A national survey analysis from South Korea found that older adults with cognitive impairment had higher average depression scores when their care came mainly from public caregivers or from a combination of public, family and community helpers.
The findings describe an association, not proof that public care causes depression. People with greater needs, fewer family resources or existing depression may have been more likely to rely on these care arrangements.
What the analysis found
The analysis examined 537 adults aged 65 and older selected from 10,078 respondents to the 2023 National Survey of Older Koreans. Participants had cognitive impairment based on a score below 24 out of 30 on the Korean Mini-Mental State Examination, and all needed help with at least some daily activities, such as dressing, bathing, eating or using the toilet.
The group had an average age of 82. About 74% were women, around half lived alone and nearly half had no formal schooling. Depression symptoms were measured with the 15-item Short Form Geriatric Depression Scale, which ranges from 0 to 15. The average score was 6.6.
Researchers grouped participants according to who provided most of their care:
- Child-centered: primarily adult children, with limited use of public services.
- Mixed: public caregivers, children, friends or neighbors, and sometimes paid help.
- Spouse-centered: care provided almost entirely by a husband or wife.
- Public-centered: nearly all care provided by public caregivers, with little family or friend involvement.
- Friends-and-neighbors-centered: mostly distant relatives, friends or neighbors.
Child-centered care was the most common pattern, involving 175 people. The mixed group included 121 people, the spouse-centered group 101, the public-centered group 97 and the friends-and-neighbors group 43.
Differences in depression scores
Before accounting for other factors, average depression scores were 5.9 in the child-centered group, 6.0 in the spouse-centered group, 6.1 in the friends-and-neighbors group, 7.3 in the public-centered group and 7.9 in the mixed group.
After adjustment for age, gender, education, living arrangement, household income, chronic diseases, cognitive score, dependence in daily activities and perceived care adequacy, the public-centered group scored 0.90 points higher than the child-centered group. The 95% confidence interval was 0.04 to 1.76, with a p-value of 0.041.
The mixed-care group scored 1.33 points higher than the child-centered group after the same adjustments. The 95% confidence interval was 0.48 to 2.18, with a p-value of 0.002.
There was no clear difference between the child-centered group and either the spouse-centered or friends-and-neighbors-centered groups. In pairwise comparisons, public-centered and mixed networks had higher scores than spouse-centered and friends-and-neighbors networks, but the two higher-scoring groups did not clearly differ from each other.
Care-network type accounted for an additional 2.7% of the variation in depression scores beyond the other factors included in the model. More chronic diseases and greater dependence in daily tasks were also associated with higher scores, while viewing care as adequate was associated with lower scores.
Why the care pattern may matter
The groups differed in ways that provide important context. The public-centered group had the highest share of people living alone, at 74%, and 60% belonged to the lowest income fifth. The mixed group was the oldest on average, at 84.5 years, and had the most chronic diseases and greatest need for help with daily activities.
Researchers proposed that mixed care networks may develop when close-family support is insufficient. They also suggested that public care may not meet every emotional need. However, the survey did not directly measure these explanations.
The results may therefore reflect the circumstances surrounding care as much as the type of caregiver. Public home care can fill gaps for people who are poorer, live alone or receive little family help. The analysis did not show that public care itself worsened mood.
What remains uncertain
The study was cross-sectional, meaning care arrangements and depression scores were measured at the same time. It cannot establish which came first. The reverse direction is possible: people who were already depressed, more seriously ill or less supported by family may have been more likely to receive public or mixed care.
The survey also did not record caregiver proximity, visit frequency, relationship quality, caregiver burden or how stable the care arrangements were. Cognitive impairment was identified with a screening score rather than a clinical dementia diagnosis.
The findings reflect South Korea’s family-care norms and public long-term-care system. They may not apply in the same way to countries with different support systems or family arrangements. A difference of about one point on a 15-point scale was described as small for any individual person.
Earlier research cited alongside the analysis has also linked formal-care reliance with more depressive symptoms, while suggesting that loneliness and whether care felt sufficient may partly explain the relationship. A meta-analysis of 20 studies found depressive symptoms in 38% of people with mild dementia, 41% with moderate dementia and 37% with severe dementia. These figures come from different research and should not be treated as estimates for the South Korean survey group.
AI tools were used to assist with the preparation of this article under our editorial standards.
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