| Summary: | Abstract Background Few studies have explored the relationship between the number of children and depression in older adults, especially across multiple countries. Methods In this Multi-National Cross-Sectional Analysis, we included the Health and Retirement Study (HRS, US), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the Korean Longitudinal Study of Aging (KLoSA), and the Longitudinal Aging Study in India (LASI), encompassing a total of 20 countries. The number of children was based on self-reports from the participants. The Center for Epidemiologic Studies Depression Scale (CESD) and the European Depression Scale (EURO-D) were used to assess depression. Logistic regression was used to evaluate the relationship between the number of children and depression, adjusting for potential confounders. A random-effects meta-regression model was used to examine differences in the relationship between the number of children and depression between Asian and Western countries. To explore potential non-linear relationships, restricted cubic spline (RCS) curves were utilized, and threshold effect analyses were performed to validate. Additionally, subgroup analyses were stratified by age, sex, and marital status. Results A total of 110,015 participants from six datasets were included. The prevalence of depressive symptoms ranged from 10.7% in the UK to 48.8% in Poland. Childlessness was most common in ELSA (15.8%), followed by SHARE (9.6%) and HRS (8.4%), while lower proportions were observed in CLHLS (1.5%), KLoSA (2.3%), and LASI (3.1%). In Western countries, childlessness was not significantly associated with depression (HRS: OR = 1.00, 95% CI: 0.83–1.23; ELSA: OR = 0.90, 95% CI: 0.69–1.17; SHARE: OR = 1.05, 95% CI: 0.97–1.15). However, in Asian countries, it was linked to a higher risk (CLHLS: OR = 2.00, 95% CI: 1.29–3.12; KLoSA: OR = 1.78, 95% CI: 1.24–2.55; LASI: OR = 1.33, 95% CI: 1.19–1.49). A random-effects meta-analysis confirmed this regional difference (β = 0.35, 95% CI: 0.15–0.55; P < 0.001). A non-linear association was observed between the number of children and depression in LASI and SHARE, with risk initially decreasing and then rising beyond a threshold. Subgroup analysis found a stronger association among ≤ 75 years individuals and men in KLoSA. In HRS, childlessness was associated with a higher risk of depression only among those living alone. Conclusions The relationship between the number of children and depression varies across countries. Individuals in Asian countries may be more prone to depression than those in Western nations when they do not have children.
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