Abstract
The present study aims to investigate, amongst all proposed determinants for depression, the perceived physical health status and perceived filial piety as two key determinants of depression amongst the Chinese eldery people in Hong Kong. The study would try, in using depression as a dependent variable and perceived physical health status and filial piety as independent variables, to acertain to what extend the control process model could explain the occurrence of depression amongst these elders. In order to establish these, an instrument for measuring depression was validated first, then the validated measurement was used in conjunctions with other scales measuring physical health status and filial piety to establish the validity of the proposed control process model. The choice of a globally used instrument (i.e. the Geriatric Depression Scale GDS originally validated in the United States) instead of a locally developed or a culturally relevant measurement was guided by the belief, which was justified by an extensive review on current literature, that there is little difference in the nature and origin of the depression amongst the elderly population across cultures. All elderly suffering from depression would express similar symptoms. The results from validating the translated version (Chinese from English) were good. A total of 461 respondents attending ten government-maintained psychiatric out-patients clinics were interviewed over a period between January 1992 to February 1993. General reliability reached a high .89 (alpha), concurrent reliability with Centre for Epidemiological Studies - Depression (CES-D) Scale was a good .96 (alpha), and the test-retest reliability with a community sample (40) was .85 over a two weeks span. Validity with psychiatrist's diagnosis as a criterion was good (.95 ). However, in establishing the cut-off scores for the scale it was found that the false positives and false negatives were too high for the scale to be used as a diagnostic measure. The GDS was therefore good for measuring depressive symptoms, but not a good diagnostic instrument. Maintaining the same theoretical stance as before, the study took that sociological and psychological factors which may lead to depression in old age in the West would equally exert the same influence on the Chinese elderly in Hong Kong. However, given that many elderly in the same adverse social or psychological conditions, not every one of them would become depressed, it requires an alternative explanation for this finer variations. The present study has proposed a control process model to explain such happenings. The control process model explains how depression could be a result of the discrepancy between the elder's expectation and reality, and his/her failure to combat the situation. Finer concepts were made in the study to cover four dimensions of the discrepancy: the discrepancy itself, the prolongation of the discrepancy, the elderly's sensitivity towards the discrepancy, and the elderly's specificity in confronting the discrepancy. Physical health and filial piety were proposed as two key factors, amongst the others, for determining depression amongst the Chinese elderly in Hong Kong. Hence these two determinants were quantified into different scales and subscales (dimensions) for establishing the control process. The results of the second study have provided evidence to confirm the control process model. It was found that the depression amongst the elderly could be determined by the discrepancy between what the elderly expected and what they actually felt to have experienced in relation to physical health and filial care (sum for the two factors by multiple R square = 1205, signF=.000). It was further established, as predicted by the control process model, that prolongation of bad health was more a determinant than discrepancy in filial piety, as indicated by their respective values in multiple R square: for prolongation of bad health .0869, signF=.000; for discrepancy in filial piety .0669, signF=.000. Such results would fit into the control process model that the elderly people in Hong Kong get depression via a process where the elderly's bad health was felt to last for a long time; and the elderly's concern for filial care was still evident. This coincides with the earlier assertion, as proposed by the model, that though filial care has changed its forms as well as has been loosing its importance in Chinese society, there is still stronger influence amongst the Chinese elderly when compared to their Western counterparts. Similarly physical ailments were felt as more of a concern than bad filial care amongst the Chinese elderly people.