Prevalence and related influencing factors of depressive symptoms for empty-nest elderly living in the rural area of YongZhou, China
Introduction
In China, the number of empty-nest elderly, of which there are no children or children had already departed from them, is on the rise, especially in rural areas, which were closely related to China's overall economic environment, such as the accelerated process of urbanization, the imbalance of economic development between the inland and coastal region, and the flow of rural surplus labor to big and Eastern coastal cities (Liu et al., 2007). At present, the “empty nest elderly family” in China account for almost 25% of elderly households, and the proportion of “empty nest elderly family” in Beijing has been over 35% (Li et al., 2003). It is estimated that the proportion of empty-nest elderly households will reach 90% by 2030, while all our elderly families will be “of the empty nest” (Li et al., 2003).
The empty-nest elderly not only experience the restructuration of lifecycle, but also undergo the transformation of family-cycle, meanwhile, the organizational structure of individual and brain function changes with aging, the functional activities of the systems significantly decreased, which lead to many psychological problems and barriers (Liu and Wang, 2006). Many empty-nest elderly must adjust to major changes in physical health; unfortunately, their mental health troubles were often overlooked in these serious of adjustment processes, such as anxiety, loneliness, Alzheimer's disease (AD) and the most common psychological symptom is depression.
Depression is the most frequent psychiatric disorder in old age (Stoppe, 2008). Almost 1 in every 6 elderly, suffer (often in silence) with late life depression (Keith et al., 2001). Of the 34 million elders in the United States, about 5 million (15%) endure persistent depressive symptoms (referred to as “minor depression” by the Surgeon General) and another 1 million (3%) suffer major depression (Thompson, 1996). Collectively, the two statistics will become 18%, the estimate was actually rather conservative. Other gerontological professionals report a 20–40% prevalence range (Beekman et al., 1999), and Tiemeier (2003) pointed out that between 1% and 3% of elderly persons who live in the community has major depression. Moreover, epidemiological studies consistently reported much higher prevalence-estimates for depression (between 10% and 20%) (Tiemeier, 2003). Nevertheless, accurate prevalence-estimates of late life minor and major depression are difficult to ascertain, because many elderly who suffer from clinically relevant depressive symptoms do not fulfill rigorous diagnostic criteria, the elderly were less likely to mention their mood/behavioral complaints with their friends or relatives, and the depressive symptom was often accompanied with physical diseases, which was likely to be neglected.
Depression damages the health of the elderly, decreases the elderly's social and physical activities, generate unsociability and self-grief, reduce the quality of life, it is one of the main reasons that affect the subjective well being (SWB) of elderly, and also one of the important factors which can cause the elderly to commit suicide (Kaneko et al., 2007). A report has suggested that depression and mood disorder may be major risk factors for suicide (Mann, 2002). The suicide mortality rate in the elderly has consistently been higher than that in other age groups. In 2001, the suicide mortality rate was 23.3 per 100,000 for the whole population and 33.1 per 100,000 for persons aged 65 years and above (Japanese Ministry of Health, 2002). Yet, the negative effects of old age depression were not limited to one group of people. Others, such as the family members, were burdened. Adult children become taxed and strained by the global changes in mood and behavior of their beloved aging parents. Under stress, family members sometime blame their depressed relatives for not coping adequately and demand different reactions to situational stressors (Hinrichsen and Hernandez, 1993).
Besides, old age is often associated with health problems and irreversible decrease in function capacity (Jylha, 2004, Fogelholm et al., 2006). Depressive symptoms in the elderly were correlated with an increased AD risk (Luchsinger et al., 2008). Simultaneously, there were statistically significant inverse associations between dementia and depression with total physical activity and leisure-time physical activity (Benedetti et al., 2008). Depression in the elderly who are medically ill, may increase both morbidity and mortality, then results in higher health care costs and utilization, as well as poorer functional status and outcomes for elderly patients (Seung Kim et al., 2001).
In China, registering over 134 million elderly, about 70% of the total population in countryside, most of them are empty-nest and depression is easiest to occur in them (Wang and Fu, 2003). According to the Cheng-chao's investigation, the incidence of depression was 26.1% among the empty nest elderly in rural community of Anhui Province, and self-evaluated health, life satisfactions, the number of negative events experienced were linked with depression (Zhou et al., 2008). The rate of depression in empty-nest elderly living in Shanghai Zhijianxi community was 15.3%, it was lower than that in the empty-nest elderly in rural area (Jia et al., 2007). Some researches found that lower mental and physical scores from the SF-36 (Medical Outcomes Study—item short from health survey) were significantly associated with empty nest conditions (Li et al., 2007a, Liu et al., 2007). A significant association was also found the empty nest groups being more prone to chronic conditions (Li et al., 2007b). A cross-sectional and longitudinal analysis showed the loneliness of empty-nest elderly was a specific risk factor for depressive symptoms, and higher levels of loneliness were associated with more depressive symptoms (Cacioppo et al., 2006). However, depressive symptoms for persons in this age group in rural area are frequently not recognized, diagnosed, or treated.
So, it is important to assess the risk factors of depressive symptoms in the elderly population living in rural area, for the purpose of suicide prevention and improvement in life quality. We designed a cross-sectional questionnaire survey, which was aimed at: (a) clarifying the prevalence of depressive symptoms of empty-nest elderly in a rural countryside in YongZhou, (b) evaluating the social support, coping style and socio-demographic factors of the empty-nest elderly and their correlation, and (c) finding out how to provide an effective theoretical basis for decreasing the rate of depression among empty-nest elderly.
Section snippets
Study design and methods
This was a cross-sectional study. We used a sampling procedure involving four steps. First, we selected YongZhou (a city in Hunan Province of China) as the study site. Second, we identified five villages by random cluster sampling. Third, we chose all of the elderly living in the rural area as our samples. Finally, we interviewed and distributed the questionnaires to each elderly subjects (aged 60 or more, i.e., he or she was voluntary to participate, who were not suffering from cognitive
General data
The distribution of socio-demographic characteristics of the 415 subjects is shown in Table 1. The resulting data included 231 (55.7%) empty-nest elder adults and 184 (44.3%) non-empty-nest elder adults. Subjects ranged in age from 60 to 100 years with a mean age of 70.18 ± 7.88 years (±S.D.), 205 (49.4%) were male, 210 (50.6%) were female; 291 (70.1%) were married, 124 (29.9%) were single. Most of the empty-nest and non-empty-nest elderly had finished their education to the primary school level,
Discussion
Issues concerning older adults are recognized as a research priority in developed countries, evidenced by a growing body of research in the area of psychological, social and health needs of the aged (Chalise et al., 2007). Despite attracting less attention, there is also great need for research in the mental health of elderly people in developing countries, especially for the depression of empty-nest elderly in the rural area.
As a special group in the elderly, the empty-nest elderly's mental
Implications to decrease the depression of the empty-nest elderly
To minimize the level of depression, improve the quality of life and prevent the suicide effectively among the empty-nest elderly, actions must be considered from multi-link, multi-ways in the care for the elderly, especially for the empty-nest elderly.
Firstly, improving the economic status and financial security of the elderly. The village and government should take measures to increase the elderly incomes, ameliorate his or her overall welfare, improve his or her actual life level, and cover
Conclusions
The present study examined the depression of older persons living in rural areas of China, that's most of empty-nest elderly (79.7%) suffered depression and demonstrated that social support, coping style, economic status, marital status and religious belief were significant in predicting depression in the empty-nest elderly. Both family members and elderly neglected their symptoms. In order to minimize the level of depression and improve the quality of life among the empty-nest elderly, more
Study limitations
Besides the interesting findings, it is important to address the limitations of this study. First, the study is a cross-sectional study, thus the results cannot establish causal relationships among the study variables. Second, this data comes from five villages of YongZhou and include only one population, so the results may not be generalized, nor compared to other castes, ethnicities and populations. Third, some data collected under the guidance of the research, because some elderly cannot
Conflict of interest statement
None.
Acknowledgements
The authors gratefully acknowledge the support received from the leaders of those villages, who extended their assistance in the data collection of the study, we also thank Man Ye, Yu Liu, Jun Zhou, Xia Zhang and Bing Xiang Yang, who gave a lot of advises in revising this paper.
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