J Cross Cult Gerontol (2012) 27:305–317

DOI 10.1007/s10823-012-9177-y

ORIGINAL ARTICLE

Perceived Family and Friend Support and the Psychological

Well-Being of American and Chinese Elderly Persons

John Poulin & Rong Deng & Travis Sky Ingersoll &
Heather Witt & Melanie Swain

Published online: 19 August 2012

# Springer Science+Business Media, LLC 2012

Abstract This study examines two sources of informal support—perceived family and
friend support—and the psychological well-being—self-esteem, depression and loneliness
—of 150 Chinese and 145 American elders. There were no significant differences between
the elderly American and Chinese persons’ mean scores on family and friend support. The
multiple linear regression analyses with interaction terms (country x family support and
country x friend support), however, indicated that the relationship between family support
and depression and family support and loneliness was stronger for the Chinese elderly than
the US elderly. Conversely, the relationship between friend support and depression and
friend support and loneliness is stronger for US elderly than Chinese elderly. The implica-
tions of these findings for social work practice in both countries is discussed.

Keywords Informal support . Psychological well-being . Friend support . Family support .

Self-esteem . Loneliness . Depression

Elder care has become a priority of the Chinese government over the last several years (Zhan
and Montgomery 2003). Concern about caring for the elderly in China has increased
dramatically as a result of the Chinese government’s recognition of the staggering projected

J. Poulin (*) : H. Witt : M. Swain

Widener University, One University Place, Chester, PA 19013, USA
e-mail: jepoulin@gmail.com
H. Witt
e-mail: heathermwitt@gmail.com
M. Swain
e-mail: melswain@msn.com

R. Deng
Chongqing Technology and Business University, Chongqing, China
e-mail: dr_lb@163.com

T. S. Ingersoll
West Chester University, West Chester, PA 19382, USA
e-mail: travis_sky_ingersoll@yahoo.com
306 J Cross Cult Gerontol (2012) 27:305–317

increase in its elderly population. Chinese demographers have predicted that by 2050,
22.4 % of China’s projected 1.4 billion people will be aged 65 or older (Population
Reference Bureau 2012).
The United States also faces substantial growth in its elderly population over the next four
decades. In 2000 the country’s population included 35 million people aged 65 years and
older. By 2030 it is predicted that 71 million Americans will be 65 years and older, which
will equal 20 % of the projected US population (Centers for Disease Control 2007).
The projected growth and increased diversity of the elderly population in China and the
US will create an increased need for social services and care arrangements for older adults.
There will also be a greater need for different types of informal social support to supplement
formal services for older adults (Leung 2006; Litwin 2001).
Numerous studies have found a positive relationship between social support and psycho-
logical well-being of the elderly in both the US and China (Bosworth and Schaie 1997; Chi
and Chou 2001; Hsu 2007; Litwin and Shiovitz-Ezra 2011; Phillips et al. 2008; Smith et al.
2004; Zhang and Li 2011). Socioemotional selectivity theory suggests that older adults who
are cognizant of their time constraints are inclined to optimize their emotional experience by
focusing on maintaining close and warm interpersonal relationships (Carstensen et al. 1999).
The two primary sources of interpersonal relationships are family members and friends
(Williams and Baker 2007).
Research findings suggest cultural differences in the importance American and Chinese
older adults place on family and friend relationships. There is substantial evidence that
informal support from friends is the primary source of emotional support for elderly persons
in the US (Litwin 2001; Pinquart and Sorensen 2000; Williams and Baker 2007), while
family support is the primary source for the Asian elderly (Cheng et al. 2009; Deng et al.
2010; Leung, Chen, Lue & Hsu 2007; Li et al. 2006). However, other studies have found
that friend support is important for Asian older adults (Chao 2012; Lee et al. 2005; Poulin
and Deng 2012; Siu and Phillips 2002; Zhang and Li 2011) and that family support is also
important for older Americans (Fiori et al. 2006; Grundy and Henretta 2006; Merz and
Consedine 2009). The research literature on family and friend support is country specific.
Studies comparing American and Chinese older adults’ family and friend support are not
available. The purpose of this study, therefore, was to examine differences in family and
friend support between American and Chinese elderly as well as differences in the impact
family and friend support have on these populations’ psychological well-being.

Family Support and Psychological Well-Being of Chinese Elderly

The importance of family is a central value among the Chinese. Filial piety is the “expression
of responsibility, respect, sacrifice, and family harmony that regulates children’s attitudes
and behaviors towards family-based support” (Wong et al. 2006, p. S4). Traditionally,
elderly persons rely on family members for care and support (Wu et al. 2010). Adult
Chinese children, particularly the oldest sons, are expected to provide care and support to
their elderly parents. Daughters-in-law are obligated to carry out their filial duties by caring
for their husband’s older parents (Wong et al. 2006). The strong value placed on family
relationships in Chinese culture, in conjunction with socioemotional selectivity theory,
suggests that family relationships will have a stronger association with psychological well-
being than friend relationships among older Chinese adults.
However, there is some evidence that the importance of family in China is changing (Lee
and Hong-Kin 2005; Ng et al. 2002). Dramatic demographic changes in China’s elderly
J Cross Cult Gerontol (2012) 27:305–317 307

population and a reduction in the number of adult children to care for aged parents are
contributing to the changing care patterns (Hesketh et al. 2005). Siu and Phillips (2002)
noted, “even though the values of the family are emotionally held very strong in Chinese
society, the patterns of assistance to older persons provided by family members have
nevertheless changed significantly” (p. 301). Furthermore, they predict that friends and
voluntary organizations will play an increasingly significant role in the care of Chinese
elderly persons (Siu and Phillips 2002).

Friend Support and Psychological Well-Being of American Elderly

There is considerable evidence demonstrating the importance of friend support for

elderly persons in the US (Williams and Baker 2007). Pinquart and Sorensen (2000)
cited at least four reasons that friend support has a stronger relationship with psy-
chological well-being than does family support. The first is that friendships are
voluntary, meaning that chosen friends are more likely to be used for emotional
support than are family members. A second reason is that friends are usually the
same age and share similar characteristics. A third possible reason is that friends tend
to be a source of enjoyment and socializing, while a fourth explanation is that
friendships are almost always of high quality since older people tend to disengage
from unsatisfactory relationships (Pinquart and Sorensen 2000). All four reasons are
consistent with socioemotional selectivity theory and support the importance of close
friends in providing emotional support to elderly persons in the US.
Other studies, however, have found significant associations between family support and
the well-being of US elderly persons (Grundy and Henretta 2006; Merz and Consedine
2009). These studies focused on the provision of instrumental support by family members
and not the provision of emotional support. It appears that kin relations are the preferred
sources of tangible concrete assistance or instrumental support, while friend relations are the
preferred sources of expressive or emotional support (Felton and Berry 1992).
This research examined differences in perceived family and friend emotional support
between American and Chinese elderly persons and explored the relationships between
family and friend emotional support and psychological well-being for these populations.
Specifically, the following research questions were addressed:
1. Are there differences in the levels of perceived family support between American and
Chinese elderly persons?
2. Are there differences in the levels of perceived friend support between American and
Chinese elderly persons?
3. Are the relationships between perceived family and friend support and psychological
well-being different for American and Chinese elderly persons?

Methods

Sample

The study respondents consist of 150 elderly residents of the Nanhu community in Chongq-
ing, China and 145 elderly residents of the City of Chester, Pennsylvania. Convenience
sampling was used for both the American and Chinese respondents. The first author’s
308 J Cross Cult Gerontol (2012) 27:305–317

University Institutional Review Board approved the research project. Ten Chinese social
work majors from a university in Chongqing conducted the interviews with the Nanhu
community residents in April and May 2009. All of the Chinese elderly respondents were
interviewed at the Nanhu Community Center. A recent BSW graduate conducted the inter-
views with the Chester residents in May and June 2009. All of the American elderly
respondents were interviewed at the Chester Senior Center. Thus, both the Chinese and
American elderly respondents were active members of senior/community centers in their
respective communities.

Nanhu community The Nanhu community is a geographically defined community in the

Nan’an District of Chongqing, China. The community has approximately 15,000 residents,
of which about 1,700 are elderly (Ying Zhou, Community Manager, personal communica-
tion, 14 May 2009). The Nanhu community is not a wealthy community, and although
economic data on the community are not available, it appears that the residents are of modest
means.
According to the community manager, approximately 80 % of the elderly community
residents participate in various programs at the Nanhu Community Center. The Center has an
elderly college where the residents can take English and other courses, a computer lab, music
and dance classes, a medical clinic, a day program for persons with mental and physical
disabilities, a small store, and three community workers who provide case management-type
services. The Center also has an open courtyard with ping-pong, mahjong, and chess tables,
exercise equipment, and benches for casual conversation. The Nanhu Community Center’s
programs appear to be well attended. During our visits to the community over a three-week
period in May, the Center was always busy with many elderly persons engaged in a variety
of activities.

Chester community Chester is one of the most economically disadvantaged communities in

the Commonwealth of Pennsylvania. In 2010 the city had a population of 33,972, of whom
10.4 % were aged 65 or older. It is predominately African American (74.7 %), and over
35.1 % of the residents have incomes below the poverty level (US Census 2012).
The Chester Senior Center has a variety of educational classes for the community
residents, numerous recreational activities, bible study groups, field trips, a medical clinic,
and a staff of three that provide information and referral services as well as organize the
Center’s various programs and events. Approximately 300 elderly community residents use
the Senior Center on a regular basis, and approximately 1,000 seniors participate in at least
one program or activity annually (Jamie Newell, Center Director, personal communication,
20 May 2009). Similar to the Nanhu Community Center, the Chester Senior Center’s
programs are always well attended with many elderly persons engaged in a range of
activities.

Demographic characteristics of American and Chinese respondents

Table 1 contains the demographic characteristics of the American and Chinese respondents.
About 63 % of the elderly from Chester were female compared to about 75 % of the elderly
from Nanhu (χ2 05.11, p<.02). In terms of race, approximately 71 % of the American
respondents were African American and 100 % of the Nanhu community residents were
ethnic Chinese. The health status of both samples was not significantly different. Almost
49 % of the Chester residents were in excellent or very good health compared to about 44 %
J Cross Cult Gerontol (2012) 27:305–317 309

Table 1 Demographic characteristics of US and Chinese elderly

Variable US Chinese Significance

N % N %

Gender
Male 52 36.9 37 24.7 χ2 05.11
Female 89 63.1 113 75.3 p0.02
Race
Caucasian 29 21.5 0 0.0
AfricanAmerican 96 71.1 0 0.0
Hispanic/Other 10 7.4 0 0.0
Chinese 0 0.0 150 100.0
Health status
Excellent 17 11.8 18 12.0 χ2 03.44
Very good 53 36.8 47 31.3 p0n.s.
Fair 58 40.3 73 48.7
Poor 16 11.1 10 6.5
Living arrangement
Alone 39 26.9 6 4.0 χ2 055.6
Spouse 59 40.7 65 43.3 p<.000
Children 31 21.4 77 51.3
Other 17 11.0 2 1.4
Marital status
Married 59 41.3 114 76.0 χ2 046.4
Sep/Div 12 8.4 2 1.3 p<.000
Widowed 52 36.4 33 22.0
Never married 15 10.5 0 0.0
Long term rel 5 3.5 1 0.7
Mean S.D. Mean S.D.
Age 73.3 8.6 67.7 9.8 t05.16
p<.000
Length of time community 36.9 23.9 50.4 22.3 t05.00
p<.000

of the Chinese respondents living in the Nanhu community (χ2 03.44, p0n.s.). There were,
however, significant differences between the American and Chinese respondents’ living
arrangements and marital statuses. Among the Chester residents, almost 27 % lived alone
compared to only 4 % of the Nanhu residents. Additionally, only 21 % of the Chester seniors
lived with their children compared to over 51 % of the Nanhu elderly (χ2 055.6, p<.000). A
much higher percentage of the Chinese elderly living in the Nanhu community were
currently married (76 %) compared to the respondents from Chester (41.3 %) who had
higher percentages in separated/divorced, widowed, never married, and in long term
relationships (χ2 046.4, p<.000). In terms of age, the American respondents were
significantly older with a mean age of 73.3 compared to a mean age of 67.7 for the
Chinese respondents (t05.16, p<.000). However, the Chinese elderly had lived in the
Nanhu community ( x 0 50.4 years) significantly longer than the elderly from Chester
had lived in their community ( x 0 36.9 years) (t05.00, p<.000).
310 J Cross Cult Gerontol (2012) 27:305–317

Measurement

The study data were collected through structured interviews. The interviewers read close-
ended items on a questionnaire to the elderly respondents and recorded their responses on
the questionnaire. The interviews took between 1 and 1.5 h to complete. Detailed interviewer
instructions were prepared in Chinese and English. The instructions described the purpose or
intent of each item on the questionnaire and clarified any words that might be unfamiliar to
the Chinese student interviewers.
All of the measures used in this article had been widely used in Western social research
for a number of years with a variety of study populations and all had previously been used in
research studies with Chinese respondents. The following measures had previously been
published in Chinese: perceived friend and family social support (Cheng and Chan 2004;
Chou 1999), self-esteem (Martin et al. 2005), depression (Chiu et al. 1994), loneliness (Wu
et al. 2010), and functional health (Chou and Chi 2002). The Alpha coefficient reported for
each measure was calculated from the study data. The following briefly describes the
measures used to examine the study’s three research questions:

& Perceived Social Support was measured using two sub-scales from the Multidimensional
Scale of Perceived Social Support (MSPSS) (Zimet et al. 1988). The MSPSS has been
used with a number of different study populations and has consistently been shown to
have excellent psychometric properties (Canty-Mitchel and Zimet 2000; Cheng and
Chan 2004; Chou 1999). Zhang and Norvilitis (2002) tested the reliability and validity
of the MSPSS with Chinese and American respondents and found that the scale
constructs were similar in both cultures and that the scale had acceptable psychometric
properties for use in China.
The two MSPSS sub-scales used in this study were perceived family and
perceived friend support. Both sub-scales have four items and scores that range
from 4 to 20. The higher the score, the higher the respondent’s perceived level of
informal family or friend social support. In this study, the perceived family support
scale had an Alpha coefficient of .80, and the perceived friend support scale had an
Alpha coefficient of .83.
& Self Esteem Index (SEI) (Rosenberg 1965) measures a person’s feelings of self-worth.
The scale scores range from 10 to 40;the higher the score, the higher the level of self-
esteem. The SEI has been used in numerous studies throughout the world since its
creation in the mid-1960s. It is widely recognized as having established reliability and
validity and has been successfully used with Chinese populations (Martin et al. 2005). In
this study the Self Esteem Index had an Alpha coefficient of .77.
& Geriatric Depression Scale (GDS) (Yesavage et al. 1983) measures older adults’ levels
of depression. The GDS has been used in numerous studies since its creation in the early
1980s. It is widely recognized as having established reliability and validity and has been
successfully used with Chinese populations (Chiu et al. 1994). The scale scores range
from 0 to 15;the higher the score, the higher the respondent’s level of depression. The
Alpha coefficient for the Geriatric Depression Scale in this study was .85.
& UCLA Loneliness Scale (Russell 1996) measures a person’s loneliness. The UCLA
Loneliness Scale has been used in numerous studies and is widely recognized as a
reliable and valid measure of loneliness. It has also been used successfully with Chinese
populations (Wu et al. 2010). The scale scores range from 10 to 40 with higher scores
associated with higher levels of loneliness. In this study the UCLA Loneliness Scale had
an Alpha coefficient of .85.
J Cross Cult Gerontol (2012) 27:305–317 311

& Functional Health Scale (Rosow and Breslau 1966) measures heath status based on
eight items scored 1 (yes) or 0 (no). The respondents received 1 point for each item they
could do without help (yes response). The functional health scale has been used widely
with Chinese populations (Chou and Chi 2000; Chou and Chi 2002). The scale items are
based on such observable behaviors as walking up and down stairs, and consequently,
the scale is appropriate for use with Chinese and other non-western populations. The
scale scores range from 0 to 8. Higher scores indicated better functional health. In this
study the Functional Health Scale had an Alpha coefficient of .76.

Data analysis

The data were analyzed using SPSS Statistics 18.0. MANOVA analysis was used to examine
mean differences between the American and Chinese respondents’ family and friend sup-
port. MANOVA was chosen because it took into account the correlation between the two
social support variables (r0.64, p<.001). Two sets of MANOVA were run. The first
examined US/China differences on the support variables. The second repeated the analysis
while controlling the influence of functional health as a covariate.
Correlation and multiple linear regression analyses were used to examine the
relationships among the study variables. Multiple linear regressions with country and
social support interaction terms were run to examine whether the relationships be-
tween the two social support variables and the three psychological well-being varia-
bles differ by country of residence. A separate multiple linear regression analysis was
run for each psychological well-being variable. The interaction terms were calculated
by multiplying the country variable (coded 00US, 10China) and the centered family
and friend support variables. The multiple linear regression of each dependent variable
included four main effect independent variables (country, functional health, family
support, and friend support) and two interaction terms (country x family support and
country x friend support).
The regression equations were examined for multicollinearity prior to the inclusion of the
two interaction terms. The Tolerance statistics were all close to 1.0, and Variance Inflation
Factor (VIP) statistics were all quite low with scores of 2.2 or lower. These results suggested
that multicollinearity was not an issue with these data.

Results

American and Chinese elderly’s family and friend support

The American and Chinese elderly had almost identical levels of perceived family and friend
support. Family support had mean scores of 16.4 (SD02.86) for the American elderly and
16.8 (SD03.11) for the Chinese elderly. Friend support had mean scores of 15.3 (SD03.34)
for the American elderly and 15.4 (SD03.46) for the Chinese elderly. A one-way MANOVA
found that the differences remained non-significant when the correlation between the two
support variables was taken into account. The MANOVA was not statistically significant
(Wilks’ λ0.992, F (2, 292)01.20, p0.303). The one-way MANOVA was repeated with the
inclusion of functional health as a covariate. The results were essentially the same with no
significant differences in the American and Chinese elderly’s levels of family and friend
social support (Wilks’ λ0.987, F (2, 291)01.93, p0.147).
312 J Cross Cult Gerontol (2012) 27:305–317

Social support and well-being

Table 2 contains the zero order correlations among country (US/China), the two social
support variables, functional health, and the three well-being variables. Perceived family
support and perceived friend support are strongly correlated (r0.64, p<.01). The higher the
level of family support, the higher the level of friend support. The three psychological well-
being variables were also significantly correlated with one another. Self-esteem was inverse-
ly correlated with depression (r0−.54, p<.01) and loneliness (r0−.43, p<.01). Those with
higher levels of self-esteem had lower levels of depression and loneliness. Depression and
loneliness had a significant positive correlation of .60 (p<.01). Family support and friend
support were both significantly correlated with the three psychological well-being variables.
Family and friend support were positively associated with self-esteem with correlations of
.50 (p<.01). The two support variables were inversely associated with depression with
correlations of −.32 and −.33 and with loneliness with correlations of −.24 and −.23 (p<.01).
Functional health was significantly correlated with the two support variables and the three
psychological well-being variables. Country (US/China), as noted earlier, was not signifi-
cantly correlated with family or friend support. It was also not correlated with the elderly’s
level of depression or loneliness. However, there was a significant but relatively modest
inverse correlation between country and self-esteem (r0−.18, p<.01). The American elderly
had slightly higher self-esteem scores than the Chinese elderly.
Multiple linear regression analyses were run for each psychological well-being variable:
self-esteem, depression, and loneliness. The predictor variables were country, functional
health, family support, friend support, and the two interaction terms. The interaction terms
were created in order to examine whether the relationships between the two support
variables and the three psychological well-being variables differed significantly by country.
The interaction terms were the variable of interest in the regression equations. The results of
the three multiple linear regression analyses are shown in Table 3.
For the full sample of elderly adults, both family support and friend support are signif-
icantly and positively associated with self-esteem. The interaction between country and
family support was significantly associated with self-esteem (B0−.08, SE0.03, p0.008).
The significant negative interaction indicated that the relationship between family support
and self-esteem was stronger for the American elderly than for the Chinese elderly. By
contrast, the interaction between country and friend support was not associated with self-
esteem (B0.02, SE0.03, p0.503), suggesting that the relationship between friend support
and self-esteem was about the same for the American and Chinese elderly.

Table 2 Zero order correlations

Variables 1. 2. 3. 4. 5. 6. 7.

1. Country –
2. Functional health .287* –
3. Friend support .020 .369* –
4. Family support .080 .307* .644* –
5. Self-esteem −.186 *
.322*
.496* .503* –
6. Depression −.102 −.437*
−.324 *
−.327* −.536* –
7. Loneliness .028 −.328* −.240* −.228* −.430* .604* –

Significance: * p<.01
J Cross Cult Gerontol (2012) 27:305–317 313

Table 3 Regression coefficients by psychological well-being

Variables B SE Beta t Significance

Self-esteem R2 0.349, F(6, 287)027.13, p<.001

Country (China) −.34 .07 −.22 −4.91 .001
Functional health .10 .02 .25 4.72 .001
Family support .12 .02 .50 5.21 .001
Friend support .02 .02 .11 1.17 .001
Family support x country −.08 .03 −.25 −2.68 .008
Friend support x country .02 .03 .06 0.67 .503
Depression R2 0.238, F(6, 288)016.33, p<.001
Country (China) .15 .35 .02 0.44 .659
Functional health −.68 .10 −.38 −6.56 .001
Family support −.34 .11 −.31 −3.02 .003
Friend support .11 .10 .11 1.08 .279
family support x country .28 .15 .19 1.89 .054
Friend support x Country −.33 .13 −.25 −2.53 .012
Loneliness R2 0.148, F(6, 287)09.52, p<.001
Country (China) 1.33 .55 .14 2.39 .017
Functional health −.88 .16 −.33 −5.424 .001
Family support −.49 .18 −.30 −2.73 .007
Friend support .23 .16 .16 1.44 .150
Family support x country .55 .24 .25 2.32 .021
Friend support x country −.54 .21 −.27 −2.62 .009

For the full sample of elderly adults, both family support and friend support are signif-
icantly and negatively associated with depression. The interaction between country and
family support on depression was statistically significant (B0.28, SE0.15, p0.054). The
significant positive interaction indicated that the relationship between family support and
depression was stronger for the Chinese elderly than the American elderly. The interaction
between country and friend support on depression was also significant (B0−.33, SE0.13,
p0.012). The significant negative interaction indicated that the relationship between friend
support and depression was stronger for the elderly in the US than in China.
For the full sample of elderly adults, both family support and friend support are signif-
icantly and negatively associated with loneliness. The interaction between country and
family support on loneliness was statistically significant (B0.55, SE0.24, p0.021). The
significant interaction indicated that the relationship between family support and loneliness
is stronger for the Chinese elderly than the American elderly. The interaction between
country and friend support on loneliness was significant (B0.54, SE0.21, p0.009). The
significant positive interaction indicated that the relationship between friend support and
loneliness was stronger for the American elderly than the Chinese elderly.

Discussion

This study examined three research questions. The first and second research questions asked
if there were differences in the level of perceived family and friend support between the
314 J Cross Cult Gerontol (2012) 27:305–317

American and Chinese elderly. The one-way MANOVA found no significant differences
between the American and Chinese elderly on either type of social support. The mean scores
on the support measures for both groups were fairly high. These findings suggest that both
the American and Chinese elderly respondents had supportive family and friend networks.
The third research question asked if the relationships between family and friend support
and psychological well-being were different for the American and Chinese elderly. The
interaction terms in the multiple linear regression equations indicated that the relationships
between family support and depression and loneliness were stronger for the Chinese elderly
than for the American elderly. Conversely, the relationships between friend support and
depression and loneliness were stronger for the American elderly than for the Chinese
elderly. These findings suggest that family support has a stronger effect on the negative
aspects of psychological well-being (depression and loneliness) for the Chinese elderly and
that friend support has a stronger effect for the American elders. The findings related to
family support are consistent with past research on the importance of family in caring for
Chinese elders (Cheng et al. 2009; Deng et al. 2010; Leung et al. 2007; Li et al. 2006). The
findings related to the importance of friend support for the alleviation of depression and
loneliness among the American elders was also consistent with prior research (Litwin 2001;
Pinquart and Sorensen 2000; Williams and Baker 2007). This study’s findings provide
additional support regarding the important role friendship networks play in helping elderly
in the US deal with depression and loneliness issues and the importance family support
among the Chinese elderly.
The regression findings for self-esteem show a different pattern. The relationship between
family support and self-esteem was stronger for the American elderly than for the Chinese
elderly and the relationship between friend support and self-esteem was about the same for
both groups. One possible explanation for the weaker relationship between family support
and self-esteem for the Chinese respondents is that the Chinese elderly have higher expect-
ations about being supported and cared for by family members (Wong et al. 2006; Wu et al.
2010). It is possible that the Chinese elderly tend to expect their children to care for them in
their old age and therefore, their self-esteem is not influenced by support from children and
family members. In contrast, American elderly have lower expectations regarding care from
children and family members (Williams and Baker 2007). Thus, it is possible that receiving
support from family members increases the American elderly’s self-esteem. Socioemotional
selectivity theory suggests close and warm interpersonal relationships with family members
would enhance the American elderly’s feelings of self-worth and esteem.
A limitation of this study is the lack of random samples that limits the generalizability of
the study findings. Both the US and China data were collected from elderly persons who
happened to attend their respective community centers on days the interviewers were on-site.
The extent to which the study respondents are representative of the community centers’
participants or the elderly in their respective communities is unknown.
A second limitation is the cross-sectional nature of the data. With these data it is
impossible to determine causality or the direction of the relationships between well-being
and social support. It is possible that the psychological well-being variables influence the
social support variables or vise versa. Thus, this study is limited to an examination of the
associations between the variables. As with all cross-sectional correlational studies, estab-
lishing causality among the study variables is a design limitation.
The findings from this research study show differences and similarities in the patterns of
informal support and psychological well-being between the American and Chinese respond-
ents which have important implications for researchers and social workers. Given the
growing elderly population in the US and China it is important for those working with older
J Cross Cult Gerontol (2012) 27:305–317 315

adults to understand their clients’ family and friend support systems. Attention must be
given to strengthening informal support networks because the evidence clearly suggests that
they are critical to the elderly’s psychological well-being. Helping the Chinese elderly
maintain their family support system will yield positive results in terms of their psycholog-
ical well-being. On the other hand, American social workers and helping professionals
should focus their efforts on maintaining and strengthening their clients’ friend support
networks.
In terms of future research, studies with larger random samples are needed to replicate
this study’s findings. In addition, future research should examine the objective aspects of
family and friend support. An understanding of the role different sources of informal support
play with regards to the elderly’s psychological well-being requires an examination of both
the objective and subjective components of informal social support. What are the differences
between Chinese and American older adults’ levels of objective social support from family
and friends? What are the relationships between subjective and objective informal support
from family and friends and psychological well-being for Chinese and American older
adults? Larger cross-sectional studies with random samples are needed to answer these
research questions. In addition, time series studies or in-depth qualitative investigations are
needed to examine possible changes related to filial piety in China.

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