Psychological well-being of the institutionalized and community-residing oldest old in China: The role of children Guangya Liu a, * , Matthew E. Dupre b, c , Danan Gu d , Christine A. Mair e , Feinian Chen f a School of Law, Duke University, Durham, NC, USA b Department of Community and Family Medicine, Duke University, Durham, NC, USA c Duke Clinical Research Institute, Duke University, Durham, NC, USA d The Center for the Study of Aging and Human Development, Duke University, USA e Department of Sociology and Anthropology, University of Maryland, Baltimore County, MD, USA f Department of Sociology, University of Maryland, College Park, MD, USA article info Article history: Available online 3 August 2012 Keywords: China Institutionalization Psychological well-being Aging Family context Filial piety Chinese Longitudinal Healthy Longevity Survey (CLHLS) abstract Studies have shown that institutionalized older adults have worse psychological health than their community-residing counterparts. However, much less is known about this association in developing countries such as China with a rapidly aging population and a short history of institutional care. This article investigates the role of children in differences in psychological well-being between institution- alized and community-residing oldest-old adults in China. Using national data from the 1998, 2000, and 2002 waves of the Chinese Longitudinal Healthy Longevity Survey, results show that the institutionalized have significantly better psychological healthdmeasured by positive affect, loneliness, and quality of lifedthan those living in the community. Furthermore, we find that the associations are moderated by child-related factors (number of children, proximity, and visits) and strengthened for the three measures of psychological well-being after adjustments for socioeconomic factors, social support, health behaviors, and health status. The results underscore the importance of family dynamics for the psychological health of the institutionalized population in a historically family-care oriented society. Ó 2012 Elsevier Ltd. All rights reserved. Introduction The psychological well-being of older adults is a cornerstone of successful aging and healthy longevity (Maddox & Campbell, 1985; Okun & Stock, 1987). Broadly conceptualized across dimensions of perceived happiness, positivity, lack of loneliness, and overall quality of life (DeNeve & Cooper, 1998), psychological well-being is consistently identified as a potent predictor and principal outcome in aging research (Binstock & George, 2001). We now know that one’s psychological disposition is not only an antecedent of mental illness but is also an important determinant of physical functioning, chronic disease, and mortality (Cho, Martin, Margrett, MacDonald, & Poon, 2011; Diener, Sapyta, & Suh, 1998). Therefore, efforts have increased to improve the psychological status of older adults to promote health, delay illness, and extend longevity (see Rowe & Kahn, 1998; Zeng, Dudley, Vlosky, & Gu, 2008). An increasing number of studies demonstrate that the living arrangement of older adults is an important determinant of well- being (Davis, Moritz, Neuhaus, Barclay, & Gee, 1997; Michael, Berkman, Colditz, & Kawachi, 2001). However, studies seldom consider institutions as separate living environmentsddistinct from the communitydbecause data are often limited to non- institutionalized adults. Furthermore, most of our knowledge about institutionalized adults is based on Western nations and little is known about the institutionalized population in China, a devel- oping country with a short and unfolding history of institutional care. Over the past several decades, China has undergone rapid population aging amid massive social and institutional changes. With this recent modernization, China offers a unique context to investigate how the intersection of cultural norms and social institutions impact aging and the well-being of its population. Currently, China has the largest elderly population in the world and the largest number of adults over age 80 (i.e., oldest old), who consume the most extensive and costly health-care resources (Peng, 2011; United Nations, 2006). However, institutional care is relatively new to China because of its strong cultural norms that emphasize family ties, intergenerational bonds, and the importance familial care (Zhan, Liu, & Bai, 2005; Zhan, Liu, & Guan, 2006). Therefore, research on institutionalized older adults in China * Corresponding author. Tel.: þ1 919 613 7178. E-mail address: guangya.liu@law.duke.edu (G. Liu). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.socscimed.2012.07.019 Social Science & Medicine 75 (2012) 1874e1882