of family, community and social participation as well as the potential for
service interventions to address this issue.

Children’s Company, Family Participation, and Mental Health and Well-being

Older people tend to place signi cant value on their home as both their main living space and the source
of emotional support. Social mobility has led to reduced family availability and disintegration of the
traditional function of the family providing support for the aged. Table 1 shows that 70% of the children
of these participants lived outside Jinan City, and 52% met their children less than twice a year. Some of
the children called them only once a month or less. Conversations were often related to food, health and
daily life, rarely about their psychological and spiritual life. Respondents reported a need for more
communication and interaction with the children, but their children did not really understand their needs.
Services, Community Participation, and Mental Health and Well-being

Table 2 re ects the types of needs for community services, among which “provide company and chat”
was the most common. The interviewees said that they hoped very much to interact with people in the
community as well as people in the society so that they could gain mental support and emotional
satisfaction. They looked forward to Fridays when the community cadres paid a visit to those who could
not go out and talk with them. A community cadre shared her experience:

Initially I thought that a brief visit to the empty nest households would be enough to understand their
basic situation and keep a record for them. After the visit, I discovered that they were very eager to have
someone to talk to, especially those who living alone with only TV as their companion. They can talk for 2
or 3 hours without realizing the time passes during our visit.

Table 2
Need for Community Services of Empty Nesters
Need for services Number Percentage

Door-to-door housekeeping service 3 12%

Acompany to hospital 6 24%

Care-giver respite 3 12%

Company and chat 21 84%

Food delivery service 3 12%

Daily shopping 3 12%

Legal assistance 1 4%

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In terms of entertainment activities, most participants watch TV, chat, play cards, plant owers, keep a pet
and go to church. These activities were con ned to their own homes, former colleagues’ homes or
churches.. An interviewee explained:

“There is little entertainment activity, just watching TV and reading newspapers to know what has
happened outside. If I got very bored, I will go to see my former colleagues and chat with them. Before
retirement, there was an activity room in my working place and we often went there for entertainment
after work. Our life was quite ful lled through these activities. However, it is different in the community.
There are so few sports and tness facilities that whenever we go, they are occupied by someone else.”
(Case No. 4).

According to the participant observation and interviews with the community cadres, the community
development lags behind expectations and it has just started to provide services for the aged. For
example, home-based care services mainly covered a meal-delivery service. Other services were still being
planned, e.g., handicraft groups, medical care seminars, psychological counseling, and more. The
development of mental health and well-being services in other communities, even within those well-
developed social services communities, did not make up for shrinking family support.

Meaning, Social Participation, and Mental Health and Well-being

Respondents noted retirement caused a lowering of their social status and less respect from working
neighbors. Some felt that the way other people looked at them was different than before, and life had
become gloomy after giving up their social life and reducing self-values and aspirations.

Most of the empty-nesters in this community participated in Christian activities as a major part of their
social life. Their beliefs focused more on the spiritual aspects and social gatherings inspired by holidays
of the religion than on any strict theological interpretation. For example, one older people respondent told
us:

“At the beginning, I don’t believe in God. I live alone and my children stay overseas most of the year. I have
not much to do every day. Once I went to the church, where I talked, sang and prayed with the others.
Believe it or not, it seemed that God heard my prayers. He let my daughter come back to visit me.
Gradually I come to believe in God and pin my hope on Him. A lot of older people here are just like me”
(Case No. 6).

One thing to note is that up to 87% of empty-nesters in this community have a high school diploma or
above (about 68% have a college diploma). However, the more educated the respondents wereless likely
to respond that they felt psychologically ful lled. This suggests that, at least in this community, highly
educated people are more likely to have lower levels of psychological ful llment. In addition, the
community cadres shared that these highly educated older people were more reluctant to seek outside
help.
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Barriers to Positive Mental Health and Wellbeing of Empty
Nesters
This case study nds that the empty nesters’ mental health and well-being may be affected by a variety
of factors, including culture change, lack of effective policy implementation and community services, and
loss of a role for the older people.

Culture Change

Chinese society values lial piety, which is especially evident in the cultural history of Shandong Province.
Shandong is the home province of Confucius and Mencius, and is thus the original place of Chinese
Confucianism and its core value of lial piety (Wang, 2012). Filial piety is a central element of Confucian
philosophy, which demands respect and support for one’s parents and family elders. It has been a core
value fundamental to Chinese moral norms and value systems. As the society has become more
industrialized, there has been a shift from family obligation to individual needs (Cheung & Kwan, 2009).
Young people attach more importance to their career achievement as the basis of their self-value, while
they show less lial duty to and respect for their parents (Sun & Zhou, 2013; Han, 2016). For example, one
single empty-nester said:

“The society has changed and the lial piety culture isn’t valued. The way they (the younger generation)
treat us is totally different from how we treated our parents. Their love for us has been commercialized.
They are competitive in buying precious stuff for me, but I don’t need them indeed. We have less respect,
emotional care, company and communication from them, and I feel that I’m not important for them (Case
No. 9)”.
Lack of Effective Policy Implementation and Community Services

The rst major relevant policy in China was the Law on Rights and Interests Protection of the Elderly
issued in the August of 1996. Article 11 stipulated that the families assumed the duties of offering
nancial and psychological support as well as life-caring services to the older people. However, in the
ensuing years, mental health issues affecting the older people did not yet draw the attention of families
and society. The amended 2013 version of this law highlighted the mental health concerns of older
people, addressed in Article 17, which was about mental care from the children, and Articles 38, 67, and
72, which demonstrated how policy can promote socialization with neighbors and participation in social
activities. It extended the obligation of psychological support of the older people from the family to the
social service sector. Nevertheless, in practice, this regulation was more of a social mandate describing
an expectation than a strictly enforced law. The 2015 revised Regulations on the Protection of the Rights
and Interests of the Elderly in Shandong Province did not highlight the importance of elders’ mental
health and well-being either.

According to the community cadres’ interviews, while assessing the old-age care needs of older people,
the administrative departments focused on material and physical indicators. As a consequence, while

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community elderly services ourished, the mental health and well-being of residents had unmet needs.
For instance, the Community-based Elder Care Public Service Platform of Shandong Province provided
care services, health services, and life services, but little to address mental health and well-being issues.
Loss of A Role for The Older People

In the current old-age care policies and services covering urban communities, the self-identi ed needs are
viewed as thoughts of passive recipients of the services and play little role in the actual provision of
services. Among those who were interviewed, their sense of personal worth and recognition of their self-
e cacy was lacking. The older people themselves also limited their roles in ageing services, which was
especially noteworthy when it came to mental health and well-being.

Some older people found that it was di cult for them to adjust to the ageing process and the changes in
their social roles. They chose to con ne themselves to their narrow living space, unwilling to take part in
social activities. As a result, many reported that they suffered from feelings of psychological emptiness.
Second, empty nesters cherished a deep-rooted notion of who they should rely on for caring, strongly
believing the responsibility lied with their children, although they were aware their children had different
notion of family support. Third, the older people did not normally spell out their psychological needs. The
older respondents themselves told us:

“How can I speak up my needs? I don’t want to ask for their care and concerns.

What I want is their voluntary care” (Case No. 15).

The community cadres also mentioned that they were cooperating with social workers in conducting
assessment on the psychological needs of the empty nesters. However, the problem was that the older
people didn’t want to articulate their needs or request help. Fourth, many older people were ashamed to
ask for help. To them, getting help meant causing their children to lose face and simultaneously bringing
trouble to the community. For example, one interviewee said:

“The community cadres are very nice. They try to do everything for me. However, I don’t think it’s
appropriate. They are busy people and they don’t need to do what my children are supposed to do for me”
(Case No. 17).

Discussion And Implication For Social Work Services

The active participation of older people in designing social support systems is critical to positive ageing.
The results indicated many empty nesters feel a tension for the lack of family support and or comparable
social services available, and very limited participation in family and community events leading to role
loss. Even lower participation by highly educated older people calls for further study. There is untapped
potential for positive ageing which social workers may address while diversifying the resources of care
provided by adult children and developing social services that address mental health and well-being. The

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implication of positive ageing theory is that community services designed to support social participation
play an irreplaceable role in promoting the value of mental health and well-being.

The sampled community represents urban communities across Jinan city which are in urgent need of
community services due to rapid social, economic and demographic changes. Social workers could work
together with the community and government departments to promote policy awareness and community-
based elderly services based on the Guide for Social Services among the Elderly, written by social work
education and research institutions, social work agencies and social work associations in 2016.. It clearly
states that social work services for older people should include psychological comfort services,
community participation, and old-age education. Social workers should follow the Guide and help the
communities and social work agencies address needs.

A focus on the development of community services designed with the active engagement of older adults
in the region is a necessary step in the resolution of mental health and well-being problems of the empty
nesters. Social workers could help the empty nesters to reframe their view of retirement and address
issues that normally challenge those without support networks through casework and group services.
This model could expand across China and similar areas which could bene t from implementing client-
centered elderly-care policies.

Finally, we should acknowledge the limitation of this research. A case study in one city based on 25
interviews is quite limited considering the diversity of contexts within China. However, this analysis of the
various layers of factors which have created challenging conditions for those living without adequate
support has identi ed some common mental health and well-being issues for Chinese empty nesters, and
accordingly the implications for further improvement are valuable. In addition, this research mainly
explores the common needs of empty nesters, and doesn’t further address the differences between males
and females which is worthwhile to tackle in future study.

Declarations
Acknowledgements

The authors would like to acknowledge the Fulbright Scholar Program for sponsoring the corresponding
author’s sabbatical in Los Angeles.

Authors’ contributions

HY and HLC were instrumental in the conception of the study. HLC provided acquisition of the data and
analysis and interpretation of the data and its theoretical context. AH provided guidance on substantial
contributions to the writing and interpretation of the results and many editing work. HY and RLZ made
substantial contributions to the writing and data analysis. All authors have read and approved the
manuscript for submission.

Funding
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The study was partially funded by the Major Program of the National Natural Science Foundation of
China Grant No. 71490733 and the Shanghai Municipal Education Commission Research and
Innovation Project [Grant No. E00026]. The rst funding supported the team to collect the data and
both funding partially supported the data analysis procedures of the paper.

Availability of data and materials

The data that support the ndings of this study but restrictions apply to the availability of these data,
which were used under license for the current study, and so are not publicly available. Data are however
available from the authors upon reasonable request and with permission of the funding unit.

Ethics approval and consent to participate

The data were collected in accordance with the Declaration of Helsinki by The research team. The study
was reviewed by the institutional Review Board at Fudan University, IRB approval number 2019SL1001.
All participants in the original survey voluntarily participated after being offered a written informed
consent explanation.

Consent for publication

The research team and the funding grant encourages publication of results for scholars who have access
to their data. Their website describes more than 150 papers published in China using their data, mostly in
Chinese.

Competing interests

The authors have no nancial, non- nancial nor commercial competing interests to declare.

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