Family Relationships and Depressive Symptoms Among Chinese Older Immigrants in the United States

Abstract

Background
Given the growth in the number of older Chinese immigrants in the United States and the importance of family support in Chinese culture, this study examines how supportive and negative relationships with family members (children and spouse) influence depressive symptom severity among this population.

Methods
Using data from the Population Study of Chinese Elderly in Chicago, we carried out multivariate negative binomial regression analysis using a sample of 3,159 Chinese older immigrants. Depressive symptom severity was measured using the Patient Health Questionnaire. Intergenerational and marital relationships were characterized using self-reported measures of two supportive features (confiding and aiding) and two negative features (demanding and criticizing).

Results
Confiding and aiding relationships with children (incident rate ratio [IRR] = .70, confidence interval [CI]: 0.57, 0.85; IRR = .70, CI: 0.56, 0.88, respectively) and spouses (IRR = .61, CI:0.47, 0.79; IRR = .66, CI: 0.52, 0.83, respectively) were significantly associated with lower depressive symptom severity among the older Chinese immigrants sampled. Demanding (IRR = 1.39, CI: 1.16, 1.68) and criticizing (IRR = 1.37, CI: 1.17, 1.60) intergenerational relationships significantly predicted higher depressive symptom severity, and spousal criticism (IRR = 1.41, CI: 1.24, 1.59) was related to higher depressive symptom severity. Aiding relationships with children appears to be more important for older women than men (IRR = .69, CI: 0.47, 1.01).

Conclusions
The findings reveal the importance of both positive and negative interactions with spouses and children in shaping mental well-being among older Chinese immigrants. Future geriatric practice and research should consider both supportive and negative features in examining and addressing interpersonal relationships and mental health.

Full text

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cite as: J Gerontol A Biol Sci Med Sci, 2017, Vol. 72, No. S1, S113–S118
doi:10.1093/gerona/glw138
PINE STUDY II: Research Article
Family Relationships and Depressive Symptoms Among
Chinese Older Immigrants in the UnitedStates
JinyuLiu,1 XinQiDong,2 DuyNguyen,3 and Daniel W.L.Lai4
1School of Social Work, Columbia University, New York. 2Department of Internal Medicine, Rush Medical College, Chicago, Illinois. 3School
of Social Work, Temple University, Philadelphia, Pennsylvania. 4Department of Applied Social Sciences, The Hong Kong Polytechnic
University, China.
Address correspondence to Jinyu Liu, PhD, School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027. E-mail:
jl4658@columbia.edu
Received January 20, 2016; Accepted July 6, 2016
Decision Editor: Stephen Kritchevsky, PhD
Abstract
Background: Given the growth in the number of older Chinese immigrants in the United States and the importance of family support in
Chinese culture, this study examines how supportive and negative relationships with family members (children and spouse) inuence depressive
symptom severity among this population.
Methods: Using data from the Population Study of Chinese Elderly in Chicago, we carried out multivariate negative binomial regression
analysis using a sample of 3,159 Chinese older immigrants. Depressive symptom severity was measured using the Patient Health Questionnaire.
Intergenerational and marital relationships were characterized using self-reported measures of two supportive features (conding and aiding)
and two negative features (demanding and criticizing).
Results: Conding and aiding relationships with children (incident rate ratio [IRR]=.70, condence interval [CI]: 0.57, 0.85; IRR=.70,
CI: 0.56, 0.88, respectively) and spouses (IRR=.61, CI:0.47, 0.79; IRR=.66, CI: 0.52, 0.83, respectively) were signicantly associated with
lower depressive symptom severity among the older Chinese immigrants sampled. Demanding (IRR= 1.39, CI: 1.16, 1.68) and criticizing
(IRR=1.37, CI: 1.17, 1.60) intergenerational relationships signicantly predicted higher depressive symptom severity, and spousal criticism
(IRR = 1.41, CI: 1.24, 1.59) was related to higher depressive symptom severity. Aiding relationships with children appears to be more
important for older women than men (IRR=.69, CI: 0.47, 1.01).
Conclusions: The ndings reveal the importance of both positive and negative interactions with spouses and children in shaping mental
well-being among older Chinese immigrants. Future geriatric practice and research should consider both supportive and negative features in
examining and addressing interpersonal relationships and mental health.
Keywords: Conict—Intergenerational relationship—Marital relationship—Older adult—Support
Depression signicantly lowers quality of life among older adults
(1). Despite growing awareness of depression in older Americans,
little is known about the prevalence and factors contributing to this
mental disorder among older ethnocultural minority adults (2). The
population of Chinese immigrants aged 65years and older in the
United States, estimated at 277,000 in 2010, is the fourth largest
group of older immigrants, following those from Mexico, Cuba, and
the Philippines (3). The number is expected to grow in the coming
years as the Chinese immigrant population in the United States rises.
These older adults face a range of mental health challenges associ-
ated with their immigrant status, and, as with the general older adult
population, depression is a common psychological disorder among
older Chinese immigrants (4,5). Prior studies suggest that depressive
symptoms result from multiple stressors related to aging and immi-
grant experiences, such as physical health problems, migratory grief,
language barriers, acculturation stress, and lack of familial support
(5–7).
Family is an important source of social support for most of the
older adults (8). Few studies, however, have focused on the specic
effects of positive and negative family interactions on depression in
older Chinese immigrants in the United States. Gender roles, though
often examined in depression studies in mainstream populations,
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have seldom been investigated in the context of family interactions.
To address these gaps in the literature, this study explores the asso-
ciations between family relationships and depression among Chinese
immigrants aged 60years and older and explores how gender shapes
these associations.
Family Relationships and Depression Among Older
Chinese Immigrants
Socioemotional selectivity theory postulates that older persons are
motivated to engage in interpersonal relationships that optimize
short-term goals of emotional fulllment. They actively select emo-
tionally “close” social partners instead of individuals who are less
intimate (7,9). For most of the older adults, relationships with family
members and friends are their primary social network (10). Studies
have shown that family support is more important in preventing
depression and loneliness for Chinese older adults than for American
older adults in general because lial piety, the core of Chinese fam-
ily culture, emphasizes the importance of family support for elders,
particularly from children (11,12).
Family relationships can also involve negative interactions, which
affect the mental well-being of older Chinese immigrants, although
few studies have explored this issue (13). Research has shown that
negative interpersonal interactions can aggravate life stress, depres-
sion, and loneliness (14). The literature also indicates that such nega-
tive interactions could have a more potent impact on individuals’
well-being than the positive aspects of social relationships (15).
For older immigrants, family members including adult children
and spouses are crucial sources of support. Acculturation challenges,
such as limited English language prociency and transportation con-
straints, restrict older immigrants’ opportunities for developing social
networks in their host countries and often lead to dependence on adult
children (16). Studies have consistently shown the strong positive
association between emotional and instrumental support from chil-
dren and mental well-being among older Chinese immigrants (7,12).
However, cultural traditions of lial piety that emphasize respect
and unconditional support for Chinese elders may be weakened in
immigrant families due to migration-related stressors and exposure to
Western cultures that value individual independence (6,17). The accul-
turation gap between generations may generate conict in relation-
ships between older immigrants and their children (18,19). However,
few studies have explored how negative intergenerational interactions
inuence depressive symptoms among older immigrants (20).
Marital relationships also signicantly inuence older adults’
well-being (21). Studies suggest that being married and marital sat-
isfaction benet older adults’ physical and mental health but that
marital dissatisfaction and dysfunction have harmful impacts in the
general American older population (22,23). Among older Chinese
adults, being married has been signicantly related to decreased
depression (24,25). However, no major studies have explored how
supportive and negative spousal interactions inuence older Chinese
immigrants’ well-being.
Gender and Depression
Prior research has found evidence that gender may affect the prev-
alence of depressive symptoms and perceptions of family support
among older Chinese adults. Several studies have found depressive
symptoms to be more prevalent among older women in China, older
Chinese American women, and older Chinese Canadian women,
compared with male cohorts (26–30). These gender differences have
been attributed to traditional patriarchal gender norms. Women are
expected to be subordinate to men and therefore have lower status in
family and society, which results in women’s educational, economic,
and health care disadvantages and greater dependence on spouses
and children. One study reported that older Chinese immigrant
women perceive higher levels of support from family and friends,
whereas older men reported more strain in marital relationships
(e.g., spousal demands or criticism) (31). However, it is not clear
how different types of family relationships inuence depression in
older Chinese women and men.
The PresentStudy
Building on socioemotional selectivity theory (9) and prior litera-
ture on interpersonal relationships and mental health among older
adults, this study examines four questions: (a) To what extent are
supportive and negative intergenerational relationships associated
with depressive symptoms in older Chinese immigrants? (b) To
what extent does the association between intergenerational rela-
tionships and depressive symptoms vary by gender in older Chinese
immigrants? (c) To what extent are supportive and negative mari-
tal relationships associated with depressive symptoms in married
older Chinese immigrants? (d) To what extent does the association
between marital relationships and depressive symptoms vary by gen-
der in married older Chinese immigrants?
Methods
Data and Measures
This study analyzed data from the Population Study of Chinese
Elderly in Chicago, a community-engaged, population-based epide-
miological study. The analytical sample includes 3,159 older Chinese
adults aged 60years and older, self-identied as Chinese, and lived
in the Greater Chicago area of the United States in 2012–2013 (32).
The dependent variable, depressive symptoms, was meas-
ured using the Patient Health Questionnaire (PHQ-9), which
assesses symptoms associated with major depressive disorder (33).
Respondents rated nine depressive symptoms in the past 2 weeks on
a 4-point scale ranging from 0 (not at all) to 3 (nearly every day),
with total scores ranging from 0 to 27 and higher scores indicat-
ing higher depressive symptom severity (Cronbach’s α=0.81). The
PHQ-9 has been validated for use with Chinese Americans (34).
The Population Study of Chinese Elderly assessed family rela-
tionships using measures of two supportive features, conding and
aiding, and two negative features, demanding and criticizing, in mar-
ital and intergenerational relationships. To measure conding and
aiding support from a spouse, respondents rated the extent to which
they opened up to and relied on their spouse along a 3-point scale
ranging from 1 (hardly ever) to 3 (often). Respondents also reported
how often they felt that demands or criticism from their spouse was
too much. Because of the highly skewed distribution, demanding and
criticizing were coded as dichotomous variables (1= sometimes or
often). Using similar measures and coding strategies, four variables
were constructed for respondents’ relationship with other family
members including children and grandchildren (conding, aiding,
demanding, and criticizing).
Analysis controlled for respondents’ sociodemographic charac-
teristics, including gender (1=female), age (in years), marital status
(1 = married), annual income (1=less than $5,000, 2= $5,000–
$9,999, 3= more than $9,999), length of U.S. residency (1 = less
than 5years, 2 =5–10 years, 3=more than 10 years), and health
status, which was based on number of reported chronic conditions,
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mobility (assessed by 3-item Rosow-Breslau Index of Mobility Scale
(35)) and a short physical performance battery (36).
Analysis
Due to the expected skewed distribution of the dependent vari-
able, multivariate negative binomial regression analysis was used
to predict incident rate ratios for depressive symptom severity in
SAS Version 9.2. To address the rst research question, associations
between family relationships and depressive symptom severity were
examined for the whole sample. Supportive and negative intergener-
ational relationships were each tested (Models 1 and 2), followed by
a model (Model 3)including the four intergenerational relationship
variables (conding, aiding, demanding, and criticizing) was tested.
To answer the second research question, four interaction terms
between four intergenerational variables and gender (conding by
gender, aiding by gender, demanding by gender, and criticizing by
gender) were tested separately and a signicant interaction term was
reported (Model 4). Using the same modeling, associations between
marital relationships and depressive symptom severity and the inter-
actions between marital relationships and gender were tested for
married respondents to address the third and fourth research ques-
tions (Models 5 to 7). All models control for sociodemographic char-
acteristics and health status. The small percentage of missing values
(6.7%) was addressed by listwise deletion in each model.
Results
Table1 reports the sample characteristics for this study. The average
score of depressive symptom severity was 2.64 (ranging from 0 to
27). About half of respondents reported frequent (“often”) conding
relationships, and 60% reported supportive (“aiding”) relationships
with their children. Only about 6% reported demanding relation-
ships, and 11% reported criticizing relationships with their children.
Almost 70% of respondents reported frequently conding in and/or
receiving aid from their spouse, and 85% reported rarely feeling that
their spouse was demanding. However, over 30% of respondents
reported sometimes or often being criticized by their spouse.
Table 2 reports the results of multivariate negative binomial
regression analysis of associations between intergenerational
relationships and depressive symptom severity among study par-
ticipants. Model 1 indicates that conding and aiding intergenera-
tional relationships (“sometimes” or “often”) are associated with
lower depressive symptom severity. The odds of developing depres-
sive symptoms in older adults who sometimes (incident rate ratio
[IRR]=0.77, condence interval [CI]= 0.64–0.93, p = 0.007) or
often (IRR = 0.70, CI= 0.57–0.85, p=.001) perceived a cond-
ing relationship with their children were 0.23 or 0.30 lower than
for those who rarely perceived a conding relationship with their
children. Sometimes (IRR=0.75, CI=0.60–0.94, p=.011) or often
(IRR= 0.70, CI=0.56–0.88, p=.003) feeling aiding relationships
with children were associated with 0.25 or 0.30 lower odds of
developing depressive symptoms. Model 2 shows that demanding
(IRR=1.39, CI=1.16–1.68, p=.0004) and criticizing (IRR=1.37,
CI=1.17–1.60, p < .0001) intergenerational relationships are asso-
ciated with higher depressive symptom severity. These results hold
in Model 3, which combines all four intergenerational relationship
variables. Of all the interaction terms for intergenerational relation-
ships and gender tested, only the female variable for aiding relation-
ships with children is marginally signicant in predicting depressive
symptom severity. Model 4 (Table2) shows that frequent (“often”)
aiding intergenerational relationships has a stronger effect on
depressive symptom severity among women than men in the sample
(IRR=0.69, CI=0.47–1.01, p=.055).
Table3 shows a similar analysis of associations between marital
relationships and depressive symptom severity. Model 5 indicates
that sometimes or often perceiving conding marital relationships
are associated with lower depressive symptom severity (IRR=0.73,
CI=0.55–0.96, p=.022; IRR=0.61, CI=0.47–0.79, p=.0002) and
that frequent (“often”) aiding relationships predicted lower depres-
sive symptom severity (IRR = 0.66, CI = 0.52–0.83, p = .0004).
Model 6 shows that spousal criticism (“sometimes” or “often”) was
associated with higher depressive symptom severity (IRR = 1.41,
CI = 1.24–1.59, p < .0001). Demanding marital relationships are
marginally related to depressive symptom severity in Model 6
(p=.082), but signicance disappears when tested with marital sup-
port variables in Model 7.None of the interaction terms for marital
Table1. Sample Characteristics
% Mean SD
Dependent variable
Depressive symptom severity
(range: 0–27)
2.64 4.12
Sociodemographic characteristics
Age (y, range: 60–105) 72.81 8.30
Female 57.95
Married 71.02
Education (y) 8.72 5.05
Annual income: less than $5000 33.31
$5,000–$9,999 51.76
$10,000 14.93
Length of residency: Less than 5 y 8.86
5–10 y 14.64
More than 10 y 76.49
Health status
Mobility (range: 0–3)a0.72 1.05
Short physical performance battery
(range: 0–20)a
10.34 3.26
Chronic condition 1.42 1.12
Characteristics of relationship with other family members
Conding: hardly ever 14.44
Sometimes 34.88
Often 50.68
Aiding: hardly ever 9.86
Sometimes 29.73
Often 60.41
Demanding: hardly ever 93.83
Sometimes or often 6.17
Criticizing: Hardly ever 88.57
Sometimes or often 11.43
Characteristics of relationship with spouse
Conding: hardly ever 10.12
Sometimes 20.25
Often 69.63
Aiding: hardly ever 12.40
Sometimes 19.16
Often 68.44
Demanding: hardly ever 85.81
Sometimes or often 14.19
Criticizing: hardly ever 68.96
Sometimes or often 31.04
Notes: N=3,159.
aHigher scores indicate poorer mobility or physical performance.
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relationships and gender was signicant in predicting depressive
symptom severity in older Chinese immigrants.
Discussion
This study sheds light on the importance of both supportive and
negative family relationships for the mental well-being among older
Chinese immigrants. The ndings suggest that aiding relationships
with children were more important for women than men. This study
builds on socioemotional selectivity theory (9) by providing evidence
of the signicant association between family relationships and well-
being among older Chinese immigrants. Further, this study extends
the knowledge base about older adults’ experience of international
migration by depicting a nuanced picture of the interactions between
positive and negative intergenerational and spousal interactions, cul-
ture of origin, and genderroles.
In this study, both positive and negative interactions with
children shaped depression among Chinese older immigrants.
Intergenerational support helped older Chinese immigrants cope
with practical barriers and emotional stress resulting from interna-
tional migration and thus benet their mental well-being. On the
other hand, negative and conict-prone relationships with children
may trigger stress in older immigrants as well as loneliness, anxiety,
and sadness, which could aggravate depressive symptoms (20). More
research is needed to examine the effects of positive and negative
relationships with children on depression among older Chinese and
other ethnocultural immigrants.
This study suggests that having a supportive partner helps older
immigrants cope with stressors related to aging and migration but
that a conictual spousal relationship could trigger postmigration
distress. Husbands and wives may have different attitudes toward
and coping strategies for dealing with challenges and stressors in
the new environment, which may cause conict and criticism in the
marital relationship. Interestingly, demanding spousal relationships
were not related to depressive symptom severity among the older
Chinese immigrants in this study. Qualitative data would be needed
to further examine how certain features of marital relationships
inuence mental well-being among the older Chinese immigrant
women andmen.
It is interesting to nd that aiding relationships with children are
more important to mental well-being for older female Chinese immi-
grants than for their male counterparts. Using the same data, Simon
Table2. Negative Binomial Regression Testing the Associations Between Intergenerational Relationships and Depressive Symptom Sever-
ity Among Older Chinese Immigrants
Model 1 (n=2,949) Model 2 (n=2,947) Model 3 (n=2,946) Model 4 (n=2,946)
IRR (CI) IRR (CI) IRR (CI) IRR (CI)
Sociodemographic characteristics
Female 1.17 (1.04, 1.33)* 1.13 (1.00, 1.27)†1.19 (1.05, 1.34)** 1.58 (1.11, 2.24)**
Age 0.99 (0.98, 1.00)†0.99 (0.98, 1.00)* 0.99 (0.98, 1.00)†0.99 (0.98, 1.00)*
Married 0.99 (0.86, 1.14) 0.92 (0.81, 1.06) 0.98 (0.85, 1.12) 0.97 (0.85, 1.11)
Education 1.01 (1.00, 1.02)* 1.01 (1.00, 1.02)* 1.01 (1.00, 1.02)†1.01 (1.00, 1.02)†
Incomea
$5,000–$9,999 0.86 (0.75, 0.98)* 0.90 (0.78, 1.03) 0.87 (0.76, 1.00)* 0.87 (0.76, 1.00)*
$10,000 0.76 (0.64, 0.91)** 0.79 (0.66, 0.95)* 0.77 (0.64, 0.92)** 0.77 (0.64, 0.92)**
Length of residencyb
5–10 y 1.01 (0.79, 1.29) 1.11 (0.87, 1.41) 1.06 (0.83, 1.34) 1.07 (0.84, 1.35)
More than 10 y 0.95 (0.77, 1.18) 1.01 (0.81, 1.25) 0.96 (0.77, 1.19) 0.97 (0.78, 1.19)
Health status
Mobility 1.10 (1.03, 1.19)** 1.11 (1.03, 1.19)** 1.10 (1.02, 1.18)** 1.10 (1.02, 1.19)**
Short physical performance battery 1.13 (1.11, 1.15)*** 1.13 (1.11, 1.16)*** 1.13 (1.11, 1.15)*** 1.13 (1.11, 1.15)***
Chronic condition 1.06 (1.01, 1.12)* 1.06 (1.01, 1.12)* 1.07 (1.01, 1.12)* 1.07 (1.01, 1.12)*
Intergenerational relationship
Condingc
Sometimes 0.77 (0.64, 0.93)** 0.78 (0.65, 0.94)* 0.78 (0.65, 0.94)**
Often 0.70 (0.57, 0.85) *** 0.72 (0.59, 0.88)** 0.72 (0.59, 0.87)***
Aidingc
Sometimes 0.75 (0.60,0.94) * 0.76 (0.61,0.95) * 0.86 (0.63,1.17)
Often 0.70 (0.56,0.88) ** 0.70 (0.56,0.88) ** 0.86 (0.64,1.17)
Demandingc
Sometimes or often 1.39 (1.16, 1.68)*** 1.43 (1.19, 1.71)*** 1.43 (1.19, 1.72)***
Criticizingc
Sometimes or often 1.37 (1.17, 1.60)*** 1.32 (1.13, 1.55)*** 1.31 (1.12, 1.54)***
Signicant interactions terms
Sex × Aiding relationship with children
Female × Sometimes 0.79 (0.53, 1.18)
Female × Often 0.69 (0.47, 1.01)†
Notes: PE=parameter estimate; SE=standard error; IRR=incident rate ratio; CI=95% condence interval.
aReference group is less than $5,000.
bReference group is less than 5years.
cReference group is hardly ever.
†p < .10. *p < .05. **p < .01. ***p < .001.
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and colleagues (31) previously reported that older female Chinese
immigrants perceived higher levels of social support, including more
support from their children. According to cultural norms of lial
piety and patriarchy, older Chinese women are expected to play car-
egiver roles for children and older parents, whereas men serve as
breadwinners. Women’s lifelong involvement in caring may help to
build close relationships with family members and generate more
support in later life. This investment in family relationships may also
make women more likely to value relationships with their children
and expect their support in later life. However, the marginal sig-
nicance of interaction between gender and perceptions of aiding
relationships with children indicates the need to repeat the analyses
with more representative samples.
Limitations
Three primary limitations to this study should be noted. First,
the use of cross-sectional data limits the ability to make causal
inferences. Second, the data in this study focused on older Chinese
immigrants in a single geographical area (Chicago), and the nd-
ings may not be fully applicable to other locations. Third, family
relationships are measured with limited indicators, and the four
characteristics (aiding, conding, demanding, and criticizing) may
not fully capture the variation in relationships in Chinese immi-
grant families. There might be a socially desirable response bias
with reluctance to report negative relationships in Chinese older
adults. The skewed distribution of negative family relationships
may reect the true nature of the construct that only a small pro-
portion of Chinese American families reported negative interac-
tions. Chinese elders may actively minimize negative interactions
as they seek to preserve family harmony, a traditional value in
Chinese culture. Future research should consider other features of
positive and negative family relationships, such as marital satis-
faction and intergenerational cultural conict, to further examine
associations between family relationships and mental well-being in
older Chinese immigrants.
Research and Practice Implications
Future research on mental well-being among older immigrant popu-
lations should consider both supportive and destructive dimensions
of interpersonal relationships in a broader social network, such as
positive and negative interactions with friends, neighbors, and even
health and social service professionals. To more fully explain how
marital relationships inuence mental well-being in older Chinese
immigrants, researchers may need to consider spousal closeness and
conict in the context of postmigration adjustment to life in the host
country. Future studies should also explore lial expectations and
lifelong gender roles to further explain mechanisms of social support
and well-being for older Chinese immigrants, particularly women,
as well as changes in these mechanisms stemming from immigration
and integration experiences.
Table3. Results of Negative Binomial Regression Testing the Associations Between Marital Relationships and Depressive Symptom Sever-
ity Among Married Older Chinese Immigrants in the United States
Model 5 (n=2,113) Model 6 (n=2,117) Model 7 (n=2,112)
IRR (CI) IRR (CI) IRR (CI)
Sociodemographic characteristics
Female 1.19 (1.04, 1.37)* 1.30 (1.13, 1.49)*** 1.26 (1.09, 1.44)***
Age 1.00 (0.99, 1.01) 1.00 (0.99, 1.01) 1.00 (0.99, 1.01)
Education 1.02 (1.00, 1.03) * 1.01 (0.99, 1.02) 1.01 (1.00, 1.02)
Incomea
$5,000–$9,999 0.83 (0.71, 0.98)* 0.89 (0.76, 1.04) 0.86 (0.74, 1.01)
$10,000 0.77 (0.63, 0.94) * 0.75 (0.61, 0.92)** 0.76 (0.62, 0.93)**
Length of residencyb
5–10 y 0.91 (0.70, 1.18) 0.99 (0.76, 1.28) 0.91 (0.70, 1.19)
More than 10 y 0.85 (0.67, 1.07) 0.94 (0.74, 1.19) 0.85 (0.67, 1.07)
Health status
Mobility 1.06 (0.97, 1.16) 1.07 (0.97, 1.17) 1.06 (0.97, 1.16)
Short physical performance battery 1.15 (1.12, 1.18) *** 1.14 (1.11, 1.18) *** 1.14 (1.11, 1.17)***
Chronic condition 1.06 (1.00, 1.13)†1.06 (1.00, 1.14)†1.07 (1.01, 1.14)*
Marital relationship
Condingc
Sometimes 0.73 (0.55,0.96)* 0.75 (0.57, 0.98)*
Often 0.61 (0.47,0.79)*** 0.67 (0.52, 0.86)**
Aidingc
Sometimes 0.85 (0.66, 1.10) 0.85 (0.66, 1.09)
Often 0.66 (0.52, 0.83)*** 0.65 (0.51, 0.82)***
Demandingc
Sometimes or often 1.15 (0.98, 1.35)†1.11 (0.95, 1.30)
Criticizingc
Sometimes or often 1.41 (1.24, 1.59)*** 1.37 (1.21, 1.55)***
Notes: PE=parameter estimate; SE=standard error; IRR=incident rate ratio; CI=95% condence interval.
aReference group is less than $5,000.
bReference group is less than 5years.
cReference group is hardly ever.
†p < .10. *p < .05. **p < .01. ***p < .001.
Journals of Gerontology: MEDICAL SCIENCES, 2017, Vol. 72, No. S1 S 117
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The ndings of this study could guide health and social service
professionals working with older Chinese immigrants. In addition
to assessing depressive symptoms, evaluation of positive and nega-
tive familial interactions could help geriatric and mental health
professionals diagnose patients and develop effective treatment
plans for depressed older Chinese immigrants. Psychologists and
counselors working with older Chinese immigrants with depres-
sion should consider involving family members in discussions of
relationships with older patients and how relationships could be
improved. To prevent depression from become more severe, prac-
titioners working with older Chinese immigrant clients could
expand treatment strategies to include educational programs
and interventions for improving marital and intergenerational
relationships.
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