{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:54:17Z","timestamp":1760147657286,"version":"build-2065373602"},"reference-count":103,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"County Health Rankings and Roadmaps program","award":["0000001678"],"award-info":[{"award-number":["0000001678"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (\u226514 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (\u226565 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.<\/jats:p>","DOI":"10.3390\/ijerph20043747","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T07:19:45Z","timestamp":1676877585000},"page":"3747","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Age-Dependent Differences in Frequent Mental Distress (FMD) of US Older Adults Living in Multigenerational Families versus Living Alone"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9854-5313","authenticated-orcid":false,"given":"Debasree","family":"Das Gupta","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT 84322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0525-0071","authenticated-orcid":false,"given":"David W. S.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA 22030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101273","DOI":"10.1016\/j.pmedr.2020.101273","article-title":"Associations between Living Alone, Depression, and Falls among Community-Dwelling Older Adults in the US","volume":"20","author":"Kelekar","year":"2020","journal-title":"Prev. Med. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1146\/annurev.clinpsy.032408.153621","article-title":"Depression in Older Adults","volume":"5","author":"Fiske","year":"2009","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1002\/wps.20193","article-title":"Prevalence of Psychiatric Disorders in U.S. Older Adults: Findings from a Nationally Representative Survey","volume":"14","author":"Reynolds","year":"2015","journal-title":"World Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1002\/art.20530","article-title":"Frequent Mental Distress Status among Adults with Arthritis Age 45 Years and Older, 2001","volume":"51","author":"Strine","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.ypmed.2004.01.022","article-title":"Characteristics of People Aged 45 Years or Older with Heart Disease by Frequent Mental Distress Status, 2001","volume":"39","author":"Strine","year":"2004","journal-title":"Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/2150131911412380","article-title":"Activity Limitations and Healthcare Access as Correlates of Frequent Mental Distress in Adults 65 Years and Older: A Behavioral Risk Factor Surveillance Study--2008","volume":"3","author":"Segev","year":"2012","journal-title":"J. Prim. Care Community Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s00038-009-0011-4","article-title":"Modifiable Characteristics of a Healthy Lifestyle and Chronic Health Conditions in Older Adults with or without Serious Psychological Distress, 2007 Behavioral Risk Factor Surveillance System","volume":"54","author":"McGuire","year":"2009","journal-title":"Int. J. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/gps.3971","article-title":"Social Relations and Depression in Late Life-a Systematic Review","volume":"29","author":"Schwarzbach","year":"2014","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.1016\/S2468-2667(19)30230-0","article-title":"Social Disconnectedness, Perceived Isolation, and Symptoms of Depression and Anxiety among Older Americans (NSHAP): A Longitudinal Mediation Analysis","volume":"5","author":"Santini","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100777","DOI":"10.1016\/j.eclinm.2021.100777","article-title":"Healthy People 2030: Moving toward Equitable Health and Well-Being in the United States","volume":"33","author":"Pronk","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_11","unstructured":"National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Health and Medicine Division, Board on Behavioral, Cognitive, and Sensory Sciences, Board on Health Sciences Policy, and Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System, National Academies Press (US)."},{"key":"ref_12","first-page":"A03","article-title":"Bridging Mental Health and Public Health","volume":"7","author":"Druss","year":"2009","journal-title":"Prev. Chronic Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E61","DOI":"10.5888\/pcd18.200573","article-title":"Effect of Inadequate Sleep on Frequent Mental Distress","volume":"18","author":"Blackwelder","year":"2021","journal-title":"Prev. Chronic Dis."},{"key":"ref_14","unstructured":"County Health Rankings and Roadmap (2023, February 07). Available online: https:\/\/www.countyhealthrankings.org\/explore-health-rankings\/county-health-rankings-model\/health-outcomes\/quality-of-life\/frequent-mental-distress."},{"key":"ref_15","unstructured":"(2020). Leading Health Indicators 2030: Advancing Health, Equity, and Well-Being, National Academies Press."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.amepre.2003.11.002","article-title":"Risk Behaviors and Healthcare Coverage among Adults by Frequent Mental Distress Status, 2001","volume":"26","author":"Strine","year":"2004","journal-title":"Am. J. Prev. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/pubmed\/fdt029","article-title":"Medical Cost and Frequent Mental Distress among the Non-Elderly US Adult Population","volume":"36","author":"Bruning","year":"2014","journal-title":"J. Public Health"},{"key":"ref_18","first-page":"A09","article-title":"Health-Related Quality of Life Among Adults With Multiple Chronic Conditions in the United States, Behavioral Risk Factor Surveillance System, 2007","volume":"8","author":"Chen","year":"2010","journal-title":"Prev. Chronic Dis."},{"key":"ref_19","first-page":"483","article-title":"Health-Related Quality of Life among Minority Populations in the United States, BRFSS 2001-2002","volume":"18","author":"Chowdhury","year":"2008","journal-title":"Ethn. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.15585\/mmwr.mm6936a2","article-title":"Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics\u2014United States, 2018","volume":"69","author":"Cree","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-13-84","article-title":"Association between Perceived Insufficient Sleep, Frequent Mental Distress, Obesity and Chronic Diseases among US Adults, 2009 Behavioral Risk Factor Surveillance System","volume":"13","author":"Liu","year":"2013","journal-title":"BMC Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1097\/JGP.0b013e3180986125","article-title":"Modifiable Characteristics of a Healthy Lifestyle in U.S. Older Adults with or without Frequent Mental Distress: 2003 Behavioral Risk Factor Surveillance System","volume":"15","author":"McGuire","year":"2007","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"230928","DOI":"10.1155\/2013\/230928","article-title":"Comparing Adult Males and Females in the United States to Examine the Association between Body Mass Index and Frequent Mental Distress: An Analysis of Data from BRFSS 2011","volume":"2013","author":"Mukherjee","year":"2013","journal-title":"Psychiatry J."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rohrer, J.E., Borders, T.F., and Blanton, J. (2005). Rural Residence Is Not a Risk Factor for Frequent Mental Distress: A Behavioral Risk Factor Surveillance Survey. BMC Public Health, 5.","DOI":"10.1186\/1471-2458-5-46"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s11136-006-9115-y","article-title":"Black-White Differences in Health-Related Quality of Life among Older Adults","volume":"16","author":"Skarupski","year":"2007","journal-title":"Qual. Life Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E95","DOI":"10.5888\/pcd15.170523","article-title":"Self-Perceived Poor\/Fair Health, Frequent Mental Distress, and Health Insurance Status Among Working-Aged US Adults","volume":"15","author":"Zhao","year":"2018","journal-title":"Prev. Chronic Dis."},{"key":"ref_27","unstructured":"Cohn, D.V., Horowitz, J.M., Minkin, R., Fry, R., and Hurst, K. (2023, February 07). Available online: https:\/\/www.pewresearch.org\/social-trends\/2022\/03\/24\/the-demographics-of-multigenerational-households\/."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/j.1741-3737.2010.00749.x","article-title":"Aging and Family Life: A Decade Review","volume":"72","author":"Silverstein","year":"2010","journal-title":"J. Marriage Fam."},{"key":"ref_29","unstructured":"Cohn, D., and Passel, J.S. (2023, February 07). Available online: https:\/\/www.pewresearch.org\/fact-tank\/2018\/04\/05\/a-record-64-million-americans-live-in-multigenerational-households\/."},{"key":"ref_30","first-page":"1","article-title":"Multigenerational Families and Food Insecurity in the United States, 1998\u20132013","volume":"1","author":"Do","year":"2015","journal-title":"Ihis Data Brief"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1007\/s13524-020-00920-5","article-title":"Historical Trends in Children Living in Multigenerational Households in the United States: 1870\u20132018","volume":"57","author":"Pilkauskas","year":"2020","journal-title":"Demography"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Baltes, P.B., and Baltes, M.M. (1990). Successful Aging: Perspectives from the Behavioral Sciences, Cambridge University Press.","DOI":"10.1017\/CBO9780511665684"},{"key":"ref_33","unstructured":"Erikson, E.H. (1950). Childhood and Society, W. W. Norton & Co."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1093\/geronb\/gbaa165","article-title":"Multigenerational Households During Childhood and Trajectories of Cognitive Functioning Among U.S. Older Adults","volume":"76","author":"Lee","year":"2021","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ssmph.2017.11.001","article-title":"Living with Parents or Grandparents Increases Social Capital and Survival: 2014 General Social Survey-National Death Index","volume":"4","author":"Muennig","year":"2017","journal-title":"SSM Popul. Health"},{"key":"ref_36","unstructured":"Erikson, E.H., and Erikson, J.M. (1998). The Life Cycle Completed (Extended Version), W. W. Norton & Company."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1177\/0164027506291872","article-title":"Should We Be Concerned About Age Segregation?: Some Theoretical and Empirical Explorations","volume":"28","author":"Hagestad","year":"2006","journal-title":"Res. Aging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S304","DOI":"10.1093\/geronb\/63.5.S304","article-title":"Preventive Health Behaviors Among Grandmothers Raising Grandchildren","volume":"63","author":"Baker","year":"2008","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_39","first-page":"285","article-title":"Depressive Symptoms Among Grandparents Raising Grandchildren: The Impact of Participation in Multiple Roles","volume":"6","author":"Baker","year":"2008","journal-title":"J. Intergener. Relatsh."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/j.1741-3737.2002.00568.x","article-title":"Solidarity, Conflict, and Ambivalence: Complementary or Competing Perspectives on Intergenerational Relationships?","volume":"64","author":"Bengtson","year":"2002","journal-title":"J. Marriage Fam."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0140525X09991105","article-title":"Grandparental Investment: Past, Present, and Future","volume":"33","author":"Coall","year":"2010","journal-title":"Behav. Brain Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/0963721411403269","article-title":"Grandparental Investment: A Relic of the Past or a Resource for the Future?","volume":"20","author":"Coall","year":"2011","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10433-021-00674-y","article-title":"Grandparenting, Health, and Well-Being: A Systematic Literature Review","volume":"19","author":"Danielsbacka","year":"2022","journal-title":"Eur. J. Ageing"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S108","DOI":"10.1093\/geronb\/62.2.S108","article-title":"All in the Family: The Impact of Caring for Grandchildren on Grandparents\u2019 Health","volume":"62","author":"Hughes","year":"2007","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S100","DOI":"10.1093\/geronb\/62.2.S100","article-title":"Solidarity-Conflict and Ambivalence: Testing Two Conceptual Frameworks and Their Impact on Quality of Life for Older Family Members","volume":"62","author":"Lowenstein","year":"2007","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"S239","DOI":"10.1093\/geronb\/63.4.S239","article-title":"Multiple Parent-Adult Child Relations and Well-Being in Middle and Later Life","volume":"63","author":"Ward","year":"2008","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1002\/gps.2712","article-title":"Psychological Resilience in Young and Older Adults","volume":"27","author":"Gooding","year":"2012","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_48","unstructured":"Hayslip, B., and Smith, G.C. (2014). Resilient Grandparent Caregivers: A Strengths-Based Perspective, Routledge & CRC Press."},{"key":"ref_49","unstructured":"Stepko, B., and AARP (2023, February 07). Available online: https:\/\/www.aarp.org\/health\/conditions-treatments\/info-2021\/older-mental-health.html."},{"key":"ref_50","unstructured":"Majmundar, M.K., and Hayward, M.D. (2018). Future Directions for the Demography of Aging: Proceedings of a Workshop, National Academies Press (US)."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1093\/ageing\/aft006","article-title":"The Transition to Living Alone and Psychological Distress in Later Life","volume":"42","author":"Stone","year":"2013","journal-title":"Age Ageing"},{"key":"ref_52","unstructured":"Centers for Disease Control and Prevention (2022, August 29). Behavioral Risk Factor Surveillance System, Available online: https:\/\/www.cdc.gov\/brfss\/index.html."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1177\/0091415015574184","article-title":"The Behavioral Risk Factor Surveillance System","volume":"79","author":"Silva","year":"2014","journal-title":"Int. J. Aging Hum. Dev."},{"key":"ref_54","unstructured":"Centers for Disease Control and Prevention (2022, August 29). CDC-BRFSS-Survey Data & Documentation, Available online: https:\/\/www.cdc.gov\/brfss\/data_documentation\/index.htm."},{"key":"ref_55","unstructured":"Centers for Disease Control and Prevention (2023, February 07). CDC-BRFSS-BRFSS Frequently Asked Questions (FAQs), Available online: https:\/\/www.cdc.gov\/brfss\/about\/brfss_faq.htm."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/1745691614568352","article-title":"Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review","volume":"10","author":"Smith","year":"2015","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_57","unstructured":"Ortiz, H. (2023, February 07). Crossing New Frontiers: Benefits Access among Isolated Seniors | advancingstates.org. Available online: http:\/\/www.advancingstates.org\/hcbs\/article\/crossing-new-frontiers-benefits-access-among-isolated-seniors."},{"key":"ref_58","unstructured":"Havinghurst, R. (1978). Ageing in Western Society. Soc. Chall. Ageing. Lond. Croom Helm, 15\u201344."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/0733464814530805","article-title":"Quality of Life and Psychological Distress among Older Adults: The Role of Living Arrangements","volume":"35","year":"2016","journal-title":"J. Appl. Gerontol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3928\/19404921-20180216-02","article-title":"Falls and Social Isolation of Older Adults in the National Health and Aging Trends Study","volume":"11","author":"Pohl","year":"2018","journal-title":"Res. Gerontol. Nurs."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1177\/0898264317703559","article-title":"Social Isolation and Medicare Spending: Among Older Adults, Objective Social Isolation Increases Expenditures While Loneliness Does Not","volume":"29","author":"Shaw","year":"2017","journal-title":"J. Aging Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"630717","DOI":"10.1155\/2015\/630717","article-title":"Health Characteristics of Solo Grandparent Caregivers and Single Parents: A Comparative Profile Using the Behavior Risk Factor Surveillance Survey","volume":"2015","author":"Whitley","year":"2015","journal-title":"Curr. Gerontol. Geriatr. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1017\/S0144686X00003457","article-title":"Social Isolation and Loneliness in Old Age: Review and Model Refinement","volume":"16","author":"Wenger","year":"1996","journal-title":"Ageing Soc."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/0002716214526530","article-title":"Grandparent Coresidence and Family Well-Being: Implications for Research and Policy","volume":"654","author":"Dunifon","year":"2014","journal-title":"ANNALS Am. Acad. Political Soc. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1111\/j.1751-9020.2010.00306.x","article-title":"Under One Roof: A Review of Research on Intergenerational Coresidence and Multigenerational Households in the United States","volume":"4","author":"Keene","year":"2010","journal-title":"Sociol. Compass"},{"key":"ref_66","unstructured":"Lofquist, D.A. (2023, February 07). Multigenerational Households: 2009\u20132011, Available online: https:\/\/www.census.gov\/library\/publications\/2012\/acs\/acsbr11-03.html."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/1540415318757219","article-title":"Latino Solo Grandparents Raising Grandchildren: Health Risks and Behaviors","volume":"16","author":"Whitley","year":"2018","journal-title":"Hisp. Health Care Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s10900-016-0257-8","article-title":"African-American Solo Grandparents Raising Grandchildren: A Representative Profile of Their Health Status","volume":"42","author":"Whitley","year":"2017","journal-title":"J. Community Health"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1177\/1557988315621604","article-title":"The Health of the Nation\u2019s Custodial Grandfathers and Older Single Fathers: Findings From the Behavior Risk Factor Surveillance System","volume":"11","author":"Whitley","year":"2017","journal-title":"Am. J. Men\u2019s Health"},{"key":"ref_70","unstructured":"(2023, February 07). Measuring Healthy Days: Population Assessment of Health-Related Quality of Life, 2000, Available online: https:\/\/www.cdc.gov\/hrqol\/pdfs\/mhd.pdf."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1136\/jech.57.5.339","article-title":"Retest Reliability of Surveillance Questions on Health Related Quality of Life","volume":"57","author":"Andresen","year":"2003","journal-title":"J. Epidemio.l Community Health"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1007\/s11136-011-0002-9","article-title":"Development and Psychometric Evaluation of the Public Health Surveillance Well-Being Scale","volume":"21","author":"Bann","year":"2012","journal-title":"Qual. Life Res."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e181","DOI":"10.1016\/j.amepre.2020.01.025","article-title":"Comparisons of Estimates From the Behavioral Risk Factor Surveillance System and Other National Health Surveys, 2011\u20132016","volume":"58","author":"Hsia","year":"2020","journal-title":"Am. J. Prev. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/1477-7525-4-66","article-title":"Psychometric Properties of the Centers for Disease Control and Prevention Health-Related Quality of Life (CDC HRQOL) Items in Adults with Arthritis","volume":"4","author":"Mielenz","year":"2006","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1477-7525-1-37","article-title":"The Centers for Disease Control and Prevention\u2019s Healthy Days Measures\u2014Population Tracking of Perceived Physical and Mental Health over Time","volume":"1","author":"Moriarty","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Pierannunzi, C., Hu, S.S., and Balluz, L. (2013). A Systematic Review of Publications Assessing Reliability and Validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004-2011. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-49"},{"key":"ref_77","unstructured":"Centers for Disease Control and Prevention (2023, February 07). Healthy Days Core Module: HRQOL-14 Measure|HRQOL|CDC, Available online: https:\/\/www.cdc.gov\/hrqol\/hrqol14_measure.htm."},{"key":"ref_78","unstructured":"Centers for Disease Control and Prevention (2003). HRQOL Measures Can Help Track Health as Population Ages. Health-Related Quality of Life, Part I, 2003. Chronic Dis. Notes Rep., 16, 1\u201336."},{"key":"ref_79","first-page":"A16","article-title":"Tracking Healthy Days\u2014A Window on the Health of Older Adults","volume":"2","author":"Moriarty","year":"2005","journal-title":"Prev. Chronic Dis."},{"key":"ref_80","first-page":"93","article-title":"Validity of the US Behavioral Risk Factor Surveillance System\u2019s Health Related Quality of Life Survey Tool in a Group of Older Canadians","volume":"22","author":"Ounpuu","year":"2001","journal-title":"Chronic Dis. Can."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1002\/ajim.22094","article-title":"Occupation and the Prevalence of Current Depression and Frequent Mental Distress, WA BRFSS 2006 and 2008","volume":"55","author":"Fan","year":"2012","journal-title":"Am. J. Ind. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1089\/pop.2015.0162","article-title":"Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days","volume":"20","author":"Slabaugh","year":"2017","journal-title":"Popul. Health Manag."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1080\/08952841.2016.1223916","article-title":"Mental Health Differences between Men and Women Caregivers, BRFSS 2009","volume":"29","author":"Edwards","year":"2017","journal-title":"J. Women Aging"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.2105\/AJPH.2020.305894","article-title":"Impact of Caregiving During Emerging Adulthood on Frequent Mental Distress, Smoking, and Drinking Behaviors: United States, 2015-2017","volume":"110","author":"Grenard","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.ypmed.2016.06.011","article-title":"Mental Distress and Functional Health in the United States","volume":"89","author":"Charara","year":"2016","journal-title":"Prev. Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12963-017-0133-5","article-title":"Self-Reported General Health, Physical Distress, Mental Distress, and Activity Limitation by US County, 1995-2012","volume":"15","author":"Mackenbach","year":"2017","journal-title":"Popul. Health Metr."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.socscimed.2016.11.040","article-title":"Immigration Policies and Mental Health Morbidity among Latinos: A State-Level Analysis","volume":"174","author":"Hatzenbuehler","year":"2017","journal-title":"Soc. Sci. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.amepre.2009.01.038","article-title":"Geographic Patterns of Frequent Mental Distress: U.S. Adults, 1993\u20132001 and 2003\u20132006","volume":"36","author":"Moriarty","year":"2009","journal-title":"Am. J. Prev. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.15585\/mmwr.mm685152a1","article-title":"State-Specific Prevalence and Characteristics of Frequent Mental Distress and History of Depression Diagnosis Among Adults with Arthritis\u2014United States, 2017","volume":"68","author":"Price","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1292594","DOI":"10.1080\/2331205X.2017.1292594","article-title":"The physical health dilemmas facing custodial grandparent caregivers: Policy considerations","volume":"4","author":"Taylor","year":"2017","journal-title":"Cogent Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1111\/j.1475-6773.2004.00312.x","article-title":"Elevated depressive symptoms among caregiving grandparents","volume":"39","author":"Blustein","year":"2004","journal-title":"Health Serv. Res."},{"key":"ref_92","first-page":"259","article-title":"Social Determinants of Mental Health: A Review of the Evidence","volume":"30","author":"Silva","year":"2016","journal-title":"Eur. J. Psychiatry"},{"key":"ref_93","unstructured":"US Census Bureau (2023, February 07). How Disability Data are Collected from The American Community Survey, Available online: https:\/\/www.census.gov\/topics\/health\/disability\/guidance\/data-collection-acs.html."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Hilbe, J.M. (2009). Logistic Regression Models, Chapman and Hall\/CRC. [1st ed.].","DOI":"10.1201\/9781420075779"},{"key":"ref_95","unstructured":"Firestone, S.K., and Butts, D. (2023, February 07). Changing the Narrative on Multigenerational Living. Available online: https:\/\/generations.asaging.org\/changing-narrative-multigenerational-living."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s10433-018-0474-3","article-title":"Trends in the Prevalence of Grandparents Living with Grandchild(Ren) in Selected European Countries and the United States","volume":"15","author":"Glaser","year":"2018","journal-title":"Eur. J. Ageing"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2190\/PM.43.1.b","article-title":"Living Arrangements and Risk for Late Life Depression: A Meta-Analysis of Published Literature","volume":"43","author":"Qian","year":"2012","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/NMD.0b013e3181b0c081","article-title":"Older Adults Are Less Accurate than Younger Adults at Identifying Symptoms of Anxiety and Depression","volume":"197","author":"Wetherell","year":"2009","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1891\/0198-8794.32.231","article-title":"Resilience and Family Caregiving","volume":"32","author":"Coon","year":"2012","journal-title":"Annu. Rev. Gerontol. Geriatr."},{"key":"ref_100","unstructured":"Giarrusso, R., Silverstein, M., and Feng, D. (2000). To Grandmother\u2019s House We Go and Stay: Perspectives on Custodial Grandparents, Springer."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/geront\/gnp067","article-title":"Examining Resilience of Quality of Life in the Face of Health-Related and Psychosocial Adversity at Older Ages: What Is \u201cRight\u201d about the Way We Age?","volume":"50","author":"Hildon","year":"2010","journal-title":"Gerontologist"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.gerinurse.2016.02.014","article-title":"The Impact of Resilience among Older Adults","volume":"37","author":"MacLeod","year":"2016","journal-title":"Geriatr. Nurs."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-5235-x","article-title":"The Fundamental Association between Mental Health and Life Satisfaction: Results from Successive Waves of a Canadian National Survey","volume":"18","author":"Lombardo","year":"2018","journal-title":"BMC Public Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/4\/3747\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:37:18Z","timestamp":1760121438000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/4\/3747"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,20]]},"references-count":103,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20043747"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20043747","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2023,2,20]]}}}