1
|
Liu R, He WB, Cao LJ, Wang L, Wei Q. Association between chronic disease and depression among older adults in China: the moderating role of social participation. Public Health 2023; 221:73-78. [PMID: 37421756 DOI: 10.1016/j.puhe.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Depression is an increasingly serious mental health problem worldwide. Therefore, this study aimed to explore the association between chronic disease and depression and to further test the moderating role of social participation in this association. STUDY DESIGN This is a cross-sectional study. METHODS We screened 6421 subjects from the 2018 wave of the China Health and Retirement Longitudinal Study database. Social participation and depressive symptoms were assessed using the 12-item self-made scale and 10-item Center for Epidemiological Studies Depression Scale, respectively. Hierarchical regression was used to determine the main effect of chronic disease and depression and the moderating effect of social participation on the relationship between chronic disease and depression. RESULTS In this study, 3172 (49.40%) eligible participants were male, 4680 (72.90%) older adults were concentrated in the 65-74 years group, and 68.20% reported good health status. In addition, gender, area, education level, marital status, health status, health insurance, health service utilization, and physical activity intensity were significant factors associated with participants' depression status (P < 0.05). The results also showed that a higher number of chronic diseases were associated with a higher depression score after adjusting for confounders (single disease: β = 0.074, P < 0.001; multimorbidity: β = 0.171, P < 0.001) and that social participation played a moderating role in this association (β = -0.030, P < 0.05). CONCLUSIONS This study tentatively suggests that a higher number of chronic diseases are associated with rising depression scores in the older Chinese population. In addition, the moderating effect of social participation suggests that more active social engagement should be promoted in this population to alleviate the depressive mood.
Collapse
Affiliation(s)
- R Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - W B He
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - L J Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - L Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Q Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China.
| |
Collapse
|
2
|
Silverstein M, Gong CH, Kendig H. Perceived availability of future care and depressive symptoms among older adults in China: evidence from CHARLS. BMC Geriatr 2020; 20:31. [PMID: 32000708 PMCID: PMC6993425 DOI: 10.1186/s12877-020-1435-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/20/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Major concerns have arisen about the challenges facing China in providing sufficient care to its older population in light of rapid population ageing, changing family structure, and considerable rates of internal migration. At the family level, these societal changes may produce care uncertainty which may adversely influence the psychological wellbeing of older individuals. This paper applies social support and control theories to examine the relationship between perceived availability of future care and psychological wellbeing of older adults in China, and how this relationship is moderated by economic insufficiency, health vulnerability, and urban/rural context. METHODS Analyses are based on data from the China Health and Retirement Longitudinal Study, a multi-panel nationally representative household survey of the Chinese population aged 45 years and older. Data are taken from 2013 and 2011 waves of the study, with an initial sample size around 17,000, in which around 11,000-14,000 respondents are used for our final regression model. The score of depressive symptoms was measured in both waves with the Center for Epidemiologic Studies Depression Scale (CES-D10), and perceived availability of future care was measured in 2013 by asking respondents the question "Suppose that in the future, you need help with basic daily activities like eating or dressing, do you have relatives or friends (besides your spouse/partner) who would be willing and able to help you over a long period of time (yes/no)?" RESULTS Multivariate regression analysis revealed that uncertainty regarding future care support was associated with greater depressive symptoms even after controlling for factors confounded with care uncertainty such as family structure, socio- economic status, and a lagged measure of depression. Further, older adults without an anticipated source of care faced double jeopardy in their depressive symptoms if they also experienced functional limitations. CONCLUSIONS Considering rapid aging of the Chinese population, anticipated increases in chronic disease burden, and possible attenuation of filial care, this analysis suggests that older adults in China may increasingly face health and social conditions detrimental to their mental health. Polices that remedy these concerns should be discussed, developed and implemented.
Collapse
Affiliation(s)
- Merril Silverstein
- Australian Research Council (ARC) Centre of Excellence in Population Ageing Research (CEPAR), Sydney, Australia
- Aging Studies Institute, Syracuse University, Syracuse, NY, USA
| | - Cathy Honge Gong
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), Research School of Population Health (RSPH), Australian National University (ANU), Canberra, ACT, Australia.
- Australian Research Council (ARC) Centre of Excellence in Population Ageing Research (CEPAR), Sydney, Australia.
| | - Hal Kendig
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), Research School of Population Health (RSPH), Australian National University (ANU), Canberra, ACT, Australia
- Australian Research Council (ARC) Centre of Excellence in Population Ageing Research (CEPAR), Sydney, Australia
| |
Collapse
|
3
|
Hoebel J, Maske UE, Zeeb H, Lampert T. Social Inequalities and Depressive Symptoms in Adults: The Role of Objective and Subjective Socioeconomic Status. PLoS One 2017; 12:e0169764. [PMID: 28107456 PMCID: PMC5249164 DOI: 10.1371/journal.pone.0169764] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is substantial evidence that lower objective socioeconomic status (SES)-as measured by education, occupation, and income-is associated with a higher risk of depression. Less is known, however, about associations between perceptions of social status and the prevalence of depression. This study investigated associations of both objective SES and subjective social status (SSS) with depressive symptoms among adults in Germany. METHODS Data were obtained from the 2013 special wave of the German Health Update study, a national health survey of the adult population in Germany. Objective SES was determined using a composite index based on education, occupation, and income. The three single dimensions of the index were also used individually. SSS was measured using the MacArthur Scale, which asks respondents to place themselves on a 10-rung 'social ladder'. Regression models were employed to examine associations of objective SES and SSS with current depressive symptoms, as assessed with the eight-item Patient Health Questionnaire depression scale (PHQ-8 sum score ≥10). RESULTS After mutual adjustment, lower objective SES and lower SSS were independently associated with current depressive symptoms. The associations were found in both sexes and persisted after further adjustment for sociodemographic factors, long-term chronic conditions, and functional limitations. Mediation analyses revealed a significant indirect relationship between objective SES and depressive symptoms through SSS. When the three individual dimensions of objective SES were mutually adjusted, occupation and income were independently associated with depressive symptoms. After additional adjustment for SSS, these associations attenuated but remained significant. CONCLUSIONS The findings suggest that perceptions of low social status in adults may be involved in the pathogenesis of depression and play a mediating role in the relationship between objective SES and depressive symptoms. Prospective studies are needed to establish the direction of effects and to address questions of causality.
Collapse
Affiliation(s)
- Jens Hoebel
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrike E. Maske
- Unit of Mental Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Thomas Lampert
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
4
|
Lee HJ, Lyu J, Lee CM, Burr JA. Intergenerational financial exchange and the psychological well-being of older adults in the Republic of Korea. Aging Ment Health 2015; 18:30-9. [PMID: 23581289 DOI: 10.1080/13607863.2013.784955] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study examined whether the exchange of instrumental support (i.e., financial resources) among older adults and their children was related to the psychological well-being of older Koreans. METHODS Data from the Korean Longitudinal Study of Ageing were employed. Older adults who were aged 65 and older and who had at least one living child who did not live in the respondent's household were included (N = 3791). Well-being was measured with depressive symptoms (CES-D-10) and life satisfaction. For the direction model of exchange, giving and receiving support was assessed with financial aid (cash and non-cash). For the reciprocity model of exchange, four patterns of financial exchanges were identified: both giving and receiving, receiving only, giving only, and no exchange. RESULTS The results from the direction model showed that older adults who give financial support were less likely to be depressed and reported higher levels of life satisfaction. The effect of receiving support was not significant for depression but was related to higher levels of life satisfaction. The results from the reciprocity model showed that those who gave and received support had better psychological health compared to those who only received support. CONCLUSIONS Both giving and receiving were positively related to the psychological well-being of older adults. Our results provide support for identity theory and equity theory as frameworks for understanding intergenerational exchange and well-being of older Koreans.
Collapse
Affiliation(s)
- Hyo Jung Lee
- a Department of Gerontology , University of Massachusetts Boston , Boston , USA
| | | | | | | |
Collapse
|
5
|
Lei X, Sun X, Strauss J, Zhang P, Zhao Y. Depressive symptoms and SES among the mid-aged and elderly in China: evidence from the China Health and Retirement Longitudinal Study national baseline. Soc Sci Med 2014; 120:224-32. [PMID: 25261616 PMCID: PMC4337774 DOI: 10.1016/j.socscimed.2014.09.028] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 09/09/2014] [Accepted: 09/16/2014] [Indexed: 01/26/2023]
Abstract
We examine the prevalence of depressive symptoms among the mid-aged and elderly in China and examine relationships between depression and current SES factors such as gender, age, education and income (per capita expenditures). In addition, we explore associations of depressive symptoms with measures of early childhood health, recent family deaths and current chronic health conditions. We use data from the China Health and Retirement Longitudinal Study (CHARLS) national baseline, fielded in 2011/12, which contains the ten question version of the Center for Epidemiologic Studies-Depression scale (CES-D) for 17,343 respondents aged 45 and older. We fill a major gap by using the CHARLS data to explore the general patterns of depression and risk factors among the Chinese elderly nationwide, which has never been possible before. We find that depressive symptoms are significantly associated with own education and per capita expenditure, and the associations are robust to the inclusion of highly disaggregated community fixed effects and to the addition of several other risk factors. Factors such as good general health during childhood are negatively associated with later depression. There exist strong gender differences, with females having higher depression scores. Being a recent widow or widower is associated with more depressive symptoms, as is having a series of chronic health problems, notably having moderate or severe pain, disability or problems with measures of physical functioning. Adding the chronic health problems to the specification greatly reduces the SES associations with depressive symptoms, suggesting that part of the pathways behind these associations are through these chronic health factors.
Collapse
|
6
|
LEE SH, KIM YB. Which type of social activities decrease depression in the elderly? An analysis of a population-based study in South Korea. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:903-12. [PMID: 25909058 PMCID: PMC4401055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/17/2014] [Indexed: 10/29/2022]
Abstract
BACKGROUND The aim of this study was to examine whether formal and informal social activities are associated with a lower risk of depression. Besides, we investigated which type of social activities may protect against late-life depression by gender using data from a population-based study of older Korean adults. METHODS Data for analysis were drawn from the 2010 Korean Longitudinal Study of Aging. Study sample included 3968 Korean adults aged ≥ 65 years. Depression was measured using the 10-item Center for Epidemiological Studies. Depression scale. Multivariate logistic regression analyses were used. RESULTS Among the informal activities, frequent contact by phone or letters with adult children is significantly associated with a lower risk of depression among older Korean adults, even after adjusting for potentially confounding factors. Face to face contact with close friends was negatively associated with depression in women, but not in men. Face to face contacts with adult children were not significantly associated with depression. All of formal social activities (attending religious activities, volunteering, and participating in alumni society or family councils, political or interest groups) were not significantly associated with depression in both men and women. CONCLUSIONS Informal social activities (contact by phone/letters with children and contact with friends) may have a greater impact on geriatric depression than formal social activities in this population. Researchers need to consider gender differences when examining the relationship between social activity and depression. More research is warranted to examine the direction of associations between particular types of social activities and late-life depression across time.
Collapse
Affiliation(s)
- Seung Hee LEE
- 1. Dept. of Nursing, University of Ulsan, Ulsan, South Korea
| | - Young Bum KIM
- 2. Hallym University Institute of Aging, Hallym University, Chuncheon, South Korea,* Corresponding Author:
| |
Collapse
|
7
|
Depression, Diabetes, and Healthcare Utilization: Results from the Korean Longitudinal Study of Aging (KLoSA). IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:6-15. [PMID: 26060674 PMCID: PMC4454035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to explore the relationship between diabetes and depression and investigate the effects of comorbid diabetes and depression on healthcare utilization. METHODS The study sample included 10,179 Korean adults aged ≥ 45 years. The presence of diabetes was assessed by asking participants if the participants had ever been diagnosed with diabetes. Depression was measured using the 10-item Center for Epidemiological Studies-Depression scale. Healthcare utilization was assessed by self-report. Multiple logistic regression analyses were performed. RESULTS Diabetes was positively associated with depression after controlling socioeconomic and health variables. Diabetic patients who had low socioeconomic status, who were obese, who were smokers, and who had higher numbers of chronic diseases had a higher depression risk. Diabetes and depression was associated with increased healthcare utilization. People with both diabetes and depression had significantly increased odds of multiple physician visits, multiple hospital admissions, and prolonged hospitalization compared with individuals with neither diabetes nor depression. Patients with both diabetes and depression had greater odds of multiple hospital admissions than patients with diabetes alone. CONCLUSIONS We found a positive association between diabetes and depression. Depression in persons with diabetes is associated with increased multiple hospital admissions. More research is warranted to clarify an association between co-occurring depression with diabetes and increased healthcare utilization.
Collapse
|
8
|
Yang SO, Jeong GH, Kim SJ, Lee SH. Correlates of self-care behaviors among low-income elderly women with hypertension in South Korea. J Obstet Gynecol Neonatal Nurs 2013; 43:97-106. [PMID: 24354464 DOI: 10.1111/1552-6909.12265] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify correlates of self-care behaviors among elderly, low-income Korean women with hypertension. RESEARCH DESIGN A secondary analysis of data from a community-based intervention trial for hypertension control. SETTING Three community health posts in the Gangwon province, South Korea. PARTICIPANTS Two hundred thirty-four (234) low-income elderly women (age 60-93) who had previously participated in a community-based intervention trial for hypertension control. METHODS The researchers collected data that included patient background characteristics, hypertension self-care behavior, self-efficacy of hypertension control, general knowledge of hypertension, and social support. The data were analyzed using descriptive and inferential statistics, including hierarchical regression analysis. RESULTS The model explained 41.1% of the total variance in hypertension self-care behavior scores. Among elderly, low-income Korean women, the significant factors of their hypertension self-care behavior included: (a) self-efficacy of hypertension control (β = .62), (b) social support (β = .16), and (c) age (β = -.14). Hierarchical regression analysis showed that elderly Korean women that had higher self-efficacy of hypertension control, higher social support, and were younger were more likely to have higher hypertension self-care behavior scores. CONCLUSIONS The results highlight the need for interventions that focus on improving an individual's self-efficacy and social support to enhance hypertension self-care. The findings of this study can help nurses better understand hypertension self-care behavior in elderly, low-income Korean women.
Collapse
|