Daniel W. L. Lai

Filial Piety, Caregiving Appraisal, and Caregiving Burden

This study examined the effects of filial piety on the appraisal of caregiving burden by Chinese-Canadian family caregivers. A quantitative telephone survey was used as the research design for this study. A total of 339 randomly selected Canadian-Chinese family caregivers of elderly were interviewed by telephone. A hypothesized model denoting both the direct and indirect effects of filial piety on caregiving burden was tested using structural equation modeling. While stressors and appraisal factors reported direct predicting effects on caregiving burden, filial piety indirectly affected caregiving burden by altering appraisals of the caregiver role. Filial piety served as a protective function to reduce the negative effects of stressors and to enhance the positive effect of appraisal factors on caregiving burden.

Impact of culture on depressive symptoms of elderly Chinese immigrants.

Objectives: The impact of culture on mental health has been inadequately researched. This study examines the effect of cultural factors on the depressive symptoms reported by elderly Chinese immigrants in Canada. Method: Data from 1537 elderly Chinese immigrants who took part in a cross-sectional multisite survey on the health and well-being of older Chinese-Canadians were used. Participants were identified through telephone screening of randomly selected telephone numbers listed with Chinese surnames. A structured questionnaire was used to conduct face-to-face interviews. A Chinese version of the 15-item Geriatric Depression Scale was used to assess depressive symptoms. Results: Close to one-quarter of the elderly Chinese immigrants reported having at least a mild level of depressive symptoms. Having more cultural barriers and a higher level of identification with Chinese cultural values resulted in a higher probability of being depressive. Conclusions: The importance of the sociocultural determinants of mental health is demonstrated. The health delivery system should be more sensitive to the unique ethnic and cultural differences of older immigrants.

The relationship between mental health literacy, personal contacts and personal stigma against depression

OBJECTIVES To estimate and compare the percentages of personal stigma by levels of depression literacy and exposure to persons with depression, overall and by gender. METHODS Data were collected in a probability sampled population-based survey of 3047 adults in Alberta, Canada. Measures included a 9-item depression stigma scale. Personal stigma was examined using bi-variate analyses and logistic regression modeling separately for men and women. RESULTS Over 45% of participants considered that people with depression were unpredictable. Over 20% reported that people with depression were dangerous. However, the percentages did not differ by levels of depression literacy and whether having a family/friend with depression. Multivariate analyses showed that the associations between depression case recognition, agreement with health professionals about treatment, personal contact with depression and stigma varied by gender. LIMITATIONS This was a cross-sectional survey which relied on self-report. Therefore, causal inferences could not be made. The findings may be affected by recall and reporting biases. The results could not provide definitive evidence about whether improving mental health literacy and personal contact with depression could reduce stigma. CONCLUSIONS In the highly educated population, the attitudes of considering individuals with depression as being unpredictable and dangerous were prevalent. Educational campaigns may have some positive effects on stigma against depression, but should be carefully designed and pay attention on the target populations.

Depression Literacy in Alberta: Findings From a General Population Sample

Objective: To assess the publics knowledge about depression, attitudes toward treatments for depression, perceived causal factors for depression, and reported prognoses of depression, overall and by sex. Methods: We conducted a cross-sectional telephone survey in Alberta between February and June 2006. We used a random phone number selection procedure to identify a sample of adults in the community (n = 3047). Participants were presented with a vignette describing an individual with depression and then asked questions to assess recognition of depression, attitudes toward mental health treatments, possible causal factors for depression, and prognosis of depression. Results: The response rate was 75.2 %. Among the final participants, 75.6% could correctly recognize depression described in a case vignette. General practitioners or family doctors were considered as being the best help for depression. Of the participants, 35% were in complete agreement with health professionals about appropriate interventions for depression, 28% believed in dealing with depression alone, and 43% thought that “weakness of character” was a likely cause of depression. Men had poorer mental health literacy than women and were more likely to endorse the use of alcohol to cope. Conclusions: Mental health promotion and education efforts are needed to improve the general publics mental health literacy and to clarify misunderstanding about depression. Men need to be a particular target of these efforts.

Chinese health beliefs of older Chinese in Canada.

Objectives: This study examines the cultural health beliefs held by older Chinese in Canada. Methods: Chinese surnames are randomly selected from the local Chinese telephone directories. Telephone screening is then conducted to identify eligible Chinese people 55 years of age or older to take part in a face-to-face interview to complete a structured survey questionnaire. Results: The results of exploratory factor analysis indicate that the health beliefs of the older Chinese are loaded onto three factors related to beliefs about traditional health practices, beliefs about traditional Chinese medicine, and beliefs about preventive diet. Education, religion, country of origin, length of residency in Canada, and city of residency are the major correlates of the various Chinese health beliefs scales. Discussion: The findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intragroup sociocultural diversity that health practitioners should acknowledge in their practice.

Gambling and the Older Chinese in Canada

In Canada, there is a lack of research on gambling among the older adults from ethnic minority groups, especially the older Chinese. In this study, two research questions were used to examine gambling among the older Chinese: (1) What is the pattern of gambling among the older Chinese in Canada? (2) What are the predictors associated with gambling among the older Chinese in Canada? The data for this study were collected as part of a multi-site study on health and well-being of 2272 older Chinese in Canada. Four main questions related to gambling were used in this study. Among the 2257 participants who answered the questions on gambling, 26.6% of them reported that they gambled. Results of the hierarchical logistic regression analysis showed that being male, having lived in Canada longer, having a higher level of social support, having more service barriers, and having a stronger level of Chinese ethnic identity would increase the probability for an older Chinese to participate in gambling. Conversely, having a post-secondary and above level of education and having a higher level of life satisfaction would reduce one’s probability of gambling. Although city of residency was also significant in predicting gambling, further analysis showed that its effect was actually caused by other factors including services barriers, social support, life satisfaction, Chinese ethnic identity, and education.

Relationships between Culture and Health Status: A Multi-Site Study of the Older Chinese in Canada

La présente étude examine les relations entre la culture et l’état de santé des aînés chinois au Canada. Les données ont été recueillies lors d’entretiens face à face avec un échantillon transversal de 2 272 aînés chinois de 55 à 101 ans sélectionnés au hasard dans sept villes canadiennes. Leur état de santé aété évalué en fonction du nombre de maladies chroniques, des limites de l’AVQ et de l’AIVQ, et de la Medical Outcome Study Short Form SF-36. Bien que les variables culturelles n’expliquent qu’une petite partie de la variance dans l’état de santé, être davantage au courant des modèles traditionnels de croyance à la santé des Chinois est important si l’on veut prévoir la santé physique, le nombre de maladies, et les limites associées aux activités instrumentales de la vie quotidienne. D’autres variables culturelles, notamment la religion, le pays d’origine, et la période de résidence au Canada étaient aussi importantes afin de prévoir certaines variables associées à la santé. Les interventions visant à améliorer la santé devraient porter sur des stratégies permettant d’améliorer la compatibilité culturelle entre les utilisateurs et le système de distribution des soins. This study examined the relationships between culture and the health status of older Chinese in Canada. Data were collected through face-to-face interviews with a cross-sectional, randomly selected sample of 2,272 older Chinese between 55 and 101 years of age in seven Canadian cities. Health status was assessed by the number of chronic illnesses, by limitations in ADL and IADL, and by information on the Medical Outcome Study Short Form SF-36. Although cultural variables explained only a small proportion of variance in health status, having a stronger level of identification with traditional Chinese health beliefs was significant in predicting physical health, number of illnesses, and limitations on IADL. Other cultural variables, including religion, country of origin, and length of residence in Canada, were also significant in predicting some health variables. Interventions to improve health should focus on strategies to enhance cultural compatibility between users and the health delivery system.

Older chinese' attitudes toward aging and the relationship to mental health: an international comparison.

This study examined the predictive effects of attitude toward aging on mental health of aging Chinese. Data were obtained from community surveys utilizing mixed sampling methods of 4,240 elderly Chinese 55 years or older in China, Hong Kong, Taiwan, Canada, and the United States. Hierarchical multiple regression analysis was used, with sociodemographic variables entered first, followed by the health variables, and then attitude toward aging. The effect of attitude toward aging on mental health was stronger than most other predictive factors. Social workers should focus on creating social/community environments that build a positive attitude toward aging.

Effects of Social Exclusion on Depressive Symptoms: Elderly Chinese Living Alone in Shanghai, China

Research has identified social exclusion as one of the social determinants of health. There are risks of social exclusion in later life in recent years. However, despite the fact that China has the largest aging population in the world and reports a rapid growth in the proportion of older people living alone, research on the role of social exclusion on depression is limited. This study examined the effects of social exclusion on depressive symptoms in older Chinese who are living alone in China, based on the data from one Shanghai neighbourhood. The data used were obtained between August and October 2008 through face-to-face interviews, using a structured survey questionnaire, from a simple random sample of 228 Chinese 60 and older living alone in a Shanghai community. Depressive symptoms were measured by a 15-item Chinese version Geriatric Depression Scale. Social exclusion was represented by income adequacy, social relations, civic participation, and housing condition. Over 30% of participants reported symptoms of a mild or above mild level of depression. When controlled for the demographics and health variables in hierarchical multiple regression, social exclusion variables, represented by a lower level income adequacy, a less favourable housing condition, and feeling more lonely correlated significantly with more depressive symptoms. Contrary to previous studies on depression in the older adults in China, this study has obtained findings indicating that social exclusion variables are more important than other socio-demographic factors in the context of contemporary China. While two significant social exclusion variables (i.e. income and housing) are related to structural changes in the economic context in China, the intra-personal role of feeling lonely that ties strongly living alone and role of older adults in an increasingly competitive market economy should not be underestimated. To address depression and mental health of older Chinese who live alone, social policies and programs to reduce various forms of social exclusion should be developed. In additional to providing assistance in financial support and housing improvement, services to strengthen the social networks and social relations of these older people are essential.

Types and Factor Structure of Barriers to Utilization of Health Services among Aging South Asians in Calgary, Canada

Souvent, les personnes aînés de groupes ethniques minoritaires éprouvent obstacles différents à l’access aux services de santé. Généralement, les études ont porté sur les groupes combinés d’immigrants âgés ou sur minorités ethno-culturels importantes, tels que les Chinois au Canada ou les Afro-américains et Latino-Américains aux États-Unis. Cette étude visait à examiner les types des facteurs qui constituent des obstacles à l’utilization des services de santé rencontrés à Calgary, Alberta, Canada, par les immigrés vieillissants d’Asie du Sud. Un sondage téléphonique a été utilisé pour rassembler des données d’un échantillon aléatoire d’immigrants d’Asie du Sud âgés de 55 ans et plus. L’analyse des éléments principaux a révélé quatre types principaux d’obstacles: l’incompatibilité culturelle; les attitudes personnelles; les problèmes administratifs dans la livraison et les défis posés par les circonstances. Elderly people from ethnic minority groups often experience different barriers in accessing health services. Studies have typically focused on combined groups of elderly immigrants or on large ethno-cultural minorities such as the Chinese in Canada, or African-Americans and Hispanics in the U.S. This study aimed to examine the types and factor structure of barriers to using health services experienced by aging South Asian immigrants in Calgary, Alberta, Canada. A telephone survey was used to collect data from a random sample of South Asian immigrants aged 55 years and older. Principal component analysis revealed four major types of barriers: cultural incompatibility, personal attitudes, administrative problems in delivery, and circumstantial challenges.