08952841%2E2011%2E587738

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Journal of Women & Aging

ISSN: 0895-2841 (Print) 1540-7322 (Online) Journal homepage: http://www.tandfonline.com/loi/wjwa20

Gender Differences in the Association BetweenStress Trajectories and Depressive SymptomsAmong Middle Aged and Older Adults in Taiwan

Hsin-Wang Lin , Hui-Chuan Hsu & Ming-Cheng Chang

To cite this article: Hsin-Wang Lin , Hui-Chuan Hsu & Ming-Cheng Chang (2011) GenderDifferences in the Association Between Stress Trajectories and Depressive Symptoms AmongMiddle Aged and Older Adults in Taiwan, Journal of Women & Aging, 23:3, 233-245, DOI:10.1080/08952841.2011.587738

To link to this article: http://dx.doi.org/10.1080/08952841.2011.587738

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Journal of Women & Aging, 23:233245, 2011Copyright Taylor & Francis Group, LLCISSN: 0895-2841 print/1540-7322 onlineDOI: 10.1080/08952841.2011.587738

Gender Differences in the Association BetweenStress Trajectories and Depressive

Symptoms Among Middle Aged and OlderAdults in Taiwan

HSIN-WANG LINArmed Forces Taichung General Hospital and Department of Health Care Administration,

Asia University, Taichung, Taiwan, and Central Taiwan University of Science andTechnology, Taichung, Taiwan

HUI-CHUAN HSU and MING-CHENG CHANGDepartment of Health Care Administration, Asia University, Taichung, Taiwan

Purpose: This study investigated the effects of gender differenceson the association of chronic stress and depressive symptoms inmiddle-aged and older adults in Taiwan. Methods: The popula-tion base was of adults aged 50 and older in Taiwan. This studyincluded 2,889 participants and examined the gender differenceson the impacts of life stress that exhibited depressive symptoms.Results: Females were more susceptible to depressive symptomswhen they felt constant stress from finances, increasing stress fromjobs, and fluctuating stress from family relationships. Discussion:Gender differences were evident when assuming social roles, aswere psychological susceptibilities.

KEYWORDS gender differences, depressive symptoms, stress

INTRODUCTION

Depression is one of the leading causes of disabilities, and older womenhave been found to have a higher prevalence than men (Vikram, 2005).This prevalence of depressive symptoms of the elderly is more than 10%(Barry, Allore, Bruce, & Gill, 2009; Chi et al., 2005). It occurs in the

Address correspondence to Hsin-Wang Lin, MD, Armed Forces Taichung GeneralHospital, No. 348 Sec. 2, Jhongshan Rd., Taichung, Taichung County 41168, Taiwan, R. O. C.E-mail: [email protected]

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234 H.-W. Lin et al.

community-dwelling elderly (27.5%) (Tsai, Yeh, & Tsai, 2005), and elderlywomen are more likely than men to suffer from depressive symptoms (Liu,2009). Gender differences in depressive symptoms were obvious, and theimpacts of life stress on depressive symptoms were reported in past research.However, there is much less research on the association of longitudinalstresses and depressive symptoms. Gender differences in depressive symp-toms responding to stress trajectories have also not been explored fully.As to trajectories, there are two typesaggregate and disaggregate trajecto-ries. In this study, we generate discrete and distinct stress trajectories overtime regarding health, finances, jobs, and family relationships. Therefore,we focus on the association between stress trajectories and depressivesymptoms in middle-aged and older adults in Taiwan.

From a psychosocial viewpoint, women have consistently been asso-ciated with higher levels of depressive symptoms, possibly attributed todifferences between men and women in the kinds of activities in whichthey engage (Hermalin, Ofstedal, & Lee, 1992a; Hermalin, Ofstedal, & Li,1992b). Greater depressive symptoms were reported by female respondents(Kornstein et al., 2000).

Previous researchers have already documented an association betweenstress and depressive symptoms (Russell & Cutrona, 1991; Wang, 2001;Weinstein, Glei, Yamazaki, & Ming-Cheng, 2004). They have discovered twotypes of stressors: specific life events and more enduring life problems, alsocalled chronic strains. Specific life events are important experiences thatinterrupt an individuals usual activities and require some adjustment. Thesecond major type of stressor was defined by Pearlin (1989) as the rela-tively enduring problems, conflicts, and threats that many people face intheir daily lives. For the elderly, common stressors emerge from the areasof health, marital status and family relationships, retirement, or financialstrain. These stressors are related to depressive symptoms. The elderly areat a stage in life where they may face extended and critical health prob-lems such as illness, disability, or injury (Barry et al., 2009; Weinberger,Raue, Meyer, & Bruce, 2009). An increase in the difficulty of functioningphysically also increases depressive symptoms and reduces life satisfaction(Hsu, 2009). Both stable disability status and transitions in disability statusare significantly related to changes in depressive symptoms (Yang & George,2005). Loss of spouse (Jang et al., 2009; St John & Montgomery, 2009) andtaking care of a sick spouse (Son et al., 2007) are also common stressorsfor the elderly. Retirement and job loss are also stressful (Nuttman-Shwartzet al., 2009). Financial strain is also related to mental health, especiallyfor the Chinese elderly (Chi et al., 2005; Zhang et al., 1997), and elderlywomen are more vulnerable to financial strain than elderly men (Keith,1993). Weinstein and others (2004) documented that higher exposure tostressorsboth daily problems and major life eventswas associated withhigher levels of psychological distress. Difficulties with close family membershave also been associated with depressive symptoms (Wang, 2001).

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Gender Differences When Facing Stress and Depressive Symptoms 235

Other predictors of depressive symptoms include age (Charles,Reynolds, & Gatz, 2001), education, marital status, living arrangement, eco-nomic status (Tsai et al., 2005), as well as living area (Chen, Chong, &Tsang, 2007). Social support (Kendler, Meyers, & Prescott, 2005; Krause &Liang, 1993; Liang et al., 1999; Russell & Cutrona, 1991), social participation,health status, and health behavior (Ahern & Hendryx, 2008; Liu, 2009; Simonet al. 2006; Tsai et al., 2005) were also important factors.

The purpose of this article is to examine gender differences in middle-aged and older adults in Taiwan. We will focus on the association betweenstress trajectories and related depressive symptoms. The stressors we chosewere health, finances, jobs, and family relationships.

METHODS

Data and Samples

Data for this study were taken from the Taiwan Survey of Health and LivingStatus of the Elderly, a nation-wide, representative, longitudinal survey. Inthe first wave, a national representative sample of people who were 60or above was drawn in 1989. Among the 4,412 participants selected forthe survey, 4,049 responded, yielding a response rate of 91.8%. The surveywas followed up in 1993, 1996, 1999, and 2003. We utilized the data from1996 (expanding the age range to 5066), 1999, and 2003. After the respon-dents with missing data were excluded, 2,889 subjects remained for furtheranalyses. The Bureau of Health Promotion, Department of Health, R.O.C.(Taiwan), approved the study and contributed the data.

Dependent Variable

The dependent variable of interest was depressive symptoms. It was charac-terized by a score from the Center for Epidemiological Studies of Depression(CES-D) scale, the 10-item Chinese version of the original 20-item CES-D(Radloff, 1977). Respondents were asked how often in the past week theyhad experienced various situations or feelings such as not being interestedin eating, doing anything was exhausting, and poor sleep. Response cate-gories included none, rarely (one day), sometimes (23 days), and often orchronically (4 or more days). The sum across all 10 items formed an indexwith a potential range of 0 to 30.

Independent Variables

STRESS

The main independent variable was stress. Our measurement of personalstress was based on questions about whether each situation made the

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respondent feel stressed. These items were the respondents own health,their financial situation, their job, and their relations with family members.Initially, each item was scored on a 3-point scale: (0) no stress, (1) somestress, or (2) a lot of stress. In this study, we categorized the measurementinto no stress (0) and stress (1).

There were eight types of trajectory patterns for stress observed acrossthe three waves through 1996, 1999, and 2003 (Please see Figure 1). We thendivided these into five groups. The first group was relatively without stressduring the three waves (none); the second group showed increasing stress(increasing); the third group (fluctuating) had stress fluctuating across three

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FIGURE 1 Five patterns of stress trajectories (color figure available online).

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waves; the fourth group showed reduced stress (declining); the last grouphad constant stress during the three waves (chronic). Each kind of stresswas divided into five groups of trajectory patterns (four dummy variables).Relatively without stress was used as the reference group in the regressionanalysis.

DEMOGRAPHICS

A variety of predictors associated with depressive symptoms were includedin the model as controlled variables. These included demographic character-istics: age (year); marital status (married or with partner = 0 and others = 1);ethnicity (Taiwanese = 0 and non-Taiwanese = 1); education (elementaryschool or less = 0 and higher = 1); living area (city = 0 and rural area = 1);and economic status (perceived as poor = 0 and good = 1).

SOCIAL SUPPORT AND SOCIAL PARTICIPATION

Two items represented social support in the 2003 period. One was livingarrangement (living alone or with spouse = 0 and living with relatives = 1)and the other was satisfaction with social support (perceived as poor = 0and good = 1). To determine social participation, respondents were askedwhether they participated in each of the following organizations or activ-ities: neighborhood association, religious association, professional group(e.g., farmers or fishermans association) or civic club, political association,social service group, village or lineage association, elderly club, and elderlyeducation. Those who joined any organization or activity were coded as (1)and those who did not join were coded as (0).

HEALTH BEHAVIOR AND HEALTH STATUS

Health behavior and health status were measured according to the par-ticipants status in 2003 as controlled variables. Health behavior includedsmoking (without smoking = 0 and with smoking = 1), and drinking habits(no = 0 and yes = 1). The last, which was health status, includes BMI(normal is in the range of 1824 kg/m2 = 0 and abnormal = 1), self-ratedhealth (perceived as poor = 0 and good = 1) as well as five major diseaseshypertension, diabetes, heart problems, stroke, or cancer (without = 0 andwith any disease = 1), and difficulty of walking 200300 meters (withoutdifficulty = 0 and with difficulty = 1).

Data Analyses

Descriptive statistics, analyses of variance (ANOVA), and multiple linearregression analyses were used. Multiple regression was carried out in two

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steps. First, we introduced gender, controlled variables, and the trajec-tory patterns of stress in health, finances, jobs, and family relationships.Second, the interactionstrajectory patterns of stress by genderwereintroduced.

RESULTS

A descriptive summary of the sample is shown in Table 1. The prevalence ofa high level of depressive symptoms (CES-D score 10) was 17.5% in 1996.

TABLE 1 Participant Characteristics by Gender

Total (%) Male (%) Female (%)(n = 2889) (n = 1494) (n = 1395)

CES-D score at baseline09 82.5 87.9 76.81030 17.5 12.1 23.2

Marital status in 2003Yes 67.5 79.7 54.5No 32.5 20.3 45.5

EthnicityTaiwanese 67.0 60.5 74.0Non-Taiwanese 33.0 39.5 26.0

EducationElementary or less 75.8 63.7 88.8Higher than elementary 24.2 36.3 11.2

Living areaCity 40.1 40.4 39.7Rural area 59.9 59.6 60.3

Income status in 2003Poor 59.7 56.0 63.7God 40.3 44.0 36.3

Living arrangementAlone or with spouse 31.3 34.6 27.7With relatives 68.7 65.4 72.3

Satisfaction of social supportPoor 17.5 18.8 16.2Good 82.5 81.2 83.8

Social participationNo 55.0 49.8 60.6Yes 45.0 50.2 39.4

Self-rated healthPoor 31.9 27.6 36.6Good 68.1 72.4 63.4

Major diseasesNo 62.7 66.5 58.6Yes 37.3 33.5 41.4

Difficulty walking 200300 metersNo 78.7 84.9 72.0Yes 21.3 15.1 28.0

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TABLE 2 Stress Trajectories by Gender

Total (%) Male (%) Female (%)(n = 2889) (n = 1494) (n = 1395) p Mean SD P

Trajectory patterns of healthNone 44.9 52.7 36.5 2.7 3.5 Increasing 27.0 23.9 30.4 7.5 6.1Fluctuating 15.4 14.6 16.3 5.5 5.8Declining 7.0 6.5 7.5 5.4 5.2Chronic 5.7 2.3 9.3 11.5 7.4

Trajectory patterns offinance

None 49.6 52.0 47.0 3.4 4.2 Increasing 22.8 22.3 23.3 7.5 6.4Fluctuating 14.6 13.5 15.8 6.0 6.1Declining 7.0 6.6 7.5 4.5 4.6Chronic 6.0 5.6 6.5 9.4 7.3

Trajectory patterns of jobNone 76.6 73.4 80.1 4.7 5.4 Increasing 8.6 8.6 8.6 8.1 6.9Fluctuating 8.6 9.3 7.8 6.1 6.1Declining 5.4 7.7 2.9 4.8 6.0Chronic 0.8 1.1 0.6 6.8 4.5

Trajectory patterns of familyrelation

None 80.8 83.7 77.6 4.2 4.9 Increasing 7.4 7.0 7.8 10.6 7.4Fluctuating 6.6 5.0 8.3 8.0 6.4Declining 4.9 4.1 5.8 7.2 6.6Chronic 0.3 0.1 0.4 15.6 6.0

Note. Analysis by one-way ANOVA. p < .001.

Females (N = 324, 23.2%) had a higher incidence than males (N = 181,12.1%).

In Table 2, the trajectory patterns of stress in health, job, and familyrelationships were independently associated with gender; finances was not.Most of the older people were relatively without stress with regard to jobsand family relationships, 76.6% and 80.8% respectively, whereas those rela-tively without stress in health and finances accounted for no more than 50%.Men experienced little stress in health, finances, and family relationshipswhereas women suffered chronic stress in those same conditions.

Table 3 shows the multiple regression results of the relationshipbetween stress trajectory and depressive symptoms. In model 1, we incor-porated gender, controlled variables, and the trajectory patterns of stress inhealth, finances, jobs, and family relationships (16 items in all as constantlywithout stress was the reference group). Results showed that gender affectedlittle (being female, b = .882, p < .001), but was still significant. The mostsignificant findings were the trajectory patterns of family relationships, espe-cially for those with constant stress (b = 4.862, p < .01) and increasingstress (b = 2.944, p < .001) compared to without constant stress. Among

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TABLE 3 Relationship of Depressive Symptoms, Stress Trajectories, and Gender

Model 1 Model 2

Variable B SE B SE

Depressive symptoms in 1996 0.147 0.017 0.144 0.170Age in 2003 0.046 0.012 0.048 0.012Gender: female 0.882 0.203 0.265 0.290Marital status: without 0.434 0.193 0.449 0.192Ethnicity: non-Taiwanese 0.094 0.178 0.105 0.178Education: higher than elementary school 0.079 0.211 0.135 0.211Living area: urban or rural area 0.656 0.173 0.663 0.173Good income status 0.639 0.184 0.639 0.184Living with relatives 0.229 0.175 0.237 0.174Good satisfaction of social support 1.906 0.224 1.898 0.224With social participation 0.028 0.165 0.012 0.156Exercise 0.474 0.181 0.462 0.181Smoking 0.225 0.226 0.273 0.227Alcoholic drinking 0.203 0.206 0.192 0.206Abnormal BMI 0.421 0.162 0.440 0.162Good self-rated health 2.487 0.199 2.481 0.199Any five major diseases 0.346 0.176 0.379 0.176Difficulty of walking 200300 meters 1.574 0.228 1.560 0.227Increasing stress of health 1.825 0.220 1.683 0.297Fluctuating stress of health 0.878 0.249 0.810 0.342Declining stress of health 0.299 0.347 0.700 0.491Chronic stress of health 2.809 0.410 1.521 0.799Increasing stress of finance 1.531 0.241 1.212 0.325Fluctuating stress of finance 0.611 0.261 0.408 0.368Declining stress of finance 0.336 0.338 0.691 0.476Chronic stress of finance 2.246 0.396 1.503 0.570Increasing stress of job 0.862 0.329 0.062 0.457Fluctuating stress of job 0.201 0.306 0.021 0.412Declining stress of job 0.423 0.405 0.533 0.496Chronic stress of job 0.259 0.963 0.201 1.176Increasing stress of family relation 2.944 0.326 3.354 0.462Fluctuating stress of family relation 0.977 0.336 0.273 0.531Declining of family relation 0.874 0.379 1.117 0.570Chronic stress of family relation 4.862 1.540 5.583 3.080Chronic stress of finance by gender 1.616 0.769Increasing stress of job by gender 1.430 0.654Fluctuating stress of family relation by gender 1.967 0.683P value

R2 43.8% 44.2%

p < .05, p < .01, p < .001.

the trajectory patterns for health and finances, the increasing, fluctuating,and constant stress patterns were statistically significant, while the reducingpattern was not. Only the increasing pattern relative to job was significant(b = 0.862, p < .01). Overall, model 1 explained 43.8% of the variation inCES-D scores.

Model 2 shows whether the trajectory patterns of stress moderated theeffect of gender on depressive symptoms. In this model, we introduced

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interaction terms (16 in all) between trajectory patterns and gender. Theinteraction terms of (constant stress of finances gender, increasing stressof job gender, and fluctuating stress of family relationships gender) werestatistically significant. Women were more susceptible than men in havingdepressive symptoms with regard to constant stress in finances, increasingjob stress, and fluctuating family relationships stress. When interaction termswere introduced, the gender effect was tremendously diminished (beingfemale, b = .265, p = .361).

DISCUSSION

We examined the effects of gender and trajectory patterns on chronicstress associated with depressive symptoms among middle-aged and olderTaiwanese (age 50 or older) in a 7-year follow-up study. Those who expe-rienced higher or changing stress concerning health, finances, and familyrelations were more likely to have higher depressive symptoms. Beingfemale and stressed was associated with more depressive symptoms aftercontrolled baseline depressive symptoms, the trajectory of stress, and relatedrisk factors. There were gender differences in depressive symptoms inresponse to different patterns of life stress. Women were more likely toshow higher depressive symptoms than men when there was constant stressfrom finances, increasing stress on the job, and fluctuating stress in familyrelationships.

Health problems are a concern for mid-life and elderly people. Inmodel 2, we found that the health trajectory patterns were associated withdepressive symptoms, except when there was a reducing stress pattern rel-ative to health. Past studies have found a relationship between physicaldisability and depressive symptoms (Hsu, 2009; Yang & George, 2005). Inthe study of Barry and others (2009), depressive symptoms were foundto be associated with disability burdens in both men and women, withmodest differences between genders. Men experiencing severe both moder-ate and high disability levels reported depressive symptoms, whereas onlyhigh depressive symptoms were associated with severe disability in women(Barry et al., 2009). Nevertheless, in our study, a change in health as aresult of stress was important for middle-aged and older people with regardto depressive symptoms. However, there was no difference between gen-ders. This may be due to the samples different age groups, which includedmiddle-aged and the elderly. As a result, the health problems for the youngersample did not show a large difference between men and women.

Financial stress was also an important factor in the development ofdepressive symptoms, as shown in previous findings (Chi et al., 2005; Zhanget al., 1997). Consistent with the findings of Keiths (1993) study, olderwomen with constant stress from finances and with increasing stress on

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the job were more likely than men to have higher depressive symptoms.In Chinese society, women are not traditionally thought to be responsiblefor the financial support of the family. The majority of the elderly womensampled in this study did not work during their old age, and they usuallydepended on their spouse or adult children for financial needs. Middle-agedwomen usually perceived job loss as challenging and threatening, and thusas emotional stress increased, psychiatric symptoms increased (Nuttman-Shwartz et al., 2009). Previous research suggests that those who report thattheir spouse or friends add to their financial burdens and who dependon their children for financial support are more likely to report higherdepressive symptoms (Weinstein et al., 2004).

Relationships with family members were a critical factor inducingdepressive symptoms. We found that increasing stress from family relation-ships was the most significant factor in increasing depressive symptoms.Women with fluctuating stress emanating from family relationships weremore likely than men to have higher depressive symptoms. There are somepossible reasons. First, married people were more likely to have depressivesymptoms than those who were widowed, single, or separated (Wang, 2001).Weinstein and others (2004) found that gender differences had a substantialeffect on the level of psychological distress among elderly Taiwanese adults,but marital status did not. Second, when there are conflicts within familyrelationships, women are more likely to feel responsible and are more sen-sitive to changes in family atmosphere. Women are more vulnerable to alife crisis on an emotional or social level (Kessler & McLeod, 1984). Third,when there were high caretaking demands, women reported they were lesshealthy, since women are usually the caretakers at home (Chen, Chang, &Yang, 2008).

A possible reason for these differences could be that marital discordappears to affect women more than men. Basically, men and women havedifferent coping styles as men tend to fight or flee. Women are more emo-tionally focused and search for a tending and befriending style of coping.In traditional Chinese culture, women are more focused on the home andhave low self-esteem. On the other hand, men are regarded as the financialpillars and have more power and authority in the family.

The merits of this study: first, our longitudinal data has allowed us toassess and control depressive symptoms at baseline. The use of a large,nationally representative data source allowed us to control extraneous influ-ences to a great extent. We were able to delineate the trajectory patternsof stress across the three waves of the survey so that the causal effects ofdepressive symptoms could be established. Second, we have elaborated onthe interaction between stress and gender. We now know more about thegender differences in different trajectory patterns of stress.

There are also limitations to this study. First, the detection of dynamicchange in stress is limited by only three points of the survey. Future studies

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may focus on the detection of dynamic change and its analysis by repeatedmeasurements. Second, missing cases due to death or loss of follow-up wereexcluded from the analysis.

This study has detected a significant influence of trajectory patterns ofstress on depressive symptoms. Certain trajectory patterns of stress diminishthe effect of gender on depressive symptoms.

ACKNOWLEDGMENTS

The data was provided by the Population and Health Research Center, theBureau of Health Promotion, Department of Health, Taiwan, Republic ofChina. The interpretation and conclusions contained herein do not representthose of the Bureau of Health Promotion. This study was funded by theArmed Forces Taichung General Hospital. None of the authors has a conflictof interest in any way.

REFERENCES

Ahern, M. M., & Hendryx, M. (2008). Community participation and the emergence oflate-life depressive symptoms: Differences between women and men. Journalof Womens Health, 17 , 14631470.

Barry, L. C., Allore, H. G., Bruce, M. L., & Gill, T. M. (2009). Longitudinal associa-tion between depressive symptoms and disability burden among older persons.Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 64,13251332.

Charles, S. T., Reynolds, C. A., & Gatz, M. (2001). Age-related differences and changein positive and negative affect over 23 years. Journal of Personality and SocialPsychology, 80, 136151.

Chen, D. R., Chang, L. Y., & Yang, M. L. (2008). Gender-specific responses to socialdeterminants associated with self-perceived health in Taiwan: A multilevelapproach. Social Science & Medicine, 67 , 16301640.

Chen, C. S., Chong, M. Y., & Tsang, H. Y. (2007). Clinically significant non-major depression in a community-dwelling elderly population: Epidemiologicalfindings. International Journal of Geriatric Psychiatry, 22, 557562.

Chi, I., Yip, P. S., Chou, K. L., Chan, K. S., Kwan, C. W., Conwell, Y., & Caine,E. (2005). Prevalence of depression and its correlates in Hong Kongs Chineseolder adults. American Journal of Geriatric Psychiatry, 13, 409416.

Hermalin, A. I., Ofstedal, M. B., & Lee, M. L. (1992a). Characteristics of childrenand intergenerational transfers in Taiwan. Comparative Study of the Elderlyin Four Asian Countries, Research Report No. 92-21. Population Studies Center,University of Michigan, Ann Arbor.

Hermalin, A. I., Ofstedal, M. B., & Li, C. (1992b). Kin availability of the elderly inTaiwan: Who is available and where are they? Comparative Study of the Elderly

Dow

nloa

ded

by [U

nivers

itara

M E

mine

escu

Iasi]

at 05

:19 29

Octo

ber 2

015


in Four Asian Countries, Research Report No. 92-18. Population Studies Center,University of Michigan, Ann Arbor.

Hsu, H. C. (2009). Physical function trajectories, depressive symptoms, and lifesatisfaction among the elderly in Taiwan. Aging & Mental Health, 13, 202212.

Jang, S. N., Kawachi, I., Chang, J., Boo, K., Shin, H. G., Lee, H., & Cho, S. I. (2009).Marital status, gender, and depression: Analysis of the baseline survey of theKorean Longitudinal Study of Ageing (KLoSA). Social Science & Medicine, 69,16081615.

Keith, V. M. (1993). Gender, financial strain, and psychological distress among olderadults. Research on Aging, 15, 123147.

Kendler, K. S., Myers, J., & Prescott, C. A. (2005). Sex differences in the relationshipbetween social support and risk for major depression: A longitudinal study ofopposite-sex twin pairs. American Journal of Psychiatry, 162, 250256.

Kessler, R. C., & McLeod, J. D. (1984). Sex-differences in vulnerability to undesirablelife events. American Sociological Review, 49, 620631.

Kornstein, S. G., Schatzberg, A. F., Thase, M. E., Yonkers, K. A., McCullough, J. P.,Keitner, G. I., . . . Keller, M. B. (2000). Gender differences in chronic major anddouble depression. Journal of Affective Disorders, 60, 111.

Krause, N., & Liang, J. (1993). Stress, social support, and psychological distressamong the Chinese elderly. Journal of Gerontology, 48, 282291.

Liang, J., Bennett, J. M., Krause, N. M., Chang, M. C., Lin, H. S., Chuang, Y. L., & Wu,S. C. (1999). Stress, social relations, and old age mortality in Taiwan. Journal ofClinical Epidemiology, 52, 983995.

Liu, C. N. (2009). The association of depressive symptoms with socioeconomic sta-tus, general health conditions, and health behaviors in community-dwellingadults. Taiwan Journal of Public Health, 28, 300311.

Nuttman-Shwartz, O., Gadot, L., & Kacen, L. (2009). Recurrent job loss and mentalhealth among women. Womens Health, 49(4), 294309.

Pearlin, L. I. (1989). The sociological study of stress. Journal of Health and SocialBehavior, 30, 241256.

Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research inthe general population. Applied Psychological Measurement, 1, 385401.

Russell, D. W., & Cutrona, C. E. (1991). Social support, stress, and depressive symp-toms among the elderlyTest of a process model. Psychology and Aging, 6 ,190201.

Simon, G. E., Von Korff, M., Saunders, K., Miglioretti, D. L., Crane, P. K., vanBelle, G., & Kessler, R. C. (2006). Association between obesity and psychi-atric disorders in the U.S. adult population. Archives of General Psychiatry, 63,824830.

Son, J., Erno, A., Shea, D. G., Femia, E. E., Zarit, S. H., & Stephens, M. A. P. (2007).The caregiver stress process and health outcomes. Journal of Aging and Health,19, 871887.

St. John, P. D., & Montgomery, P. R. (2009). Marital status, partner satisfaction,and depressive symptoms in older men and women. Canadian Journal ofPsychiatry/Revue Canadienne de Psychiatrie, 54, 487492.

Dow

nloa

ded

by [U

nivers

itara

M E

mine

escu

Iasi]

at 05

:19 29

Octo

ber 2

015


Tsai, Y. F., Yeh, S. H., & Tsai, H. H. (2005). Prevalence and risk factors for depressivesymptoms among community-dwelling elders in Taiwan. International Journalof Geriatric Psychiatry, 20, 10971102.

Vikram, P. (2005). Gender in mental health research. Gender and Health ResearchSeries. Geneva, Switzerland: World Health Organization Press.

Wang, J. J. (2001). Prevalence and correlates of depressive symptoms in the elderlyof rural communities in southern Taiwan. Journal of Nursing Research, 9(3),112.

Weinberger, M. I., Raue, P. J., Meyer, B. S., & Bruce, M. L. (2009). Predictors ofnew onset depression in medically ill, disabled older adults at 1 year follow-up.American Journal of Geriatric Psychiatry, 17 , 802809.

Weinstein, M., Glei, D. A., Yamazaki, A., & Ming-Cheng, C. (2004). The role of inter-generational relations in the association between life stressors and depressivesymptoms. Research on Aging, 26 , 511530.

Yang, Y., & George, L. K. (2005). Functional disability, disability transitions, anddepressive symptoms in late life. Journal of Aging and Health, 17 , 263292.

Zhang, A. Y., Yu, L. C., Yuan, J. P., Tong, Z. F., Yang, C. Y., & Foreman, S. E.(1997). Family and cultural correlates of depression among Chinese elderly.International Journal of Social Psychiatry, 43, 199212.

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