Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan

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Abstract

Background Relatively little empirical attention has focused on the association between social participation and depressive symptoms amongst older adults in Asian nations, where persons over the age of 65 represent a rapidly growing segment of the population. This study explores the dynamic relationship between participation in social activities and trajectories of depressive symptomatology among older Taiwanese adults surveyed over 18 years. Methods Data are from a nationally representative sample of 1,388 adults aged 60-64 first surveyed in 1989 and followed over an 18-year time period for a total of six waves. Individual involvement in social activities was categorized into continuous participation, ceased participation before age 70, initiating participation in older adulthood, never participated, and dropped out before age 70. Two domains of depressive symptoms--negative affect and lack of positive affect--were measured using a 10-item version of the Center for Epidemiologic Studies-Depression Scale. Results Analyses using growth curve modeling showed that continuously participating or initiating participation in social activities later life is significantly associated with fewer depressive symptoms among older Taiwanese adults, even after controlling for the confounding effects of aging, individual demographic differences, and health status. Conclusions These findings suggest that maintaining or initiating social participation in later life benefits the mental health of older adults. Facilitating social activities among older adults is a promising direction for programs intended to promote mental health and successful aging among older adults in Taiwan.

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Cross-validation of a short form of the CES-D in Chinese elderly.

Kam Weng Boey (1999)

To establish the reliability and validity of a 10-item short form of the CES-D (CESD-10). Cross-sectional and longitudinal follow-up over 3 years. Standardized questionnaire and face-to-face interview were conducted. Community and psychogeriatric assessment clinic of a voluntary organization. Five hundred and fifty-four elderly in the general community, 30 elderly from a community centre and 31 elderly patients with depressive symptoms. Instruments other than the CESD-10 included Activities of Daily Living (ADL), the Life Satisfaction Scale (LSS), the Lubben Social Network Scale, a single-item measure of self-rated health. Reliability of the CESD-10 in terms of internal consistency was satisfactory (Cronbach alpha = 0.78-0.79). Moderate consistency over a period of 3 years was also found to be significant (r = 0.44, p < 0.01). The CESD-10 showed comparable accuracy to the original CES-D in classifying cases with depressive symptoms (kappa = 0.84, p < 0.01). Significant relationships of the CESD-10 with impairments of daily functioning, life satisfaction, social support, and self-rated health were established. The CESD-10 also differentiated significantly between groups of 'normal' and clinically depressed elderly. The CESD-10 attained satisfactory content and temporal reliability. Its construct and concurrent validity were established. With its brevity, it should prove a useful mental health measure for the elderly.

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Stress, health, and the life course: some conceptual perspectives.

E Fazio, Stephen Meersman, Scott Schieman … (2005)

This article proposes several conceptual perspectives designed to advance our understanding of the material and experiential conditions contributing to persistent disparities in rates of morbidity and mortality among groups unequal in their social and economic statuses. An underlying assumption is that these disparities, which are in clear evidence at mid- and late life, may be anchored to earlier circumstances of the life course. Of particular interest are those circumstances resulting in people with the least privileged statuses having the greatest chances of exposure to health-related stressors. Among the stressors closely linked to status and status attainment are those that continue or are repeated across the life course, such as enduring economic strain and discriminatory experiences. Also taking a long-range toll on health are circumstances of stress proliferation, a process that places people exposed to a serious adversity at risk for later exposure to additional adversities. We suggest that this process can be observed in instances of trauma, in early out-of-sequence transitions, and in the case of undesired changes that disrupt behaviors and relationships in established roles. Effective effort to close the systemic health gaps must recognize their structural underpinnings.

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The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms.

Sheung-Tak Cheng, Anca K. C. Chan (2005)

No study has examined the diagnostic validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in the Chinese elderly. This study aims to determine appropriate cutoffs for the 20- (CESD-20) as well as a ten-item (CESD-10) version of the instrument. Data were also provided, based on simulated scoring, for the diagnostic performance of the scales when using dichotomous instead of 4-point rating scales. Three hundred and ninety eight persons aged 60 +referred for psychiatric assessment by a physician were administered the CES-D as well as given an independent psychiatric assessment. A spectrum of depression diagnosis as the criterion was used to assess the diagnostic validity of the CES-D. The ten and the 20-item version of the CES-D, regardless of scoring method, produced essentially identical performance indices. The optimal thresholds were 12 and 22 for CESD-10 and CESD-20 respectively, and based on these thresholds, sensitivity, specificity, positive predictive value and negative predictive value were 0.76, 0.55, 0.57 and 0.74 for CESD-10, and 0.75, 0.51, 0.55 and 0.72 for CESD-20. With both ends of the rating scale collapsed to create dichotomous items, the optimal thresholds became 4 for CESD-10 and 7 for CESD-20, and the corresponding performance indices were 0.67, 0.58, 0.56 and 0.69 for CESD-10, and 0.70, 0.58, 0.57 and 0.70 for CESD-20. The ten-item version can be used in lieu of the 20-item version, and a dichotomous response format would probably work as well as the original four-point format, in order to simplify administration for elderly persons. Copyright 2005 John Wiley & Sons, Ltd.