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| '''[[Geriatric]] [[Depression (mood)|depression]]''' is the prolonged occurrence of depression in elderly-aged people. A [[meta-analysis]] done by the [http://www.liv.ac.uk University of Liverpool] found a 3.86% prevalence rate of depressed elderly in The [[People's Republic of China]],<ref>[[#reference-idChen R. 1999|Chen, R., J. R. M. Copeland, and L. Wei. "A Meta-Analysis of Epidemiological Studies in Depression of Older People in the People's Republic of China."]]</ref> compared to a 12% prevalence in [[Western Europe]].<ref>[[#reference-idCopeland 1999|Copeland, J. R. M., et al (1999). "Depression in Europe".]]</ref> Factors for depression in '''Chinese elderly''' are affected by [[Chinese culture]], social expectations, and living conditions. There is dispute to whether the low-level reported rates are due to differences in culture and traditions.<ref>[[#reference-idHarvard 2001|"Depression in China: Lost in Translation?" Harvard Mental Health Letter.]]</ref>
| | {{Short description|Overview of geriatric depression in China}} |
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| ==Symptoms and diagnosis== | | ==Geriatric Depression in China== |
| The most common used method of measuring [[Depression (mood)|depression]] for many studies on Chinese elderly is the [http://www.stanford.edu/~yesavage/GDS.english.long.html Geriatric Depression Scale] [[Geriatric Depression Scale|(GDS)]] by Yesavage & Brink.<ref>[[#reference-idYesavage & Brink|Yesavage JA, Brink TL, Rose TL, et al. 1983. Development and validation of a geriatric depression screening scale: a preliminary report.]]</ref> The [http://www.stanford.edu/~yesavage/Chinese.html Chinese version of the GDS] was translated by Chu Lee Hing of the [http://www.cuhk.edu.hk/v6/en Chinese University of Hong Kong].<ref>[[#reference-idHing|Hing Chu B. Lee. "Chinese Geriatric Depression Scale."]]</ref> A study in [[Hong Kong]] found its "[brief] and simple response format [to be] particularly favourable for use among the elderly" and was found to be "satisfactory" for screening depression in elderly Chinese.<ref>[[#reference-idChiu|Chiu, HFK, et al. "Reliability, Validity, and Structure of the Chinese Geriatric Depression Scale in a Hong Kong Context: A Preliminary Report."]]p. 477</ref>
| | Geriatric depression is a significant public health concern in China, affecting the elderly population. It is characterized by persistent feelings of sadness, loss of interest in activities, and various physical and cognitive symptoms. The condition is often underdiagnosed and undertreated in China due to cultural, social, and systemic factors. |
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| The use of the GDS analyzes simple behavior symptoms of crying, loss of appetite, sleep, weight, memory, concentration, energy, and enjoyment, whereas analysis of pure feelings may have different cultural connotations.<ref>[[#reference-idChen R. 1999|Chen, R., J. R. M. Copeland, and L. Wei. "A Meta-Analysis of Epidemiological Studies in Depression of Older People in the People's Republic of China."]] p. 827</ref> | | ==Epidemiology== |
| | The prevalence of [[geriatric depression]] in China varies across different studies, but it is generally estimated to affect a substantial portion of the elderly population. Factors contributing to the high prevalence include rapid [[urbanization]], changes in family structure, and increased life expectancy. The aging population in China is growing, with a significant proportion of individuals over the age of 60, making geriatric depression a critical issue. |
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| The [http://www.gp-training.net/protocol/docs/ghq.doc General Health Questionnare]<ref>D. Goldberg <http://www.gp-training.net/protocol/docs/ghq.doc></ref> (GHQ) was also deemed reliable in another study but not as sensitive as the GDS.<ref>[[#reference-idBoey|Boey, K. W., H. F. K. Chiu. "Assessing Psychological Well-being of the Old-Old: A Comparative Study of GDS-15 and GHQ-12."]]</ref> This study also sampled Hong Kong elderly. Another assessment that has been used among Chinese old-aged is the Geriatric Mental State Schedule (GMS). It is an interview for assessing psychopathology in 65+ aged patients which classifies by symptom type and any changes over time within that type.<ref>[[#reference-idCopeland 1976|Copeland, J. R. M., et al (1976). "A semi-structured Clinical interview for the assessment of diagnosis and mental state in the elderly: The Geriatric Mental State Schedule. I. Development and reliability."]]</ref> Further detailed diagnosis can made with the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) by using the scores from the GMS.<ref>[[#reference-idCopeland 1999|Copeland, J. R. M., et al (1999). "Depression in Europe". Geographical distribution among older people."]]</ref><ref>[[#reference-idCopeland 1986|Copeland, J. R. M., et al (1986). "Computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT."]]</ref><ref>[[#reference-idDewey & Copeland|Dewey, M. E. & Copeland, J. R. M. (1986). "Computerized psychiatric diagnosis in the elderly: AGECAT."]]</ref><ref>[[#reference-idBurns|Burns, Alistair, Brian Lawlor, Sarah Craig. "Rating scales in old age psychiatry."]]</ref>
| | ==Risk Factors== |
| | Several risk factors contribute to the development of geriatric depression in China: |
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| ===Cultural differences===
| | * '''Social Isolation''': Many elderly individuals experience social isolation due to the migration of younger family members to urban areas for work. |
| The differences between Chinese and Western definitions of depression have long been studied. "In traditional Chinese medicine, mental illness is often attributed to maladies of the heart",<ref>[[#reference-idMiller|Miller, Greg. "China: Healing the Metaphorical Heart."]]p. 463</ref> writes Greg Miller, a mental health journalist for the [http://www.sciencemag.org ''Science Magazine.''] The ''Harvard Review of Psychiatry'' found that [[Traditional Chinese medicine]] has no conception of emotional disorders; rather, it has a concept of physical imbalance.<ref>[[#reference-idHarvard 2007|"Depression in China: Finding a Translation." Harvard Mental Health Letter.]]</ref> It was reported that patients with depression described their being as "emotional...disturbance combined with references to the body, especially the heart...these references were not just metaphors; some patients literally felt their depression as discomfort inside or over the heart"<ref>[[#reference-idLee DTS|Lee DTS, et al. "Rethinking Depression: An Ethnographic Study of the Experience of Depression among Chinese."]]</ref> in a [http://www.harvard.edu Harvard] study on the [[ethnographic]] differences in depressive experiences. Phrases like ''xinhuang'' (heart panic), ''xinfan'' (heart vexed), and ''xintong'' (heart pain) are used by depressed patients to describe literal discomfort in the body.<ref name="Miller, Greg p. 462">[[#reference-idMiller|Miller, Greg. "China: Healing the Metaphorical Heart."]]p. 462</ref>
| | * '''Chronic Illness''': The presence of chronic illnesses such as [[diabetes]], [[hypertension]], and [[arthritis]] can increase the risk of depression. |
| | * '''Cultural Stigma''': Mental health issues are often stigmatized in Chinese culture, leading to reluctance in seeking help. |
| | * '''Economic Stress''': Financial difficulties and lack of adequate pension systems can contribute to stress and depression among the elderly. |
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| [[Maoist]] doctrine teaches that unhappiness in a people is a result of poor politics, and this led to an outlawing of [[clinical psychology]] in the mainland during 1950-1980—an attempt to prevent the diagnosis of unhappiness.<ref name="China p. 8">[[#reference-idHarvard 2001|"Depression in China: Lost in Translation?" Harvard Mental Health Letter.]]p. 8</ref> The following excerpt illustrates how far politics affected emotional health in a [[labor camp#2|labor camp]] during the Maoist era:
| | ==Symptoms== |
| | The symptoms of geriatric depression in China are similar to those observed globally, including: |
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| <blockquote>
| | * Persistent sadness or low mood |
| I never met a man in the camps at this time who talked about his parents, wife, lover or children in warm, earnest, loving terms – not even the shortest sentence ... A mention of one's home, that is one's real home, was bound to be related to receiving a package of things to eat in the mail ... Other than that, home had no place in a man's emotions, because he had lost his emotions.<ref>[[#reference-idZhang|Zhang, X.L. (1994) Grass Soup. Boston: Godine.]]p. 227-8</ref>
| | * Loss of interest or pleasure in activities |
| </blockquote>
| | * Changes in appetite and weight |
| | * Sleep disturbances |
| | * Fatigue and loss of energy |
| | * Difficulty concentrating |
| | * Feelings of worthlessness or guilt |
| | * Suicidal thoughts or behaviors |
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| Patients in the Harvard study rarely described their feelings as sadness, as it is generally viewed as shameful, a sign of weakness in character.<ref>[[#reference-idLee DTS|Lee DTS, et al. "Rethinking Depression: An Ethnographic Study of the Experience of Depression among Chinese"]]</ref> The culturally stoic Chinese, as a result, are more willing to accept physical ailments, such as heart pain or sleeplessness, than emotional problems.<ref name="China p. 8"/>
| | ==Diagnosis== |
| | Diagnosing geriatric depression in China involves a comprehensive assessment by healthcare professionals. This includes a detailed medical history, physical examination, and the use of standardized screening tools such as the [[Geriatric Depression Scale]] (GDS). Cultural sensitivity is crucial in the diagnostic process to ensure accurate identification of symptoms. |
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| [[Neurasthenia]], "lack of nerve strength", became the preferred diagnosis for mental problems once it was introduced to China in the early 1900s. Translation of neurasthenia to Chinese, ''shenjing shuairuo,'' describes a weakness in the flow of vital energy ([[qi]]) throughout the body.<ref name="Lee S p. 859">[[#reference-idLee S.|Lee S. "Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China."]]p. 859</ref> This gave an appeal of physical disease, with physical symptoms of fatigue, nonspecific aches and pains on the body, dizziness, upset stomach, appetite loss, poor memory, and insomnia.<ref name="Miller, Greg p. 462"/><ref name="China p. 8"/><ref name="Lee S p. 859"/> It was not until the pragmatic era of ''[[Deng Xiaoping]]'' that politics allowed "the demarcation between public and private space to reemerge",<ref>[[#reference-idLee S.|Lee S. "Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China."]]p. 359</ref> thus relaxing the social acceptability to admit to feelings and leading to the study and treatment of emotional disorder. By the 1980s the ''shenjing shuairuo'' labeling was removed and the Western label of "depression" used.<ref>[[#reference-idLee S.|Lee S. "Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China."]]</ref>
| | ==Treatment== |
| | Treatment for geriatric depression in China typically involves a combination of pharmacological and non-pharmacological approaches: |
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| ===In regards to the elderly===
| | * '''Pharmacotherapy''': Antidepressant medications, such as [[selective serotonin reuptake inhibitors]] (SSRIs), are commonly prescribed. |
| Chinese culture holds great importance on caring for the elderly.<ref name="ReferenceA">[[#reference-idChan|Chan, Sally W. C., et al. "Quality of Life in Chinese Elderly People with Depression."]]</ref> Physical, financial, and emotional care are traditionally provided by the children as a way to show honor, believed to come from [[Confucianism]].<ref>[[#reference-idHo|Ho, D. Y. F. (1996). "Filial piety and its psychological consequences."]]</ref> At the same time, elders' expectations lie heavily on contributing to their community with their advice and service than receiving it themselves—also called ''renqing''.<ref>[[#reference-idCheung|Cheung, F. M. C., Leung, K., Fan, R., Song, W. Z., Zhang, J. X., & Zhang, J. P. (1996). "Development of the Chinese personality assessment inventory."]]</ref> For elderly who adhere to tradition, old-aged life's purpose and one's self-worth is measured by the positive impact one has on their family.<ref>[[#reference-idYang|Yang, K. S. (1995). "Chinese social orientation: An integrative analysis."]]</ref>
| | * '''Psychotherapy''': Cognitive-behavioral therapy (CBT) and other forms of counseling can be effective. |
| | * '''Social Support''': Enhancing social support networks and community engagement is vital. |
| | * '''Traditional Chinese Medicine''': Some patients may also use traditional Chinese medicine as part of their treatment plan. |
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| Regarding Chinese [[filial piety|filial]] culture and the financial care of elderly, of a sample of Mainland Chinese-Canadian immigrants, 23.2% were assessed to have depressive symptoms, and among that depressed group, 17.3% were considered to have an unstable financial status<ref>[[#reference-idLai|Lai, Daniel. "Depression among Elderly Chinese-Canadian Immigrants from Mainland China."]]p. 681-2</ref>—study done for the [http://www.cmj.org ''Chinese Medical Journal.'']
| | ==Challenges== |
| | Several challenges exist in addressing geriatric depression in China: |
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| Overall it can be said that the number of women sampled in many of the studies, compared to men, was significantly greater. This may be caused by the socialization in Chinese societies—that men are to suppress emotions and that any need for help with emotional matters is viewed as a sign of weakness.<ref>[[#reference-idThompson|Thompson D. "The Male Role Stereotype."]]</ref> A study funded by the [http://english.nhri.org.tw National Health Research Institute of Taiwan] found a high prevalence of depression in [[Taiwan]]ese elderly, contradictory to many studies held previously in Asia and "comparable to rates reported in some studies of UK samples."<ref>[[#reference-idChong|Chong, M. Y., et al. "Community Study of Depression in Old Age in Taiwan Prevalence, Life Events and Socio-Demographic Correlates."]]p. 29</ref> Furthermore, the study found lowly educated widows in urban communities were higher risk for depressive disorders.
| | * '''Limited Access to Mental Health Services''': There is a shortage of mental health professionals and facilities, particularly in rural areas. |
| | * '''Cultural Barriers''': Cultural beliefs and stigma surrounding mental illness can hinder treatment. |
| | * '''Policy and Infrastructure''': There is a need for improved mental health policies and infrastructure to support the elderly population. |
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| ==Possible factors== | | ==Related Pages== |
| ===Physical===
| | * [[Depression (mood disorder)]] |
| | | * [[Mental health in China]] |
| The same study by Chong et al. also observed that the main stress factor for the sampled Taiwanese elderly was health problems.<ref>[[#reference-idChong|Chong, M. Y., et al. "Community Study of Depression in Old Age in Taiwan Prevalence, Life Events and Socio-Demographic Correlates."]]</ref> A separate study found that Chinese elderly who participated in tai chi were found to reduce depressive symptoms in comparison with elderly with no treatment at all, as found in a study for the ''International Journal for Geriatric Psychiatry''<ref>[[#reference-idChou 2004|Chou, Kee-Lee, et al. "Effect of Tai Chi on Depressive Symptoms Amongst Chinese Older Patients with Depressive Disorders: A Randomized Clinical Trial."]]p. 1106</ref> Physical abilities and health problems affect a patient's perceived quality of life which affects level of depression, according to a study done by the Chinese University of Hong Kong.<ref name="ReferenceA"/> Confirmed by data from a study published in [http://stroke.ahajournals.org ''Stroke,''] post-stroke depression is common. Stroke decreased the activities of daily living and had a strong effect on the severity of depression in rural Chinese elderly.<ref>[[#reference-idFuh|Fuh, J. L., et al. "Poststroke Depression among the Chinese Elderly in a Rural Community."]]</ref> Another study in rural China found that "undetected" [[hypertension]] had a significant relation to depression, suggesting that "hypertension screening among older populations may be warranted for preventing depression and cardiovascular disease."<ref>[[#reference-idChen, R. 2005|Chen, R., et al. "Depression in Older People in Rural China."]]p. 2025</ref>
| | * [[Aging in China]] |
| | | * [[Public health in China]] |
| It has also been learned that "current smokers and former smokers are more likely to have depressive symptoms than never smokers",<ref>[[#reference-idLam|Lam, T. H., et al. "Smoking and Depressive Symptoms in Chinese Elderly in Hong Kong."]]</ref> as found in a study on Chinese elderly in Hong Kong.
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| ===Living conditions===
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| According to research, the living set-up of most Chinese elderly in 1987 was 65% living with two (and some-times three) generations of family and 18% with one generation, while 11% of couples lived together without their children and only 4% lived alone (although they had children). 2% were alone (i.e. single).<ref>[[#reference-idChen, X. S.|Chen, X. S., Zhang, J. Z., Jiang, Z. N., Zhu, Z. H., Liu, X. H., Wang, L. H. et al. (1987) "An epidemiological survey of mental disorders in old people in urban districts of Beijing."]]</ref> It was observed that loneliness increased prevalence of depression in old-aged women more than old-aged men in Hong Kong. The study concluded that because of the known trend of older men (who could not find a wife in Hong Kong) marrying women across the border in the mainland, lifestyles adapted to the separation families.<ref>[[#reference-idChou 2006|Chou, Kee-Lee, A. H. Y. Ho, and I. Chi. "Living Alone and Depression in Chinese Older Adults."]]</ref>
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| ===Economic===
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| In 1999, 48% of Chinese elderly relied on their spouses and 40% on their children, indicates Li Hong and Martin Tracy's survey.<ref>[[#reference-idHong|Hong, Li and Martin B. Tracy. 1999. "Family Support, Financial Needs, and Health Care Needs of Rural Elderly in China: A Field Study."]]</ref> "Worry about not having enough money to cover medical care is a new source of stress among urban residents"<ref>[[#reference-idSun|Sun, Rongjun. "Worry about Medical Care, Family Support, and Depression of the Elders in Urban China."]]p. 561</ref> claims Rongjun Sun of [http://www.csuohio.edu Cleveland State University.] The results of Sun's research show that "adequacy of medical care coverage has a substantial impact" on the elders' well-being and that "of all family support measures, emotional support from children is found to have significant buffering effects on the elders' depression."<ref>[[#reference-idSun|Sun, Rongjun. "Worry about Medical Care, Family Support, and Depression of the Elders in Urban China."]]p. 578</ref>
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| Different from income, financial strain—the ability to pay for daily expenses and the worry felt when "the need for unexpected expenditures arise"<ref>[[#reference-idChi|Chi, Iris, and Kee-Lee Chou. "Financial Strain and Depressive Symptoms among Hong Kong Chinese Elderly: A Longitudinal Study."]]p. 48</ref>—affects depression. This study on Hong Kong elderly further found that women with physical problems were more likely to worsen in depression from financial strain.<ref>[[#reference-idChi|Chi, Iris, and Kee-Lee Chou. "Financial Strain and Depressive Symptoms among Hong Kong Chinese Elderly: A Longitudinal Study."]]p. 57-58</ref> Furthermore, it was concluded that a better social support did not necessarily lessen the impact of financial strain on depression—which contradicts Sun's findings (previously mentioned) of "buffering effects". A 1998 study of [[Wuhan]] elders found that "anticipated support" was the source of reduced impact of financial strain on depression. Anticipated support brought about feelings of security whereas "received support" usually aroused a sense of guilt in the elderly.<ref>[[#reference-idKrause|Neal Krause, Jersey Liang, and Shengzu Gu. 1998. "Financial Strain, Received Support, Anticipated Support, and Depressive Symptoms in the People's Republic of China."]]</ref>
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| ==Question of depression==
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| Some sources argue that reported low prevalence of depression is faulty because of the differences in culture while others argue that the difference in cultures is the cause of low-prevalence. Gordon Parker et al. suggests most Chinese deny depression, that "depression appears to be less evident in the Chinese and more likely to be expressed somatically, as a result of a rich set of interconnecting influences,"<ref>[[#reference-idParker|Parker, Gordon, Gemma Gladstone, and Kuan Tsee Chee. "Depression in the Planet's Largest Ethnic Group: The Chinese."]]p. 862</ref> whereas Mjelde-Mossey et al. suggests that holding onto "tradition was found to be negatively associated with depression and thus a protective factor"<ref>[[#reference-idMjelde-Mossey|Mjelde-Mossey, L. A., I. Chi, and V. W. Q. Lou. "Relationship between Adherence to Tradition and Depression in Chinese Elders in China."]]p. 24</ref> against depression. Three reasons for the lower prevalence of depression give by R. Chen, et al. based on a study on rural Chinese elders:
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| <blockquote>
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| First, there were higher levels of social support and positive life values among older people in China. Second, working and living environments in rural areas were more relaxed (eg, less stressful work and more physical farming activity). Third, the causes of diseases within populations may differ from the factors that explain differences between populations.<ref>[[#reference-idChen, R. 2005|Chen, R., et al. "Depression in Older People in Rural China."]]p. 2024</ref>
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| </blockquote>
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| <blockquote>
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| Contributors to low-prevalence rates, from Parker's research:<ref>[[#reference-idParker|Parker, Gordon, Gemma Gladstone, and Kuan Tsee Chee. "Depression in the Planet's Largest Ethnic Group: The Chinese."]]p. 862-3</ref>
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| *low level of reporting depression
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| *"idiomatic reporting" of neurasthenia
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| *"lack of criterion-based classification" which leads to problems in detection of depression | |
| *coping mechanisms of stoicism, cultural support, and lower level of urbanization
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| </blockquote>
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| Frequency distribution of the items in the Chinese tradition scale used in the Mjolde-Mossey study:<ref>[[#reference-idMjelde-Mossey|Mjelde-Mossey, L. A., I. Chi, and V. W. Q. Lou. "Relationship between Adherence to Tradition and Depression in Chinese Elders in China."]]p. 22</ref>
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| {| class="wikitable" border="1"
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| ! Chinese Tradition Scale Item
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| ! Agree (%)
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| | Count on children when you are ill
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| | 79.4
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| | Seek help from children on financial difficulties
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| | 74.9
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| | Children should take responsibility for financial needs of elderly
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| | 71.6
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| | Source of income from children
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| | 62.9
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| | Help people around with household tasks
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| | 56.4
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| | Receive financial assistance from children when in need
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| | 51.5
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| | Comfort immediate family members when they feel down
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| | 50.1
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| | Other people talk to you for important decisions
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| | 41.9
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| | Comfort extended relatives when they feel down
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| | 22.2
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| |}
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| ==Prognosis==
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| It is predicted that by the middle of the 22nd century, 25% of the world's elderly population will consist of '''Chinese elders'''.<ref>[[#reference-idBanister|Banister, J. (1990). "Implications of the ageing of China's population."]]</ref> With such a statistic, understanding how to prevent depression in Chinese elderly will serve to improve some of the problems that may come in caring for the well-being of the elderly and their families.
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| Sun's research found that elderly that lived near their children were associated with better well-being than those that lived in the same household as or lived far from their children.<ref name="Sun, Rongjun p. 579">[[#reference-idSun|Sun, Rongjun. "Worry about Medical Care, Family Support, and Depression of the Elders in Urban China."]]p. 579</ref> Because of the complex nature of human relationships and the variables that effect measuring methods, it is important to note that family support is not a consistent positive effect on elderly well-being, "nevertheless, [Sun's] study confirms that family ties play a critical role in buffering the impact of undesirable social event."<ref name="Sun, Rongjun p. 579"/> In regards to China's future family situation, the [[one-child policy]] presents an issue for the single child sons/daughters that face two pairs of parents to support.<ref>[[#reference-idZeng|Zeng, Yi. 1986. "Changes in Family Structure in China: A Simulation Study."]]</ref>
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| The previously mentioned study by Mjelde-Mossey et al. concluded that because adherence to traditions is known to reduce depression an elder can achieve a level of mental stability by applying the purpose of their traditional beliefs to whatever non-traditional situations and relationships come into their life.<ref>[[#research-idMjelde-Mossey|Mjelde-Mossey, L. A., I. Chi, and V. W. Q. Lou. "Relationship between Adherence to Tradition and Depression in Chinese Elders in China."]]p. 25</ref> With this kind of background, Chinese elderly can change the way they are impacted by changes in society—independent children, less contact between family members, and westernized traditions that support youth-self-centeredness.<ref>[[#reference-idYip|Yip P, Chi I, Chiu H. 2002. "A multi-disciplinary study on the cause of elderly suicide in Hong Kong."]]</ref>
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| ==See also==
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| *[[Geriatric psychiatry]] | |
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| ==Citations==
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| {{reflist}}
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| ==References==
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| *{{wikicite|id=idBanister|reference=Banister, J. (1990). "Implications of the ageing of China's population." In Z. Yi, Z. Chunyuan, & P. Songjian (Eds.), Changing family structure and population aging in China: A Comparative approach. BeiJing, China: Peking University Press.}}
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| *{{wikicite|id=idBoey|reference=Boey, K. W., H. F. K. Chiu. "Assessing Psychological Well-being of the Old-Old: A Comparative Study of GDS-15 and GHQ-12." Clinical gerontologist 19 (1998): 65-76.}}
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| *{{wikicite|id=idBurns|reference=Burns, Alistair, Brian Lawlor, Sarah Craig. "Rating scales in old age psychiatry." Br. J. Psychiatry, Feb 2002; 180: 161 - 167.}}
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| *{{wikicite|id=idChan|reference=Chan, Sally W. C., et al. "Quality of Life in Chinese Elderly People with Depression." International journal of geriatric psychiatry 21.4 (2006): 312-8.}}
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| *{{wikicite|id=idChen R. 2005|reference=Chen, R., et al. "Depression in Older People in Rural China." Archives of Internal Medicine 165.17 (2005): 2019-25.}}
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| *{{wikicite|id=idChen R. 1999|reference=Chen, R., J. R. M. Copeland, and L. Wei. "A Meta-Analysis of Epidemiological Studies in Depression of Older People in the People's Republic of China." International journal of geriatric psychiatry 14.10 (1999): 821-30.}}
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| *{{wikicite|id=idChen, X.S.|reference=Chen, X. S., Zhang, J. Z., Jiang, Z. N., Zhu, Z. H., Liu, X. H., Wang, L. H. et al. (1987) An epidemiological survey of mental disorders in old people in urban districts of Beijing. Chinese J. Neurol. Psychiatry 20, 145±149.}}
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| *{{wikicite|id=idCheung|reference=Cheung, F. M. C., Leung, K., Fan, R., Song, W. Z., Zhang, J. X., & Zhang, J. P. (1996). Development of the Chinese personality assessment inventory. Journal of Cross-Cultural Psychology, 27, 181–199.}}
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| *{{wikicite|id=idChi|reference=Chi, Iris, and Kee-Lee Chou. "Financial Strain and Depressive Symptoms among Hong Kong Chinese Elderly: A Longitudinal Study." Journal of Gerontological Social Work 32.4 (1999): 41-60.}}
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| *{{wikicite|id=idChiu|reference=Chiu, HFK, et al. "Reliability, Validity, and Structure of the Chinese Geriatric Depression Scale in a Hong Kong Context: A Preliminary Report." Singapore medical journal 35 (1994): 477.}}
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| *{{wikicite|id=idChong|reference=Chong, M. Y., et al. "Community Study of Depression in Old Age in Taiwan Prevalence, Life Events and Socio-Demographic Correlates." The British Journal of Psychiatry 178.1 (2001): 29-35.}}
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| *{{wikicite|id=idChou 2004|reference=Chou, Kee-Lee, et al. "Effect of Tai Chi on Depressive Symptoms Amongst Chinese Older Patients with Depressive Disorders: A Randomized Clinical Trial." International journal of geriatric psychiatry 19.11 (2004): 1105.}}
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| *{{wikicite|id=idChou 2006|reference=Chou, Kee-Lee, A. H. Y. Ho, and I. Chi. "Living Alone and Depression in Chinese Older Adults." Aging & Mental Health 10.6 (2006): 583-91.}}
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| *{{wikicite|id=idCopeland 1976|reference=Copeland, J. R. M., et al (1976). "A semi-structured Clinical interview for the assessment of diagnosis and mental state in the elderly: The Geriatric Mental State Schedule. I. Development and reliability." Psychological Medicine 6, 439-449.}}
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| *{{wikicite|id=idCopeland 1986|reference=Copeland, J. R. M., et al (1986). "Computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT." Psychological Medicine, 16, 89-99.}}
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| [[Category:Geriatrics]] | | [[Category:Geriatrics]] |
| [[Category:Geriatric psychiatry|Depression]] | | [[Category:Mental health in China]] |
| [[Category:Mood disorders]] | | [[Category:Depression (mood disorder)]] |
| {{dictionary-stub1}}
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