File 1

GENERAL HEALTH CONDITION, LIVING ARRANGEMENTS,
AND SOCIOECONOMIC STATUS AS CONTRIBUTING
FACTORS OF DEPRESSION AMONG THE
ELDERLY POPULATION
A Thesis
Presented to
The Faculty of the School of Social Work
California State University, Los Angeles
In Partial Fulfillment
of the Requirements for the Degree
Master of Social Work
By
Carmen Avalos
June 2016
ProQuest Number: 10141090
All rights reserved
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ProQuest 10141090
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Carmen Avalos
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ii
The thesis of Carmen Avalos is approved.
Sei-Young Lee, Ph.D., Committee Chair
Nikola Alenkin, Ph.D., LCSW
Siyon Rhee, Ph.D., School Director
California State University, Los Angeles
June 2016
iii
ABSTRACT
General Health Condition, Living Arrangements, and Socioeconomic Status as
Contributing Factors of Depression Among the Elderly Population
By
Carmen Avalos
The purpose of this study is to examine the relationship between general health
condition, living arrangements, socioeconomic status, and depression among elderly
adults. The California Health Interview Survey (CHIS) 2011-2012 dataset was utilized in
order to conduct the secondary analysis of variables for this study. This study found that
there is a significant relationship between general health condition, socioeconomic status,
ethnicity, gender, and depression among the sample of elderly adult participants. The
results from this study found that elderly participants who reported a poor general health
condition (self-rated health) had higher levels of depression, and elderly adults who
reported an excellent general health condition had lower levels of depression. A low
socioeconomic status was correlated to higher levels of depression among elderly adults.
This study also found that elderly minorities have higher levels of depression when
compared to their counterparts. Female elderly adults were found to have higher levels
of depression than males in this study. The results of this study serve to raise awareness
and contribute knowledge of significant contributing factors correlated to depression
among the elderly population.
iv
ACKNOWLEDGMENTS
I would like to thank my family for being very supportive of my education.
Everything I have achieved thus far is all thanks to them. A special thank you to my
mother for always encouraging me to become the strong, educated, and independent
woman I am today. Also, a huge thank you to my cohort friends who have been very
kind and supportive throughout our program. Thank you to all my close friends from Cal
State LA who have helped me in way or another throughout my years on this campus. To
those who took the time to read my thesis, I am very thankful for your time. I am very
grateful to have all of you in my life as I continue following my career goals.
I would also like to thank my mentors and role models who have helped me
develop as a student and professional social worker throughout my education at Cal State
LA. Thank you Dean Yorker, Dr. Brown, Dr. Corley, Dr. Huynh-Hohnbaum, Dr.
Altschuler, Dr. Villa, and many others who have supported me throughout my
undergraduate and graduate education on this campus.
Lastly, I would like to express my sincere gratitude and admiration to my thesis
advisor Dr. Lee. I am very thankful to have end up with you as my advisor after a
difficult start to thesis. I am very glad that there is faculty like yourself in our department
who are dedicated to the success of their students. Your time and support was much
appreciated throughout this year. Thank you very much Dr. Lee!
v
TABLE OF CONTENTS
Abstract .............................................................................................................................. iv
Acknowledgments................................................................................................................v
List of Tables ................................................................................................................... viii
Chapter
1. Introduction .............................................................................................................1
Statement of the Problem ...................................................................................2
Scope of the Problem .........................................................................................3
Purpose of Study ................................................................................................5
Objectives ..........................................................................................................5
Hypothesis..........................................................................................................6
Variable and Operational Definitions ................................................................7
Theoretical Framework ......................................................................................7
2. Literature Review..................................................................................................10
Review Process ................................................................................................10
General Health Condition and Depression ......................................................10
Living Arrangements and Depression .............................................................12
Socioeconomic Status and Depression ............................................................13
Ethnicity and Depression .................................................................................16
Gender and Depression ....................................................................................17
Summary ..........................................................................................................19
3. Methodology .........................................................................................................21
Research Design...............................................................................................21
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Sampling ..........................................................................................................21
Data Collection ................................................................................................22
Instrumentation ................................................................................................23
Data Analysis ...................................................................................................26
Limitations and Strength of Research Design .................................................27
4. Results ...............................................................................................................28
Demographic Characteristics ...........................................................................28
Living Arrangements .......................................................................................29
Socioeconomic Status ......................................................................................29
General Health Condition ................................................................................30
Depression among Elderly Adults 65 and Older .............................................31
Bivariate Analysis ............................................................................................34
Multivariate Analysis .......................................................................................38
5. Discussion .........................................................................................................40
Significance of the Findings ............................................................................40
Implications for Social Work ...........................................................................43
Recommendations for Future Research ...........................................................45
Conclusion .......................................................................................................46
References ..........................................................................................................................47
vii
LIST OF TABLES
Table
1. Independent & Dependent Variables .......................................................................7
2. Independent Variables ...........................................................................................25
3. Dependent Variables ..............................................................................................26
4. Demographic Characteristics of Elderly Adults 65 and Older ..............................29
5. Living Arrangements of Elderly Adults 65 and Older...........................................29
6. Socioeconomic Status of Elderly Adults 65 and Older .........................................30
7. General Health Condition of Elderly Adults 65 and Older....................................31
8. Depression among Elderly Adults 65 and Older ...................................................33
9. Depression by Gender (t-test) ................................................................................34
10. Depression by Living Armaments (t-test)..............................................................35
11. Correlation between Depression and Age; Poverty Level; General Health
Condition................................................................................................................36
12. Depression by Ethnicity (one-way ANOVA) ........................................................37
13. Depression by Educational Attainment (one-way ANOVA).................................38
14. Linear Multiple Regression of Depression with Age, Gender, Latino, Asian,
African American, White, Poverty Level, High School Degree, Some College,
College and Above, Living Arrangements, and General Health Condition ..........39
viii
CHAPTER 1
Introduction
In the United States, it is expected by the year 2050, that the older population age
65 and older will consist of 83.7 million (U.S. Census Bureau, 2015). This estimate was
considerably doubled as the estimated older adult population consisted of 43.1 million
people in the year 2012 in the United States (U.S. Census Bureau, 2015). A higher
number of elderly individuals is due to the aging cohort of baby boomers, who started to
reach the age of 65 in the past few years.
Aging individuals are more susceptible to mental illnesses in later adulthood.
Therefore, it is no surprise that two million elderly individuals are affected by depression
after the age of 65 (Ashford & LeCroy, 2013, p. 623). A person can experience
depressive symptoms at any age. However, its usually more difficult to recognize and
understand when an elderly individual is experiencing depression.
Depression is a common, but very serious mental illness that is characterized by a
combination of symptoms that interfere with a person's ability to work, sleep, study, eat,
and enjoy once-pleasurable activities (National Institute of Mental Health [NIMH],
2015). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5;
American Psychiatric Association [APA], 2013) defined depression as a period of at least
two weeks in which an individual experiences a loss of interest or pleasure in almost all
activities. Additionally, at least four supplementary symptoms from a list of criteria have
to be experienced by the individual, symptoms include: changes in appetite or weight,
difficulty thinking, difficulty concentrating, decreased energy, sleepiness, feelings of
1
worthlessness or guilt, trouble making decisions, regular thoughts of death, and plans or
ideas of suicide (APA, 2013).
Recognizing these depressive symptoms can be difficult as they are commonly
associated with the aging process of elderly individuals. Mortality in the elderly
population is affected by the emergence of ego integrity versus despair as individuals
have more time to reflect on their past. Therefore, it is important to examine contributing
factors of depression that elderly individuals might not be able to change or control as
independence begins to decrease with age. General health conditions, living
arrangements, and socioeconomic status are factors of concern in regards to the influence
they might have on the psychological well-being of elderly individuals.
Statement of the Problem
Identifying depression among the elderly population might be difficult as some
may think sadness and isolation is part of the aging process. It has been reported that
older adults have an increased risk of experiencing depression (Center for Disease
Control and Prevention, 2015). This increased risk of depression among elderly adults
could be due to changing, new, and existing stressors that come along with the aging
process. Most of the research that has been conducted on this topic has found that
depression is the most commonly diagnosed mental illness among the elderly population
(Djernes, 2006). Due to the known prevalence of elderly adults being at an increased risk
for depression, it is important that influencing factors be identified for the benefit of
increasing awareness of depression among the elderly population.
It has been found that elderly individuals are at risk of experiencing depression
due to several factors (Rogers, 1999). The perception elderly individuals have of their
2
own general health condition is a significant contributing factor for depression. (Jahn &
Cukrowicz, 2012). The aspects of the living arrangements are an important contributing
factor, as a correlation between living arrangements and the risk of elderly depression has
been found in research (Chan, Malhotra, Malhotra & stbye, 2011). Economic hardship
has been found to be associated with depression among the elderly population (Fukunaga
et al., 2012). In the United States, many elderly minorities significantly depend on
public assistance from the government for food, rent, and transportation. Elderly adults
living in socioeconomically disadvantaged neighborhoods have a greater prevalence to
depression (Almeida et al., 2012). Elderly adults are usually expected to have a higher
socioeconomic status because of the perception that they have worked all their life, and in
return they get to enjoy their retirement. This perception is not accurate as many elderly
adults live in poverty and rely on financial assistance from the government. Living in
poverty can impact the likelihood of elderly adults seeking and receiving treatment for
depression. Therefore, socioeconomic status is also a significant contributing factor of
depression among the elderly population that should be further examined. Elderly adults
might be less motivated to seek treatment for depression when experiencing symptoms
because of the stigma that is associated to depression among this population. Therefore,
it is imperative that we examine these contributing factors of depression among the
elderly population.
Scope of the Problem
In the last couple decades, modern medicine has made it possible for people to
live longer. As people experience longer longevity, the prevalence of mental illness
might increase as well. One in four older adults have a mental disorder, and by the year
3
2030, it is expected that 15 million older adults will experience some type of mental
illness (National Council on Aging [NCOA], 2015).
Depression can impact activities of daily life as the desire to accomplish simple
tasks are affected due to a loss of interest (Ganatra, Zafar, Qidwai, & Rozi, 2008). In the
United States of America, seven million elderly individuals experience depression
(NCOA, 2015). A study found that depression in elderly adults has a prevalence of
22.9% (Ganatra et al., 2008). It is likely that the prevalence of depression among these
elderly individuals is also influenced by other variables. Ethnicity is a factor that
contributes to the level of poverty an elderly individual might face in their lifetime
(Cawthorne & Americans, 2008). A high percent of elderly minorities of color were
found to most likely live in poverty when compared to the 7.9 percent of white
Americans who live in poverty (Cawthorne & Americans, 2008). In regard to gender,
Katsumata et al. (2005) found that elderly women have a higher prevalence for
depressive symptoms than elderly men. According to a report by the Center for
American Progress, over 3.4 million older adults 65 and older in the Unites States, live
below the poverty line (Cawthorne & Americans, 2008). In 2006, 9.4 percent of elderly
adults were surviving with an income that was below the poverty threshold ($9,669) for
individuals (Cawthorne & Americans, 2008). Elderly adults who depend on their income
for basic needs are not going to take the initiative to use their money on mental health
services. Therefore, elderly adult minorities with depressive symptoms are likely to
continue living under poor conditions that are contributing to their risk of depression.
The lack of awareness and treatment services available for elderly adults with
depression is significantly evident. Research from Satcher (1999), reported that
4
depression is a directly associated with suicide among older adults. Two thirds of suicide
cases in adults 65 years old and older, report depression as the main cause for every one
out of four suicides (Blazer, 2002; McDougall, Blixen & Suen, 1997). The statistics of
elderly individuals who committed suicide is an example of the consequences of letting
depression go unrecognized and untreated among the elderly population. Therefore,
raising awareness of this problem is essential as it could make a difference in the overall
well-being of elderly adults.
Purpose of Study
The purpose of this study is to examine contributing factors influencing
depression among the elderly population. Using data from the California Health
Interview Survey, (2011-2012), general health condition, living arrangements, and
socioeconomic status were examined as contributing factors influencing depression
among elderly adults. The results of this study serve to contribute knowledge of
significant contributing factors found to be associated with depression among the elderly
population. Lastly, this study serves to raise awareness of this mental illness as stigma is
commonly associated to depression diagnosis and treatment among the elderly
population.
Objectives
The research objectives for this study are:
1. To examine sociodemographic characteristics among elderly adults.
2. To examine general health condition among elderly adults.
3. To examine living arrangements among elderly adults.
4. To examine socioeconomic status among elderly adults.
5
5. To examine depression among elderly adults.
6. To examine the relationship between general health condition and depression
among elderly adults.
7. To examine the relationship between living arrangements and depression among
elderly adults.
8. To examine the relationship between socioeconomic status and depression among
elderly adults.
9. To examine the relationship between ethnicity and depression.
10. To examine the relationship between gender and depression.
11. To investigate which independent variables (general health condition, living
arrangement, socioeconomic status, age, ethnicity and gender) predict depression
Hypothesis
Research hypotheses for this study include:
1. A lower general health condition is more likely to influence the level of
depression among elderly adults.
2. Living alone is more likely to predict an increased risk of depression among
elderly adults.
3. A lower socioeconomic status influences an increased risk of depression among
elderly adults.
4. Elderly minorities are more likely to be at risk for depression than their
counterparts.
6
5. Female elderly adults are more likely to have higher levels of depression than
male elderly adults.
Variables and Operational Definitions
The main dependent variable in this study is depression among elderly adults.
Depression was defined in the mental health section of the CHIS (2011-2012) dataset
using the Kessler 6 psychological distress scale that is presented in details in chapter 3.
Three major independent variables were examined for the purposes of this study,
which are general health condition, living arrangements, and socioeconomic status (SES).
Ethnicity, gender, and age are the only sociodemographic variables that was addressed in
this study. The adult data set of the California Health Interview Survey (CHIS) (2011-
2012) was used to identify and define the three independent variables of the study.
Table 1
Independent & Dependent Variables

________________________________________________________________________
Independent Variables Dependent Variables

________________________________________________________________________
Psychological Distress
General Health Condition (1) Feel Nervous Past 30 Days

Living Arrangements (2) Feel Hopeless Past 30 Days
Socioeconomic Status (SES) (3) Feel Restless Past 30 Days
Educational Attainment (4) Feel Depressed Past 30 Days
Poverty Level (5) Feel Everything An Effort Past 30 Days
Age (6) Feel Worthless Past 30 Days
Ethnicity
Gender
________________________________________________________________________
Theoretical Framework
This research is guided by the theoretical framework of Erick Ericksons
psychosocial development theory. Ericksons psychosocial development theory has eight
7
stages. For the purpose of this study, only the eighth stage of ego integrity versus despair
will be addressed. In this stage, older adults reflect on their life as they are closer to
death. According to Hearn et al., (2012) elderly individuals who achieve ego integrity
are realistic, optimistic, self-aware and are not depressed nor self-critical. Ego integrated
elderly individuals achieve life satisfaction because they affirm their lifes worth, values,
and have accepted their accomplishments without feeling overwhelmed by feelings of
regret (Hearn et al., 2012). According to Hearn et al., (2012) elderly individuals in
despair are willing to reflect on their life course, but are not able to accept their
accomplishments and therefore, feelings of regret end up leaving them unsatisfied with
life. Despairing persons in this stage are depressed about missed chances in life,
disappointments, and failures (Hearn et al., 2012). Acknowledgment and achievement of
the challenges that arise in this final psychosocial crisis is vital for the psychological
well-being of elder individuals (Dezutter, Wiesmann, Apers, and Luyckx, 2013).
According to Dezutter et al. (2013) loss of independence, physical and mental
decline, and bereavement of a partner are outcomes elderly individuals face in the final
stage of psychosocial development and therefore, depressive feelings can result from
these new experiences. A study of a longitudinal sample of elderly adults concluded that
life satisfaction and depressive symptoms are independent predictors of elderly mortality
over time (Collins, Glei, and Goldman 2009). This means that elderly individuals who
are in Ericksons stage of integrity versus despair are more likely to be at risk of
depression if they are in despair. Elderly individuals in despair are unsatisfied with life,
hence they are more likely to contemplate suicide if they have depressive symptoms. The
research available correlating depression and Ericksons eighth stage of ego integrity
8
versus despair is very minimal. Therefore, more studies are needed for the purpose of
raising awareness of contributing factors that influence depression among the elderly
population.
9
CHAPTER 2
Literature Review
This literature review examined contributing factors of depression among elderly
adults. The three primary contributing factors are general health condition, living
arrangements, and socioeconomic status. The variables ethnicity and gender were also
examined in this literature review in regards to depression among elderly adults.
Review Process
The data base Academic Search Complete and Google Scholar were used for this
literature review. The primary terms that were researched in the search engines included
elderly adults, depression, general health condition, living arrangements, and
socioeconomic status. When the search term elderly did not give a significant variety of
results, the terms such as older adults and seniors were also included in the search engine.
When depression was not used as a search term, the term depressive symptoms and
psychological distress were also searched in the data bases.
General Health Condition and Depression
General health condition is interchangeably referenced as subjective health, self-
perceived health and self-rated health in the literature. Depression is a mood disorder
that affects many aspects of a persons life. Depression is often underdiagnosed among
the elderly as depression symptoms are often mistaken as part of the aging processes. A
study by Han and Jylha (2006) examined the relationship between changes in self-rated
health and the improvement of depressive symptoms among community-dwelling
disabled and non-disabled older adults. In a two year follow up period, 4766 older adults
took part in the study. The results from Han and Jylha (2006) study indicate that from
10
1993 to 1995, a decrease in depressive symptoms was found in both disabled and
nondisabled community-dwelling elderly adults. Decreased depressive symptom were
correlated to an increased chance of improvement in self-rated health, and also to a
decreased chance of decline in self-rated health for these particular participants (Han &
Jylha, 2006). In addition to Han & Jylha (2006) study, another study also explored self-
rated health and depressive symptoms.
Similarly, Jahn and Cukrowicz (2012) sought to examine the association between
depressive symptoms and functional impairment, and self-rated health with a sample of
98 elderly adults. They hypothesized that self-rated health in elderly adults was a
moderating factor in relation to depressive symptoms and functional impairment. The
results from their study found that increased levels of functional impairment were
correlated with fewer depressive symptoms as these individuals reported having a better
self-rated health, but poor self-rated health reported by elderly adults was associated to
higher severe depressive symptoms in functionally impaired individuals (Jahn &
Cukrowicz, 2012). They also reported that little functional impairment in elderly adults
was associated with the least amount of severe depressive symptoms when self-rated
health was better (Jahn & Cukrowicz, 2012). The findings help to further establish that
self-rated health is a mediator between depressive symptoms and functional impairment.
Therefore, elderly adults with a functional impairment who might not rate their health as
high as other elderly adults, will most likely have an increased prevalence for higher
depression levels.
Based on the results from the previous studies, the review of literature in regards
to general health condition among elderly adults has found that self-rated health is a
11
significant contributing factor to depression. Additionally, Pu, Bai, and Chou (2013)
conducted a study were they hypothesized that self-rated health by itself could explain
the relationship between the utilization of medical care and depression among older
adults. The study measured depressive symptoms and self-rated health in 2,727
participants. They found that self-rated health alone has an influence on the relationship
between medical care utilization and depression among older adults. The study also
found that elderly adults with higher depressive symptoms reported a poorer general
health condition when compared to those who reported having an excellent general health
condition (Pu, et al., 2013). Therefore, an improvement in self-rated health among
elderly adults with depression can lead to an increased rate of medical care utilization by
this population. The results of the studies reviewed were found to contribute to the
significance of general health condition as it has been established in the literature that the
perception of a poor health condition can influence higher depressive symptoms among
elderly adults.
Living Arrangements and Depression
Depression symptoms can be influenced significantly by the living arrangements
of an elderly individual. Most typical living arrangements among elderly adults are
comprised of living alone, living with a spouse and living with others. Several studies
have look at such living arrangements and their association to depression among elderly
adults. Lin and Wang (2011) examined the risk factor associated with depressive
symptoms and the prevalence of depressive symptoms among 192 community-dwelling
elderly adults living alone. They found that women have a 74% increased prevalence of
depressive symptoms when living alone, and men have a 45% increased prevalence of
12
higher depressive symptoms when living alone. The study also reported gender
differences, which indicated that self-perceived health, chronic illness, educational level,
religious beliefs, and social support are risk factors influencing depressive symptoms in
men who live alone, while social support and age are risks factors influencing depressive
symptoms in women who live alone (Lin & Wang, 2011).
Similarly to Lin and Wangs (2011) study, Fukunaga et al. (2012) sought to
examine the association between depression and living arrangements, and the differences
in factors influencing depression among elderly adults. Such living arrangements
consisted of participants living with others or living alone (without a partner or spouse).
They hypothesized that living alone influenced the risk of depression symptoms, and
therefore, postulated a correlation of increased suicidal ideation and living alone. The
study found that living alone in its self was significantly associated to depression.
Factors such as suicide ideation, long-term care insurance, financial strain, loss of
appetite, worries in life, and low levels of social support are the only factors that were
significantly associated to depression and elderly adults who lived alone or with others
(Fukunaga et al., 2012). Factors only associated among elderly adults who live with
others, included sleep loss, hospital visits, absence of work with income, and the number
of generations living together (Fukunaga et al., 2012). These results contribute to the
significance of living arrangements as it has been established in the literature that both
types living arrangements can influence the risk of depression among elderly adults.
Socioeconomic Status and Depression
Socioeconomic status (SES) is a risk factor of concern when it comes to its
influence on the level of depression among elderly adults. Murata, Kondo, Hirai, Ichida,
13
and Ojima (2008) conducted a research study examining depression and SES among
elderly Japanese adults. The study also looked at depression among elderly adults and
whether their area of residence is associated to the prevalence of depression. The sample
of participants in the study consisted 29,860 elderly adults 65 and older. The results of
the study found that low-income elderly adults were 2.35 times more likely to be
depressed then their high-income elderly adults (Murata et al., 2008). Their study also
found that rural elderly adults had a 1.3 higher likelihood of being more depressed than
then elderly adults in urban areas. The study also adjustments for age, sex, marital status,
self-rated health, illness, and higher levels of ADL. After controlling for these
covariates, the findings also showed that the SES gradient of depression still existed
(Murata et al., 2008).
Socioeconomic status can be defined in different ways. Income and educational
level of attainment are commonly used to define and identify a persons socioeconomic
status. Socioeconomic status has been reported to influence the prevalence, and the
treatment of depression among the elderly population. Koster et al. (2006) examined
correlations between the onset of depression and SES among older adults. The study
utilized a longitudinal data collection method that followed older adults over 9 years.
Educational attainment and income were used to define the SES. The study found that
SES was a predictor of the incidence of depression in older adults. The study also found
that older adults with low SES had two times higher incidence rate of depression, which
predicted more depressive symptoms when compared to a person with high SES. Low
SES people had lower education and income levels that were correlated to being a
smoker and also less physically active when compared to high SES older adults. Low
14
SES in the study also indicated that a higher prevalence of diseases and were more
vulnerable to end up with higher hazard ratios of physical health when compared to those
with high-SES. The study also reported that low SES was significantly associated to a
decline in physical health, psychological and behavioral problems. They reported that
older adults with lower SES showed a smaller network, less emotional support, lower
feelings of mastery, and lower self-efficacy when compared to those with higher SES
(Koster et al., 2006).
In addition to Koster et al.s (2006) study on SES and depression, Almeida et al.
(2012) study also investigated the relationship between socioeconomic disadvantage and
depression. This study examined 21,417 older adults age 60 and over who were recruited
over a three-year period in Australia. The Socio-Economic Indexes for Areas of
Australia were used to measure socioeconomic disadvantage and depressive symptoms
were measured by a primary health questionnaire that measured nine items (PHQ-9)
(Almeida et al., 2012). The results of the study indicated that 6% of participants in the
least disadvantaged quintile were affected by depression, while 10% of participants in the
most disadvantaged quintile were affected as well. The study also indicated that the risk
of depressive symptoms in later life increases with socioeconomic disadvantage, and
particularly this study reported a possible two years of depressive symptoms to be present
when socioeconomic disadvantages are experienced (Almeida et al., 2012). The
literature established that SES is a significant contributing factor of depression among
elderly adults. Therefore, the more socioeconomic disadvantaged experienced by this
population, the more likely they are to experience higher levels of depression.
15
Ethnicity and Depression
Ethnicity is an important factor to consider when looking at contributing factors
that may influence depression among the elderly population. A study by Falcon and
Tucker (2000) examined the association of situational factors and the prevalence of
depressive symptomatology among Hispanic elderly adults living in the same
neighborhood in Massachusetts. The different situational factors included health
problems, household arrangements, socioeconomic status, and acculturation. The sample
of participants consisted of Hispanic and non-Hispanic White elderly adults. The sample
included 238 non-Hispanic White, 429 Puerto Rican, 128 Dominican, and 149 elderly
adults who were considered as other Hispanic. Falcon and Tucker (2000) found that
health problems were significantly associated to higher depressive symptoms for both
Hispanic and non-Hispanic White elderly adults. Their study found an association
between living alone and higher depression symptoms as living with a spouse or with
others was correlated to lower depression symptoms among both Hispanic and non-
Hispanic Whites. Falcon and Tucker (2000) report that elderly Puerto Ricans and elderly
Dominicans were found to have a low socioeconomic status which influenced a higher
prevalence of depression symptoms when compared to other Hispanic or non-Hispanic
Whites. Among the sample, only Dominicans had a significant association between
acculturation and depressive symptoms. The studys results established that ethnic
minorities such as Hispanics in this sample, are more likely to have a higher prevalence
of depression symptoms than other ethnicities among the elderly adult population.
In addition to Falcon and Tuckers (2000) study, another research study by
Akincigil et al. (2012) examined racial and ethnic differences in the diagnosis of
16
depression and treatment of depression among community-dwelling elderly adults. The
study consisted of a sample size of 12,353 Medicare beneficiaries who were 65 years old
and older. In regards to ethnicity, the sample of participants consisted of 2.5 % of non-
Hispanic other, 1.9% were Hispanic, 8.3% were African American and 87.3% were non-
Hispanic White. Akincigil et al. (2012) study found that Hispanics had higher levels of
depressive symptoms than the other ethnic groups in the sample. The results of the study
also indicate that African American elderly adults have a lower odd of being diagnosed
with depression when compared to non-Hispanic Whites. Their study reports that among
Hispanic and non-Hispanic Whites, the diagnosis of depression was more likely for both
groups. The study also found that treatments of depression were similar among all four
groups, but elderly African Americans and elderly non-Hispanic Whites were half as
likely to receive any treatment for a diagnosis of depression. While the type of
treatments are the same among all ethnic groups, the actual acceptance of treatment
varies among minorities as it was found that non-Hispanic Whites are less likely to
proceed with any treatment for depression (Akincigil et al., 2012). The findings in the
literature suggest that among elderly adults, minorities are less likely to receive a
depression diagnosis despite having depressive symptoms. Such findings are of concern
as it infers that health professionals are less likely to recognize and treat depression
among elderly minorities.
Gender and Depression
A study by Kockler and Heun (2002) sought to examine gender differences in
relation to depressive symptoms among depressed and non-depressed elderly adults. The
study examined different hypotheses for depressed and non-depressed elderly adults.
17
Among depressed elderly adults, it was hypothesizes that elderly women present more
symptoms of major depression than elderly men and that depressive symptoms differ
among elderly women and men with major depression. Among non-depressed elderly
adults, it was hypothesized that depressive symptoms differ among elderly men and
women, and that more depressive symptoms are suffered by elderly woman then elderly
men. The study consisted if a sample of 236 depressed elderly participants and 357 non-
depressed elderly participants. The results of the study indicated that the number of
symptoms did not differ significantly between genders, but that depressed elderly women
presented different significant symptoms such as more appetite disturbances when
compared to elderly men who suffered from more agitation (Kockler and Heun, 2002).
Their study also found that among non-depressed elderly adults, symptoms of depression
differed as females suffered from more joylessness and reduced appetite than men due to
the influence of different demographic and psychosocial variables. It was also found that
non-depressed elderly women have more depressive symptoms than non-depressed
elderly men (Kockler and Heun, 2002). The literature suggest that the number of
symptoms does not differ between depressed elderly females and males, but the type
symptomology does differ, indicating different sub-types of depression among both
genders.
In addition to Knockler and Heuns (2002) study, other research studies have also
examined contributing factors of depression and whether gender outweighs the impact of
these risk factors. A cross-sectional study by Minicuci, Maggi, Pavan, Enzi & Crepaldi
(2002) examined physical, social and psychological factors associated to the prevalence
of depressive symptoms and gender among elderly adults in Italy. The sample of
18
participants consisted of a random sample of 2,398 individuals aged 65 and older. The
Italian version the Epidemiologic Studies Depression Scale (CES-D) was used to
measure depression among the sample of participants. Minicuci et al. (2002) study found
that there is a higher prevalence of depressive symptoms in women (58%) than in men
(34%). Their study also found that women are at more risk of depressive symptoms,
even when other risk factors such as a lack of support, physical impairment, or poor self-
rated health, are considered (Minicuci et al., 2002). The research findings suggest that
most associated factors of depressive symptoms tend to always put elderly women at a
higher risk for depression when compared to elderly men, which parallels existing
literature on gender and depression among the elderly population.
Summary
The literature on general health condition, living arrangements, socioeconomic
status and depression has shown that all of the independent variables are significantly
correlated to the main dependent variable. The literature points out that self-rated health
is one of the most significant contributing factors influencing the risk of depression
among the elderly population. Living arrangements were correlated to higher depression
symptoms when participants lived alone. Indicating that elderly adults who live alone
will have an increased risk for depression when there is a lack of support in the home.
The review of literature correlated socioeconomic status significantly to an increased risk
of depression among elderly adults. Educational attainment and income seem to be
significant factors that help to further establish and support the correlation of the
independent and dependent variables. Additionally, when ethnicity was considered,
elderly minorities were more at risk for depression than their counterparts in the
19
literature. Thus, indicating the significance culture plays to the prevalence and treatment
of depression among the elderly population. The literature review on depression and
gender among elderly adults correlates females significantly more to be at risk for
depression. Other gender difference where found, but in regard to the different
symptomatology that the elderly adults might experience. This study will further
explore the reviewed contributing factors and examine how they correlate to depression
among the elderly population.
20
CHAPTER 3
Methodology
This chapter discusses the research methodology used for this thesis. This section
describes the research design, sampling methods, instrumentation, data collection, and
data analysis of research design used. This study utilized secondary data to examine the
contributing factors influencing depression among the elderly population.
Research Design
The UCLA 2011-2012 California Health Interview Survey (CHIS 2011-2012),
Adult Data File was used for this thesis project. The CHIS 2011-2012 is a population-
based random-digit dial telephone survey of the population in California. The CHIS has
been conducted every other year since 2001. The UCLA Center for Health Policy
Research (UCLA-CHPR), in conjunction with the Department of Health Care Services,
First 5 California and the California Department of Public Health, The California
Endowment, Kaiser Permanente, and the National Cancer Institute worked
collaboratively to conduct CHIS. CHIS gathered comprehensive information for all age
groups in the areas of health status, health conditions, health related behaviors, health
insurance coverage, access to health care services, and other issues related to health.
Sampling
The sample from CHIS 2011-2012 was designed to provide estimates of the
overall population in California and, for the majority of counties and groups of counties
with small populations. It was also designed to provide estimates of larger racial and
ethnic groups, including smaller ethnic subgroups as well. CHIS utilized a multi-stage
sample design in order to achieve their objectives. The state of California was dived into
21
56 geographic sampling strata which included 41 single-county strata, three multi-county
strata and 2 counties with sub-county strata. The Random-digit-dial (RDD) sample was
utilized to choose phone numbers of California residents. In the sample, 80 percent of
phone numbers were from landlines and 20 percent were cellular service phone numbers.
Within each household selected, one adult (18 years and older) was randomly chosen.
Households with adolescents (12-17 years old) and children under the age of 12, allowed
for one adolescent and one child to be randomly selected. For adolescents, interviews
were conducted directly, but for children, the parent who was more knowledgeable of the
child, completed the interview. Cellular service could not be stratified at geographically
by counties like landlines could and therefore cellular RDD was stratified into 28 strata
using 7 CHIS regions and telephone area codes. If the cellular number randomly selected
was shared by two or more adults, only one adult completed the interview. Cellular
numbers belonging to individuals under 18 years of age were excluded.
Data Collection
A private company that specializes in statistical research and large-scale sample
surveys known as Westat, conducted the CHIS 2011-2012 data collection. Westat
conducted data collection under a contact with the UCLA Center for Health Policy
Research. All interviews were administered using Westats computer-assisted telephone
interviewing (CATI) system. In order to maximize participation and cooperation from
California population, an advance letter in five languages was mailed to all landline
sampled phone numbers of which an address could be obtained from reverse directory
services. Along with the advance letter, a $2 bill was attached to encourage cooperation.
In order to ensure diversity through data collection, interviews were conducted in
22
English, Spanish, Chinese (Mandarin and Cantonese dialects), Vietnamese, and Korean.
These languages were chosen based on the 2000 Census data which identified the largest
ethnic groups in California. On average, adult interviews took about 38.5 minutes to
complete, child and adolescent interviews took about 14.5 minutes and 21.5 minutes.
Interviews conducted in languages other than English were completed in a longer time
frame. An estimate of 7 percent of all adolescent interviews and 28 percent of all child
and 15 percent of adult interviews were conducted in languages other than English.
Within each sampled household, one randomly selected adult was interviewed, one
sampled adolescent and one child if the sampled adult was present and was the parent or
legal guardian of child. Overall, a possible of three interviews could have been
conducted per household. After all follow-up attempts were conducted to complete the
full questionnaire, adults who completed at least 80 percent of the questionnaire were
considered as completed. Overall, a total of 42,935 adults, 7,334 children and 2,799
adolescents were part of the CHIS 2011-2012 sample size.
Instrumentation
The variables used in this study were adopted from the CHIS 2011-2012 Adult
Survey Public Use File. The independent variables were specific to general health
condition, living arrangements, socioeconomic status, and general-demographic
variables. Socioeconomic status data included educational attainment, and poverty level.
General demographic variable data included age, ethnicity and self-reported gender.
The main dependent variable, psychological well-being was measured by the
following questions: feeling nervous, feeling hopeless, feeling restless, feeling depressed,
23
feeling everything an effort, and feeling worthless. Table 2 and 3 present independent
and dependent variables for the current study.
In order to conduct further data analysis, gender was recoded as to male (=0) and
female (=1). Ethnicity was regrouped and recoded as to (0) Latino, (1) Asian, (2) White,
(3) African American, and (4) Other. For socioeconomic status variables, educational
attainment was originally collected with 11 levels and recoded into four groups of (0)
Less Than High School, (1) High School Diploma, (2) Some College, and (3) College
and Above. Poverty levels was computed into federal poverty levels by annual income
and number of household size that were supported by annual income with four levels of
(1) 0-99% FPL, (2) 100-199% FPL, (3) 200-299% FPL, and (4) 300% FPL. Living
arrangement was measured on whether the elderly adult was currently living with a
spouse in the same household (1) yes or (2) no. General health condition was measured
by asking in general, how the elderly adult would rate their health condition from
excellent (=1), very good (=2), good (=3), fair (=4) or poor (=5). For data analysis, it was
reverse coded from poor (=0) to excellent (4).
Finally, depression was measured by the Kessler 6-item Psychological Distress
Scale with the following questions in the past 30 days: feeling nervous, feeling hopeless,
feeling restless, feeling depressed, feeling everything is effort, and feeling worthless. All
six items were reverse coded so that the greater the frequency of symptoms, the higher
the score. A value of four is assigned to answers equaling all of the time. A value of
zero is assigned to not at all answers. A score of 24 is the highest score available for
severe psychological distress. Elderly adults with a cumulative score of thirteen or more
is determined to have experienced psychological distress in the past thirty days. The
24
operational definitions, the re-coded variables and the details of the variables used are
provided (see Table 2 and Table 3).
Table 2
Independent Variables
________________________________________________________________________
Variable Level of Measurement Variable Information
Age Ratio 65 and older
Ethnicity (Recoded) Nominal (0) Latino, (1) Asian, (2) African American,
(3) White, (4) Other
Gender (recoded) Dichotomous Self-Reported (0) Male, (1) Female
Poverty Level Ordinal Was your total annual household income before taxes
less than or more than ${POVRT50}?
(1)0-99% FPL, (2)100-199% FPL, (3)200-299% FPL,

(4)300% FPL and Above
Educational Attainment Ordinal What is the highest grade of education you have
(recoded) completed and received credit for?
(0)Less Than High School, (1)High School Diploma,

(2)Some College, (3) College and Above
Living Arrangements
Nominal Spouse living in the same household?
(recoded)
(1).Yes, (0) No
General Health Ordinal In general, would you say your health is excellent, very
Condition (recoded) good, good, fair or poor?"
(4) Excellent, (3) Very Good, (2) Good, (1) Fair,

(0) Poor
________________________________________________________________________
25
Table 3
Dependent Variables
PSYCHOLOGICAL DISTRESS
Composite Score
(Interval)
Feeling Nervous
Ratio (recode) (0)Not At All, (1)A Little of the Time, (2)Some of the Time,
(3)Most of the Time, (4)All of the Time
Feeling Hopeless
Feeling Restless
Feeling Depressed
Feeling Everything An Effort

Feeling Worthless
Data Analysis
The Statistical Package for Social Sciences (SPSS) version 20.0 was utilized to
analyze the data in this study. Bivariate and multivariate analyses were completed to
analyze independent, and dependent variables including sample frequencies, means,
standard deviations and percentages. Bivariate analysis were utilized to examine
statistical associations between independent and dependent variables. Multivariate
26
analysis was used to examine which independent variables were predictors of
psychological distress.
Limitations and Strengths of Research Design
This study was limited to only the available variables in the dataset, and so the use
of secondary data did not allow for as much flexibility as primary data because questions
were extracted from an existing questionnaire of a previous study. The purpose of this
study was to examine 65 and older adults perceptions of their own psychological well-
being. Therefore, further limitations of this study may include the presence of
subjectivity since data was collected directly from elderly adults in regard to their
psychological distress. Their own perceptions might be significantly different from
clinical depression diagnosed by mental health professionals based on DSM-IV. Further
research is suggested to compare these perceptions to objective data.
There were also significant strengths of the research design in this study. Data
was collected from a large-scale survey of randomly chosen elderly adults 65 and older
throughout the state of California. Therefore, the results of this study can be generalized
to all elderly adults 65 and older in California. In addition, the original study had already
been approved by the Institutional Review Board and other data previously collected.
The use of secondary data for this study resulted in cost and time effective benefits.
27
CHAPTER 4
Results
This chapter displays the results of the statistical analysis of data obtained from
the CHIS (2011-2012). Using univariate, bivariate, and multivariate data analyses,
general health condition, living arrangements, and socioeconomic status were examined
as contributing factors influencing depression in the elderly population.
Demographic Characteristics
Table 4 shows the sociodemographic characteristics of elderly adults 65 and
older. The variables examined for sociodemographic characteristics are age, gender and
ethnicity. There was a total of 2,867 participants in this study. The average age of the
sample was 74.69 years with a standard deviation of 6.622. The minimum age for the
sample was 65 years and the maximum age was 85 years. With respect to gender, 1,138
(39.7%) of the participants were male, while 1729 (60.3%) of participants were female.
In regards to ethnicity, 5.8% (n =165) were Latino, 8.6% (n = 247) were Asian, 76.5% (n
= 2192) were White, 3.8% (n = 109) were African Americans, and 5.46% (n = 154) were
classified as others.
28
Table 4
Demographic Characteristics of Elderly Adults 65 and Older
Variable Total N Mean SD Min Max N (%)

Age N=2867 74.69 6.622 65 85
Gender
Male N=2867 1138(39.7%)
Female 1729 (60.3%)
Ethnicity
Latino N=2867 165 (5.8%)
Asian 247 (8.6%)
White 2192 (76.5%)
African American 109 (3.8%)
Other 154 (5.4%)
Living Arrangements
Table 5 displays living arrangements of participating elderly adults who
responded to this question. Participants were asked if their spouse lives in the same
household, 96.7% (n = 1301) responded Yes while 3.3% (n = 45) answered No.
Table 5
Living Arrangements of Elderly Adults 65 and Older
Variable Total N N (%)
Spouse lives in same household
Yes N=1346 1301 (96.7%)

NNNN=1346
No 45 (3.3%)
Socioeconomic Status
Table 6 shows the socioeconomic status (SES) of elderly adults 65 and older. The
variables examined for SES were poverty level and educational attainment. With respect
to poverty level, 10.7% (n=307) reported living in the lowest level of poverty (0-99%
29
FPL), 20.7% (n=594) reported living in the 100-199% FPL range, 17.2% (n=492)
reported living in the 200-299% FPL range, and 51.4% (1474) reported living at the
300% FPL or above. To reduce the selection of educational attainment, values were
recoded for this study. Of the participants, 45.0% (n = 1,291) reported having a college
degree and above while 21.3% (n = 610) attended some college, 22.4% (n =642) had a
high school diploma, and 11.3% (n = 324) had education less than high school.
Table 6
Socioeconomic status of Elderly Adults 65 and Older
Poverty Level
0-99% FPL 307 (10.7%)
100-199% FPL N=2867 594 (20.7%)
200-299% FPL 492 (17.2%)
300% FPL and Above 1474 (51.4%)
Educational Attainment
Less Than High School 324 (11.3%)
High School Diploma N=2867 642 (22.4%)
Some College 610 (21.3%)
College and Above 1291 (45.0%)
General Health Condition
As displayed in Table 7, general health condition was self-reported by elderly
adult participants 65 and older. Among the elderly participants, 15.0% (n=430) reported
being in poor health, 30.0% (n=860) reported being in fair health, 29.0% (n=831)
reported being in good health, 17.0% (n=486) reported being in very good health, and
9.1% (n=260) reported being in excellent health when asked to self-rate their general
health condition.
30
Table 7
General Health Condition of Elderly Adults 65 and Older
General Health Condition N=2867

Poor 430 (15.0%)
Fair 860 (30.0%)
Good 831 (29.0%)
Very Good 486 (17.0%)
Excellent 260 (9.1%)
Depression among Elderly Adults 65 and Older
Table 8 provides a summary of results from a 6 question distress scale utilized to
measure depression expressed by the respondents. Respondents were ask the following 6
questions: feeling nervous in the past 30 days, feeling hopeless in the past 30 days,
feeling restless in the past 30 days, feeling depressed in the past 30 days, feeling that
everything is an effort in the past 30 days, and feeling worthless in the past 30 days.
Possible responses for the 6 items were: all of the time, most of the time, some of
the time, a little of the time, and not at all. When asked about feeling nervous in the past
30 days, 1.6% (n=44) reported feeling nervous all of the time, 2.4% (n=67) reported
feeling nervous most of the time, 13.0% (n=367) reported feeling nervous some of the
time, 29.2% (n=821) reported feeling nervous a little of the time, and more than half of
the respondents 53.9% (n=1517) reported feeling nervous not at all. More than half of
the respondents 83.3% (n=2346) reported feeling hopeless not at all, 9.2% (n=259)
reported feeling hopeless a little of the time, 6.0% (n=168) reported feeling hopeless
some of the time, 1.0% (n=28) reported feeling hopeless most of the time, and .5%
(n=15) reported feeling hopeless all of the time. In reference to feeling restless in the
past 30 days, 1.60% (n=45) reported all the time, 1.5% (n=42) reported feeling restless
31
most of the time, 11.7% (n=329) reported feeling restless some of the time, 23.5%
(n=662) reported feeling restless a little of the time, and 61.7% (1738) reported feeling
restless not at all. The majority of respondents 87.0% (n=2449) reported feeling
depressed not at all, 6.8% (n=191) reported feeling depressed a little of the time, 4.3%
(n=121) reported feeling depressed some of the time, 1.1% (n=32) reported feeling
depressed most of the time, and .8% (n=23) reported feeling depressed all of the time.
When asked about feeling everything is an effort in the past 30 days, 2.7% (n=77)
reported feeling everything is an effort all of the time, 2.9% (82) reported feeling
everything is an effort most of the time, 10.9% (n=306) reported feeling everything is
an effort some of the time, 16.8% (n=474) reported feeling everything is an effort little
of the time, and 66.7% (1877) reported feeling everything is an effort not at all. Lastly,
majority of respondents 88.9% (n=2503) reported feeling worthless not at all, 5.4%
(n=153) reported feeling worthless a little of the time, 3.7% (104) reported feeling
worthless some of the time, 1.2% (n=33) reported feeling worthless most of the time,
and .8% (n=23) reported feeling worthless all of the time.
32
Table 8
Depression among Elderly Adults 65 and Older
Total
Variable N (%) Mean SD Min. Max.
N
Depression Composite Score N=2816 2.52 3.418 0 24
Feel Nervous the Past 30 Days

All the Time 44 (1.6%)
Most of the Time 67 (2.4%)
Some of the Time N=2816 367 (13.0%)
A Little of the Time 821 (29.2%)
Not At All 1517 (53.9%)
Feel Hopeless the Past 30 Days

All the Time 15 (.5%)
Most of the Time N=2816 28 (1.0%)
Some of the Time 168 (6.0%)
Not At All 2346 (83.3)
Feel Restless the Past 30 Days

Not At All 1738 (61.7%)
Feel Depressed the Past 30 Days

Not At All 2449 (87.0%)
Feel Everything an Effort the Past

30 Days
Not At All 1877 (66.7%)
Feel Worthless the Past 30 Days

Not At All 2503 (88.9%)
33
Bivariate Analysis
Different bivariate analyses were used to understand the relationships between the
independent variables and the dependent variable. An independent sample t- tests was
conducted to examine the levels of depression by gender. The difference in the level of
depression between males and females was examined. The results are presented in Table
9. Results indicated that there is a statistically significant difference in depression
between male and female respondents in this sample. The average level of depression for
the female participants was 2.71 (SD = 3.458), while the average for the male
respondents was 2.24 (SD = 3.338). The level of depression for females was higher than
males with a statistical significance of (t = 3.554, df = 2814, p =.047).
Table 9
Depression by Gender (t-test)
Gender N Mean SD t df p
Male 1111 2.24 3.338 3.554 2814 .047
Female 1705 2.71 3.458
Table 10 presents the difference in the level of depression between elderly adults
who reported living with a spouse in the same household and those who reported their
spouse not living in the same household. Results indicated that there is not a statistically
significant difference in depression between the two groups (t = .255, df = 1313, p =
.217) in this sample. Therefore, the level of depression among elderly adults who do not
live in the same household as their spouse (M=2.07, SD= 2.654) were not significantly
34
lower when compared to elderly adults who do live with their spouse (M=2.19, SD=
3.038).
Table 10
Depression by Living Armaments (t-test)
Spouse lives in
same household N Mean SD t df p
Yes 1271 2.19 3.038 .255 1313 .217
No 44 2.07 2.654
Correlation analysis was performed to investigate a relationship between
depression and age, poverty level, and general health condition. Results are presented in
Table 11. Results indicated that there is not a significant relationship in the sample
between depression and age (r= -.033; p= .081) at the p<0.05. Additionally, though the
relationship is low, there is a significant negative correlation between depression and
poverty level (r = -.242; p = .000) at the p<0.001, indicating that the higher income older
adults earn the less they suffer from depression. A significant relationship was found
between depression and general health condition (r = -.374; p = .000) at the p<0.001,
suggesting that older adults who report a better general health condition suffer from
lower levels of depression.
35
Table 11
Correlation between Depression and Age; Poverty Level; General Health

Condition
Variable r p
Age -.033 .081
Poverty Level -.242 .000
General Health Condition -.374 .000
One-way ANOVA tests were conducted to examine the bivariate relationship
between depression and the variables of ethnicity and educational attainment among
elderly adults. As indicated in Table 12, there is a significant group difference in the
level of depression (F = 17.171, df = 2815, p = 0.000) between the different ethnicities.
A Post Hoc test was used to determine differences within this independent variable. The
test revealed that Latino had a significantly higher level of depression (M = 4.14, SD =
5.113), than Asian (M = 2.75, SD = 4.154, p=.002), White (M = 2.28, SD = 3.009,
p=.000), and African American (M = 2.81, SD = 3.373, p=.043).
36
Table 12
Depression by Ethnicity (one-way ANOVA)
Depression N Mean SD F df p
Latino 162 4.14 5.113 17.171 2815 .000
Asian 246 2.75 4.154
White 2148 2.28 3.009
African
American 107 2.81 3.373
Other 153 3.71 4.456
Significance level: p<.05
The results of the analyses are presented in Table 13, which indicate that the
difference in education and level of depression is statistically significant (F = 42.357, df
= 2815, p = 0.00). A Post Hoc test was used to determine differences in this independent
variable. Elderly participants with less than high school (M = 4.47, SD = 5.168) had a
significantly higher depression level when compared to participants with a high school
degree (M = 2.56, SD = 3.395, p=.000), participants with some college education (M =
2.33, SD = 3.024, p=.000), and participants with an education of college and above (M =
2.12, SD = 2.857, p=.000).
37
Table 13
Depression by Educational Attainment (one-way ANOVA)
Depression N Mean SD F df p
Less than
High School 315 4.47 5.168 42.357 2815 .000
High School 627 2.56 3.395
Some College 597 2.33 3.024
College and
Above 1277 2.12 2.857
Significance level: * p<.05; ** p<.01; *** p<.001
Multivariate Analysis
A multiple regression analysis of independent variables was conducted to
determine the degree of how demographics (age, gender and ethnicity), socioeconomic
status (poverty level and educational attainment), living arrangements (spouse lives in the
same household), and general health condition are predictors of depression among the
elderly. As indicated in Table 14, results showed that the regression model was
statistically significant (F = 13.610, df =1314, p = 0.00). The model summary coefficient
showed that approximately 10.3% (R2 =.103) of the variation in the dependent variable
(depression) is explained by the overall model. Variables such as age ( = -.06, p =
.025), gender ( = -.081, p = .002), general health condition ( = -.274, p = .000), Asian
( = -.128, p = .004), and educational attainment [high school ( = -.153 p = .001), some
college ( = -.161, p = .000), college and above ( = -.164, p = .003)] are significant
predictors of depression among elderly participants when all the other independent
variables are held constant. The results suggest that being male, higher income, higher in
38
general health condition, higher levels of educational attainment, and being Asians
decrease the levels of depression.
Table 14
Linear Multiple Regression of Depression with Age, Gender, Latino, Asian,

African American, White, Poverty Level, High School Degree, Some College,
College and Above, Living Arrangements, and General Health Condition
Predictor
Variables B p
Age -.030 -.060 .025
Gender -.509 -.081 .002
Latino -.906 -.071 .084
Asian -1.343 -.128 .004
African American -1.174 -.056 .078
White -.497 -.067 .220
Poverty Level -.132 -.040 .210
High School Degree -1.225 -.153 .001
Some College -1.282 -.161 .000
College and Above -1.026 -.164 .003
Living Arrangments -.206 -.012 .654
General Health Condition -.753 -.274 .000
Model Summary: R2 = .103, F(12, 1314) = 13.610, p = .000
39
CHAPTER 5
Discussion
This research sought to identify factors that contribute to depression among the
elderly population. The purpose of this study was to examine the relationship general
health condition, living arrangements, socioeconomic status (independent variables), and
depression (dependent variable) among elderly adults. This chapter discusses the
significance of the findings, recommendations for future research and implications for
social work practice.
Significance of the Findings
The results of the data analysis indicated that general health condition,
socioeconomic status (educational attainment and poverty), ethnicity, and gender were
statically significant factors for depression among elderly adult as hypothesized. The
results from this study showed that elderly participants who reported a poor general
health condition (self-rated health) had higher levels of depression, and elderly adults
who reported an excellent general health condition had lower levels of depression. The
significant finding in regard to general health condition are consistent with existing
studies, Pu, et al. (2013) found that elderly adults with higher depressive symptoms
reported a poorer general health condition when compared to those who reported having
an excellent general health condition. Such findings suggesting that an improvement in
general health condition will decrease the level of depressive symptoms experienced by
elderly adults.
Socioeconomic status was also explored in the study using the variables of
educational attainment and poverty level. In the current study it was found that both
40
educational attainment and poverty level were significant predictors of depression among
elderly adults. Additionally, elderly participants with a low poverty level and less than a
high school degree were also found to be statistically and significantly correlated with
higher levels of depression in the current study. This studys findings parallel those in
the literature, which indicated an increased risk of depressive symptoms for elderly adults
with a socioeconomic disadvantage. One study found that elderly adults with a low SES
had two times a higher incidence rate for depression, which predicted more depressive
symptoms when compared to a person with high SES (Koster et al. 2006). The current
studys significant findings support the hypothesis in regard to SES and suggest that
either a higher or lower SES could significantly impact both the incidence and level of
depression among the elderly population.
Another factor that was explored in the study was ethnicity. Specifically the
study intended to further research the significance of elderly depression in relation to
ethnic minorities. It was found that among the different ethnicities, elderly Latinos had
higher levels of depression and, Whites were associated to lower levels of depression
when compared to all other ethnic minorities in this study. Furthermore, results indicate
that ethnicity was significantly associated a as predictor of depression among elderly
adults. The current studys findings are consistent with the literature as another study
also found among their sample of participants that Hispanics elderly adults experience
higher levels of depression than other ethnic groups (Akincigil et al., 2012). The
correlations between ethnicity and depression are significant, which contributes to the
emerging literature that seeks to further examine the associations of the two variables,
specifically when looking at ethnic minorities and their counterparts.
41
Studies have suggested that living arrangement such as living alone are an
influence on the risk of depression among the elderly population. A study by Fukunaga
et al. (2012) found that living alone in its self was significantly associated to depression
among elderly adults. The findings on living arrangements did not support the hypothesis
of this study. Results also did not consist with the existing literature on living
arrangements and depression among elderly adults. One research study found that living
alone increased the prevalence of depressive symptoms among elderly adults (Lin &
Wang, 2011). Results suggest that the inconstancy between this studys findings on
living arrangements and depression among elderly adults is due to a significantly low
number of elderly participants reporting that they live alone. Additionally, there was a
significant number of missing cases in the data analysis which also limited the results for
this studys hypothesis.
Gender and depression among the elderly population has been explore throughout
multiple studies and it has been suggested that elderly women experience higher
depressive symptoms than elderly men (Kockler and Heun, 2002). The current study
provides support for existing literature that has found gender to be significantly
associated with the risk of depression among elderly adults. The results of this study
indicated that there is a statistically significant difference in depression between female
and male elderly respondents in the sample. As hypothesized, female elderly adults were
found to have higher levels of depression than males in the study. Furthermore,
Katsumata et al. (2005) found in their study that female elderly adults are significantly
associated to a higher prevalence of depressive symptoms as well as being at risk for
more depressive symptoms than elderly males. Findings from both the current study and
42
existing literature suggest that females for the most part will always out number males in
regard to the different correlations between depression and gender.
Implications for Social Work
This study found that there is a significant relationship between general health
condition, socioeconomic status, ethnicity, and gender, and depression among elderly
adult participants. The most statistically significant relationship was between general
health condition and depression among elderly adults. This suggests that there is a
correlation between the perceptions of health and depression among the elderly
population. This study also highlights the importance of continuing the dialogue and
cooperation between the medical and mental health field to further explore the
significance of the findings for the elderly population.
It is imperative that social workers, medical and mental health professionals
develop strategies to respond to psychological issues as they tend to physical health
concerns. Existing literature has shown that the elderly population is expected to
encounter increased vulnerability to illnesses and, therefore, to be more prone to suffering
from depression. An increased risk of health issues among the elderly speaks to the
importance of implementing additional programs or services that target the elderly
population. The implementation and use of a screening tool by physicians to assess the
level of general health condition among elderly patients would be of significant benefit
for his population. Additionally, establishing programs that focus on increasing levels of
self-rated health, as well as programs targeting the female elderly (given the findings
correlate depression more to females) are of the uttermost importance for this population.
Raising levels of self-rated health will not only address the increasing levels of
43
depression issues among the elderly, but also carry the potential to address depression
and other mental health issues across various cultures and aging populations. It is also
important that all medical professionals and social workers are knowledgeable and
culturally competent on elderly minorities and the risk of depression among the different
groups. They should particularly be experienced with Latino, African American and
Asian elderly adults perceived health and the stigma associated with depression when
working with these different ethnic groups.
Additionally, addressing the outcomes of socioeconomic status (educational
attainment and poverty) and its implications for depression among the elderly population
is critically important. The concept and implementation of lifelong learning among the
elderly population could be beneficial in many ways. An increase in classes or programs
seeking to promote educational levels among elderly adults within impoverished
communities, could prove to be highly beneficial. When lifelong learning is practiced by
the elderly population, individuals are more aware and prepared with knowledge that may
benefit their overall well-being. The creation of such classes or programs within
impoverished communities also carries the potential for promoting changes within these
communities, which are populated primarily by ethnic minorities. Moreover, such
stimulating activities could serve to assist the development of strong, motivational elderly
role models, who may have the ability to influence younger aging populations to be more
aware of their psychological well-being as they age. Through initiatives like these, social
workers and elderly adults can both decrease the stigma associated with depression and
the treatment of depression among the elderly population.
44
Lastly, it is important for social workers to advocate for policies that can
influence the production of such services that will assist in addressing mental health
issues such as depression among the elderly population. The impactions for social work
on this subject lie not only on the micro level, but on the macro level as policy is directly
associated with the initiatives that will address the issue of mental illness among the
elderly population.
Recommendations for Future Research
The existing literature in regard to mental health of elderly adults 65 and older is
very limited. Specifically, studies on the contributing factors influencing depression
among the elderly population are also limited. The present study, although limited on
sample size, sampling methods, and representation of population, has made an important
contribution to understanding some of the factors that lead to depression among elderly
adults. It is recommended that future studies should focus on the following areas:
1. Future research should continue to explore the correlation that ethnic elderly
minorities have to the risks depression.
2. Future studies should also examine the relationship of physical illnesses and
disabilities that may contribute to general health condition and depression
3. Further research should explore how different forms socioeconomic
disadvantage correlate to depression among elderly adults.
4. It is also critical for studies to continue to explore living arrangements among
the elderly population and, the relationship between depression and elderly
adults who live alone.
45
Conclusion
The findings in this study highlighted some of the unique factors that are likely to
contribute to both the incidence and level of depression experienced among the elderly
population. Specific factors that were found to have a statistically significant relationship
with depression among elderly adults include general health condition, socioeconomic
status, ethnicity, and gender. Limitations in this study suggest living arrangements
among elderly adults in regard to depression should continue to be explored.
Understanding contributing factors of depression among the elderly population is
essential for the development and utilization of best practices and long-term interventions
for this specific mental illness.
46
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GENERAL HEALTH CONDITION, LIVING ARRANGEMENTS,

AND SOCIOECONOMIC STATUS AS CONTRIBUTING

FACTORS OF DEPRESSION AMONG THE

The Faculty of the School of Social Work

California State University, Los Angeles

of the Requirements for the Degree

Master of Social Work

All rights reserved

INFORMATION TO ALL USERS

All rights reserved.

ALL RIGHTS RESERVED

Sei-Young Lee, Ph.D., Committee Chair

Nikola Alenkin, Ph.D., LCSW

Siyon Rhee, Ph.D., School Director

California State University, Los Angeles

General Health Condition, Living Arrangements, and Socioeconomic Status as

Contributing Factors of Depression Among the Elderly Population

condition, living arrangements, socioeconomic status, and depression among elderly

there is a significant relationship between general health condition, socioeconomic status,

and contribute knowledge of significant contributing factors correlated to depression

among the elderly population.

I would like to thank my family for being very supportive of my education.

grateful to have all of you in my life as I continue following my career goals.

undergraduate and graduate education on this campus.

Lastly, I would like to express my sincere gratitude and admiration to my thesis

List of Tables ................................................................................................................... viii

Statement of the Problem ...................................................................................2

Scope of the Problem .........................................................................................3

Purpose of Study ................................................................................................5

Variable and Operational Definitions ................................................................7

Theoretical Framework ......................................................................................7

Review Process ................................................................................................10

General Health Condition and Depression ......................................................10

Living Arrangements and Depression .............................................................12

Socioeconomic Status and Depression ............................................................13

Ethnicity and Depression .................................................................................16

Gender and Depression ....................................................................................17

Data Collection ................................................................................................22

Data Analysis ...................................................................................................26

Limitations and Strength of Research Design .................................................27

Demographic Characteristics ...........................................................................28

Living Arrangements .......................................................................................29

Socioeconomic Status ......................................................................................29

General Health Condition ................................................................................30

Depression among Elderly Adults 65 and Older .............................................31

Bivariate Analysis ............................................................................................34

Multivariate Analysis .......................................................................................38

Significance of the Findings ............................................................................40

Implications for Social Work ...........................................................................43

Recommendations for Future Research ...........................................................45

1. Independent & Dependent Variables .......................................................................7

2. Independent Variables ...........................................................................................25

3. Dependent Variables ..............................................................................................26

4. Demographic Characteristics of Elderly Adults 65 and Older ..............................29

5. Living Arrangements of Elderly Adults 65 and Older...........................................29

6. Socioeconomic Status of Elderly Adults 65 and Older .........................................30

7. General Health Condition of Elderly Adults 65 and Older....................................31

8. Depression among Elderly Adults 65 and Older ...................................................33

9. Depression by Gender (t-test) ................................................................................34

10. Depression by Living Armaments (t-test)..............................................................35

12. Depression by Ethnicity (one-way ANOVA) ........................................................37

13. Depression by Educational Attainment (one-way ANOVA).................................38

reach the age of 65 in the past few years.