The Relationship Between Activities of Daily Living (ADL), Chronic Diseases and Depression Among Older Korean Immigrants
Methods: The sample (N=205) consisted of community-dwelling older Korean immigrants, a group that has been found to be particularly high in depressive symptomatology. Using a cross-sectional survey, data were collected from January through February 2010 in Los Angeles County, California. Selection sites in Los Angeles County were senior centers, churches, and adult day health care centers predominantly serving older Koreans. The inclusion criteria were as follows: (a) Korean immigrant from the Republic of Korea; (b) age 65 years and older; (c) living in Los Angeles County. The screening procedure involved the administration of the Short Portable Mental Status Questionnaire (SPMSQ) and only participants with the score of 8 or over (interact cognitive functioning) were included in the survey. In terms of measures, the Katz Index of ADL, the number of chronic diseases, and the 15-item Geriatric Depression Scale-Short Form measured depression (GDS-SF) were used. The multivariate analysis of the data involved robust hierarchical regression estimates of the effects of ADL and the number of chronic diseases variables on depressive symptoms. Using STATA version 10, the four sets of predictive variables were modeled: (a) sociodemographic variables (age, gender, marital status, and education); (b) activities of daily living; (c) chronic diseases; (d) an interaction between activities of daily living and chronic diseases. Centered scores were used when computing the interaction term between ADL and chronic diseases. A significant relationship between an interaction term and depression confirmed the buffering.
Results: In the initial model, socio-demographic variables were entered and 27% of the total variance was explained. Age (β=-.34, p<.01), gender (β=-.29, p<.01), and marital status (β=-.24, p<.01) significantly predicted depression. Individuals who were younger, female, and not married were likely to have higher depression levels. In the next model, ADL explained an additional 4% (p<.01) of the variance. Those who had lower performance levels of ADL (β=-.19, p<.01) were more likely to report depression. The subsequent model with the number of chronic diseases accounted for an additional 5% of variance (p<.01). Having more chronic diseases (β=.23, p<.01) was a significant predictor of depression. The final model included the interaction term between ADL and chronic diseases; this interaction added 2% (p<.05) to the explained variance. The total variance explained by the estimated model was 37%. The significant interaction suggests that the coexistence of higher ADL performance and less chronic diseases had a synergetic effect to predict depression.
Conclusions/Implications: Our findings call attention to the role of ADL and chronic diseases in the mental health of older Korean immigrants. Social workers and health care providers must develop strategies for decreasing depression in this population by increasing physical health status through improvement in ADL and by reducing chronic diseases.