Geriatric depression is the prolonged occurrence of depression in elderly-aged people. A meta-analysis done by the University of Liverpool found a 3.86% prevalence rate of depressed elderly in The People's Republic of China,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." compared to a 12% prevalence in Western Europe.Copeland, J. R. M., et al (1999). "Depression in Europe". 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."Depression in China: Lost in Translation?" Harvard Mental Health Letter.

Symptoms and diagnosis The most common used method of measuring depression for many studies on Chinese elderly is the Geriatric Depression Scale (GDS) by Yesavage & Brink.Yesavage JA, Brink TL, Rose TL, et al. 1983. Development and validation of a geriatric depression screening scale: a preliminary report. The Chinese version of the GDS was translated by Chu Lee Hing of the Chinese University of Hong Kong.Hing Chu B. Lee. "Chinese Geriatric Depression Scale." 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.Chiu, HFK, et al. "Reliability, Validity, and Structure of the Chinese Geriatric Depression Scale in a Hong Kong Context: A Preliminary Report."p. 477

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.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

The General Health QuestionnaireD. Goldberg <http://www.gp-training.net/protocol/docs/ghq.doc > (GHQ) was also deemed reliable in another study but not as sensitive as the GDS.Boey, K. W., H. F. K. Chiu. "Assessing Psychological Well-being of the Old-Old: A Comparative Study of GDS-15 and GHQ-12." 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.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." Further detailed diagnosis can made with the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) by using the scores from the GMS.Copeland, J. R. M., et al (1999). "Depression in Europe". Geographical distribution among older people."Copeland, J. R. M., et al (1986). "Computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT."Dewey, M. E. & Copeland, J. R. M. (1986). "Computerized psychiatric diagnosis in the elderly: AGECAT."Burns, Alistair, Brian Lawlor, Sarah Craig. "Rating scales in old age psychiatry."

Cultural differences 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",Miller, Greg. "China: Healing the Metaphorical Heart."p. 463 writes Greg Miller, a mental health journalist for the 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."Depression in China: Finding a Translation." Harvard Mental Health Letter. 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"Lee DTS, et al. "Rethinking Depression: An Ethnographic Study of the Experience of Depression among Chinese." in a 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.Miller, Greg. "China: Healing the Metaphorical Heart."p. 462

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."Depression in China: Lost in Translation?" Harvard Mental Health Letter.p. 8 The following excerpt illustrates how far politics affected emotional health in a labor camp during the Maoist era:

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.Zhang, X.L. (1994) Grass Soup. Boston: Godine.p. 227-8

Patients in the Harvard study rarely described their feelings as sadness, as it is generally viewed as shameful, a sign of weakness in character.Lee DTS, et al. "Rethinking Depression: An Ethnographic Study of the Experience of Depression among Chinese" The culturally stoic Chinese, as a result, are more willing to accept physical ailments, such as heart pain or sleeplessness, than emotional problems.

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.Lee S. "Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China."p. 859 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. It was not until the pragmatic era of Deng Xiaoping that politics allowed "the demarcation between public and private space to reemerge",Lee S. "Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China."p. 359 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.Lee S. "Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China."

In regards to the elderly Chinese culture holds great importance on caring for the elderly.Chan, Sally W. C., et al. "Quality of Life in Chinese Elderly People with Depression." Physical, financial, and emotional care are traditionally provided by the children as a way to show honor, believed to come from Confucianism.Ho, D. Y. F. (1996). "Filial piety and its psychological consequences." 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.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." 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.Yang, K. S. (1995). "Chinese social orientation: An integrative analysis."

Regarding Chinese 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 statusLai, Daniel. "Depression among Elderly Chinese-Canadian Immigrants from Mainland China."p. 681-2—study done for the Chinese Medical Journal.

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.Thompson D. "The Male Role Stereotype." A study funded by the National Health Research Institute of Taiwan found a high prevalence of depression in Taiwanese elderly, contradictory to many studies held previously in Asia and "comparable to rates reported in some studies of UK samples."Chong, M. Y., et al. "Community Study of Depression in Old Age in Taiwan Prevalence, Life Events and Socio-Demographic Correlates."p. 29 Furthermore, the study found lowly educated widows in urban communities were higher risk for depressive disorders.

Possible factors Physical

The same study by Chong et al. also observed that the main stress factor for the sampled Taiwanese elderly was health problems.Chong, M. Y., et al. "Community Study of Depression in Old Age in Taiwan Prevalence, Life Events and Socio-Demographic Correlates." 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 PsychiatryChou, Kee-Lee, et al. "Effect of Tai Chi on Depressive Symptoms Amongst Chinese Older Patients with Depressive Disorders: A Randomized Clinical Trial."p. 1106 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. Confirmed by data from a study published in 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.Fuh, J. L., et al. "Poststroke Depression among the Chinese Elderly in a Rural Community." 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."Chen, R., et al. "Depression in Older People in Rural China."p. 2025

It has also been learned that "current smokers and former smokers are more likely to have depressive symptoms than never smokers",Lam, T. H., et al. "Smoking and Depressive Symptoms in Chinese Elderly in Hong Kong." as found in a study on Chinese elderly in Hong Kong.

Living conditions

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).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." 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.Chou, Kee-Lee, A. H. Y. Ho, and I. Chi. "Living Alone and Depression in Chinese Older Adults."

Economic