Prevalence and related influencing factors of depressive symptoms for empty-nest elderly living in the rural area of YongZhou, China

Abstract

The number of empty-nest elderly is on the rise, especially in rural areas of China. The empty-nest elderly were concerned from social and demographic perspective, but researches on mental health issues of the aged were still rare in China. To clarify the prevalence of depression among empty-nest elderly in a rural area of YongZhou, Hunan and evaluate the impact of social support, coping style and socio-demographic factors on depression of the empty-nest elderly, with the goal of decreasing the rate of depression in empty-nest elderly, a questionnaire survey was conducted on 415 elderly persons. The determined prevalence of depressive symptoms was 74.46%. The empty-nest group, in comparison with the non-empty nest group, had higher levels of depression. Multivariate linear regression analysis showed associations between depressive symptoms and negative coping style, support utilization, religious beliefs, economic status, marital status and subjective support. The results suggested that the strategy to alleviate the depression in empty-nest elderly can be considered by the society, village committee, the family members and the empty-nest elderly subjects themselves, which could control effectively the incidence of depression.

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.