Alfred C. M. Chan

Clinical Validation of the Geriatric Depression Scale (GDS) Chinese Version

This study has attempted to validate the Geriatric Depression Scale translated version (Chinese) with a psychiatric outpatient sample (N= 461) of males and females aged 60 or above, from 10 government-maintained psychiatric outpatient clinics between January 1992 and February 1993. Reliabilities and validities were exceptional. Internal consistency reliability was .89 (alpha), and the test-retest reliability was .85 (alpha). Criterion-related (psychiatrist diagnosis) validity was good at .95, and concurrent validity (with CES-D) was .96. Item analysis also confirmed consistency—all 30 items were significantly correlated with the full GDS. However, its sensitivity (70.6%), specificity (70.1%), false negatives (29.4%), and false positives (29.9%), though acceptable, were not as impressive. The overall result has shown that the GDS is generally applicable to the Chinese elderly population and is good for measuring depressive symptoms. The scale can be easily applied in the community by health care professionals. However, further follow-up studies are recommended.

Impact of caregiving on health and quality of life : a comparative population-based study of caregivers for elderly persons and noncaregivers

This study aims to investigate the impact of caregiving on the health status and quality of life (QOL) of primary informal caregivers (PCGs) of elderly care recipients in Hong Kong. A total of 246 PCGs and 492 matched noncaregiver (NCG) controls were identified in a population-based cross-sectional study through random telephone dialing. Their health status and QOL were assessed based on structured questionnaires and Short Form 36 (SF-36) Health Survey. Multiple conditional logistic regression analysis showed that compared with NCGs, PCGs had significantly increased risks for reporting worse health, more doctor visits, anxiety and depression, and weight loss. Female PCGs were more likely to report chronic diseases, symptoms, and insomnia. PCGs, particularly women, had significantly lower scores in all eight domains of SF-36 Health Survey. High caregiver burden score (Zarit Burden Scale) was positively associated with adverse physical and psychological health and poorer QOL. The results indicate that PCGs, particularly women, had an adverse physical and psychological health profile and poorer QOL compared with NCGs.

Social Exchanges and Subjective Well-being: Do Sources of Positive and Negative Exchanges Matter?

OBJECTIVES To decompose the effects of positive and negative social exchanges on well-being in terms of relationship type (vertically extended family, horizontally extended family, or nonfamily) and subjective closeness (close vs. peripheral). METHODS One thousand and five Chinese older adults rated each network member on positive and negative exchanges, which were aggregated for each relationship type and closeness category. Regression analyses estimated the influences of positive and negative exchanges on well-being, controlling for network size, health, and demographic factors. RESULTS Social exchanges with close and peripheral vertical family members as well as close horizontal family members were associated with well-being, whereas exchanges with nonkin did not contribute independent effects. These results were similar for both positive and negative exchanges. DISCUSSION Well-being is determined not just by social exchanges but also by where they come from. In this regard, the vertical family, the horizontal family, and the nonfamily represent a hierarchy of preference for Chinese older adults, which, to some extent, reflects the influence of familism.

Factorial Structure of the Kidcope in Hong Kong Adolescents

Abstract The Kidcope (A. Spirito, L. J. Stark, & C. Williams, 1988), a brief screening measure of coping strategies for children and adolescents, was subjected to exploratory and confirmatory factor analyses in a sample of adolescents in Hong Kong. A 2-factor model was found to fit the data when only the 2 emotional regulation items were treated separately and were allowed to load on the 2 different factors. Further analyses showed that factor loadings, factor variances, and factor covariance were invariant across age and gender. On the basis of the factor analyses, the authors created 2 composite scores, representing control-oriented and escape-oriented coping strategies. Implications for the use of the Kidcope in research and preventive intervention are discussed.

A brief version of the Geriatric Depression Scale for the Chinese

Elderly persons (N = 310) attending outpatient psychiatric clinics were given an interview on the 30-item Geriatric Depression Scale (T. L. Brink et al., 1982; J. A. Yesavage et al., 1983) and received an independent psychiatric evaluation. A 3-step binary logistic regression showed that 2 items measuring positive affect and 2 others measuring negative affect combined to produce diagnostic performance comparable with the full scale. This result was cross-validated on a different sample (N = 134). A hierarchical measurement model in which the 4 items tapped 2 first-order factors (positive and negative affect), which in turn tapped a higher order construct of depression, provided excellent fit to the data.

Leisure Activities Alleviate Depressive Symptoms in Nursing Home Residents With Very Mild or Mild Dementia

OBJECTIVES : To examine whether leisure activities can alleviate depressive symptoms among nursing home residents with very mild to mild dementia. METHODS : A cluster-randomized open-label controlled design. Thirty-six residents with at least moderate depressive symptoms were randomized by home into three conditions-mahjong (a.k.a. mah-jongg), tai chi, and handicrafts (placebo). Activities were conducted three times weekly for 12 weeks. Outcome measure was Geriatric Depression Scale (GDS) administered at baseline, posttreatment, and at 6 months. RESULTS : Repeated-measures analysis of variance showed a group by time interaction on the GDS. Unlike control and tai chi participants whose scores remained relatively unchanged, the mahjong group reported a drop of 3.25 points (95% confidence interval: 1.00-5.50) on the GDS at posttreatment but gained back 2.83 points (95% confidence interval: 1.95-5.47) at 6 months. Activity discontinuation might be the reason for depression to return to baseline. CONCLUSIONS : Mahjong can lower depressive symptoms in those with mild dementia, but activity maintenance may be essential for long-term effects.

Self-perception and psychological well-being: the benefits of foreseeing a worse future.

This study examined whether having a negative expectation of the future may protect well-being in old age. Participants were 200 adults age 60 years or older who rated their current and future selves in the physical and social domains at 2 time points over a 12-month period. Structural equation modeling revealed that future self was positively related to well-being concurrently; yet, it was negatively related to well-being 12 months later, after the authors had controlled for symptoms and current self. Moreover, individuals who underestimated their future selves had higher well-being 12 months later than did those who overestimated their future selves. Findings are interpreted in a framework of discounting: Older adults may actively construct representations of the future that are consistent with the normative age-related declines and losses, so that the effects of these declines and losses are lessened when they actually occur.

The Development of a Brief Measure of School Attitude

This article reports on the development of a brief measure of school attitude, validated in a sample of Hong Kong secondary school students. The 9-item scale incorporates the three components of school attitude—cognition, affect, and behavioral intention—into a single measure, and the scores showed high internal consistency and test-retest reliability. Confirmatory factor analysis showed that the items tap a unidimensional latent construct that is equally valid for boys and girls, and for senior and junior students. The measure can be differentiated from academic achievement and relates to desirable and undesirable behaviors in the expected directions. School attitude was more positive among boys and junior students, and possible explanations are suggested. Future research directions are discussed.

Living status and psychological well-being: social comparison as a moderator in later life.

Objectives: Older adults who live alone have been found to have lower psychological well-being than their age peers who live with someone. This study examined whether downward social comparison, i.e. perceiving oneself as better than others, would moderate this relationship. Method: A total of 205 Chinese aged 60 years or over were recruited. They rated themselves and ‘someone their age’ on a list of personal descriptions. Downward social comparison was defined as the extent to which their ratings of self were better than ratings of age peers. Life satisfaction and depression were measured by the Satisfaction with Life Scale and the CES-D Scale, respectively. Results: Participants living alone were more depressed than those living with someone; yet this difference was larger among those with lower levels than those with higher levels of downward social comparison. This interaction effect was not found for life satisfaction. Conclusion: Findings suggest that, although living alone is a risk factor for depression in old age, its negative effect can be reduced or even eliminated when downward social comparison is practised. These findings highlight the importance and effectiveness of psychological adaptation in the face of relatively more objective challenges in old age.

Older people's realisation of generativity in a changing society: The case of Hong Kong

ABSTRACT Generativity refers to activities that help to establish and guide the next generation. This paper explores the nature of generative concern among older people and how it manifests itself in an era of rapid social and technological changes that have produced wide generation gaps. Eight focus groups were conducted with 51 women and 20 men who were recruited from social centres in Hong Kong on the basis of age, socio-economic status, and level of participation in the centres. The discussions were transcribed verbatim and analysed using grounded-theory principles. The elders frequently referred to the superior educational level and technological knowledge of their offspring, as well as the differences in values and lifestyles between the generations, which they thought had made their own knowledge and wisdom obsolete. They had concerns about social and technological changes, however, and they aroused a sense of urgency to protect the younger generation from contemporary evils, while many considered that passing on moral and behavioural codes nowadays was the most important generative role. Although they wanted to help, their efforts were often criticised. In order to maintain harmonious relationships and to avoid conflicts with their offspring, many participants adopted passive generative roles. Attempts to stabilise the generative self by redefining generativity were also observed. The final section of the paper discusses the implications of the findings for the maintenance of the generative self in personal situations of declining resources.