Caught in the middle: depressive symptoms and life satisfaction of the sandwich generation in four-generation lineages in China

Abstract This study examines the implications of intergenerational caregiving for depressive symptoms and life satisfaction among China’s “sandwich generation” individuals embedded in four-generation lineages. Using data from 9081 respondents aged 45–80 from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we measure depressive symptoms with the CES-D-10 scale and life satisfaction through a direct self-report question. Our analyses employ ordinary least squares and ordered logistic regression models, supplemented by propensity score matching and mediation analysis. Findings indicate that individuals providing simultaneous care for both aging parents and grandchildren report significantly higher levels of depressive symptoms and lower life satisfaction than non-caregivers and those providing single types of care. This association is mediated through three pathways: increased financial burden, constrained social participation, and reduced physical activity. Heterogeneity analyses reveal more pronounced adverse effects among women, rural residents, and those not yet retired, highlighting stratification in caregiving burden distribution. Women experience greater deterioration in well-being due to culturally prescribed caregiving roles, while rural residents face heightened vulnerability resulting from underdeveloped formal support systems. These findings challenge conventional assumptions about familial care in Confucian societies and advance the sociological understanding of family adaptation to modernization. By examining China’s case, our research illuminates parallel challenges across East Asian societies experiencing rapid demographic aging, where traditional filial norms increasingly intersect with modern socioeconomic pressures. The results underscore the urgent need for policy interventions that can effectively reconcile traditional family values with contemporary social realities across rapidly aging societies.