behavioral

sciences
Article
Intergenerational Support and Second-Child Fertility Intention
in the Chinese Sandwich Generation: The Parallel Mediation
Model of Double Burnout
Wenxiao Fu 1, *, Wenlong Zhao 1 and Fei Deng 2

1 School of Humanities and Social Science, Xi’an Jiaotong University, Xi’an 710049, China
2 School of Education, Xi’an International Studies University, Xi’an 710128, China
* Correspondence: [email protected]

Abstract: In 2013, the Chinese government implemented a two-child policy to increase the coun-
try’s fertility rate. However, the persistently low rates necessitated other measures to boost fertility.
This study empirically investigated the association between intergenerational support and second-
child fertility intention in the Chinese sandwich generation and demonstrated the mediating role of
parental burnout and burnout in caring for grandparents. Survey data collected at Time 1, Time 2, and
Time 3 included 2939 participants from different regions of China. Before analyzing the data, coars-
ened exact matching and propensity score matching was conducted to reduce sampling bias. Regres-
sion analysis results indicated that intergenerational support has a significant total positive effect on
second-child fertility intention. Furthermore, mediation path analysis revealed that parental burnout
and burnout in caring for grandparents play significant but opposite directional mediating roles in
the association between intergenerational support and second-child fertility intention. Sensitivity
analysis using different calipers yielded similar results. These results indicated that second-child
fertility intention can be increased among the Chinese sandwich generation with intergenerational
support, by mitigating parental burnout. However, intergenerational support did not alleviate
burnout in caring for grandparents in the sandwich generation; therefore, formal older adult care
policies are required to help the sandwich generation experience lower burnout, while receiving
intergenerational support.
Citation: Fu, W.; Zhao, W.; Deng, F.
Intergenerational Support and
Keywords: intergenerational support; parental burnout; burnout in caring for grandparents; fertility
Second-Child Fertility Intention in
intention; sandwich generation
the Chinese Sandwich Generation:
The Parallel Mediation Model of
Double Burnout. Behav. Sci. 2023, 13,
256. https://doi.org/10.3390/
bs13030256 1. Introduction

Academic Editor: Gert G. Wagner

China’s National Bureau of Statistics stated that the nation’s total fertility rate declined
from 2.75 in 1980 to 1.15 in 2021 [1]. The 50 year-long one-child policy in China has not
Received: 27 January 2023 only restricted reproductive behavior and changed traditional fertility intentions, but has
Revised: 2 March 2023 also created a unique Chinese sandwich generation. In China, the sandwich generation
Accepted: 5 March 2023 is characterized by only children, who bear heavier care burdens in parenting and caring
Published: 14 March 2023
for older adults than sandwich generations in other countries [2]. Under the threat of
dual stress, the Chinese sandwich generation is at high risk of developing psychological
problems, such as parental burnout (PB) and burnout in caring for grandparents (BCG),
Copyright: © 2023 by the authors.
which may affect their intention to have more children [3]. In such circumstances, most
Licensee MDPI, Basel, Switzerland. Chinese grandparents will provide extra help to alleviate this double pressure.
This article is an open access article Existing research has significantly explored fertility intentions in China; however,
distributed under the terms and some important issues remain unexplored [4]. On the one hand, few studies have examined
conditions of the Creative Commons the combined effects of dual burnout on the fertility intentions of the sandwich generation.
Attribution (CC BY) license (https:// Given their shared impact on fertility intentions, the failure to combine these two types
creativecommons.org/licenses/by/ of burnouts may lead to misleading conclusions. On the other hand, many studies have
4.0/). confirmed the effect of intergenerational support (IS) on fertility intentions; however,

Behav. Sci. 2023, 13, 256. https://doi.org/10.3390/bs13030256 https://www.mdpi.com/journal/behavsci

Behav. Sci. 2023, 13, 256 2 of 19

little is known about the mechanisms underlying how IS affects second-child fertility
intention (SCFI).
Considering these arguments, this study aimed to explore the mediating role of PB and
BCG between IS and SCFI. In other words, this study sought to understand as to whether
IS increases SCFI by mitigating the double burnout of the sandwich generation. These
findings may provide a pathway to alleviate this double burnout, and accordingly offer
insights into how best to address China’s low fertility rate. In addition, the findings could
also be informative for other countries with very low fertility rates and fertility intentions
(e.g., Republic of Korea).

2. Literature Review and Hypothesis Development

2.1. Cooperative Breeding Hypothesis
The cooperative breeding hypothesis suggests that humans have developed a system
of “cooperative breeding” in childrearing—specifically, mothers can get help from others
to raise their children better [5]. The findings of the cooperative breeding hypothesis
correspond with some earlier studies by anthropologists who found that women living in
extended families were more inclined to have more children [6]. Sear and Coall reviewed
the literature exploring family members helping mothers raise their children, and found
that they cannot raise too many children on their own, and that some family members
are important for child development and fertility [7]. In summary, we contend that the
cooperative breeding hypothesis provides theoretical guidance for examining the impact of
IS on the SCFI of the sandwich generation in China.

2.2. Intergenerational Solidarity Theory

The relationship between parents and children is special and complex; moreover, for a
long time, no theory had directly explored intergenerational relationships. It was not until
1991 that Bengtson and Roberts proposed the intergenerational solidarity theory, which
provided an important framework for exploring intergenerational relationships. The inter-
generational solidarity theory is a multi-dimensional structure comprising six dimensions:
affectual, associational, consensual, functional, normative, and structural solidarity [8].
A recent review mentioned that this theory provides a more comprehensive framework for
investigating intergenerational support [9]. We contend that intergenerational solidarity
theory may offer a suitable theoretical framework to test the underlying mechanism of IS
and SCFI.

2.3. Intergenerational Support and Second-Child Fertility Intention

In 2016, the Chinese government implemented a two-child policy, which allows all
married couples to have two children. Although the total fertility rate rose briefly to
1.6 in 2017, it declined to 1.15 by 2021. This reveals that the current family-planning
policy has played only a limited role in increasing fertility rates. Globally, the number
of countries entering aging societies is increasing, as is the proportion of the population
with grandparents. Currently, grandparents make up 20% of the world’s population [10].
Although grandparents are not considered to be a productive population, they contribute
to society by providing support to their children and increasing “family capital” [11].
Although the support provided by grandparents is voluntary and unpaid, we cannot
ignore the positive effects of IS, such as a higher fertility rate.
In contemporary society, childbirth costs are rising rapidly, and having more children
means requiring more resources from parents. Further, multiple pressures dilute the
resources of the sandwich generation, driving couples to turn to their parents for additional
resources. The existing literature indicates that the support provided by grandparents
involves three main aspects. First, grandparents provide practical help, such as child care
and household chores. According to China’s Research Center on Aging, 70% of children
under age six are cared for by at least one grandparent [12]. Data from the U.S. and some
European countries show that more than a quarter of families have grandparents to help
Behav. Sci. 2023, 13, 256 3 of 19

with childcare and take care of some household tasks [13]. Gu et al. provided evidence from
China that grandparents helping with childrearing can boost child fertility [14]. Secondly,
grandparents also provide financial support, in order to reduce their children’s financial
stress. Using data from 13,626 grandparents, Luo et al. showed that more than 60% of
grandparents provided care for their grandchildren during a 10 year period, with higher-
income grandparents providing additional financial support, such as paying for formal
childcare costs [15]. Finally, researchers have confirmed that emotional assistance from
grandparents affects parents’ attitudes and actions toward childbearing and parenting.
Sear explored the link between support from grandparents and fertility, and confirmed that
emotional support increases the likelihood of subsequent births [16]. Using longitudinal
data from France and Norway, Tanskanen and Rotkirch suggested that both emotional
support and child-care help from grandparents are associated with increased fertility
intentions [17]. Therefore, we propose the following:

H1. IS plays a positive role in SCFI.

2.4. Intergenerational Support, Parental Burnout, and Second-Child Fertility Intention

Although existing studies confirm the positive aggregate effect of IS on having more
children, some unanswered questions still exist. On the one hand, the question of the
underlying mechanisms between IS and fertility intention remains unclear, and on the other
hand, existing studies have not explored IS and fertility among the sandwich generation in
China. For this generation, the one-child policy has left them with the burden of raising
children and also caring for grandparents. Whether IS can increase fertility by alleviating
the double burden of the sandwich generation is the next question for further exploration.
Raising children is very demanding, especially for the sandwich generation. When
parents are chronically unable to access additional resources to deal with parenting stresses,
they face the threat of PB. PB is defined as “a state of intense exhaustion related to one’s
parental role, in which one becomes emotionally detached from one’s children and doubtful
of one’s capacity to be a good parent” [18]. Chen et al. showed that the average parental
burnout score for Chinese parents was 48.03 (0–138), with a prevalence rate of 3% [19]. So
far, researchers have focused on exploring the factors contributing to PB. Few researchers
have explored and provided empirical evidence for factors that mitigate PB. According
to the initial theoretical framework of PB (the balance between risks and resources (BR2 ))
theory, risk factors that can lead to high parenting stress levels are antecedents of PB,
while adequate parenting resources can alleviate parenting burnout [20]. As an additional
resource, IS may reduce parenting stress and mitigate PB. Thus, we propose:

H2a. IS is negatively related to PB.

A recent study of 17,409 parents from 42 countries demonstrated that the prevalence
of PB varies globally, ranging from 1% to 10% [21]. The notion of PB has gained widespread
attention, due to its high prevalence and serious consequences. Parents threatened by PB
may lose their sense of fulfillment in raising children and begin to reject their parental role,
eventually becoming increasingly emotionally distant from their children [22,23]. Yang et al.
demonstrated that parental burnout was not only harmful to parents’ mental health but
also predicted mental health problems (e.g., depression) in children [24]. A recent article
shows that overwhelming parenting stress reduces a couple’s intention to have another
child [25]. Given that parenting stress is one of the core features of PB, we infer that PB
also reduces the likelihood that couples will have more children. Therefore, we propose
the following:

H2b. PB is negatively related to SCFI.

Behav. Sci. 2023, 13, 256 4 of 19

2.5. Intergenerational Support, Burnout in Caring for Grandparents, and Second-Child

Fertility Intention
In China, adult children are not only influenced by Confucian culture, but are also
governed by law to support their parents. Confucian culture considers adult children
supporting their grandparents as an expression of filial piety, and China’s civil code
includes legal obligations for children to support older adults, which has resulted in
adult children and parents being embedded, by moral norms and laws, into a network of
lifelong mutual obligations. Additionally, due to the one-child policy, many families lack
enough adult children to share the burden of caring for parents. Thus, for the sandwich
generation, a future of providing care for parents as they age is predictable. As a result,
burnout from the stress of supporting older adults is likely to affect the fertility plans of the
sandwich generation. Similar to PB, BCG can be defined as a syndrome that arises from
supporting older adults in response to the stress caused by the caregiving environment.
BCG also contains three dimensions: emotional exhaustion, depersonalization, and loss of
accomplishment [26]. Although some researchers have suggested focusing on the effects
of BCG in sandwich generation studies [27,28], few have done so. In summary, this study
argues that there is a need to test the role played by BCG in the model.
The existing literature does not agree on the relationship between IS and BCG. On
the one hand, some researchers have argued through qualitative and quantitative analysis
that IS can reduce caregiver burden and stress. Using data from 56 primary informal
caregivers (mostly adult children or adult grandchildren), Reid et al. confirmed that the
burden on caregivers would be significantly reduced if reciprocity existed between the
care receiver and the caregiver [29]. In a recent article, Japanese researchers conducted
open-ended interviews with 50 pairs of caregivers and care receivers, and confirmed that IS
can reduce the burden of caring for parents by adult children [30]. On the other hand, some
researchers have concluded, from an equitable reciprocity perspective, that grandparent
support is not a purely altruistic act, but more of a filial investment. Offer further explained
that there are three stages of reciprocity—giving, receiving, and repaying—and that the
pressure to repay is most likely to be the main burden for people, which is also the main
cause of psychological burden for the recipient [31]. As Blau asserts, reciprocity constitutes
“a necessary condition of exchange that individuals, in the interest of continuing to receive
needed services, discharge their obligations for having received them in the past” [32]. Non-
reciprocated behaviors will usually lead to the breaking-off of social ties. Grandparental
support is the giving component of reciprocity, and after receiving this support, adult
children need to reciprocate to maintain intergenerational interactions, which may increase
the burden on adult children and induce psychological burnout [33]. Therefore, we propose
the following:

H3a. IS is positively related to BCG.

In China, adult children are the primary means of supporting older adults, but the
long-term one-child policy has greatly reduced the birth rate, which has led to a serious
reduction in the number of caregivers supporting older adults. Will adult children plan
to have more children when supporting older adults becomes a major source of stress?
Although the literature on BCG and fertility intention is limited, a few researchers have
explored the relationship between older adult care-related stress and fertility. Exploring
the support provided by adult children with full-time jobs in Canada to support their
aging parents, Duxbury et al. noted that caring for older adults is strongly associated with
absenteeism, lower well-being, and lower fertility, effects that are stronger for women [34].
The results of a recent quantitative article by Japanese researchers Sakata and McKenzie
suggest that the stress of caring for parents directly reduces the number of children born to
Japanese couples [35]. In addition, Sakata and McKenzie used the 1998 and 2008 National
Family Research of Japan surveys to explore the link between older adult care-related
stress and child quality, and confirmed that parental caregiving stress affects the quality of
Behav. Sci. 2023, 13, 256 5 of 19

education for the third and subsequent children [36]. Considering that caregiving stress is
an important indicator of BCG, we propose the following:

H3b. BCG is negatively related to SCFI.

2.6. Intergenerational Support, Parental Burnout, Burnout in Caring for Grandparents, and
Second-Child Fertility Intention
Most previous studies on IS and fertility intentions have concluded that IS can increase
fertility or fertility intentions. However, a few studies still conclude that IS can only increase
fertility in specific populations or even that there is no direct relationship between IS and
fertility [37]. An important reason for the inconsistent findings is the possibility of other
factors influencing the path between IS and fertility intention—that is, whether IS affects
fertility intention through other variables. IS reduces the financial and time pressures on
couples, who have more resources to care for older adults and raise children and therefore
have a higher likelihood of having more children. However, sandwich generations are
aware of the need to provide care as their parents age in return for present-day support;
therefore, they are likely to delay or cancel childbearing plans to avoid conflicts in allocating
future support and resources. The exploration of the underlying mechanisms echoes the
call of Sear and Coall. In a literature review, they noted that the relationship between IS and
fertility intentions varies depending on the mediating variable [7]. We argue that IS may
affect parents’ fertility intentions through PB and BCG. Moreover, researchers have pointed
out that based on a significant total effect, if there is a significant mediating effect, then the
direct effect of the independent variable on the dependent variable needs to be further tested
to explain whether the indirect effect is fully or partially mediated [38]. Full mediation
indicates that the researcher has fully revealed the mechanism of the independent variable’s
influence on the dependent variable, and that there is no other mediating influence. Partial
mediation implies that the independent variable’s influence on the dependent variable is
other than the mediating factors in the model, implying the plausibility of other causal
mechanisms. For the sandwich generation, it is possible that BCG and PB are mediating
variables between IS and SCFI, but this does not determine the absence of other influencing
mechanisms. For example, in a recent study, Wang and Zhao demonstrated that IS improves
the odds of couples having a second child by alleviating incompatibility in maternal time
allocation [39]. As expected, we propose the following:

H4a. PB acts as a mediator between IS and SCFI.

H4b. BCG acts as a mediator between IS and SCFI.

H4c. There is a significant direct effect between IS and SCFI.

2.7. Factors Influencing Intergenerational Support

IS is not random. Unobserved covariates are likely to exert effects on both IS and SCFI,
confounding the causal effects between variables. Factors that may influence grandparents’
willingness to provide support, such as their own health status and their own, as well as
their children’s, economic statuses, are crucial variables to control for when testing the
effect of IS on fertility intentions [40]. Referring to the influential factors used to examine IS
in previous studies, hukou (household registration in China), age, grandparents’ health and
income, and other variables were covered in this study. Additionally, IS should consider
variables related to both grandparents and adult children. Adult children with greater
needs are more likely to expect support from grandparents than adult children with fewer
needs. Therefore, adult children’s economic conditions and socioeconomic status are also
included. Since different factors may influence IS and further affect fertility intention,
particular methods are required, in order to reduce the selection bias, before analyzing the
relationship between IS and SCFI. Figure 1 shows the study proposed model.
 with fewer needs. Therefore, adult children’s economic conditions and socioecono
tus are also included. Since different factors may influence IS and further affect
intention, particular methods are required, in order to reduce the selection bias
analyzing the relationship between IS and SCFI. Figure 1 shows the study p
Behav. Sci. 2023, 13, 256 6 of 19
model.

Figure
Figure Proposed
1. 1. Model.
Proposed Model.
3. Methods
3. Methods
3.1. Participants and Data Collection
3.1.An
Participants and Data
ethics approval of the Collection
research was granted by the Human Research Ethics Com-
mittee (HREC), Xi’an JiaoTong University prior to data collection. We surveyed parents
An ethics approval of the research was granted by the Human Research Ethi
with one child in six Chinese cities in 2020 and 2021. The Center of Health Supervision
mittee (HREC),
National Commission Xi’an
of theJiaoTong
PRC conducted University
a survey prior
of moretothan
data
5.8 collection. Wewho
million couples surveyed
withhad
only oneonechild
child. in
Wesix
foundChinese
that 95% cities infirst
of their 2020 and 2021.
children The Center
were under of Health
15. Therefore, the Sup
National Commission of the PRC conducted a survey of more than 5.8 million
“parents of children currently in kindergarten, elementary school, and junior high school”
were
whoselected
only hadas respondents
one child.inWe this found
study. that 95% of their first children were under 15
To select respondents, the survey employed a multistage random sampling procedure
fore, the “parents of children currently in kindergarten, elementary school, an
based on levels of region, city, school, grade, and class. We selected six cities of different
high(different
types school”economic
were selected as respondents
development in thissizes,
levels, population study.
and social cultures) from
Toregions
different select (eastern,
respondents,
central, the survey employed
and western) a multistage
as a good representation random
of the samplin
different
regions of China (Table 1).
dure based on levels of region, city, school, grade, and class. We selected six citie
ferent types (different economic development levels, population sizes, and social c
Table 1. Surveyed Cities.
from different regions (eastern, central, and western) as a good representation of
ferent regions of ChinaEastern
(TableRegion
1). Central Region Western Region
Cities Fujian Xiamen Hunan Changsha Shaanxi Xi’an
Counties Zhuhai Jinwan Shanxi Yuci Shaanxi Sanyuan
Table 1. Surveyed Cities.

Eastern 300
We extracted approximately Region Central
children, 600 primary Region
school students, and 300Western
junior Reg
high school
Cities students from each city
Fujian Xiamen and county. Subsequently,
Hunan Changsha the students’ parents
Shaanxi Xi’a
(approximately 7232) were invited to participate in the survey.
Counties Zhuhai Jinwan Shanxi Yuci
Data were collected from respondents through online questionnaires, which were
Shaanxi Sany
distributed by the head teachers via WeChat and QQ (the two most popular applications
We extracted
for information exchangeapproximately
in China). Web 300 children, have
questionnaires 600 primary school
the advantages students,
of low cost and
and
ior convenient
high school operation,
students butfrom
they also
eachhave
citycertain limitations
and county. [41]. On the onethe
Subsequently, hand,
students’
although the online questionnaire format allows respondents to fill out the questionnaire
(approximately 7232) were invited to participate in the survey.
anytime and anywhere, the high degree of freedom in filling out the questionnaire and the
Data
limitation were
of the collected
researcher not from respondents
being able to be present through online
in the room makes questionnaires,
it impossible whi
distributed
for by the
the researcher head teachers
to effectively control via
the WeChat
processes and QQ (the two
of questionnaire most popular
distribution and app
filling out the questionnaire, which, in turn, does not guarantee an effective
for information exchange in China). Web questionnaires have the advantages of response. On
the
and other hand, afteroperation,
convenient the questionnaire link isalso
but they sent to the online
have certainplatform, the respondents
limitations [41]. On the on
may redistribute the questionnaire again. Therefore, in the questionnaire diffusion process,
although the online questionnaire format allows respondents
respondents may be both the respondent and the diffusers, which partly deprives to fill outthe
the quest
anytime and anywhere, the high degree of freedom in filling out the questionn
the limitation of the researcher not being able to be present in the room makes it
ble for the researcher to effectively control the processes of questionnaire distribu
Behav. Sci. 2023, 13, 256 7 of 19

researcher of control over the questionnaire to some extent. Therefore, there is a need to
technically control the forwarding privileges of the questionnaire when distributing the
online questionnaire, in order to ensure the researcher’s control over the questionnaire.
Before the survey began, participants were asked to consent to participate. To reduce
common method variance, this study was designed to conduct three measurements. The
independent variables (IS) and demographic variables were measured at Time 1, while
the mediators (PB and BCG) were measured at Time 2, with a four-month interval. Three
months later, the outcome variable (SCFI) was measured at Time 3.
At Time 1, 7232 online questionnaires were distributed, and after excluding invalid
questionnaires, 6901 were usable at a 95% response rate. Approximately four months
later, we distributed a second questionnaire and received 6346 valid questionnaires with
a response rate of 91%. At Time 3, we collected a total of 3812 questionnaires, with a
return rate of 60%. Given that our study focused on the SCFI of sandwich families, we
excluded those without grandparents and those that already had two or more children. The
included sample consisted of 2939 parents. The survey respondents were from different
socioeconomic and sociocultural backgrounds. Specifically, approximately 49.1% were men
and 50.9% were women. Furthermore, 56% of the respondents had urban hukou (household
registration system in China), and 44% had rural hukou. The majority of the respondents
(95%) were between the ages of 20 and 49 years old, with a minority being over 50.

3.2. Measures
This study uses scales validated in previous research to measure IS, PB, BCG, and
SCFI. The scales were translated and back-translated with the help of three researchers in
related fields, and minor revisions were made to make the scales applicable to Chinese
culture. All scales can be found in the Appendix A (Tables A1–A4).

3.2.1. Intergenerational Support

An adapted version of the Intergenerational Support Scale (ISS) was used in this
study [42]. We asked parents whether they received support from their parents along
three dimensions (i.e., financial, emotional, and practical). Each dimension included one
question (“Do you receive financial/emotional/practical support from your parents?”).
The following choice case was coded as either 1 (with respondents selecting “yes” to at
least one dimension, representing the presence of IS) or 0 (representing the absence of IS).

3.2.2. Parental Burnout

PB was assessed with the Chinese version of the parental burnout assessment (PBA) [43].
The scale consists of 23 items related to four subscales: exhaustion in one’s parental role
(9 items), contrast with previous parental self (6 items), feelings of being fed up with one’s
parental role (5 items), and emotional distancing from one’s children (3 items). PBA items
were rated on the 7-point Likert scale—from never (0) to every day (6). The total score for
all 23 items ranged from 0 to 138, with higher scores indicating higher levels of PBA. In
the current sample, Cronbach’s alphas were 0.90, 0.88, 0.79, and 0.80 for the four subscales,
and 0.92 for the global score. All the estimated factor loadings found in the CFA were
significant at p < 0.001. Standardized factor loadings ranged between 0.79 and 0.91. In the
fit indices, CFI = 0.96, TLI = 0.95, RMSEA = 0.04, and SRMR = 0.03. These results confirm
the reliability of the PBA scale and the validity of its four-factor internal structure. Results
are detailed in Table 2.
Behav. Sci. 2023, 13, 256 8 of 19

Table 2. The results of CFA and its correlations.

Cronbach’s std. Factor

Items χ2 /df CFI TLI RMSEA SRMR
Alphas Loading
PB PB scale 23 0.92 - 5895.69 *** 0.96 0.95 0.04 0.03
Subscale 1 9 0.90 0.91
Subscale 2 6 0.88 0.79
Subscale 3 5 0.79 0.85
Subscale 4 3 0.80 0.82
BCG BCG scale 22 0.88 - 4859.44 *** 0.92 0.93 0.05 0.04
Subscale 1 9 0.92 0.93
Subscale 2 5 0.73 0.76
Subscale 3 8 0.85 0.88
SCFI SCFI scale 5 0.89 0.95 2140.70 *** 0.96 0.94 0.03 0.02
IS PB BCG
PB −0.31 ***
BCG 0.40 *** 0.23 *
SCFI 0.39 ** −0.46 *** −0.38 **
Note. * p < 0.05, ** p < 0.01, *** p < 0.001.

3.2.3. Burnout in Caring for Grandparents

An adapted version of the Maslach Burnout Scale—Human Services Survey (MBI-
HSS) was used to measure BCG [44]. The scale contains 22 items and is divided into
three subscales: emotional exhaustion (9 items), depersonalization (5 items), and personal
accomplishment (8 items). The MBI-HSS is a 7-point Likert scale, with answers ranging
from 0 (never) to 6 (every day). As such, a high score means a high level of BCG. In this study,
the internal consistency was good to excellent for the three subscales, and the Cronbach’s
alphas were 0.92, 0.73, 0.85, and 0.88 for the global score. All the estimated factor loadings
found in the CFA were significant at p < 0.001. Standardized factor loadings ranged between
0.76 and 0.93. In the fit indices, CFI = 0.92, TLI = 0.93, RMSEA = 0.05, and SRMR = 0.04.
These results confirm the reliability of the BCG scale and the validity of its three-factor
internal structure. Results are detailed in Table 2.

3.2.4. Second-Child Fertility Intention

This study uses an adapted version of the Fertility Intention Scale to collect data on
the intention to have a second child [45]. The scale contains 5 items (e.g., Do you intend
to have a second child in the following years?), and each item was scored using a 5-point
Likert scale, with higher scale scores meaning greater second child fertility intention. In
this study, Cronbach’s alpha of the scale was 0.89. All the estimated factor loadings found
in the CFA were significant at p < 0.001. The standardized factor loading is 0.95. In the fit
indices, CFI = 0.96, TLI = 0.94, RMSEA = 0.03, and SRMR = 0.02. These results confirm the
reliability of the SCFI scale and the structure validity. Results are detailed in Table 2.

3.2.5. Control Variables

This study used a set of control variables to estimate the propensity scores, specifically,
paternal grandparents’ hukou, socioeconomic status, and health conditions, as well as the
fathers’ age, occupational reputation, the first child’s gender, maximum years of education,
whether subjects were living with parents or not, and the age of the first-born child. The
hukou system was measured as a dichotomous dummy variable, coded as 1 for rural and
2 for urban. This study built the International Socio-Economic Index of Occupational Status
(ISEI) based on the International Standard Classification of Occupation (ISCO-88) and used
Treiman’s Standard International Occupational Prestige Scale (Treiman’s SIOPS) to measure
participants’ occupational reputation. This scale measures grandparents’ health conditions,
with the answers coded as 1 = “very bad” to 5 = “very good”.
Behav. Sci. 2023, 13, 256 9 of 19

3.2.6. Analytical Strategy

Descriptive analysis, Chi-squared tests, and t-tests were first conducted on the general
characteristic of variables. To address the selection bias, coarsened exact matching (CEM)
for coarsening pruning was first performed by Stata 16.0, and then the nearest neighbor
matching with put-back was performed by the PSMATCH2 program in the Stata 16.0 pack-
age. Subsequently, the matching effect was further tested for balance and sensitivity.
Then, regression and mediation analyses were performed using the post-matching
sample. Since both the mediating and dependent variables are continuous variables, this
paper uses ordinary least squares (OLS) regression to analyze the relationship between the
variables. We built an SEM model, following the approach introduced by Preacher and
Hayes, to test the multiple mediation effects [46]. Moreover, this paper uses bootstrapping
to calculate the mediation effect, mainly because this method does not require the sample
to be normally distributed, which greatly reduces the type I error rate and obtains valid
asymptotic refinement estimates. Mplus is preferred over other applications because it
provides not only the total indirect effects, but also each specific indirect effect, so that
comparisons between different indirect effects can be easily made. Therefore, all the
mediation analyses were conducted in Mplus 8.0.
Before matching, all variables had missing data rates of around or below 1%. We
used multiple imputations to impute missing data. After matching, all variables within
the matched sample had no missing values. Additionally, to test the validity and robust-
ness of the assumption that unmeasured covariates are ignorable, the balancing test and
Rosenbaum sensitivity test procedures were run.

4. Results
4.1. Descriptive Statistics, Chi-Squared Tests, and t-Tests before Matching
This study first conducted descriptive statistics on the variables to determine the
differences between families with and without IR. As shown in Table 3, 67.98% of the
families had IS, while 32.02% did not. The families with IS reported a higher intention to
have a second child. In addition, PB was slightly lower in families with IS. In terms of BCG,
the score of the two groups was equal. For the control variables, there were significant
differences between the two groups. Detailed results are shown in Table 3.

Table 3. Study sample characteristics, stratified by support status, before CEM and PSM.

Intergenerational Intergenerational
Total Sample
Non-Support Support
Mean SD Mean Mean p
Independent variable
Intergenerational (non)support 0.680 0.467
Dependent variable
SCFI 3.3667 1.010 2.879 3.596 <0.001 a
Mediator
PB 49.131 13.386 51.487 48.021 <0.001 a
BCG 46.868 12.236 47.534 46.554 0.039 a
Control variables
Father’s socioeconomic status 2.416 0.893 2.239 2.499 <0.001 a
Mather’s socioeconomic status 2.323 0.847 2.271 2.348 <0.001 a
Father’s age 37.096 6.029 37.738 36.794 <0.001 a
Mather’s age 36.266 6.028 36.021 36.381 <0.001 a
Paternal grandfather’s socioeconomic status 33.448 11.995 32.812 33.748 <0.001 a
Maternal grandfather’s socioeconomic status 31.874 10.254 31.354 32.119 <0.001 a
Paternal grandparents’ health condition 3.808 0.995 3.411 3.995 <0.001 a
Maternal grandparents’ health condition 3.749 1.024 3.486 3.873 <0.001 a
Paternal grandparents’ hukou (1 = rural) 1.188 0.391 1.224 1.171 <0.001 b
Behav. Sci. 2023, 13, 256 10 of 19

Table 3. Cont.

Intergenerational Intergenerational
Total Sample
Non-Support Support
Mean SD Mean Mean p
Father’s occupational reputation 40.339 8.715 39.473 40.747 <0.001 a
Mather’s occupational reputation 39.636 8.716 38.184 40.320 <0.001 a
First child’s gender (1 = men) 1.469 0.499 1.467 1.470 <0.001 b
Maximum years of parents’ education 12.384 3.017 12.397 12.379 0.591 a
Living with grandparents or not (1 = no) 1.239 0.425 1.107 1.301 <0.001 b
Firstborn children’s age 8.521 5.261 7.165 9.160 <0.001 a
N 2939 941 1998
Note: p values are from the t-tests(two-tailed), b p values are from the chi-square tests.
a

4.2. Results of CEM and PSM

King and Nielsen note that “the more balanced the data, or the more balanced it
becomes by pruning some observations through matching, the more likely PSM will
degrade inferences—a problem we refer to as the PSM paradox” [47]. Therefore, the first
step in using PSM is to detect the balance of the original data. Based on the t-test in Table 1,
there is indeed a significant difference between the two groups, indicating that the raw data
would be more balanced using PSM. However, PSM also suffers from inefficiencies, model
dependencies, and excessive data pruning. King and Nielsen suggest that if researchers
need to use PSM, they can first use CEM for coarse pruning, before using PSM for exact
matching after carefully checking for imbalances. Recently, it has also been pointed out
that there is no single matching method that can reduce the bias across all scenarios [48].
Therefore, in this study, based on the recommendation of King and Guo, it was decided to
first use CEM for coarsening pruning and then PSM for nearest neighbor matching with
put-back. After coarsening pruning with CEM, the total number of participants was 2228,
including 1406 in the intervention group and 822 in the control group, and the overall
imbalance L1 = 0.518. The L1 value itself has no value, but serves as a point of comparison
between matching solutions. L1 = 0 indicates perfect global balance, while larger values
indicate large imbalances between groups, with the maximum value L1 = 1, indicating
complete separation.
The estimation of the propensity value consists of two steps, the first being the selection
of appropriate control variables and the second being the selection of the model to perform
the estimation. There are various strategies for selecting variables, and this study chose the
approach proposed by Heckman et al. [49]. This approach relies on statistical significance.
Specifically, if a variable is significant at conventional levels, it will be retained. Notably, any
discrete choice model can be selected, in principle. Due to the well-known shortcomings
of the linear probability model, researchers prefer logit or probit models. In this paper,
we used the logit model to estimate the set of variables. The variables and logit results
are detailed in Table S1. After obtaining the propensity values, this study was matched
using the put-back nearest neighbor method, and the total number of respondents after
CEM and PSM matching was 1445, including 827 in the intervention group and 618 in the
control group.

4.3. Results of the Balance Test and Common Support

The post-PSM Chi-squared tests and t-test revealed that the standardized deviations of
the variables mentioned above are significantly reduced, and the means of all the variables
are not significantly different, indicating a better matching effect. According to Rubin,
the results for the matched sample showed a B-value of 10.5, which is less than 25 and,
therefore, acceptable, as well as an R-value of 0.71, which was within the acceptable level
of 0.05 to 2 [50]. The results showed that PSM significantly reduced the difference between
the two groups, minimized the sample selection bias, and satisfied the balancing property,
which also means that unobserved covariates did not influence the test results. Matching
results are detailed in Table S2.
Behav. Sci. 2023, 13, 256 11 of 19

Besides, checking the overlap and the region of common support between treatment
and comparison groups is important in determining the validity of PSM. In this study,
there were adequately matched samples between the treatment and comparison groups
and very few lost samples, suggesting that the use of this sample for data estimation was
representative. The histogram of the common support region is detailed in Figure S1.
The new matched sample generated by PSM (Nfamilies with IS = 827; Nfamilies without IS = 618)
was used for regression and mediation analysis. Table 4 indicated the associations between
IS, PB, BCG, and SCFI. IS had a significantly negative effect on PB (β = −1.814, p < 0.05),
indicating that families with IS report less PB. H2a was supported. In addition, there were
positive and significant links between IS and BCG (β = 2.043, p < 0.05). Therefore, H3a was
supported. To test H1, H2b, and H3b, we examined the direct effect of IS, PB, and BCG on
SCFI. Model 3 shows that IS had a positive total effect on SCFI (β = 0.446, p < 0.01), which
suggested that families with IS reported a higher SCFI. Both PB and BCG had a negative
effect on SCFI (βPB = −0.022, p < 0.05; βBCG = −0.005, p < 0.05), which means the greater
the PB and BCG, the lower the SCFI. Thereby, H1, H2b, and H3b were supported.

Table 4. Results of the regression analysis after PSM.

Variables PB (M1) BCG (M2) SCFI (M3)

Coefficient SE Coefficient SE Coefficient SE
Father’s socioeconomic status −1.271 * 0.561 −1.612 0.414 0.183 * 0.033
Mather’s socioeconomic status −1.511 * 0.561 −1.609 0.414 0.192 * 0.033
Father’s occupational reputation 0.001 0.074 0.065 0.061 0.011 * 0.004
Mather’s occupational reputation 0.001 0.074 0.065 0.060 0.008 * 0.004
Father’s age −0.038 0.072 0.084 0.064 0.005 0.004
Mather’s age −0.041 0.072 0.092 0.064 0.006 0.004
Paternal grandfather’s socioeconomic
0.002 0.062 −0.053 0.054 −0.003 0.003
status
Maternal grandfather’s socioeconomic
0.002 0.012 0.021 0.043 0.004 0.002
status
Paternal grandparents’ health condition −2.87 * 0.491 −1.314 * 0.427 0.317 ** 0.029
Maternal grandparents’ health condition −0.471 0.427 −1.272 * 0.383 −0.029 0.026
Paternal grandfather’s hukou (1 = rural) −0.116 * 0.120 −1.523 1.065 −0.221 * 0.071
First child’s gender (1 = men) 0.047 * 0.019 0.128 0.094 0.227 * 0.147
Living with grandparents or not (1 = no) −0.138 0.057 0.124 0.047 0.179 * 0.095
Firstborn children’s age 0.004 0.002 0.003 0.001 0.069 0.031
IS −1.814 * 0.911 2.043 * 0.847 0.446 ** 0.055
PB −0.022 * 0.013
BCG −0.005 * 0.002
Constant 61.286 4.410 51.731 3.917 1.727 0.312
R2 0.059 0.058 0.270
F 5.41 5.38 28.39
Note. * p < 0.05, ** p < 0.01.

Furthermore, a fitting structural equation model in Mplus and the bootstrap approach
were used to analyze the mediation relationships between variables. In general, the indirect
effects of IS on SCFI through two mediators were significant, with relevant variables under
control. H4a and H4b were supported. More specifically, according to the results of
2000 iterations of bootstrap resampling, Table 5 presents the lower-level and upper-level
confidence intervals that do not contain zero, which confirmed the indirect effect of IS on
SCFI via PB, with BCG under control. Similarly, following the steps mentioned above,
the lower-level and upper-level confidence intervals do not contain zero, confirming the
direct effect of IS on SCFI through BCG, with PB under control. Comparing the two specific
mediating effects, the difference is found to be 0.03, and the lower-level and upper-level
confidence intervals do not contain zero, indicating that the mediation effect of PB was
stronger than that of BCG. Additionally, there was a significant direct effect between IS
and SCFI, i.e., PB, as well as BCG, were shown to play a partial mediating effect. H4c was
supported. The p-values for all results were significant, and the detailed results are shown
in Table 5.
Behav. Sci. 2023, 13, 256 12 of 19

Table 5. Results of mediation analysis after PSM.

Bootstrap BC 95% CI
Effect Estimate SE Lower Upper p-Value
IS->PB (a1 ) −1.814 0.817 −2.322 −0.384 0.042
IS->BCG (a2 ) 2.043 0.847 0.741 3.544 0.009
PB->SCFI (b1 ) −0.022 0.011 −0.020 −0.009 0.000
BCG->SCFI (b2 ) −0.005 0.003 −0.009 −0.004 0.011
IS->SCFI (c’) 0.396 0.012 0.886 2.569 0.000
IS->PB->SCFI (a1 *b1 ) 0.0404 0.014 0.005 0.038 0.040
IS->BCG->SCFI (a2 *b2 ) −0.010 0.005 −0.012 −0.005 0.050
a1 *b1 -a2 *b2 0.03 0.015 0.009 0.053 0.008
Model fit information CMIN/DF = 1.570; GFI = 0.945; TLI = 0.956; RMSEA = 0.071; SRMR = 0.080

4.4. Sensitivity Analysis

Matching effects are based on the conditional independence assumption. Hidden bias
may occur if unobserved variables affect both the dependent and independent variables
simultaneously. This problem can be fixed by adding additional variables, collecting
additional data, or designing the experiment as a completely randomized experiment,
but these strategies have challenges, such as being too costly and difficult to implement.
A preferable approach would be to first perform a sensitivity analysis, in order to estimate
the bias level. Two methods were used for sensitivity analysis in this study. On the one
hand, different calipers were selected for matching to test the robustness of the matching
results in this paper. On the other hand, the bounding approach proposed by Rosenbaum
was used to detect hidden bias. In general, if the value of Γ is too small (Γ < 2), the model is
too sensitive, and the problem of unobserved variables in the model is more serious. This
study uses the Wilcoxon Signrank Tests, which are currently supported by most analytic
software, in order to test the sensitivity of the matching analysis results. The result of the
Wilcoxon Signrank Tests showed that the value of Γ was larger than 2.9, which satisfied
the condition that Γ was greater than two, indicating that the model was more robust.
Tables S3 and S4 present the results of the sensitivity analysis.

5. Discussion and Conclusions

Using the post-PSM data, we aimed to develop a parallel mediation model to test the
relationship between IS and SCFI, as well as to test the mediating role played by PB and
BCG among the Chinese sandwich generation. The findings confirm that IS has a positive
effect on SCFI and that it affects SCFI through dual burnouts; however, the impacts of the
two mediators do not occur in the same direction. We proposed four sets of hypotheses to
investigate the relationship between IS, PB, BCG, and SCFI.
The first set concerned the total effects of IS and SCFI. Before conducting the mech-
anism analysis, a total effects analysis of the independent and dependent variables was
needed to prepare for calculating the mediating effects’ share. Regression analysis indi-
cated that IS had a significant positive effect on SCFI. This finding was consistent with
Harknett et al., who demonstrated that the IS environment was more strongly related to
higher-order births than to first births [51]. Further, an article using data on Chinese work-
ing women confirmed the positive effect of IS on fertility [14]. However, the existing litera-
ture does not explore the mechanism of action between IS and fertility among the Chinese
sandwich generation.
The second set of hypotheses concerns the mediation effects of PB on the link between
IS and SCFI. The results showed that IR had a significant indirect effect on SCFI through PB,
which meant that IS mitigates the PB of the sandwich generation, thereby increasing SCFI.
Parenting is a very demanding task, and parents would have more resources to raise their
children if they had access, such as grandparent support. Thus, one possible explanation
for IS’s ability to increase SCFI by reducing parental burnout is that parents receive more
support from grandparents, which reduces parenting stress and burnout, and ultimately
leads to an intention to have more children.
Behav. Sci. 2023, 13, 256 13 of 19

The third set tested the mediating role of BCG. Regression analysis indicated that IS had a
significant positive effect on BCG, which meant the more assistance the sandwich generation
had with their parents, the higher their BCG level. The results of the structural equation in Mplus
showed that IS had a significant negative indirect effect on SCFI through BCG. One possible
explanation was that the greater the grandparents’ investment in the “filial bank”, the more care
the sandwich generation needed to return to their parents, which increased the burden on adult
children as caregivers. The study’s findings were similar to Offer’s [31]. Ultimately, IS reduced
the fertility intentions of the sandwich generation through BCG. Moreover, comparing the effect
sizes of the two parallel mediators, PB played a greater mediating role, which implied that IS
increased SCFI by lowering the PB of the sandwich generation.
The fourth hypothesis tested whether the direct effect of IS on SCFI was significant.
The results showed a significant direct effect of IS on SCFI, which also indicated that the
mediating effect in the model was partially, rather than fully, mediated. Moreover, the
results of partial mediation revealed that PB and BCG were only partially mediating causes
in the pathways of IS and SCFI effects, and the possibility of other mediating mechanisms
still existed. It is noteworthy that although the two mediating variables do not have the
same direction of effect, both mediating effects were smaller than the direct effect. One
possible explanation was that IS still increased or decreased SCFI through other variables,
but, overall, the direct positive effect of IS on the sandwich generation was significant,
which may imply that although the pathway of the positive effect of IS is complex, the
intention of the sandwich generation to have a second child will increase if the frequency
and support level are increased.

6. Implications
This study carries several theoretical implications. First, it proposed a dual mediator
model to explore the relationship between IS and sandwich generation’s SCFI. Although
existing articles confirm a positive relationship between IS and having more children, no
research has revealed the underlying mechanisms between the two variables. This study
confirmed the mediating effect played by PB and BCG and also revealed that PB and BCG
play a partial mediating role, revealing the possibility of other mechanisms of action and
providing a possible direction for further research.
Second, as a concept that has only been clearly defined by researchers in recent years,
PB and BCG have quickly sparked the attention of other researchers. Researchers have
found that PB and BCG are more difficult to avoid and more prevalent than job burnout;
accordingly, they deserve further exploration [52]. Although some Chinese scholars have
keenly captured this cutting-edge research direction, few empirical articles have examined
PB and BCG in Chinese parents, and even fewer have explored PB and BCG in the sandwich
generation in the context of Chinese culture. Therefore, this study expanded the application
of PB and BCG in the Chinese cultural context.
Finally, the results of this study have implications for other countries with low fertility
rates. Vollset et al. published an article on global fertility in The Lancet, noting the steady
decline in global fertility and the continuing decline in fertility intentions [53]. Other
countries that have had birth control policies (e.g., Iran, Vietnam) and very low fertility
rates (e.g., Japan, South Korea) have a large sandwich generation that faces the same PB and
BCG as the sandwich generation in China. Arguably, there is a global threat of lower fertility
intentions. Therefore, the results of this study not only help to understand the double burnout
faced by the sandwich generation in China and ways to enhance fertility intentions, but they
also help to provide experiences and insights for other countries with similar social problems.
This study also has important practical implications for demographers and policy-
makers, especially those concerned with the fertility rate. On the one hand, by empirically
testing the main factors that can boost fertility intentions, we find that IS can significantly
increase SCFI for the sandwich generation. To ensure more frequent intergenerational
exchanges and intergenerational support, the Chinese government released a guide to
create a better life for the elderly in November 2021, which promotes young adult children
Behav. Sci. 2023, 13, 256 14 of 19

to live close to or co-reside with their parents. At the same time, the government will
appropriately reduce personal income tax for adult children living with their parents, in
order to more effectively protect the shared welfare of young adult children and the elderly.
On the other hand, perhaps the most important finding of this study was that IS failed
to reduce BCG in the sandwich generation. Therefore, more support is needed to help the
sandwich generation care for older adults. Although the Chinese government advocates
for the construction of formal care institutions for older adults, most older adults still reject
them. Those children who send older adults to institutions are considered unfilial; hence,
implementing formal institutions is very difficult. Du suggests that community-based
services can be developed to meet older adults’ expectations to stay in their homes, while
reducing the stress of the sandwich generation [54]. In short, while living in an environment
filled with stress and burnout, the sandwich generation is likely to be reluctant to have
more children. Therefore, building an environment in which parenting and caregiving are
easier is most important for raising the fertility rate.

7. Limitations and Suggestions for Future Research

This study had several limitations. First, although the CEM and PSM approach could
avoid self-selection bias in the independent variable, such bias in the mediating variables
was still not properly addressed [55]. Thus, future research could address this issue, from
support status to SCFI, by controlling for variables that may influence IS, PB, and BCG.
Second, this study measured IS in three main dimensions, based on intergenerational
solidarity; however, it was still insufficient to include all IS behaviors. Therefore, future
research could measure IS from a broader perspective. Third, the parallel mediation model
constructed in this paper is only a first step in exploring the mechanisms underlying IS and
SCFI and does not discuss the relationship between the two mediators. Whether there is a
competitive relationship between PB and BCG and whether there is a chain relationship are
next steps for future research. Finally, although intentions may be a powerful predictor of
fertility, they do not always match outcomes. Therefore, future studies should examine fertility
trajectories instead of intentions. Specifically, future research could conduct a longer-term
longitudinal survey, splitting the outcomes of SCFI into groups (e.g., intention—stability,
intention—revision, intention—realization) and separately testing the relationship between
the independent variable and the different SCFI outcomes.

Supplementary Materials: The following supporting information can be downloaded at: https://
www.mdpi.com/article/10.3390/bs13030256/s1, Table S1: Logistic regression predicting propensity
score of supporting. Table S2: Propensity score matching covariate balance. Figure S1: Common
support of treated and untreated sample. Table S3: Average treatment effect (ATT) of IS on PB, BCG,
and SCFI in Chinese sandwich generation. Table S4: Results of sensitivity analysis via regressions
using different calipers in PSM.
Author Contributions: W.F. and W.Z. carried out research and methodology in the manuscript. W.F.
and F.D. wrote original draft, interpreted the results, created tables and figures, and W.F. and F.D.
reviewed, edited and corrected the paper. All authors have read and agreed to the published version
of the manuscript.
Funding: This work was supported in part by the National Social Science Foundation of China (BDX210285).
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Xi’an Jiaotong
University (protocol code 2001304 and 20200122). The procedures used in the study followed the
ethical principles of research formulated by the government. The contents of the questionnaire were
all multiple-choice questions with clear instructions and did not involve ethical issues. The Author is
respected for the autonomy, privacy, and dignity of all participants involved in the survey, and the
datasets contain no personal identities for the participants with their informed consent. All contents
of the questionnaire were communicated in advance to the survey participants, who assisted the
authors in completing the questionnaire activities out of social responsibility and total voluntariness.
Behav. Sci. 2023, 13, 256 15 of 19

Informed Consent Statement: By clarifying the information about the researchers, objectives, data
uses, and the voluntary attribute of participation at the beginning of the questionnaire interface,
informed consent was obtained from all participants.
Data Availability Statement: The datasets generated during and/or analyzed during the current
study are available from the author on reasonable request.
Conflicts of Interest: No potential conflict of interest was reported by the authors.

Appendix A

Table A1. Intergenerational Support Scale.

Items Yes No
Do you receive financial support from your parents?
Do you receive emotional support from your parents?
Do you receive practical support from your parents?

Table A2. Parental Burnout Assessment.

Once a
A few Times A few Times Once a A few Times
Items Never (0) Month or Everyday (6)
a Year (1) a Month (3) Week (4) a Week (5)
Less (2)
I feel completely run down by
my role as a parent
I have the sense that I am really
worn out as a parent
I’m so tired out by my role as a
parent that sleeping does not
seem like enough
When I get up in the morning
and have to face another day
with my child(ren), I feel
exhausted before I’ve
even started
I find it exhausting just thinking
of everything I have to do for
my child(ren)
I have zero energy for looking
after my child(ren)
My role as a parent uses up all
my resources
I sometimes have the
impression that I am looking
after my child(ren) on autopilot
I am in survival mode in my
role as a parent
I do not think I am the good
father/mother that I used to be
to my child(ren)
I tell myself that I am no longer
the parent I used to be
I am ashamed of the parent that
I have become
I am no longer proud of myself
as a parent
Behav. Sci. 2023, 13, 256 16 of 19

Table A2. Cont.

Once a
A few Times A few Times Once a A few Times
Items Never (0) Month or Everyday (6)
a Year (1) a Month (3) Week (4) a Week (5)
Less (2)
I have the impression that I am
not myself any more when I’m
interacting with my child(ren)
I feel as though I have lost my
direction as a dad/mum
I cannot stand my role as
father/mother any more
I cannot take being a parent
any more
I feel like I cannot take any
more as a parent
I feel like I cannot cope as
a parent
I do not enjoy being with my
child(ren)
I do what I am supposed to do
for my child(ren), but
nothing more
Outside the usual routines (lifts
in the car, bedtime, meals), I am
no longer able to make an effort
for my child(ren)
I am no longer able to show my
child(ren) how much
I love them

Table A3. Burnout in Caring for Grandparents Assessment.

A few Times Once a

A few Times Once a A few Times
Items Never (0) a Year or Month or Everyday (6)
a Month (3) Week (4) a Week (5)
Less (1) Less (2)
I feel emotionally drained from
providing care to my parents
I feel used up at the end of
taking care of my parents
I feel fatigued when I get up in
the morning and have to face
another day of caring for
the elderly.
I can easily understand how my
parents feel about things.
I feel I treat parents as if they
were impersonal objects.
Working with people all day is
really a strain for me.
I deal very effectively with the
problems of my parents.
I found it exhausting to take
care of my parents
I feel that I am positively
impacting my parents’ lives
through my caregiving.
Since I started taking care of my
parents, I have become more
callous towards them
Behav. Sci. 2023, 13, 256 17 of 19

Table A3. Cont.

A few Times Once a

A few Times Once a A few Times
Items Never (0) a Year or Month or Everyday (6)
a Month (3) Week (4) a Week (5)
Less (1) Less (2)
I was worried that taking care
of my parents would harden
me emotionally.
I feel very energetic
I was frustrated with taking
care of my parents
I think it is too hard to take care
of my parents
I don’t really care what happens
to my parents
Dealing with my parents put
too much pressure on me
I can easily create a relaxed
atmosphere with my parents
After living with my parents, I
felt refreshed.
I have accomplished many
worthwhile things in caring for
my parents
I feel like I am at the end of
my rope
In caring for my parents, I deal
with emotional issues
very calmly.
I think my parents blamed me
for some of their problems

Table A4. Second-child fertility intention scale.

Strongly Neither Agree or

Items Disagree Agree Strongly Agree
Disagree Disagree
I feel a sense of accomplishment if I have a
second child
I feel having a second child will make me happier
I feel having a second child will not place an extra
burden on my life
I feel I can handle taking care of the second child
I feel I have received enough resources to raise a
second child

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