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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 Between


Stress Trajectories and Depressive Symptoms
Among 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) Gender
Differences in the Association Between Stress Trajectories and Depressive Symptoms Among
Middle 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

Published online: 18 Jul 2011.

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Date: 29 October 2015, At: 05:19

Journal of Women & Aging, 23:233245, 2011


Copyright Taylor & Francis Group, LLC
ISSN: 0895-2841 print/1540-7322 online
DOI: 10.1080/08952841.2011.587738

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Gender Differences in the Association Between


Stress Trajectories and Depressive
Symptoms Among Middle Aged and Older
Adults in Taiwan
HSIN-WANG LIN
Armed Forces Taichung General Hospital and Department of Health Care Administration,
Asia University, Taichung, Taiwan, and Central Taiwan University of Science and
Technology, Taichung, Taiwan

HUI-CHUAN HSU and MING-CHENG CHANG


Department of Health Care Administration, Asia University, Taichung, Taiwan

Purpose: This study investigated the effects of gender differences


on the association of chronic stress and depressive symptoms in
middle-aged and older adults in Taiwan. Methods: The population base was of adults aged 50 and older in Taiwan. This study
included 2,889 participants and examined the gender differences
on the impacts of life stress that exhibited depressive symptoms.
Results: Females were more susceptible to depressive symptoms
when they felt constant stress from finances, increasing stress from
jobs, and fluctuating stress from family relationships. Discussion:
Gender differences were evident when assuming social roles, as
were psychological susceptibilities.
KEYWORDS gender differences, depressive symptoms, stress

INTRODUCTION
Depression is one of the leading causes of disabilities, and older women
have 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 General
Hospital, No. 348 Sec. 2, Jhongshan Rd., Taichung, Taichung County 41168, Taiwan, R. O. C.
E-mail: gyn010@yahoo.com.tw
233

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H.-W. Lin et al.

community-dwelling elderly (27.5%) (Tsai, Yeh, & Tsai, 2005), and elderly
women are more likely than men to suffer from depressive symptoms (Liu,
2009). Gender differences in depressive symptoms were obvious, and the
impacts of life stress on depressive symptoms were reported in past research.
However, there is much less research on the association of longitudinal
stresses and depressive symptoms. Gender differences in depressive symptoms responding to stress trajectories have also not been explored fully.
As to trajectories, there are two typesaggregate and disaggregate trajectories. In this study, we generate discrete and distinct stress trajectories over
time regarding health, finances, jobs, and family relationships. Therefore,
we focus on the association between stress trajectories and depressive
symptoms in middle-aged and older adults in Taiwan.
From a psychosocial viewpoint, women have consistently been associated with higher levels of depressive symptoms, possibly attributed to
differences between men and women in the kinds of activities in which
they 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 between
stress and depressive symptoms (Russell & Cutrona, 1991; Wang, 2001;
Weinstein, Glei, Yamazaki, & Ming-Cheng, 2004). They have discovered two
types of stressors: specific life events and more enduring life problems, also
called chronic strains. Specific life events are important experiences that
interrupt an individuals usual activities and require some adjustment. The
second major type of stressor was defined by Pearlin (1989) as the relatively enduring problems, conflicts, and threats that many people face in
their daily lives. For the elderly, common stressors emerge from the areas
of health, marital status and family relationships, retirement, or financial
strain. These stressors are related to depressive symptoms. The elderly are
at a stage in life where they may face extended and critical health problems such as illness, disability, or injury (Barry et al., 2009; Weinberger,
Raue, Meyer, & Bruce, 2009). An increase in the difficulty of functioning
physically also increases depressive symptoms and reduces life satisfaction
(Hsu, 2009). Both stable disability status and transitions in disability status
are significantly related to changes in depressive symptoms (Yang & George,
2005). Loss of spouse (Jang et al., 2009; St John & Montgomery, 2009) and
taking care of a sick spouse (Son et al., 2007) are also common stressors
for the elderly. Retirement and job loss are also stressful (Nuttman-Shwartz
et al., 2009). Financial strain is also related to mental health, especially
for the Chinese elderly (Chi et al., 2005; Zhang et al., 1997), and elderly
women are more vulnerable to financial strain than elderly men (Keith,
1993). Weinstein and others (2004) documented that higher exposure to
stressorsboth daily problems and major life eventswas associated with
higher levels of psychological distress. Difficulties with close family members
have also been associated with depressive symptoms (Wang, 2001).

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235

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Other predictors of depressive symptoms include age (Charles,


Reynolds, & Gatz, 2001), education, marital status, living arrangement, economic 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; Simon
et al. 2006; Tsai et al., 2005) were also important factors.
The purpose of this article is to examine gender differences in middleaged and older adults in Taiwan. We will focus on the association between
stress trajectories and related depressive symptoms. The stressors we chose
were health, finances, jobs, and family relationships.

METHODS
Data and Samples
Data for this study were taken from the Taiwan Survey of Health and Living
Status of the Elderly, a nation-wide, representative, longitudinal survey. In
the first wave, a national representative sample of people who were 60
or above was drawn in 1989. Among the 4,412 participants selected for
the survey, 4,049 responded, yielding a response rate of 91.8%. The survey
was followed up in 1993, 1996, 1999, and 2003. We utilized the data from
1996 (expanding the age range to 5066), 1999, and 2003. After the respondents with missing data were excluded, 2,889 subjects remained for further
analyses. 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 characterized 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 they
had experienced various situations or feelings such as not being interested
in eating, doing anything was exhausting, and poor sleep. Response categories included none, rarely (one day), sometimes (23 days), and often or
chronically (4 or more days). The sum across all 10 items formed an index
with a potential range of 0 to 30.

Independent Variables
STRESS
The main independent variable was stress. Our measurement of personal
stress was based on questions about whether each situation made the

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H.-W. Lin et al.

1996

1999
Year

2003

None
Inceasing stress
1

1996

1999
Year

2003

Chronic stress

Chronic stress

Chronic stress
Chronic stress

Maintaining without stress


1

Maintaining with stress


1

1996

1999
Year

2003

Chronic
Inceasing stress
1

1996

1999
Year

2003

Fluctuating stress

Fluctuating stress

1996

1999
Year

2003

Chronic stress

Chronic stress

Increasing
1

1996

1999
Year

2003

Fluctuating
Reducing stress

1996

1999
Year

2003

Chronic stress

Reducing stress
Chronic stress

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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) some
stress, or (2) a lot of stress. In this study, we categorized the measurement
into no stress (0) and stress (1).
There were eight types of trajectory patterns for stress observed across
the three waves through 1996, 1999, and 2003 (Please see Figure 1). We then
divided these into five groups. The first group was relatively without stress
during the three waves (none); the second group showed increasing stress
(increasing); the third group (fluctuating) had stress fluctuating across three

Declining

0
1996

1999
Year

2003

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

Gender Differences When Facing Stress and Depressive Symptoms

237

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

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DEMOGRAPHICS
A variety of predictors associated with depressive symptoms were included
in the model as controlled variables. These included demographic characteristics: age (year); marital status (married or with partner = 0 and others = 1);
ethnicity (Taiwanese = 0 and non-Taiwanese = 1); education (elementary
school 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 living
arrangement (living alone or with spouse = 0 and living with relatives = 1)
and the other was satisfaction with social support (perceived as poor = 0
and good = 1). To determine social participation, respondents were asked
whether they participated in each of the following organizations or activities: 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 elderly
education. 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 participants status in 2003 as controlled variables. Health behavior included
smoking (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-rated
health (perceived as poor = 0 and good = 1) as well as five major diseases
hypertension, diabetes, heart problems, stroke, or cancer (without = 0 and
with any disease = 1), and difficulty of walking 200300 meters (without
difficulty = 0 and with difficulty = 1).

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

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H.-W. Lin et al.

steps. First, we introduced gender, controlled variables, and the trajectory patterns of stress in health, finances, jobs, and family relationships.
Second, the interactionstrajectory patterns of stress by genderwere
introduced.

RESULTS

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A descriptive summary of the sample is shown in Table 1. The prevalence of


a high level of depressive symptoms (CES-D score  10) was 17.5% in 1996.
TABLE 1 Participant Characteristics by Gender

CES-D score at baseline


09
1030
Marital status in 2003
Yes
No
Ethnicity
Taiwanese
Non-Taiwanese
Education
Elementary or less
Higher than elementary
Living area
City
Rural area
Income status in 2003
Poor
God
Living arrangement
Alone or with spouse
With relatives
Satisfaction of social support
Poor
Good
Social participation
No
Yes
Self-rated health
Poor
Good
Major diseases
No
Yes
Difficulty walking 200300 meters
No
Yes

Total (%)
(n = 2889)

Male (%)
(n = 1494)

Female (%)
(n = 1395)

82.5
17.5

87.9
12.1

76.8
23.2

67.5
32.5

79.7
20.3

54.5
45.5

67.0
33.0

60.5
39.5

74.0
26.0

75.8
24.2

63.7
36.3

88.8
11.2

40.1
59.9

40.4
59.6

39.7
60.3

59.7
40.3

56.0
44.0

63.7
36.3

31.3
68.7

34.6
65.4

27.7
72.3

17.5
82.5

18.8
81.2

16.2
83.8

55.0
45.0

49.8
50.2

60.6
39.4

31.9
68.1

27.6
72.4

36.6
63.4

62.7
37.3

66.5
33.5

58.6
41.4

78.7
21.3

84.9
15.1

72.0
28.0

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TABLE 2 Stress Trajectories by Gender

Trajectory patterns
None
Increasing
Fluctuating
Declining
Chronic
Trajectory patterns
finance
None
Increasing
Fluctuating
Declining
Chronic
Trajectory patterns
None
Increasing
Fluctuating
Declining
Chronic
Trajectory patterns
relation
None
Increasing
Fluctuating
Declining
Chronic

Total (%)
(n = 2889)

Male (%)
(n = 1494)

Female (%)
(n = 1395)

44.9
27.0
15.4
7.0
5.7

52.7
23.9
14.6
6.5
2.3

36.5
30.4
16.3
7.5
9.3

49.6
22.8
14.6
7.0
6.0

52.0
22.3
13.5
6.6
5.6

47.0
23.3
15.8
7.5
6.5

76.6
8.6
8.6
5.4
0.8

73.4
8.6
9.3
7.7
1.1

80.1
8.6
7.8
2.9
0.6

80.8
7.4
6.6
4.9
0.3

83.7
7.0
5.0
4.1
0.1

77.6
7.8
8.3
5.8
0.4

of health

Mean SD

2.7 3.5
7.5 6.1
5.5 5.8
5.4 5.2
11.5 7.4

3.4 4.2
7.5 6.4
6.0 6.1
4.5 4.6
9.4 7.3

4.7 5.4
8.1 6.9
6.1 6.1
4.8 6.0
6.8 4.5

4.2 4.9
10.6 7.4
8.0 6.4
7.2 6.6
15.6 6.0

of

of job

of family

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 family
relationships were independently associated with gender; finances was not.
Most of the older people were relatively without stress with regard to jobs
and family relationships, 76.6% and 80.8% respectively, whereas those relatively without stress in health and finances accounted for no more than 50%.
Men experienced little stress in health, finances, and family relationships
whereas women suffered chronic stress in those same conditions.
Table 3 shows the multiple regression results of the relationship
between stress trajectory and depressive symptoms. In model 1, we incorporated gender, controlled variables, and the trajectory patterns of stress in
health, finances, jobs, and family relationships (16 items in all as constantly
without stress was the reference group). Results showed that gender affected
little (being female, b = .882, p < .001), but was still significant. The most
significant findings were the trajectory patterns of family relationships, especially for those with constant stress (b = 4.862, p < .01) and increasing
stress (b = 2.944, p < .001) compared to without constant stress. Among

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H.-W. Lin et al.

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


Model 1

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Variable
Depressive symptoms in 1996
Age in 2003
Gender: female
Marital status: without
Ethnicity: non-Taiwanese
Education: higher than elementary school
Living area: urban or rural area
Good income status
Living with relatives
Good satisfaction of social support
With social participation
Exercise
Smoking
Alcoholic drinking
Abnormal BMI
Good self-rated health
Any five major diseases
Difficulty of walking 200300 meters
Increasing stress of health
Fluctuating stress of health
Declining stress of health
Chronic stress of health
Increasing stress of finance
Fluctuating stress of finance
Declining stress of finance
Chronic stress of finance
Increasing stress of job
Fluctuating stress of job
Declining stress of job
Chronic stress of job
Increasing stress of family relation
Fluctuating stress of family relation
Declining of family relation
Chronic stress of family relation
Chronic stress of finance by gender
Increasing stress of job by gender
Fluctuating stress of family relation by gender
P value
R2

p < .05,

p < .01,

Model 2

SE

SE

0.147
0.046
0.882
0.434
0.094
0.079
0.656
0.639
0.229
1.906
0.028
0.474
0.225
0.203
0.421
2.487
0.346
1.574
1.825
0.878
0.299
2.809
1.531
0.611
0.336
2.246
0.862
0.201
0.423
0.259
2.944
0.977
0.874
4.862

0.017
0.012
0.203
0.193
0.178
0.211
0.173
0.184
0.175
0.224
0.165
0.181
0.226
0.206
0.162
0.199
0.176
0.228
0.220
0.249
0.347
0.410
0.241
0.261
0.338
0.396
0.329
0.306
0.405
0.963
0.326
0.336
0.379
1.540

0.144
0.048
0.265
0.449
0.105
0.135
0.663
0.639
0.237
1.898
0.012
0.462
0.273
0.192
0.440
2.481
0.379
1.560
1.683
0.810
0.700
1.521
1.212
0.408
0.691
1.503
0.062
0.021
0.533
0.201
3.354
0.273
1.117
5.583
1.616
1.430
1.967

0.170
0.012
0.290
0.192
0.178
0.211
0.173
0.184
0.174
0.224
0.156
0.181
0.227
0.206
0.162
0.199
0.176
0.227
0.297
0.342
0.491
0.799
0.325
0.368
0.476
0.570
0.457
0.412
0.496
1.176
0.462
0.531
0.570
3.080
0.769
0.654
0.683

43.8%

44.2%

p < .001.

the trajectory patterns for health and finances, the increasing, fluctuating,
and constant stress patterns were statistically significant, while the reducing
pattern 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 in
CES-D scores.
Model 2 shows whether the trajectory patterns of stress moderated the
effect of gender on depressive symptoms. In this model, we introduced

Gender Differences When Facing Stress and Depressive Symptoms

241

interaction terms (16 in all) between trajectory patterns and gender. The
interaction terms of (constant stress of finances gender, increasing stress
of job gender, and fluctuating stress of family relationships gender) were
statistically significant. Women were more susceptible than men in having
depressive symptoms with regard to constant stress in finances, increasing
job stress, and fluctuating family relationships stress. When interaction terms
were introduced, the gender effect was tremendously diminished (being
female, b = .265, p = .361).

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DISCUSSION
We examined the effects of gender and trajectory patterns on chronic
stress associated with depressive symptoms among middle-aged and older
Taiwanese (age 50 or older) in a 7-year follow-up study. Those who experienced higher or changing stress concerning health, finances, and family
relations were more likely to have higher depressive symptoms. Being
female and stressed was associated with more depressive symptoms after
controlled baseline depressive symptoms, the trajectory of stress, and related
risk factors. There were gender differences in depressive symptoms in
response to different patterns of life stress. Women were more likely to
show higher depressive symptoms than men when there was constant stress
from finances, increasing stress on the job, and fluctuating stress in family
relationships.
Health problems are a concern for mid-life and elderly people. In
model 2, we found that the health trajectory patterns were associated with
depressive symptoms, except when there was a reducing stress pattern relative to health. Past studies have found a relationship between physical
disability and depressive symptoms (Hsu, 2009; Yang & George, 2005). In
the study of Barry and others (2009), depressive symptoms were found
to be associated with disability burdens in both men and women, with
modest differences between genders. Men experiencing severe both moderate and high disability levels reported depressive symptoms, whereas only
high depressive symptoms were associated with severe disability in women
(Barry et al., 2009). Nevertheless, in our study, a change in health as a
result of stress was important for middle-aged and older people with regard
to depressive symptoms. However, there was no difference between genders. This may be due to the samples different age groups, which included
middle-aged and the elderly. As a result, the health problems for the younger
sample did not show a large difference between men and women.
Financial stress was also an important factor in the development of
depressive symptoms, as shown in previous findings (Chi et al., 2005; Zhang
et al., 1997). Consistent with the findings of Keiths (1993) study, older
women with constant stress from finances and with increasing stress on

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H.-W. Lin et al.

the job were more likely than men to have higher depressive symptoms.
In Chinese society, women are not traditionally thought to be responsible
for the financial support of the family. The majority of the elderly women
sampled in this study did not work during their old age, and they usually
depended on their spouse or adult children for financial needs. Middle-aged
women usually perceived job loss as challenging and threatening, and thus
as emotional stress increased, psychiatric symptoms increased (NuttmanShwartz et al., 2009). Previous research suggests that those who report that
their spouse or friends add to their financial burdens and who depend
on their children for financial support are more likely to report higher
depressive symptoms (Weinstein et al., 2004).
Relationships with family members were a critical factor inducing
depressive symptoms. We found that increasing stress from family relationships was the most significant factor in increasing depressive symptoms.
Women with fluctuating stress emanating from family relationships were
more likely than men to have higher depressive symptoms. There are some
possible reasons. First, married people were more likely to have depressive
symptoms than those who were widowed, single, or separated (Wang, 2001).
Weinstein and others (2004) found that gender differences had a substantial
effect on the level of psychological distress among elderly Taiwanese adults,
but marital status did not. Second, when there are conflicts within family
relationships, women are more likely to feel responsible and are more sensitive to changes in family atmosphere. Women are more vulnerable to a
life crisis on an emotional or social level (Kessler & McLeod, 1984). Third,
when there were high caretaking demands, women reported they were less
healthy, since women are usually the caretakers at home (Chen, Chang, &
Yang, 2008).
A possible reason for these differences could be that marital discord
appears to affect women more than men. Basically, men and women have
different coping styles as men tend to fight or flee. Women are more emotionally focused and search for a tending and befriending style of coping.
In traditional Chinese culture, women are more focused on the home and
have low self-esteem. On the other hand, men are regarded as the financial
pillars and have more power and authority in the family.
The merits of this study: first, our longitudinal data has allowed us to
assess and control depressive symptoms at baseline. The use of a large,
nationally representative data source allowed us to control extraneous influences to a great extent. We were able to delineate the trajectory patterns
of stress across the three waves of the survey so that the causal effects of
depressive symptoms could be established. Second, we have elaborated on
the interaction between stress and gender. We now know more about the
gender differences in different trajectory patterns of stress.
There are also limitations to this study. First, the detection of dynamic
change in stress is limited by only three points of the survey. Future studies

Gender Differences When Facing Stress and Depressive Symptoms

243

may focus on the detection of dynamic change and its analysis by repeated
measurements. Second, missing cases due to death or loss of follow-up were
excluded from the analysis.
This study has detected a significant influence of trajectory patterns of
stress on depressive symptoms. Certain trajectory patterns of stress diminish
the effect of gender on depressive symptoms.

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ACKNOWLEDGMENTS
The data was provided by the Population and Health Research Center, the
Bureau of Health Promotion, Department of Health, Taiwan, Republic of
China. The interpretation and conclusions contained herein do not represent
those of the Bureau of Health Promotion. This study was funded by the
Armed Forces Taichung General Hospital. None of the authors has a conflict
of interest in any way.

REFERENCES
Ahern, M. M., & Hendryx, M. (2008). Community participation and the emergence of
late-life depressive symptoms: Differences between women and men. Journal
of Womens Health, 17, 14631470.
Barry, L. C., Allore, H. G., Bruce, M. L., & Gill, T. M. (2009). Longitudinal association 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 change
in positive and negative affect over 23 years. Journal of Personality and Social
Psychology, 80, 136151.
Chen, D. R., Chang, L. Y., & Yang, M. L. (2008). Gender-specific responses to social
determinants associated with self-perceived health in Taiwan: A multilevel
approach. Social Science & Medicine, 67, 16301640.
Chen, C. S., Chong, M. Y., & Tsang, H. Y. (2007). Clinically significant nonmajor depression in a community-dwelling elderly population: Epidemiological
findings. 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 Chinese
older adults. American Journal of Geriatric Psychiatry, 13, 409416.
Hermalin, A. I., Ofstedal, M. B., & Lee, M. L. (1992a). Characteristics of children
and intergenerational transfers in Taiwan. Comparative Study of the Elderly
in 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 in
Taiwan: Who is available and where are they? Comparative Study of the Elderly

Downloaded by [Universitara M Emineescu Iasi] at 05:19 29 October 2015

244

H.-W. Lin et al.

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 life
satisfaction 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 the
Korean Longitudinal Study of Ageing (KLoSA). Social Science & Medicine, 69,
16081615.
Keith, V. M. (1993). Gender, financial strain, and psychological distress among older
adults. Research on Aging, 15, 123147.
Kendler, K. S., Myers, J., & Prescott, C. A. (2005). Sex differences in the relationship
between social support and risk for major depression: A longitudinal study of
opposite-sex twin pairs. American Journal of Psychiatry, 162, 250256.
Kessler, R. C., & McLeod, J. D. (1984). Sex-differences in vulnerability to undesirable
life 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 and
double depression. Journal of Affective Disorders, 60, 111.
Krause, N., & Liang, J. (1993). Stress, social support, and psychological distress
among 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 of
Clinical Epidemiology, 52, 983995.
Liu, C. N. (2009). The association of depressive symptoms with socioeconomic status, general health conditions, and health behaviors in community-dwelling
adults. Taiwan Journal of Public Health, 28, 300311.
Nuttman-Shwartz, O., Gadot, L., & Kacen, L. (2009). Recurrent job loss and mental
health among women. Womens Health, 49(4), 294309.
Pearlin, L. I. (1989). The sociological study of stress. Journal of Health and Social
Behavior, 30, 241256.
Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research in
the general population. Applied Psychological Measurement, 1, 385401.
Russell, D. W., & Cutrona, C. E. (1991). Social support, stress, and depressive symptoms 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., van
Belle, G., & Kessler, R. C. (2006). Association between obesity and psychiatric 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 of
Psychiatry/Revue Canadienne de Psychiatrie, 54, 487492.

Downloaded by [Universitara M Emineescu Iasi] at 05:19 29 October 2015

Gender Differences When Facing Stress and Depressive Symptoms

245

Tsai, Y. F., Yeh, S. H., & Tsai, H. H. (2005). Prevalence and risk factors for depressive
symptoms among community-dwelling elders in Taiwan. International Journal
of Geriatric Psychiatry, 20, 10971102.
Vikram, P. (2005). Gender in mental health research. Gender and Health Research
Series. Geneva, Switzerland: World Health Organization Press.
Wang, J. J. (2001). Prevalence and correlates of depressive symptoms in the elderly
of 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 of
new 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 intergenerational relations in the association between life stressors and depressive
symptoms. Research on Aging, 26, 511530.
Yang, Y., & George, L. K. (2005). Functional disability, disability transitions, and
depressive 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.