The social determinants of depression in elderly Korean immigrants in Canada: does acculturation matter?

Depression in old age significantly decreases the quality of life and may lead to serious consequences, such as suicide. Existing literature indicates that elderly Korean immigrants may experience higher levels of depression than other racial ethnic group elders. The purpose of this exploratory study was to investigate factors that influence depression among older Korean immigrants in Toronto. A total of 148 participants, ages 60 years or older (mean age = 74.01, SD = 8.24), completed face-to-face interviews in Korean language. Hierarchical regression analyses were conducted by adding variables in three steps: (1) demographic variables; (2) acculturation variables (years of immigration and English proficiency); and (3) social determinants (social integration variables, physical health, and financial satisfaction). Results showed that acculturation factors were not associated with depression. Instead, social determinants variables, including lower physical health status and lower financial status, living alone, and lower level of social activity, predicted higher level of depressive symptoms, along with lower education. The final regression model explained about 37% of variance of depression in the sample. These results suggest that social determinants, not acculturation, are important factors explaining the levels of depression in Korean immigrant elders living in a metropolitan city in Canada. Implications for practice are discussed.     

Residency in the United States, subjective well-being, and depression in an older Mexican-origin sample

OBJECTIVE: To compare the mental health and well-being of Mexican immigrants with native-born Mexican Americans living in the Lower Rio Grande Valley of Texas. METHODS: A randomly stratified sample of 353 Hispanics aged 45 and older were interviewed. The immigrant group (n = 148) was compared with native-born Mexican Americans (n = 205). RESULTS: The findings showed that the native-born group was not significantly different from the immigrant group on measures of depression, health status, life satisfaction, or self-esteem. The immigrant group was found to report significantly more stress than the Mexican American group. Income, age, gender, and acculturation were significant predictors of well-being, whereas immigration status and years of residency were not. DISCUSSION: The well-being of Mexican immigrants in the United States is confounded by such variables as income, age, gender, and acculturation, along with various other contextual factors that characterize their life experiences in the United States.     

The Role of Acculturation in Health Status and Utilization of Health Services among the Iranian Elderly in Metropolitan Sydney

The present study explores the impact of acculturation on health status and use of health and community aged care services among elderly Iranian-born immigrants to Australia. Three hundred two Iranian immigrants aged 65 years and over who had lived in the Sydney Metropolitan area for at least six months participated. Data were collected using a written survey instrument, face-to-face interviews, and telephone interviews. Iranian immigrants had higher levels of psychological distress, more limited physical function, greater need for help or assistance with activities of daily living, lower feelings of wellbeing, and were much less likely to use aged care services than the general population of older Australians. Participants who did not speak English at home were more likely to experience psychological distress and had greater limitations in their physical functioning. Elderly Iranians with better English proficiency had lower levels of anxiety and depressive symptoms and reported less need for help and supervision in activities of daily living; they were also more likely to access health care services. Elderly Iranian immigrants experience higher levels of psychological distress and lower levels of physical function than the general population of older Australians; those with limited proficiency in English are at greatest risk. These findings contribute to the enrichment of multicultural policy, social fairness, access, and equity for ethnic aged people.     

Factors Related to Depressive Symptoms in an Elderly Chinese American Sample

ABSTRACT

We assessed depressive symptomatology and its correlates in a sample of Chinese American elderly residing in a mid-western city. A structured questionnaire was developed for the project and administered by trained bilingual interviewers. In our community-dwelling sample (N = 45), aged 59 to 89 years, 20.0% had clinically significant depressive symptoms. Life satisfaction, social support, health status, functional status, number of years present in America, level of acculturation, and command of the English language were all found to be inversely related to depressive symptoms.     

Strain, social support, and mental health in rural elderly individuals

This study examined the relationships among social support, life strain, and mental health in a sample of 210 rural elderly individuals. Life strain was operationalized as economic deprivation, illness disability, and ADL impairment. Demographic characteristics had little effect on mental health. Physical health status was highly predictive of life satisfaction and psychological distress among rural elderly individuals. Disability associated with chronic illness and ADL impairment was related to increased reports of symptoms of emotional and psychosomatic distress. Measures of social contacts and instrumental support exerted small to moderate effects on life satisfaction, psychosomatic distress, and emotional distress. Affective support moderated the effects of health-related strain on mental health.     

Health Perception and Depressive Symptoms Among Older Korean Americans

Given the increasing recognition of racial/ethnic health disparities, the present study focused on older Korean Americans. Using data from 230 older Korean Americans in Florida (M age = 69.8, SD = 7.05), we assessed (a) how background variables (demographic information and acculturation), health constraints (chronic conditions and functional disability), and psychosocial factors (sense of mastery and filial satisfaction) were associated with health perception and depressive symptoms; and (b) whether health perception mediated the connections between health constraints and depressive symptoms. We observed positive perceptions of health and emotional states among individuals with higher levels of acculturation, fewer chronic conditions, less disability, and a greater sense of mastery. We also found that persons who were more satisfied with their relationships with adult children and who had more positive health perception were less depressed. Additionally, the findings supported a mediation model of health perception in the linkages between physical and mental health. Findings and implications are discussed here in a cultural context.     

Perceived autonomy support,psychological needs satisfaction,depressive symptoms and apathy in French hospitalized older people

Based on the self-determination theory, the aim of the present study was (1) to provide a better understanding of older people’s psychological needs satisfaction in geriatric care units, then to link this information with depressive symptoms and apathy; (2) to examine whether the perceived autonomy support from health care professionals differs between needs satisfaction profiles; and (3) to investigate for all participants how each need satisfaction was related to depressive symptoms and apathy. Participants (N = 100; M_age = 83.33 years, SD = 7.78, 61% female) completed the measures of psychological needs satisfaction, perceived autonomy support, geriatric depression and apathy. Sociodemographic data were also collected. Cluster analyses showed three distinct profiles: one profile with low-moderate need satisfaction, one profile with high-moderate need satisfaction and one profile with high need satisfaction. These profiles are distinct, and did not differ in terms of participants' characteristics, except gender. Multivariate analysis of covariance (MANCOVA) revealed that participants with low-moderate need satisfaction profile have significantly higher level of depressive symptoms and apathy, and lower levels of perceived autonomy support than participants of the two other profiles. Moreover, for all participants, regression analyses revealed that both competence and relatedness needs satisfaction significantly and negatively explained 28% of the variance in depressive symptoms score and 44% of the variance in apathy score. Our results highlight the interest to examine more thoroughly the variables fostering autonomy-supportive environment in geriatric care units, and to deepen the relationship between competence and relatedness needs satisfaction and depressive symptoms and apathy.     

National context of healthcare, economy and religion, and the association between disability and depressive symptoms in older Europeans: results from the EURODEP concerted action

Associations between disability and depression have been shown to be consistent across cultures among middle-aged adults. In later life the association between disability and depression is much more substantial and may be amenable to influences by health care facilities as well as economic and sociocultural factors. Fourteen community-based studies on depression in later life in 11 western European countries contribute to a total study sample of 22,570 respondents aged 65 years or older. Measures are harmonised for depressive symptoms (EURO-D scale) and disability. Using multilevel modelling to control for the stratified data structure we examined whether the association between disability and depressive symptoms is modified by national health care and mental health care availability, national economic circumstances, demographic characteristics and religious tradition. The association between depressive symptoms and disability is attenuated by health care expenditure and availability of mental health care and also by gross domestic product; it was more pronounced in countries with high levels of orthodox religious beliefs. Higher levels of depressive symptoms are found in countries with a larger gross domestic product (per capita) and higher health care expenses but are interpreted with care because of measurement differences between the centres. The findings from this contextual perspective indicate that general and mental health care should be geared to one another wherever possible.     

Is cognitive lifestyle associated with depressive thoughts and self-reported depressive symptoms in later life?

Key components of cognitive lifestyle are educational attainment, occupational complexity and engagement in cognitively stimulating leisure activities. Each of these factors is associated with experiencing fewer depressive symptoms in later life, but no study to date has examined the relationship between overall cognitive lifestyle and depressive symptoms. This task is made more complex because relatively few older participants in cross-sectional studies will be currently experiencing depression. However, many more will show evidence of a depressive thinking style that predisposes them towards depression. This study aimed to investigate the extent to which cognitive lifestyle and its individual components are associated with depressive thoughts and symptoms. Two hundred and six community-dwelling participants aged 65+ completed the depressive cognitions scale, the geriatric depression scale and the lifetime of experiences questionnaire, which assesses cognitive lifestyle. Correlational analysis indicated that each of the individual lifestyle factors—education, occupational complexity and activities in young adulthood, mid-life and later life—and the combined cognitive lifestyle score was positively associated with each other and negatively with depressive symptoms, while all except education were negatively associated with depressive thoughts. Depressive thoughts and symptoms were strongly correlated. Cognitive lifestyle score explained 4.6 % of the variance in depressive thoughts and 10.2 % of the variance in depressive symptoms. The association of greater participation in cognitive activities, especially in later life, with fewer depressive symptoms and thoughts suggests that preventive interventions aimed at increasing participation in cognitively stimulating leisure activity could be beneficial in decreasing the risk of experiencing depressive thoughts and symptoms in later life.     

The Role of Psychosocial and Cultural Factors as Correlates of Depressive Symptoms in Chinese-American Older Adults

Building upon the literature showing the negative impact of physical health constraints on depressive symptoms, this study examined the role of health and psychosocial and cultural factors as correlates of depressive symptoms in community-dwelling Chinese-American older adults. Data were drawn from surveys with 108 older Chinese Americans living in the Tampa and Orlando areas of Florida (M age = 70.6 years, SD?=?7.70). Results from hierarchical regression analysis suggest the importance of chronic health conditions and functional status as correlates of depressive symptoms. In addition, high levels of sense of mastery and acculturation were also found to be significant. Findings highlight the importance of psychosocial and cultural factors and suggest that such factors need to be considered in efforts to promote the mental health of ethnic minority older adults. Limitations and clinical implications of the findings are discussed.     

Correlates of Depression in the Korean American Elderly: Focusing on Personal Resources of Social Support

Today’s Korean American elderly are predominantly first-generation immigrants who face stern challenges of acculturation, which is often associated with depression. Social support has been identified as an effective personal resource for alleviating acculturative stress and achieving better mental health outcomes. The purposes of this study were to describe available sources of social support utilized by Korean elders and to examine the relationships among acculturative stress, social support, and depression. In particular, social support was operationalized as an integrative concept encompassing the size of the social network, satisfaction with the support received, and appraisals of the level of social support. This study was a secondary data analysis of an existing survey of 205 elderly Korean immigrants (≥60 years) in a major metropolitan city on the East coast. Adult children were found to be the main source of support utilized by elders, even when the elder had a living spouse. Hierarchical multiple regression analysis revealed that higher acculturative stress and lower social support were associated with higher depression scores after demographics and health status were controlled for, whereas network size and satisfaction with support were not. Future interventions should address the cultural/social needs of these immigrants, not only by reinforcing their existing social network but also by providing additional support for their family members to prevent social isolation and depression in the population.     

Major life stress, coping styles, and social support in relation to psychological distress in patients with systemic lupus erythematosus

The objective of this study was to examine psychological processes in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients in relation to measures of life stress, coping styles, social support and cognitive ability. Fifty-two SLE patients without overt neuropsychiatric symptoms, 29 RA patients and 27 healthy controls completed measures of depression, mood, disease activity, perceived health, stressful life events, coping, and social support. Variables entered into the multiple regression analysis following principal component analysis were: group, major difficult event, major life threatening event, disengaging coping, emotional coping, social support, and cognitive impairment. Depressive symptoms were associated with SLE group status (P < 0.001), major life-threatening events (P < 0.01), disengage coping (P < 0.001) and emotional coping (P < 0.05). SLE group status (P < 0.05), disengage coping (P < 0.05) and emotional coping (P < 0.05) were associated with current distressed mood. SLE patients without overt, major neuropsychiatric symptoms had greater psychological distress compared to RA and control subjects. Increased depressive symptoms and distressed mood state in SLE patients were related to use of disengaging and emotional coping styles. These findings are limited to SLE patients with no overt neuropsychiatric illness and low disease activity, suggesting the need for future studies with a greater variety of SLE patients. Interventions aimed at improving active coping and minimizing emotional response to stress may lower psychological distress in SLE patients with mild disease.     

A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea

Self-rated health and physical functioning are recognized as important indicators of health in older persons. Rarely, however, there have been studies done which examine cross-cultural differences in the health of older people using these measures, especially among non-Western countries. The objective of this study was to examine patterns of association of self-rated health and functional disability of Japanese and Korean elderly people living in the community, using nationwide surveys of persons aged 60 years or over. There were striking similarities in the general pattern of associations with covariates. In the multivariate analysis, age, work status, comorbidity, depressive symptoms, life satisfaction, hospitalization, and functional disability were strongly associated with self-rated health in both populations. For functional disability, older age, female, low social contact, depressive symptoms, poor life satisfaction, and poor self-rated health were found to be significantly associated. Some differences in the structure of associations with self-rated health, however, were noted. Women tended to assess their health more favorably than men in Korea, but in the Japanese elderly gender differences disappeared when other variables were taken into account. Health-related variables tended to be more closely associated with functional disability in the Japanese sample. An overall similarity, however, in the pattern of associations of these measures supports their utility in assessing and comparing the health of older populations in this region.     

Association between multiple geriatric syndromes and life satisfaction in community-dwelling older adults: A nationwide study in Taiwan

ObjectiveAlthough previous studies have investigated the association between a single geriatric syndrome and life satisfaction in the older adults, the accumulated effects of multiple geriatric syndromes on life satisfaction remain unclear.MethodsWe conducted a nationwide study by using data from the Taiwan Longitudinal Study on Aging database. A total of 2415 older adults were enrolled. Life satisfaction was evaluated according to the Life Satisfaction Index, and the geriatric syndromes included a depressive disorder, cognitive impairment, functional impairment, urine incontinence, pain, a fall, and polypharmacy. Other characteristics were age, sex, marital status, education level, self-rated health, and chronic diseases.ResultsUnivariate analysis revealed that the older adults, who were illiterate, did not live with a partner, yet other issues such as stroke, malignancy, osteoarthritis, poor self-rated health, a depressive disorder, functional impairment, urine incontinence, or pain were associated with lower life satisfaction. In the multivariate regression model, the older adults who were male, illiterate, lived without a partner, had poor self-rated health, or had a depressive disorder were more likely to have lower life satisfaction. In addition, life satisfaction was unaffected in the older adults with only 1 geriatric syndrome, but among those with ≥2 geriatric syndromes, an increased number of geriatric syndromes were associated with lower life satisfaction.ConclusionIn addition to socio-demographic factors, cumulative effects of multiple geriatric syndromes might affect life satisfaction in the older adults. Further study of interventions for reducing geriatric syndromes to maintain life satisfaction is required.     

Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure

OBJECTIVES: The purpose of this study was to assess whether depressive symptoms are independently associated with changes in heart failure (HF)-specific health status. BACKGROUND: Depression is common in patients with HF, but the impact of depressive symptoms on the health status of these patients over time is unknown. METHODS: We conducted a multicenter prospective cohort study of outpatients with HF. Data from 460 patients who completed a baseline Medical Outcomes Study-Depression Questionnaire and both a baseline and follow-up (6 +/- 2 weeks) Kansas City Cardiomyopathy Questionnaire (KCCQ) were analyzed. The KCCQ measures HF-specific health status, including symptoms, physical and social function, and quality of life. Multivariable regression was used to evaluate depressive symptoms as a predictor of change in KCCQ scores, adjusting for baseline KCCQ scores and other patient variables. The primary outcome was change in KCCQ summary scores (range 0 to 100; higher scores indicate better health status; 5 points is a clinically meaningful change). RESULTS: Approximately 30% (139/460) of the patients had significant depressive symptoms at baseline. Depressed patients had markedly lower baseline KCCQ summary scores (beta = -19.6; p < 0.001). After adjustment for potential confounders, depressed patients were at risk for significant worsening of their HF symptoms, physical and social function, and quality of life (average change in KCCQ summary score = -7.1 points; p < 0.001). Depressive symptoms were the strongest predictor of decline in health status in the multivariable models. CONCLUSIONS: Depressive symptoms are a strong predictor of short-term worsening of HF-specific health status. The recognition and treatment of depression may be an important component of HF care.     

Change of depressive symptoms in a French nine-year longitudinal study of aging: Gender differences and relationships between social support,health status and depressive symptoms

ObjectivesThe aims of this study were to examine the trajectory of depressive symptoms among older French people, to investigate the role of gender in the developmental trajectory of depressive symptoms and to explore whether the linear increase in depressive symptoms might be accentuated or attenuated at time points during which the older adults’ scores on social support and health satisfaction scales were higher than their individual averages.Methods/materialsData were used from a subsample of older adults living at home who participated in a longitudinal study initiated by researchers from the University of Tours. They were collected at five time points over a 9-year period (T1: 2003; T2: 2005; T3: 2007; T4: 2009; T5: 2011). This study included 707 participants, and multilevel growth curve analysis was used on measures of depressive symptoms, gender differences, social support and health satisfaction.ResultsResults indicated (1) a significant positive linear effect of age on depressive symptoms; (2) that women reported significantly higher scores of depressive symptoms than men at 63 years old (i.e., intercept) and that this gender difference remained constant across age; (3) that the slope of depressive symptoms appeared to increase at time points during which participants had higher levels of social support and to decrease when they had greater health satisfaction.ConclusionThis study provides pertinent information about the change of depressive symptoms in older people living at home and particularly highlights the interest in studying gender, social support and health satisfaction.     

Health and social antecedents of relocation in rural elderly persons

Sociodemographic, health, and psychobehavioral correlates of anticipated and actual relocation were examined in a geographically-defined rural elderly population (N = 3097). Intent to move was associated with higher levels of depressive symptoms. Of those responding, 4.8 percent moved between the baseline and one-year follow-up interviews. Disproportionally high numbers of women, persons over 84 years of age, those who lived alone, persons with lower incomes, and the less educated made noninstitutional moves. Actual noninstitutional relocation was associated with poorer physical functional status, poorer self-perceived health status, higher levels of depressive symptomatology and anxiety, and poorer life satisfaction at baseline. Death of spouse, marriage of offspring, and having someone move in with the respondent were associated with noninstitutional relocation, but retirement was not. The outcomes are generally consistent with Litwak and Longino's (1987) developmental model of relocation among elderly persons.     

Childhood adversities and mid-late depressive symptoms over the life course: evidence from a retrospective cohort study in China

Background

The cumulative effect of childhood adversities on depressive symptoms in later life is well documented in many countries. However, there is a dearth of accurate information about this effect in the Chinese population. We aimed to examine the cumulative effect of childhood adversities on depressive symptoms in mid-to-late life, using data from the Chinese population.