For centuries in China, the phrase “four generations under one roof” was synonymous with the ideal family. In just a few short words, it encapsulated the dreams of fertility, longevity, and harmony to which hundreds of millions of Chinese aspired.

Today, however, the country’s traditional, tight-knit family unit is under siege from a combination of declining birth rates, delayed marriages, and domestic migration. No demographic has been harder-hit by these changes than the 240 million Chinese over the age of 60. A recently published report estimates that as of 2016, the number of elderly Chinese living apart from their children had ballooned to 118 million. And as China’s population continues to age — and its family configurations continue to evolve — the question of how best to address the needs of its empty nesters will only grow more pressing.

Although the government has known for years that this demographic wave was coming, in some ways China has been caught flat-footed by the sheer scale of the shift. In particular, the gradual weakening of the country’s traditional family structures — which for much of China’s history provided the bulk of the country’s safety net — has left policymakers struggling to fill the void. At stake is not just senior citizens’ material well-being, but also their psychological health.

In many Western countries, it is customary for children to live apart from their parents after reaching adulthood. Parents are therefore relatively prepared for this split, and governments have decades of experience in helping to pick up the slack. This living arrangement is relatively new to China, however, and separation from their children has taken many parents — especially those in rural areas — by surprise.

This drastic shift in societal and familial values in such a short period of time has naturally had an impact on people’s psyches. In an effort to understand this change and address seniors’ evolving psychological needs, three researchers at Renmin University of China — Jin Yongai, Zhou Feng, and Zhai Zhenwu — analyzed data from the 2014 edition of a government-administered survey titled “Longitudinal Data of Chinese Families’ Development.”

The trio focused on one of the most widespread mental health issues among senior citizens: depression. The survey had included a section based on the PHQ-9, a commonly used screening tool for depression. The researchers found that according to the PHQ-9 scale, more than 5 percent of all senior citizens surveyed showed signs of either severe or somewhat severe depression. By comparison, the estimate for senior citizens in the U.S. who are dealing with depression ranges from 1 to 5 percent. Their findings also indicate that the average senior citizen living alone is experiencing symptoms that suggest mild depression. And although Chinese seniors who reported living with a spouse or with their children had scores less indicative of depression, depressive thoughts remained a serious issue even within these groups.

While a 5 percent incidence rate may not seem dire, even a few million more patients would pose a problem for China’s overloaded mental health industry. In 2015, there were fewer than 3,000 institutions providing such services in the entire country, with roughly 30,000 psychiatrists and 5,000 psychotherapists spread across a nation of more than 1.3 billion people.

Fortunately, this study also sheds light on potential ways China could improve the living conditions and emotional health of its elderly population, including some that go beyond treatment by allowing for more emphasis to be placed on prevention. Based on the researchers’ findings, one of the most effective means of improving mental health outcomes among older Chinese is to provide them with more targeted community services. This could involve anything from psychological counseling to more material forms of assistance, including meal delivery and housekeeping services.

Most important, however, is providing them with opportunities to take part in cultural activities. Senior citizens who live alone but have access to four or more community or cultural events scored 43 percent lower on the PHQ-9 scale — with higher scores indicating more severe symptoms — than those living in communities without access to cultural activities. For elderly couples living apart from their children, community cultural activities also helped to reduce depression scores, this time by 36 percent. In other words, if the government wants to improve the mental health of the country’s elderly, it should encourage local officials to organize more cultural activities, such as calligraphy classes, painting exhibitions, and sporting competitions.

These events push seniors to leave their empty nests and venture out into society, if only for a short time. Another potential means of accomplishing this goal would be to expand the country’s network of elderly universities, which offer courses in everything from dancing and online shopping to more academic subjects. Such schools would also serve as a symbol of our society’s continued commitment to its older members.

Ultimately, however, these approaches merely treat the symptoms of the problem. If the government really wants to improve the mental health of its older citizens, it must find ways to reduce the number of solitary and empty-nest elderly.

Fortunately, there are a number of viable strategies for doing so. One of the most direct would require rebuilding the country’s fragmented families. In particular, China could implement policies and offer incentives designed to encourage children and parents to live together. Such efforts cannot be limited to the usual sloganeering and guilt trips. The government must recognize the ways in which it has contributed to the problem and work to address them.

One important step forward would be to amend the country’s existing hukou household registration system. Originally designed to keep urban and rural residents in their respective places, the system now effectively works to keep the elderly — many of whom are limited to rural hukou — from joining their children in the city. At present, seniors can only access public health benefits in their officially registered communities, which are often in the countryside. Action should also be taken to address concerns over skyrocketing rents and housing costs. It is not realistic to expect young Chinese couples to bring their parents under their roofs when they can only afford to live in tiny studio apartments.

Despite what we may wish, it is not always feasible to keep families together. But that doesn’t mean other steps cannot be taken to help elderly parents and their adult children stay connected. Currently, Chinese law mandates little in the way of paid vacation, and workers often must spend years with a single company before they qualify for any significant paid leave. Compensated time off should be expanded, and children encouraged to use it to visit their parents.

Additionally, authorities can work to increase social acceptance of remarriage. Single seniors score approximately 20 percent higher on the PHQ-9 scale than those who live with a spouse, but many worry about the stigma attached to second marriages. Such prejudices belong in the past. The country already invests heavily in promoting relationships between younger Chinese; it could hold similar blind date events for the elderly — thereby fulfilling seniors’ needs for social activity as well as for companionship.

The current generation of senior citizens was responsible in no small part for making China the country it is today. We might not be able to revive the “four generations under one roof” ideal, but the least we can do is give them a retirement worth living for.

Translator: Matt Turner; editors: Lu Hua and Kilian O’Donnell.

The writer thanks Jin Yongai, an assistant professor of demography in the Population Development Studies Center at Renmin University of China, for her generous help during the composition of this article. Her paper can be found here.

(Header image: A elderly woman sews a quilt in her home in Yuncheng,Shanxi province, June 25, 2011. VCG)