The Impact of Cognitive Impairment and Family Support On Depression Among Older Adults in Rural China

Background: Depression among older adults is an important public health problem since it is associated with increased risk of morbidity, mortality, and suicide. Older adults with both cognitive impairment and depression are more likely to develop Alzheimer’s disease or other dementias. Additionally, deficits in social support have been studied as risk factors for depression in late life. However, social support from family members is predicted to be more important than support from friends or others in Asian culture. While there has been a growing body of work on older adults’ depression, there has been little research on depression among older adults living in rural China. The purpose of this study is to understand the effect of cognitive impairment and family support on depression among older adults in rural China.

Method: A sample of 1,391 Chinese older adults living in rural China was recruited in 2003 in Anhui Province, China. All responses were based on face-to-face interview. Cognitive impairment was measured by a modified Short Portable Mental State Questionnaire. Family support was defined as financial and emotional support in this study.  For financial support, one question was asked, “In the past 12 months, how much did the children and other relatives living with you give you/and your spouse (money and other things)?” in Chinese currency (RMB) and was dichotomized (received or not). Emotional support was measured by three questions and the average of each of three items was summed up across sons and daughters, respectively. Depression was based on modified CES-D scale with a total of 9 items. Multivariate regression model was conducted to predict the impact of cognitive impairment and family support on depression by controlling age, gender, marital status, income, and perceived health status.

Results: Over half of the sample was female (53.7%) and were married and living with a spouse (51.9%).  The mean age of the respondents was 81 years and the average annual income was 921 RMB (150 USD). About one third (34.3%) of sample considered health status to be ‘excellent’ or ‘good’. Close to one-fourth (23.8%) received financial support from their family members in the last 12 months. Regression analysis results showed that cognitive impairment was positively associated with depression (b=0.87, t=3.19, p<.01). Financial support from family members had negative association with depression (b=-0.56, t=-2.23, p<.05). Emotional supports from sons (b=-3.85, t=-9.17, p<.001) and daughters (b=-1.51, t=-3.96, p<.001) were both negatively related with level of depression among older adults.

Discussion: The findings have important implications for designing intervention for older adults in rural China. Since cognitive impairment and family support were significantly associated with depression, social workers can screen for older adults with cognitive impairment or who rarely get financial and emotional support from their family members as high risk group for depression. In addition, studying this population provides the insights into the cause and prevention of elderly depression that may be applicable to other developing countries.