The uneven distribution of resources based on gender identity is common in various social contexts. When social norms emphasize that women should be in a subordinate position, gender discrimination arises. China has experienced thousands of years of feudal culture, and the concept that the status of men is above that of women has become an important feature of traditional Chinese culture. Although the gender productivity gap has narrowed with the shift from agriculture to industrial production, the late start of industrialization in China means that the differences in the identity and status of men and women has not yet been eliminated. In addition, China’s one-child policy before 1979 implied parental son preference (PSP). At that time, when there was no legislative mandate to have only one child, when the first child of a rural family was a girl, a second child could be born (J. Li & Santana Cooney, 1993), After 1979, the condition that couples have only one child, regardless of whether it was a boy or a girl, was incorporated into the Constitution of China. This one-child policy was not cancelled until after 2016. Thus, the concept of men’s superiority over women has a deep foundation in Chinese families.

Studies have shown that gender discrimination is associated with worse mental health for those experiencing the discrimination. For example, in 2021 the Chinese government proposed a policy allowing couples to have three children and supporting measures, which made the discrimination against women in job hunting even more serious (Xu, 2021). Women are more likely to be laid off than men are in the wake of the COVID-19 pandemic, which has increased the mental strain of some women (Cai & Chen, 2021). However, the focus in previous studies has been mainly on the experience of gender discrimination in the labor market, while gender discrimination within the family has not been explored (Batool, 2020). Life-course theory proposes that there is a long-term relationship between early experiences and various adulthood outcomes (Settersten, 2002). Therefore, when children are disadvantaged through the influence of parents’ sexism in their early years, it may have a lasting impact on their mental health in adulthood and even in old age. In addition, as one of the main forms of primary group relationships, early peer relationships have a long-term impact on and are related to mental health in adulthood and the whole life process (Burr et al., 2020; H. Chen et al., 2020; Jiang & Wang, 2020). Therefore, experience of sexism and childhood friendship are two factors that are present early in the life course, and childhood friendship may have a buffering effect that alleviates the poor mental health that is a consequence of the child experiencing sexism.

Conceptual Framework

Parental Son Preference and Health

Although many people protest against gender discrimination, it still exists, with cultural factors—including traditional and religious rituals, politics, and economic factors—playing an important role in discrimination against women (B. Liu et al., 2006). In China, PSP affects all aspects of women’s lives, including limiting access to employment opportunities and medical insurance (Qiao & Li, 2010). Empirical evidence shows that PSP is associated with major depression and posttraumatic stress disorder (McLaughlin et al., 2010). For example, PSP has a more profound influence on depression, anxiety, and symptoms of physical illness in women than in men (Klonoff et al., 2000; L. Platt & Polavieja, 2016). In contrast, no difference according to gender has been observed in depressive symptoms among spouses where the woman’s income is higher than the man’s (J. Platt et al., 2016).

The health risks brought about by perceived gender discrimination may be persistent and show a cumulative effect. Many studies have explored the relationship between early experience and adult health, and it has been recognized that early experience is the basis of people’s entire life cycle development, childhood experience is the starting point of many diseases, and adult health is the continuation of childhood diseases (H. Chen et al., 2020; Y. Chen et al., 2021; Friedman et al., 2015; Jiang & Wang, 2020; Levine et al., 2015; Warren, 2016). Gender discrimination can also create additional personal stressors through denial of opportunities and systematic stratification into stressful social roles and contexts (Pearlin et al., 2005; Taylor & Turner, 2002), which is known as stress proliferation (Pearlin et al., 2005) and reflects the trend of early and chronic stressors spreading outward to other fields, resulting in secondary stressors. Through such a mechanism, the health risks brought by gender discrimination continue to expand in a lifetime, resulting in the accumulation of disadvantages (Geronimus et al., 2006; Taylor & Turner, 2002; Walsemann et al., 2008). Therefore, PSP may be related to depression symptoms in adulthood, which accumulate with age.

Parental Son Preference and Health Outcome: Gender Disparity

Although PSP is aimed at women, it may also have spillover effects onto men’s health. PSP leads to gender segregation of peer relationships in early childhood (Kovacs et al., 1996), which hinders communication between children and their other-gender peers. The ability to build relationships with peers of other genders increases the diversity of children’s experiences and helps them learn how to interact with peers with different skills, backgrounds, and interests (Poulin & Pedersen, 2007), which improves their thinking flexibility (Poulin & Pedersen, 2007). Therefore, experiencing PSP may impact boys’ social communication ability by breaking ties between children, subsequently affecting their health status in adulthood. However, gender discrimination is still targeted at women, so that for gender identity, PSP has a greater impact on women’s depression symptoms than is the case for men.

Childhood Friendship Experience and Health

As one of the main forms of primary group relationship, early peer relationships have a long-term impact on mental health in the whole life process. The early peer relationship has the characteristics of intimacy and reciprocity and conveys more emotional than interest demands and also more emotional demands than instrumental values. In contrast, social networks in adulthood are more purposeful than purely emotional, containing more instrumental values or interest demands. Findings from many theoretical and empirical studies show that social relationships are the key determinant of mental health. Positive social interaction improves mental health, whereas isolated and inactive interaction usually leads to poor mental health (Burr et al., 2020; H. Chen et al., 2020; Jiang & Wang, 2020).

The experience of gender discrimination may inhibit the ability of young people to make friends with other-gender peers. Andrews et al. (2018) found that young people who experience higher levels of gender discrimination before entering middle school spend less time than their peers do with other-gender friends throughout middle school and are less willing to make friends with people of other genders. An important challenge in building friendships with peers is encountering rejection or discrimination. Such experiences often result in lower self-esteem and adverse effects, leading to withdrawal and opposition to friendship building (Beale Spencer et al., 1997; Smart Richman & Leary, 2009). In addition, experiences of rejection and discrimination affect how young people see themselves and how they interact with the world and the self (Beale Spencer et al., 1997). Early association with peers may, however, alleviate the decline in mental health brought by experiencing sexism.

Study Aims and Hypotheses

Method

Participants and Procedure

The data were drawn from the China Health and Retirement Longitudinal Studies that were conducted in 2014 and 2018. These surveys were conducted in China with 450 neighborhood (village) committees in 150 counties and districts of 28 provinces (autonomous regions and municipalities directly under the central government). The data were collected mainly from people aged over 45 years and included community, family, and individual questionnaires, covering basic information, income, occupation, health status, and pension. The survey in 2014 included the particular topic of the life course, in which the respondents’ childhood family, parents, health status, and other aspects were investigated. For our study we derived the data on childhood friendship experience, childhood socioeconomic status, and childhood health status from the survey in 2014. Depression symptoms, demographics, and socioeconomic characteristics came from the survey in 2018.

Measures

Symptoms of Depression

Parental Son Preference

Childhood Friendship Experience

Control Variables

Data Analysis

We first compiled a statistical description to show the features of the sample. Since CES-D scores form a continuous variable, for our statistical model we adopted multiple regression analysis based on ordinary least squares (OLS) regression. Considering that the independent variable has a certain degree of selectivity, we used the generalized propensity score method to investigate the intervention effect of PSP on depression.

The first part of the empirical analysis was mainly a discussion of the partial correlation between PSP and depression, in which we examined the cumulative relationship between these two variables. First, the OLS estimations of PSP and depression were analyzed with the total sample. Second, we used OLS estimation of interactive items and depression to construct the interactive items between PSP and age groups.

Gender differentiation in depression is widespread, so it is necessary to pay attention to gender heterogeneity when exploring the effect of PSP on depression. In the empirical analysis we constructed the interaction term of PSP × gender to explore whether there is gender heterogeneity in the relationship between PSP and depression in Chinese people aged 45 years and over. Then, we used urban and rural subsamples to investigate differences in the interaction between PSP and gender. Finally, we constructed the interaction term of PSP × age and investigated the coefficient difference between subsamples of men and women.

Considering that PSP has a certain degree of selectivity, to alleviate the estimation bias caused by the error of omitting variables, we used the generalized propensity score matching method to investigate the intervention effect of PSP on depression. Generalized propensity score matching inherits the core of propensity score matching. The most significant advantage of generalized propensity score matching is that it breaks through the constraint of propensity score matching that the treatment variables must be dummy variables and retains propensity score matching to eliminate the measurement error caused by the heterogeneity between the processing group and the control group before receiving policy processing. The matching process of generalized propensity scoring satisfies three stages: (a) estimating the conditional density function of processing intensity under a given covariate; (b) according to the processing intensity and generalized propensity score, a model for estimating the conditional expectation of output variables is constructed; and (c) on this basis, the processing intensity value to the processing variable and the score value to the score value estimation function is replaced, and then the images of the average dose-response function and the processing effect function in the value range are drawn.

Finally, we constructed the interaction term of PSP × CFE to investigate the moderating effect of CFE. In addition, we used the subsamples (men and women) to investigate differences in the moderating effect of CFE between these two genders, which allowed us to establish whether the effect of CFE was stronger for women than it was for men.

Results

Sample Description

Table 1 shows the essential features of the sample. There were about 5% more women than men and the mean age was over 60 years. More than 60% of the sample was educated at or below a primary school level, and the proportion of the sample with a college-level education or higher was low. Just under 15% of the sample were not married. Few had a Communist Party membership. In terms of residence, rural residents made up the majority, with only one in five living in urban areas. The proportion of respondents who had been unhealthy as children was slightly higher than that of the group who had been healthy as children. From the characteristics of independent and dependent variables, the degree of depression was relatively low but the variation was high. Most respondents perceived their parents’ son preference as not serious. Childhood friendship experience was relatively positive.

Association Between Parental Son Preference and Symptoms of Depression

Table 2 shows the association between PSP and symptoms of depression. In Model 1 we used a multiple regression model based on OLS to analyze the relationship between PSP and depression in later life. In Model 2 we divided the sample into three age groups: under 60 years, 60–70 years, and over 70 years, and we also constructed the interaction term of age group × PSP and then explored whether there is a cumulative effect of disadvantage by PSP.

Results in Model 1 suggest that the more pronounced was PSP, the more serious was the depression of individuals in later life. Results in Model 2 suggest that the positive relationship between PSP and depression was cumulative as age increased. Thus, PSP experienced as a child was a risk factor for depression in people aged 45 years and over, and there was a significant cumulative effect of disadvantage alongside increasing age.

Table 3 shows the relationship between PSP and symptoms of depression in later life from the perspective of gender differentiation. Model 1 constructs the interaction term of PSP × gender, with men as the reference group. Models 2 and 3 construct the interaction term of PSP × age group, and we used the subsampling method to explore the role of PSP in depression of the participants in later life. In Models 4 and 5 we investigated differences in the interaction coefficients of PSP according to age group.

Results in Model 1 suggest that more serious PSP was associated with more symptoms of depression in later life, and the link was stronger for women than for men. Models 2 and 3 suggest that the more serious the PSP, the more symptoms of depression rural women have. Models 4 and 5 show that the positive association between PSP and depression increased with age. However, there were gender differences in reducing depression by PSP. Compared with the sample aged 45–60 years, in the sample aged over 60 years the coefficient for women decreased from −.059 to −.699, a decrease of .340, whereas the coefficient for men decreased from −.538 to −.790, a decrease of .252, which suggests that the cumulative effect of the disadvantage of PSP on depression was stronger for women than it was for men.

The Treatment Effect of Parental Son Preference on Symptoms of Depression

The dose-response relationship function takes the mean value at each level of PSP, and the function has the direct effect of reporting the intervention effect. The solid line is the PSP estimate of symptoms of depression, and the dotted line is the 95% confidence interval based on 100 bootstrapped resamples. The dose-response function shows the predicted values of dependent variables at different intervention levels after experiencing PSP. The treatment effect function shows the marginal utility of the dependent variable at each intervention level.

The treatment effect function reports the change rate of symptoms of depression at different PSP levels. As can be seen in Figure 1, the depression symptoms corresponding to varying levels of PSP value showed a similar V-shaped change. When the PSP value was greater than 2, the change rate of depression symptoms showed an increasing marginal trend.

From the dose-response function, men and women showed consistency in the monotonicity and shape of the curve but differences in the magnitude. When the specific level of PSP for the women was less than 2, the value of PSP for the men was less than 0. When the level of PSP was 3, the predicted value of depression symptoms for women was about 21, which decreased by approximately six units, whereas that for men was about 18, which fell by about five units. Therefore, from the analysis of the intervention effect, with the decrease of PSP, symptoms of depression also showed a trend of synchronous decrease and, compared to the men, the decrease range of the women was relatively greater.

The Moderating Role of Childhood Friendship Experience

In Model 1 we explored the moderating role of childhood friendship experience for the full sample. In Models 2 and 3 we divided the sample into men and women, to explore the gender heterogeneity of the moderating effect of childhood friendship experience.

The Model 1 interaction term coefficient of PSP × CFE suggests that a positive childhood friendship experience alleviated depression in later life after experiencing PSP. The subsample results of Models 2 and 3 for the interaction term coefficients of PSP × CFE suggest that a positive CFE had a stronger moderating effect for women than it did for men.

Discussion

We found that PSP positively influences depression symptoms of men and women in later life, and that depression symptoms in later life following the experiencing of PSP in childhood accumulate as individuals age. This result also supports disadvantage cumulative risk theory, that is, the impact of unfortunate early experiences on future health is not only sustainable but also has strong cumulative characteristics (Greenfield & Marks, 2009; Lloyd & Taylor, 2006; Lloyd & Turner, 2008). Therefore, the negative health consequences brought by the experience of PSP deserve attention. We note also that the experience of gender discrimination has a profound historical and cultural foundation. On the basis of gender roles bred during the ancient mode of agricultural production by plowing, gender inequality still exists even thousands of years later (Alesina et al., 2012), which derives from the concept of gender division in the labor market and in the family at social and cultural levels. Finally, the concept of gender division in the labor market and in the family forms the idea of preference for boys over girls in some extreme cases. Hosang and Bhui (2018) found that experiencing PSP has a negative impact on children’s sense of belonging, self-confidence, and material acquisition. Therefore, experiencing sexism during childhood has long-term and cumulative impacts on mental health.

We also found that, compared to men, women have more symptoms of depression in later life after experiencing PSP in childhood, especially rural women. First, early friendship plays an important role in children’s physical and mental health. The negative emotions of female playmates may be transmitted through social communication activities so that both men and women are affected by sexism. Second, girls who suffer from gender discrimination may spontaneously isolate boys as a group. The lack of heterosexual communication may also be detrimental to their physical and mental health. For example, Andrews et al. (2018) found that young people who experience sexism are less likely than are their peers to have other-gender friends, and tend to have fewer friends of other genders.

We found that symptoms of depression in later life following the experience of PSP in childhood were more obvious among rural (vs. urban) residents. There may be several reasons for this result: First, the model for and content of social production in rural areas are still dominated by male productivity requiring greater physical strength. Therefore, in the eyes of rural parents, women may not be competent for the production function of the family economy. Second, the idea of son preference is more extreme in the rural context of China, and in some economic situations of rural families in China, each child cannot be treated equally. Therefore, families may have a gender preference in the allocation of education, nutrition, and other resources, resulting in lower access to health and education of girls during their early life, which leads to poor health in later life.

CFE can buffer the long-term health risks that follow experiencing PSP during childhood. Previous studies have shown that children who lack friends and have no contact with their peers are at greater risk of poor health in adulthood than are children with close friendships (Burr et al., 2020; H. Chen et al., 2020; Jiang & Wang, 2020). Therefore, the better the friendship experience in childhood, the more the positive effects of PSP may be hindered in later life. First, CFE is significantly related to social and cognitive development. Social interaction with friends will promote cognitive development in childhood and reduce loneliness and assist in educational achievement (Lessard & Juvonen, 2018; Spithoven et al., 2018). These factors are related to the situation that in comparison with those who have experienced negative CFE, those who have had positive, close friendship experiences have fewer symptoms of depression in later life. Second, forming an early friendship provides children with opportunities for learning and social practice, laying the foundation for their future social relations. In contrast, the lack of friendship in childhood will lead to a vicious circle of loneliness and marginalization, which will lead to further self-defense and inappropriate interaction with others (Cacioppo & Hawkley, 2009). Therefore, having childhood friendships may buffer health risks by pulling children who have experienced PSP back from the edge.

In addition, we found that the moderating effect of CFE was more potent for women than it was for men. With the acceleration of health socialization, the health differentiation caused by socioeconomic factors shows an aggravating trend. Women have certain disadvantages compared with men regarding income, wealth, and occupation, making it more likely that their health will be poor after facing risk factors (H. Liu & Hummer, 2008; Ross et al., 2012). For example, the degree of health inequality caused by education is more significant among women, indicating that women reap greater health returns from education because they lack other resources (Denton et al., 2004; McDonough & Walters, 2001; Rose & Hartmann, 2004). Therefore, the positive intervention effect of childhood friendship on health is stronger for women.

Limitations

First, the data on CFE and PSP that we used for analysis were drawn from the life course module in the China Health and Retirement Longitudinal Study of 2014. The measurement of CFE is a retrospective variable, so that recall bias makes this unreliable to a certain extent. Therefore, it is of great significance to obtain long-term follow-up survey data in future research to overcome this problem. However, such recall bias is acceptable because studies have shown that recall data have relatively high accuracy (Friedenreich, 1994), and the use of retrospective information has also been widely adopted (Berney & Blane, 1997; Y. Li et al., 2020). Second, the mechanical factors of the effects of PSP on depression symptoms need to be further considered, and this has important practical significance for policy intervention. Finally, depression symptoms were measured using only the CES-D Scale. In the future, a variety of measurement methods could be used for multiple robustness tests, such as clinical diagnostic tools.

Conclusion

PSP is regarded as a risk factor for depressive symptoms in older adults. This novel study has extended understanding of the enduring relationships between PSP and depression symptoms later in life. We also found that CFE can moderate the harmful role of PSP. This study expands scientific research based on life cycle theory in several respects: (a) We found that the positive correlation between PSP and depression symptoms is persistent and cumulative, (b) the positive effect of PSP on depression symptoms is stronger for women than it is for men, especially rural women, and (c) CFE effectively moderates the positive relationship between PSP and depression symptoms in later life. The focus in future research should be on factors mediating the link between PSP and depression symptoms, especially for women.

 

References

Dan Yang, School of Public Administration, East China Normal University, No. 3663, North Zhongshan Road, Shanghai, People’s Republic of China. Email: [email protected]