Financial strain, received support, anticipated support, and depressive symptoms in the People's Republic of China

The interrelations between psychological outcome trajectories and resource changes amid large-scale disasters: A growth mixture modeling analysis

Currently little is known about the interrelations between changes in psychiatric symptoms and changes in resources (personal, social, financial) amid large-scale disasters. This study investigated trajectories of psychiatric symptoms and their relationships with different patterns of changes in personal, social, and financial resources between 2020 and 2022 amid the COVID-19 pandemic. A population-representative sample (N = 1333) was recruited to complete self-report instruments at the pandemic's acute phase (February-July 2020, T1), and again at 1-year (March-August 2021, T2) and 1.5-year (September 2021-February 2022, T3) follow-ups. Respondents reported depressive and anxiety symptoms, self-efficacy, perceived social support, and financial capacity. Growth mixture modeling (GMM) identified four trajectories of depressive and anxiety symptoms: resilience (72.39-74.19%), recovery (8.40-11.93%), delayed distress (7.20-7.35%), and chronic distress (8.33-10.20%). Four patterns were demonstrated in resource changes: persistent high resources (40.89-47.64%), resource gain (12.08-15.60%), resource loss (6.30-10.43%), and persistent low resources (28.73-36.61%). Loss and gain in financial resources characterized chronic distress and resilience, respectively. Loss in personal resources characterized delayed distress, whereas loss or no gain in social resources was related to chronic/delayed distress. Respondents in resilience were also more likely to have persistent high resources while those with delayed/chronic distress were more likely to have persistent low resources. These results provide an initial evidence base for advancing current understanding on trajectories of resilience and psychopathology in the context of resource changes during and after large-scale disasters.

The Impact of Social Pension Schemes on the Mental Health of the Chinese Elderly: A Mediating Effect Perspective of Two-Way Intergenerational Support

With the rapid decline in China’s fertility rate, the acceleration of aging, the continuous miniaturization and nucleation of China’s family structure, and the deterioration of the elderly’s living conditions and mental states, the elderly’s mental health has emerged as a major public health issue and a major social problem. Pensions are the elderly’s primary source of income, and they can help them meet their basic needs while also promoting family harmony and improving their mental health. Based on the data of the 2012, 2016, and 2018 Chinese Family Panel Studies (CFPS), we empirically examined the impact of pensions on the elderly’s mental health by using the fixed effects model, mediating effect model, and so on. The results show that receiving pension benefits can significantly reduce the level of depression and improve the mental health of the elderly. Receiving pension benefits causes reverse intergenerational economic transfer, which reduces the effect of pensions on the elderly’s mental health to some extent, but the life care and mental comfort provided by children increases when the elderly share pensions with their children. Overall, receiving pension benefits improves the mental health of the elderly. In addition, the effect of pensions on the elderly with different characteristics is heterogeneous. The older elderly, women, the elderly living with their children, and the elderly in rural areas all benefit more from receiving pension benefits. Moreover, the worse the mental health of the elderly is, the stronger the influence of pensions on their mental health is. Our discussion has important policy implications.

Financial stress and depression in adults: A systematic review

Financial stress has been proposed as an economic determinant of depression. However, there is little systematic analysis of different dimensions of financial stress and their association with depression. This paper reports a systematic review of 40 observational studies quantifying the relationship between various measures of financial stress and depression outcomes in adults. Most of the reviewed studies show that financial stress is positively associated with depression. A positive association between financial stress and depression is found in both high-income and low-and middle-income countries, but is generally stronger among populations with low income or wealth. In addition to the "social causation" pathway, other pathways such as "psychological stress" and "social selection" can also explain the effects of financial stress on depression. More longitudinal research would be useful to investigate the causal relationship and mechanisms linking different dimensions of financial stress and depression. Furthermore, exploration of effects in subgroups could help target interventions to break the cycle of financial stress and depression.

Household indebtedness and depressive symptoms among older adults in China: The moderating role of social network and anticipated support

BACKGROUND

Examine the association of household financial indebtedness with depressive symptoms in old age, and investigate whether social network and support anticipation moderate the association.

METHODS

Data were obtained from Sample Survey on Vulnerable Populations from Poor Families in Urban/Rural China (2018), with a sample of 5 934 older adults included. Center for Epidemiologic Studies Depression Scales was applied to measure depressive symptoms. Household indebtedness was measured in several ways, including whether the household was indebted, the amount of debts, and types of debts. We used the 6-item Lubben Social Network Scale to measure individual's social network. Socio-demographic, socioeconomic status and physical health variables were included as covariates.

RESULTS

Household indebtedness, in form of being indebted and increased amount of debts, was associated with greater depressive symptoms in the Chinese elderly. The association of indebtedness and depressive symptoms may be driven by consumption and emergency debts. The moderating roles of social network and anticipation of support in the association of household indebtedness and depressive symptoms were found. Among those with household debts, older adults with larger size of social network and/or higher anticipation of being supported in the future reported with less symptoms of depressed.

LIMITATIONS

Due to a lack of information on the duration and debtor of household debt, we were not able to present a precise estimate for the exact impact of household indebtedness on mental health of elderly.

CONCLUSION

Familial financial strain was associated with aging mental well-being, increased social networks and social protections benefit aging health.

Grandparents caring for grandchildren in rural China: consequences for emotional and cognitive health in later life

In rural China, where families serve as critical safety-nets for their vulnerable members, grandparents play an essential role caring for the offspring of their migrant children. Evidence is mixed as to whether caring for grandchildren provides health benefits or incurs health risks. In this article, we used six waves of data from a study in rural China to examine the impact of caregiving for grandchildren on grandparents' emotional and cognitive health. Further, we examined financial transfers from adult children as a resource that potentially moderates the impact of high intensity caregiving on these outcomes. Data derived from six waves (2001-2015) of the Longitudinal Study of Older Adults in Anhui Province, China. We constructed 2,835 person-interval observations derived from 1,067 grandparents to examine lagged change in depressive symptoms and cognitive ability. Results show that caregiving frequency is not by itself harmful or beneficial to the emotional and cognitive health of grandparents, but it does appear to be harmful in the context of custodial care that is less economically supported by adult children. These results are discussed in terms of their relevance to intergenerational reciprocity in a filial culture, time-for-money exchange expectations, and the need for financial resources among caregiving grandparents in rural China.

Effect of family "upward" intergenerational support on the health of rural elderly in China: Evidence from Chinese Longitudinal Healthy Longevity Survey

As health challenging rural elderly in an aging population, more attention is being paid on impact of family intergenerational support on the health of the elderly. This paper investigates the effects of children's intergenerational economic support and non-economic support on physical, mental, and functional health of rural elderly in China in the mean while. This paper applies the 2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS), in particular, applying exploratory factor analysis to ascertain latent variables and Structural Equation Model (SEM), and analyzes the impacts of "Upward" intergenerational support on health of rural elderly. As resulted, after controlling the socioeconomic status of the rural elderly, the family "upward" intergenerational support influences the elderly's physical health at a percentage of 11.7%, mental health 29.8%, and physiological function 12.6%. Moreover, "Upward" economic support has a positive effect on physiological function (P<0.05). "Upward" non-economic support has negative effects on physiological function and mental health (P<0.05), while it has a positive effect on physical health. In addition, economically independent rural elderly are more likely to benefit from the health of "upward" intergenerational support, especially mental health. In particular, those results are robust. "Upward" intergenerational support plays an important role for the health of rural elderly. For the rural elderly of economic independence, to improve the quality of care and spiritual support, it is important to solve the health problems. In addition, it is necessary to build a comprehensive old-age security and support system for family, community, and society jointly to improve the health of the rural elderly.

Depressive Symptoms Among Adult Children Aged 55 Years or Older: The Effects of Support Provided to Their Older Parents

Objectives

This study examines the effects of frequency of visits, monetary, and in-kind support provided to older parents on the depressive symptoms of adult children.

Method

This study drew secondary data from the China Health and Retirement Longitudinal Study Follow-up Questionnaire. A total of 629 older children aged 55 years and older ( M = 59.80, standard deviation = 3.90) met the inclusion criteria. The dependent variable—depressive symptoms—was measured with the Center for Epidemiological Studies Depression scale.

Results

Approximately 22% of participants reported clinically significant levels of depressive symptoms. Hierarchical regression analyses found that more frequent visits and monetary support to older parents were related to lower levels of depressive symptoms in older children.

Conclusion

Providing monetary support to parents may help mitigate a major concern of parents: health-care costs. Older children’s altruistic behaviors meet legal and cultural expectations in Chinese society, contributing to family intimacy and thereby their own mental health outcomes.

Cell Phone Use and Happiness Among Chinese Older Adults: Does Rural/Urban Residence Status Matter?

This study explores the relationship between cell phone use and self-reported happiness among older adults in Mainland China and whether rural/urban residence status moderates this relationship. The analysis is based on a sample of 6,952 respondents over the age of 60, from the 2010 wave of China Family Panel Studies. Findings show that using own cell phone is positively associated with self-reported happiness among Chinese older adults (odds ratio [ OR] = 1.283, p < .001). This relationship remains for respondents residing in rural areas ( OR = 1.616, p < .01) but not for their urban counterparts. Findings reflect on how the happiness of Chinese older adults has been affected by a growing shift in the traditional family values due to the unprecedented economic growth. Results also highlight the disparities between state support for older adults in rural and urban areas as well as the necessity to develop relevant policies to improve the subjective well-being of China's rapidly growing population of older adults.

Intergenerational support and life satisfaction of young-, old- and oldest-old adults in China

OBJECTIVES

This study investigated variation across different old-age groups in the association between intergenerational support and elderly life satisfaction in China, taking into account both exchange patterns and different types of support.

METHOD

Using the first two waves (2010 and 2012) of China Family Panel Studies, we applied the fixed-effect approach to examine the moderating effect of age separately for exchange patterns and different types of intergenerational support. The sample included 3989 elderly people.

RESULTS

There were age differences in the association between intergenerational support and elderly life satisfaction, for both exchange patterns and different types of support. Particularly, there was significant difference between the young-old (61-70) and the oldest-old (85+) in terms of the association.

CONCLUSION

Theoretically, this study helps to elaborate on social exchange and equity theories by introducing explanations from socio-emotional selectivity theory. It further highlights how policies for elderly care should be developed considering the diverse needs, characteristics and goals of elderly people rather than treating them as a singular homogenous group, in particular in relation to different old-age groups.

Anticipated support from children and later-life health in the United States and China

Past research has shown that anticipated support, the belief that someone will provide support if needed, benefits health. Few studies considered whether the relationship between anticipated support and health depends on the source of such support. This project addresses this gap and examines how anticipated support from children is related to older parents' health and whether such support can be replaced by anticipated support from other relatives and friends. Ordered logit and negative binomial regression models with lagged health outcomes were estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study and the 2011 and 2013 China Health and Retirement Longitudinal Study. Results suggest that anticipated support from children is related to older parents' better self-rated health and fewer depressive symptoms in both countries. In the U.S. where filial norms are relatively weak, anticipated support from others is no less important for health than anticipated support from children. However, in China where filial norms are relatively strong, parents anticipating support only from others are no different in health from those anticipating support from no one.

Worry about Medical Care, Family Support, and Depression of the Elders in Urban China

This study examines the role of family support in reducing the elders’s depression in the face of the perceived inadequate public medical care in urban China. Using data from the Survey on Aging and Intergenerational Relations in Baoding City, this article investigates the overall depression level, somatic symptoms, and affective symptoms, respectively. The findings suggest that perceived inadequate public medical care, which results from dramatic changes in China’s socioeconomic transformation, has a stressful impact on all measures of depression. Family support, by its structure and function, shows both direct and moderating effects in counteracting such stress from the public domain. In light of China’s demographic transition, the state is called upon to adopt a comprehensive strategy in designing its socioeconomic development policy to meet the needs of an aging population

Assessing Change in Social Support During Late Life

The purpose of this study is to evaluate change in 14 measures of social support with data provided by a nationwide longitudinal study of older adults. The findings reveal that fairly substantial change took place during the three-year follow-up period. More important, the data indicate that change is not uniform or systematic across the entire study sample. Instead, there appears to be considerable individual-level change taking place. The implications of these findings for the development of conceptual models as well as support-based interventions are discussed.

Intergenerational Social Support and the Psychological Well-Being of Older Parents in China

This study explores the relationship between intergenerational social support and the psychological well-being of older Chinese parents. Effects of structural, functional, emotional, and appraisal social support on older Chinese parents’ well-being were tested by analyzing data collected from a random sample of 3,039 persons aged 55 and over who participated in the 1992 baseline survey of the Beijing Multidimensional Longitudinal Study on Aging (BMLSOA). Multiple regression is used to determine whether intergenerational exchanges of social support influence older parents’ morale. Findings reveal that providing instrumental support to children and satisfaction with children directly improve parents’well-being. The benefits of receiving support from children are fully mediated by parents’satisfaction with their children. The positive effects of providing functional support are magnified among parents who adhere to more traditional norms regarding family support. The results suggest that the psychological benefits of intergenerational support exchanges should not be ignored when developing elder care policy in China.

Depression in Older Ethnic Groups

The generality of George's model of the social precursors of depression was tested in a sample of older persons ( N = 803) from three ethnic groups: U.S.-born African Americans, African Caribbeans, and U.S.-born European Americans. The social precursors model includes demographic variables, early events and achievements, later events and achievements, social integration, vulnerability and protective factors, and provoking agents and coping efforts. Zero-order correlations indicated that nearly all the predictor variables were significantly associated with depression. A test of the overall model with all six stages was followed by separate regressions for each ethnic group. Four of the six stages of the model contributed unique variance to the prediction of depressed affect in European Americans but only two in the case of African Americans and African Caribbeans. The most robust and consistent predictor of depression was the sixth-stage variables of stress and emotion regulation.

Links between Family Relationships and Best Friendships in the United States and Japan

This study was designed to examine associations between family relationship quality and friendship quality in the United States and Japan using surveys of representative samples of individuals ranging in age from 13 to 93 in the United States ( n = 1498) and Japan ( n = 1641). Associations between family relationships and friendships were stronger and more pervasive in Japan than in the United States. In the United States, there was some evidence that having higher quality family relationships was associated with having higher quality friendships; in Japan, there was similar evidence for consistency in quality across relationships, as well as evidence that qualities lacking in one relationship were sometimes present in another. Gender and age did not moderate the associations between family relationship and friendship quality in either country. These findings extend into adulthood work that has previously focused on family relationships and friendships of children and suggest cultural differences in patterns of association between family relationships and friendships.

The relationship between financial strain, perceived stress, psychological symptoms, and academic and social integration in undergraduate students

OBJECTIVE

Financial strain may directly or indirectly (i.e., through perceived stress) impact students' psychological symptoms and academic and social integration, yet few studies have tested these relationships. The authors explored the mediating effect of perceived stress on the relationship between financial strain and 2 important outcomes: psychological symptomology and academic and social integration.

PARTICIPANTS

Participants were 157 undergraduate students. Data were collected from December 2013 to March 2014.

METHODS

Cross-sectional data collection conducted using online survey software.

RESULTS

It was found that perceived stress mediated the relationship between financial strain and (a) psychological symptomology and (b) academic and social integration. Both models included first-generation status as a covariate.

CONCLUSIONS

Results suggest that perceived stress is an important intervention target for reducing psychological symptoms and improving academic and social integration for undergraduate students. Implications for university health centers and mental health professionals include incorporating a public health model to minimize stress risk.

An exploratory discrete-time multilevel analysis of the effect of social support on the survival of elderly people in China

This study undertakes a survival analysis of elderly persons in China using Chinese Longitudinal Healthy Longevity Survey 2002-2008. Employing discrete-time multilevel models, we explored the effect of social support on the survival of elderly people in China. This study focuses on objective (living arrangements and received support) and subjective activities (perceived support) of social support, finding that the effect of different activities of social support on the survival of elderly people varies according to the availability of different support resources. Specifically, living with a spouse, financial independence, perceiving care support from any resource is associated with higher survival rates for elderly people. Separate analysis focusing on urban elderly and rural elderly revealed broadly similar results. There is a larger difference between those perceiving care support from family or social service and not perceiving care support in urban areas comparing to those in rural areas. Those who cannot pay medical expenses are the least likely to survive. The higher level of economic development in province has no significant effect on the survival of elderly people for the whole sample model and the elderly people in urban areas; however, there is a negative influence on the survival of the rural elderly people.

Family Stressors, Home Demands and Responsibilities, Coping Resources, Social Connectedness, and Thai Older Adult Health Problems

Objectives: To examine gender variations in the linkages among family stressors, home demands and responsibilities, coping resources, social connectedness, and older adult health problems. Methods: Data were collected from 3,800 elderly participants (1,654 men and 2,146 women) residing in Kanchanaburi province, Thailand. Results: Findings indicated gender variations in the levels of these constructs and in the mediational pathways. Thai women indicated greater health problems than men. Emotional empathy was the central variable that linked financial strain, home demands and responsibilities, and older adult health problems through social connectedness. Financial strain (and negative life events for women) was associated with lowered coping self-efficacy and increased health problems. The model indicated greater strength in predicting female health problems. Discussion: Findings support gender variations in the relationships between ecological factors and older adult health problems.

Effect of intergenerational and intragenerational support on perceived health of older adults: a population-based analysis in rural China

BACKGROUND

The family, together with the individual and society, and the state and market are the three pillars of well-being and social security over the life course, with responsibility for the health of older adults.

OBJECTIVE

The aim of current study was to explore the effect of intergenerational and intragenerational support on perceived health of older adults.

METHODS

A cross-sectional survey with 64.36% (1318/2048) response rate was conducted door to door in rural China with a sample of 1318 individuals aged 60 years and older. There were three sets of independent variables: intergenerational support from children as well as intragenerational spousal support and intragenerational sibling support, sociodemographic variables, and behaviour variables. Multiple logistic regression analysis was used to analyse the influence of family member support on physical and psychological health.

RESULTS

After adjusting for potential confounding variables (sociodemographic variables and behaviour variables), it was observed that intergenerational support from children had a significant effect on the self-rated physical health and psychological health of older adults [odds ratios (OR) = 1.48, 95% confidence interval (CI): 1.10-2.00; OR = 1.82, 95% CI: 1.36-2.44, respectively]. However, intragenerational support from spouse and siblings was not significant.

CONCLUSION

The importance of intergenerational support from children would suggest that family practice and health-related policy of older adults may need to be extended to their children. With the rapid development of global population movements, family practices need to pay attention to the changes of family support among migrant families.

Loneliness and social support of older people in China: a systematic literature review

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty-six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well-being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well-designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.

Gender in Marriage and Life Satisfaction Under Gender Imbalance in China: The Role of Intergenerational Support and SES

This study examined gender differences in the influence of marital status and marital quality on life satisfaction. The roles of intergenerational support and perceived socioeconomic status in the relationship between marriage and life satisfaction were also explored. The analysis was conducted with data from the Chinese General Social Survey (CGSS) in 2006, representing 1,317 women and 1,152 men at least 25 years old. Chi-squared tests and logistic regression models were used in this process. Marriage, including marital status and relationship quality, has a protective function for life satisfaction. Marital status is more important for males, but marital quality is more important for females. The moderating roles of intergenerational support and perceived socioeconomic status are gender specific, perhaps due to norms that ascribe different roles to men and women in marriage.

Impact of perceived social support on the mental health and health-related quality of life in cancer patients: results from a nationwide, multicenter survey in South Korea

OBJECTIVE

We investigated whether and how perceived social support is associated with depression and quality of life among patients with various cancer diagnoses.

METHODS

Data were collected from 1930 cancer patients treated at the National Cancer Center and nine regional cancer centers across Korea. The Duke-UNC functional social support scale was used to measure the perceived social support, and the PHQ-9 and the EORTC QLQ-C30 were used to measure the cancer patients' depression levels and quality of life, respectively.

RESULTS

Subjects with low perceived social support reported significantly higher levels of depression, lower scores on all functional scales, higher scores on all three symptom scales, lower global health/quality of life scale scores, and higher scores on most single items than subjects with high perceived social support. There was no interaction between potential stressors and perceived social support, supporting the main effect model as the mechanism that the perceived social support reduce the adverse psychological outcomes.

CONCLUSION

Perceived social support was associated with mental health and quality of life in cancer patients, through direct effect rather than stress-buffering effect. Interventions to enhance perceived social support might be helpful for improving mental health and QOL in cancer patients.

Influence of social support on cognitive change and mortality in old age: results from the prospective multicentre cohort study AgeCoDe

Background

Social support has been suggested to positively influence cognition and mortality in old age. However, this suggestion has been questioned due to inconsistent operationalisations of social support among studies and the small number of longitudinal studies available. This study aims to investigate the influence of perceived social support, understood as the emotional component of social support, on cognition and mortality in old age as part of a prospective longitudinal multicentre study in Germany.

Methods

A national subsample of 2,367 primary care patients was assessed twice over an observation period of 18 months regarding the influence of social support on cognitive function and mortality. Perceived social support was assessed using the 14-item version of the FSozU, which is a standardised and validated questionnaire of social support. Cognition was tested by the neuropsychological test battery of the Structured Interview for the Diagnosis of Dementia (SIDAM). The influence of perceived support on cognitive change was analysed by multivariate ANCOVA; mortality was analysed by multivariate logistic and cox regression.

Results

Sample cognitive change (N = 1,869): Mean age was 82.4 years (SD 3.3) at the beginning of the observation period, 65.9% were female, mean cognition was 49 (SD 4.4) in the SIDAM. Over the observation period cognitive function declined in 47.2% by a mean of 3.4 points. Sample mortality (N = 2,367): Mean age was 82.5 years (SD 3.4), 65.7% were female and 185 patients died during the observation period. Perceived social support showed no longitudinal association with cognitive change (F = 2.235; p = 0.135) and mortality (p = 0.332; CI 0.829-1.743).

Conclusions

Perceived social support did not influence cognition and mortality over an 18 months observation period. However, previous studies using different operationalisations of social support and longer observation periods indicate that such an influence may exist. This influence is rather small and the result of complex interaction mechanisms between different components of social support; the emotional component seems to have no or only a limited effect. Further research is needed to describe the complex interactions between components of social support. Longer observation periods are necessary and standardised operationalisations of social support should be applied.

The Impact of Perceived Stress, Social Support, and Home-Based Physical Activity on Mental Health among Older Adults

This study investigated how perceived stress, social support, and home-based physical activity affected older adults' fatigue, loneliness, and depression. We also explored whether social support and physical activity mediated the relationships between stress and mental health problems. The data of 163 older participants were analyzed in this study. Structural equation modeling using LISREL 8.71 was performed to assess the effects of stress, support, and physical activity on mental health. The findings indicate that perceived stress predicted higher levels of depression, social support predicted lower levels of loneliness and fatigue, and physical activity predicted lower levels of fatigue among older adults. Social support and physical activity mediated the relationships between stress and mental health, except depression. In conclusion, the relative impacts of perceived stress, social support, and physical activity on types of mental health (e.g., fatigue, loneliness, and depression) were different. Furthermore, stress had direct and indirect effects on each construct of mental health (e.g., fatigue, loneliness, and depression).

Age and social support perception in Eastern Europe: Social change and support in four rapidly changing countries

Despite a growing literature on social support processes across the life-span, few studies have examined support perceptions in societies undergoing rapid social transition. This study reports data on age, support and mental health from 2672 participants in four former Soviet nations. Results suggest a small but significant decline in overall support across age (r = -.12), with this slope significantly influenced by nationality and gender. Mental health also declines with age (r = -.15), with tangible support having the greatest mediational effect on the age-mental health relationship. These findings are discussed in the light of the continuing economic and social strains influencing the inhabitants of this region.

Will the public's health fall victim to the home foreclosure epidemic?

Gary Bennett and colleagues discuss the ways in which the dramatic rise in home foreclosures, particularly in the US, may have health consequences.

The relationship of built environment to perceived social support and psychological distress in Hispanic elders: the role of "eyes on the street"

BACKGROUND

Research on contextual and neighborhood effects increasingly includes the built (physical) environment's influences on health and social well-being. A population-based study examined whether architectural features of the built environment theorized to promote observations and social interactions (e.g., porches, windows) predict Hispanic elders' psychological distress.

METHODS

Coding of built environment features of all 3,857 lots across 403 blocks in East Little Havana, Florida, and enumeration of elders in 16,000 households was followed by assessments of perceived social support and psychological distress in a representative sample of 273 low socioeconomic status (SES) Hispanic elders. Structural-equation modeling was used to assess relationships between block-level built environment features, elders' perceived social support, and psychological distress.

RESULTS

Architectural features of the front entrance such as porches that promote visibility from a building's exterior were positively associated with perceived social support. In contrast, architectural features such as window areas that promote visibility from a building's interior were negatively associated with perceived social support. Perceived social support in turn was associated with reduced psychological distress after controlling for demographics. Additionally, perceived social support mediated the relationship of built environment variables to psychological distress.

CONCLUSIONS

Architectural features that facilitate direct, in-person interactions may be beneficial for Hispanic elders' mental health.

Inner happiness among Thai elderly

This study, based on data collected in 2005 from Chai Nat province, examines the level of happiness of the Thai elderly population and its relationship to various external and internal factors. It was found that mean happiness was slightly above a feeling of "neutral." According to multiple regression analyses, external factors including economic hardship, living arrangements, functional ability, perceived social environment, and consumerism significantly influence the level of happiness. The strongest predictor of happiness is, however, the internal factor-that is, a feeling of relative poverty when compared to their neighbors. Controlling for demographic and all external factors, the respondents who do not feel poor show the highest level of happiness compared to those who feel as poor as or poorer than their neighbors. This is self-interpreted as a feeling of contentment with what one has, which has been influenced by Thai culture, which is pervaded by Buddhism.

Factors affecting physician visits in Chinese and Chinese immigrant samples

This study examines predictors of Western physician utilization using the Andersen's Behavioral Model of Health Services Use for Chinese elders who reside in Shanghai and immigrant Chinese elders who reside in the US Chinese elders are under-studied relative to their population size and in the US are known to underutilize the healthcare system. Underutilization is highly correlated with poor health and well-being. A unique dataset allowed us to examine predictors of physician utilization for Chinese elders who resided in different countries, in an effort to determine how being an immigrant affects utilization. One hundred and seventy-seven Chinese elders in Boston and 420 Chinese elders in Shanghai participated in the survey. Multiple regression analyses were conducted separately for each sample. Predictors of physician visits for the Boston sample are insurance status, health, and social network, and for the Shanghai sample, use of Chinese medicine, health, and marital status predicted physician visits. We found that access to care variables significantly affects physician utilization for immigrant elders, and that Chinese elders in Shanghai utilize a bicultural system of care. The results indicate that in order to create effective healthcare practices for elder Chinese, alternative healthcare beliefs should be understood by Western physicians.

Health and life satisfaction of ethnic minority older adults in mainland China: effects of financial strain

China has achieved indisputable economic growth in the past decades but, with it, unbalanced development across region and socio-economic groups. Little is known about how this impacts the lives of minority older adults who tend to live in remote inland areas. This study is the first attempt to examine and compare the relationships between financial strain, health conditions, and life satisfaction among ethnic minority and non-minority older adults in mainland China. Research data was obtained from respondents aged 60 and over who participated in the National Survey of the Aged Population in China (N = 995) in 2000. Hierarchical linear regression revealed financial strain to be significantly associated with life satisfaction and health, however functional health measurements of ADL were only associated for ethnic minority groups after controlling for socio-demographic variables. The impact of underdeveloped socio-economic levels and unfavorable living environments on health and life satisfaction is stronger among minority groups and warrants further attention.

Intergenerational transfers and living arrangements of older people in rural China: consequences for psychological well-being

OBJECTIVE

The migration of working-age adults from rural to urban China has altered traditional patterns of living arrangements and intergenerational support among elderly persons who remain in rural regions. This investigation examined how household composition and support exchanges with adult children influenced the psychological well-being of older parents in rural China.

METHODS

Data derived from a 2001 survey of 1,561 parents aged 60 and older living in rural Anhui Province, China. We used multiple regression in order to estimate the effects of multigenerational living arrangements and intergenerational transfers of financial, instrumental, and emotional support on depression and life satisfaction in older parents.

RESULT

Older parents living in three-generation households or with grandchildren in skipped-generation households had better psychological well-being than those living in single-generation households. Receiving greater remittances from adult children increased well-being and explained why living with grandchildren was beneficial. Stronger emotional cohesion with children also improved well-being.

DISCUSSION

These results suggest that traditional family arrangements are beneficial in rural Chinese society as they represent the fulfillment of a cultural ideal. We discuss implications in the context of the corporate Chinese family, characterized by mutual aid and interdependence across generations, and its adaptation to social change.

Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65

The objective was to evaluate the associations between older persons' health status and their social integration and social networks (family, children, friends and community), in two French-speaking, Canadian community dwelling populations aged 65 years and over, using the conceptual framework proposed by Berkman and Thomas. Data were taken from two 1995 surveys conducted in the city of Moncton (n = 1518) and the Montreal neighbourhood of Hochelaga-Maisonneuve (n = 1500). Social engagement (a cumulative index of social activities), networks consisting of friends, family and children and social support were measured using validated scales. Multiple logistic regressions based on structured inclusion of potentially mediating variables were fitted to estimate the associations between health status and social networks. Self-rated health was better for those with a high level of social integration and a strong network of friends in both locations. In addition, in Hochelaga-Maisonneuve family and children networks were positively associated with good health, though the effect of friend networks was attenuated in the presence of disability, good social support from children was associated with good health. Age, sex and education were included as antecedent variables; smoking, alcohol consumption, exercise, locus of control and depressive symptoms were considered intermediary variables between social networks and health. In conclusion, social networks, integration and support demonstrated unique positive associations with health. The nature of these associations may vary between populations and cultures.

Sources of income and depression in elderly Hong Kong Chinese: mediating and moderating effects of social support and financial strain

This study examines the relationship between major source of income (i.e., adult children, financial independence and government welfare) and depression among elderly Hong Kong people. We also assessed the mediating and moderating effects of family social support and financial strain in the linkage between source of income and depression. The data came from a cross-sectional survey of a representative community sample of 1106 elderly respondents in Hong Kong. Using multiple regression models, data revealed that there was a differential impact of major sources of income on depression. Welfare participation and financial independence contributed to a higher level of depressive symptoms whereas people whose source of income was their adult children were more likely to report a lower level of depression than the others who were not. We also found that family social support was either a complete mediator or partial mediator in the relationship between different major sources of income and depression but it was not a significant moderator in the linkage between different major sources of income and depression. In contrast, financial strain was a significant moderator in the link between different major sources of income and depression. Specific and effective interventions must be developed for those who are financially independent or on welfare.

Stress and depressive symptoms among Mexican American elders

Although social stressors have successfully predicted depressive symptomatology in a number of populations, few studies have examined the relevance of stressors for Mexican American elders. Results are reported here from a multistage probability sample of 3,050 Mexican Americans aged 65 and older drawn from a 5-state region. Participants reported low levels of education and income, and most reported difficulty in reading or writing in English. Deaths, illness of close other, and financial problems were the three most frequent life events, and many reported financial strains. Depressive symptoms were then regressed on demographic indicators, cognitive status, linguistic acculturation, social supports, and three types of stressors. Being a woman, lower income, decreased income, chronic financial strain, and several health stressors were associated with greater symptomatology. Results identified a cluster of economic stressors and conditions that may play a critical role in the etiology of depressive symptoms in this minority population.

Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain

OBJECTIVE

To assess the association between emotional and instrumental support from children and living arrangements with the physical and mental health of older people in Spain.

METHODS

A face-to-face home interview was carried out with 1284 community-dwelling people over 65 (response rate = 83%) randomly sampled according to an age- and sex-stratified sampling scheme in 1993 at Leganés (Spain). Close to 93% of the participants had children and 45% of them coresided with them. Depressive symptoms were assessed by the CES-D (Center for Epidemiologic study depression scale) and self-rated health (SRH) by a single-item question. Emotional support was measured with a six-item scale on affection and reciprocity. Instrumental support was assessed by help received from children in 17 activities of daily living. Four living arrangements were considered: Living with spouse only, living with a spouse and children, widower living alone, and widower living with children.

RESULTS

Multivariate analysis controlling for age, gender, education and functional status showed that low emotional support and reception of instrumental aid were significantly associated with poor SRH. Being a widower and sharing living arrangements with children was associated with good SRH. Living arrangements modify some of the associations of support of children with SRH. Depressive symptoms were associated with low emotional support, reception of instrumental help and being a widower who did not share living arrangements with children. For widowers who do not cohabit with children, reception of instrumental aid is associated with low depressive symptomatology.

DISCUSSION

Emotional support from children seems to play an important role in maintaining the physical and mental health of elderly people in Spain. Instrumental support is widely available. Coresidence with children is very common and it is associated with good self-perceived health and low prevalence of depressive symptoms in a culture where family interdependence is highly valued. Families should be protected and encouraged to continue care-giving through a variety of community services and respite care, adapted to their needs and preferences. Research should be undertaken to find more efficient ways to help family caregivers in the Mediterranean context.

Financial strain and depressive symptoms in Hong Kong elderly Chinese: the moderating or mediating effect of sense of control

For many Hong Kong Chinese elderly, depression and financial strain are quite a common occurrence. This study examines the mediating and moderating effect of sense of control in the relationship between financial strain and depressive symptoms. The data came from a survey of a representative community sample of 411 elderly respondents in Hong Kong. Using multiple regression models, the authors found that generalized sense of control mediated and moderated the linkage between financial strain and depressive symptoms even after controlling socio-demographic variables but sense of control over finances did not. Findings suggest that generalized sense of control should be enhanced to protect older people under chronic financial strain from depression.