The Journal of Psychology Interdisciplinary and Applied
ISSN: 0022-3980 (Print) 1940-1019 (Online) Journal homepage: http://www.tandfonline.com/loi/vjrl20
Ethnicity, Social Support, and Depression Among Elderly Chilean People Lorena P. Gallardo-Peralta, Esteban Sánchez-Moreno, Ana Barrón López De Roda & Andrés Arias Astray To cite this article: Lorena P. Gallardo-Peralta, Esteban Sánchez-Moreno, Ana Barrón López De Roda & Andrés Arias Astray (2015) Ethnicity, Social Support, and Depression Among Elderly Chilean People, The Journal of Psychology, 149:6, 601-629, DOI: 10.1080/00223980.2014.946462 To link to this article: http://dx.doi.org/10.1080/00223980.2014.946462
Published online: 30 Aug 2014.
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Ethnicity, Social Support, and Depression Among Elderly Chilean People LORENA P. GALLARDO-PERALTA University of Tarapac´a ´ ESTEBAN SANCHEZ-MORENO ´ LOPEZ ´ ANA BARRON DE RODA ´ ARIAS ASTRAY ANDRES Complutense University of Madrid
ABSTRACT. Recent evidence regarding the relationship between social support and depression in elderly people shows the important role of ethnicity. This research describes the characteristics of social support in a sample of elderly people aged 60 and above living in northern Chile (n = 493), and analyzes the differences in the relationship between social support and depression between an indigenous group (Aymara population, n = 147) and a nonindigenous group (white, Caucasian, mestizo, n = 346). Various dimensions of social support were considered: structural elements, functional social support according to source, and community participation. The results show the existence of significant differences in the characteristics and dimensions of social support depending on sex, ethnicity, and marital status. Further, the central role of the family group is observed for both Aymara and nonindigenous elderly people. The hierarchical regression models obtained result in notable differences in the role of the structural, functional, and community elements of support in explaining depression for the ethnic groups considered. Keywords: depression, elderly people, ethnicity, indigenous groups, social support
DECADES OF RESEARCH HAVE DEMONSTRATED the existence of a complex relationship between social support and depression in elderly people (Altintas, Gallouj, & Guerrien, 2012; Antonucci, Lansford, & Akiyama, 2001; Vanderhorst & McLaren, 2005). An increasing amount of research considers this complexity within the contextual framework of ethnicity (Chappell & Funk, 2011). Ethnic identity and different culturally associated values influence the consideration of
Address correspondence to Lorena P. Gallardo-Peralta, 18 de Septiembre 222, Arica, Chile; [email protected] (e-mail). 601
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relationships of support and mutual exchange, especially in the family environment (Tomaka, Thompson, & Palacios, 2006), affecting the experience and consequences of social isolation and loneliness (Fokkema, de Jong, & Dykstra, 2012). Ethnicity thus constitutes a fundamental element in accounting for the relationship between social support and the well-being of elderly people. Practically all published research concerns the particular characteristics of ethnic minorities formed as a consequence of migratory processes. The available empirical evidence hence focuses on the relationships between social support and psychological deterioration for ethnic groups placed in social contexts outside their social and cultural origins. This article concerns the relationships between ethnicity, social support, and depression, with a distinctive feature. Following the suggestion of Berkman, Glass, Brissette, and Seeman (2000), our research seeks to analyze the aforementioned processes in a specific area of a country (the two groups considered in this study live in their natural social and geographical environments), and for clearly defined and differentiated ethnic groups. Specifically, our study analyzes the association existing between different dimensions of social support and depression in the Arica-Parinacota region (Chile), comparing relationship patterns between elderly people of Aymara ethnicity (indigenous) and nonindigenous elderly people. This latter group comprises the sum of various nonnative groups, principally including Caucasians, whites, and mestizos, descendants of European immigrants and the Creole population. On the other hand, the Aymara are one of the native ethnic groups in the country; to be precise, the second largest. Though a native ethnic group, the Aymara do not live in isolation from the general population. They share language (all speak Spanish as a vehicular language, but make equal use of the Aymara language) and a broad range of social and economic activities particular to the region in which they are resident. For example, a significant part of the Aymara population identify themselves as Catholic and their daily activities involve systematic interaction with the non-Aymara population. Yet, importantly for this study, cultural aspects that characterize and distinguish the group do exist. Among others, the family-centered nature of their community (the family being part of the community) and their highly religious and ritualistic characteristics stand out. In this regard, their social links are based around reciprocity toward the community, with the nuclear and extended family developing this process of social exchange. It is important to emphasize that the fundamental actor in community life is not the individual but the family, which is also the lead protagonist in economic terms. The ethnic group in question is thus strongly collectivist, its intensity constituting a fundamental difference with respect to the nonindigenous population. This intense collectivism reduces the importance of the individual as a social actor in the context of the community. Our study contemplates two research aims. First, to describe the characteristics and dimensions of social support for elderly people resident in northern Chile, analyzing the ethnic differences. The dimensions of support considered in
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this study are as follows: structural elements of the support network (size and frequency of contact), satisfaction with relationships established within the context of said network, functional (emotional, instrumental, informational–guidance) social support (perceived) according to source (partner, children, other family, and friends), and participation in community activities likely to generate integration and support (elderly people’s clubs, religion, and participation in indigenous associations). The literature in this area emphasizes the role played by family networks in the case of elderly people (Antonucci, Birditt, Sherman, & Trinh, 2011), a repeated finding in studies undertaken in Chile (Herrera, Barros, & Fern´andez, 2011). Consequently, it is expected that the fundamental source of support for elderly people will be the partner. In situations where the partner is absent—typically due to death—the remaining family sources are expected to occupy this leading role (Seeman & Berkman, 1988) in the provision of social support to elderly people. Furthermore, various studies suggest the existence of gender-dependent differences in social support provision from the different available sources (Scott & Wenger, 1995). In comparison with men, women are thus expected to perceive less partner support and report lower levels of satisfaction with that support, and to perceive more support from children and other family members. The second aim consists of comparing the group of associations existing between the different dimensions of social support considered in our study and scores for depression for the two ethnic groups under consideration. The empirical evidence suggests that the impact on depression of structural dimensions of support, such as size of network and frequency of contact, is determined by how elderly people appraise such interaction and by the levels of satisfaction with the links established (Antonucci & Akiyama, 1987; Moos, Brennan, Schutte, & Moos, 2010). Similarly, the empirical record demonstrates the great importance of functional aspects of support as protective factors against psychological distress, in general, and depression, in particular. In this regard, ample research shows that functional aspects have a greater impact on depression than structural factors (Antonucci, Fuhrer, & Dartigues, 1997; Murrell, Norris, & Chipley, 1992; Robitaille, Orpana, & McIntosh, 2012). Functional support perceived by elderly people will have different effects on depression, with differing intensities, depending on the source of support. S. Cohen and McKay (1984) indicated in their classic matching model that not all sources would have the same effectiveness when buffering stress, emphasizing the role of similar others. It is reasonable to argue that support from diverse sources is related with elderly people exhibiting a lower incidence of depressive symptoms (Dean, Kolody, & Wood, 1990), particularly bearing in mind the importance of processes of substitution of significant sources for advanced ages. These processes would increase the protective role of available networks that are not exclusively family-oriented (Fiori, Antonucci, & Cortina, 2006). Yet, these results may not be capable of generalization across all cultural contexts, instead varying depending on the ethnic groups considered (Antonucci et al., 2011).
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The same argument is applicable to the potential influence of integration and community participation on the mental health of elderly people (Bukov, Maas, & Lampert, 2002; Mackean & Abbott-Chapman, 2012). The empirical evidence shows that religion-based community participation tends to reduce levels of depression (Alvarado, Temper, Bresler, & Thomas-Dobson, 1995; Yoon, 2008). Integration and community participation are particularly susceptible to being influenced and delineated by cultural content specific to ethnic groups. As previously indicated, the very idea of community is contextually and culturally constructed, meaning that community environments with a potential impact on measurements of depression will vary in significance and intensity among different ethnic groups. In the context of this study, the findings of Herrera et al. (2011) suggest that support from family sources is pivotal to psychological wellbeing for elderly people in Chile. However, previous research concerning the specificity of indigenous ethnic groups not being available, it is difficult to formulate a hypothesis. Given Aymara cultural characteristics, one may expect the principal differences in the relationship between social support and depression to arise in measures of functional support according to source. A negative association with the depression measure for functional support emanating from partner, children, and friends is expected for nonindigenous participants, with the hypothesis that such association will be significantly less intense for the latter source. In the case of Aymara (indigenous) participants, it is expected that a negative association will be found exclusively for support from partner and children, and not from other family or friends. As regards community integration, participation in religion-based community activities is expected to be more intensely associated with depression scores for nonindigenous persons than for Aymara, for whom a stronger association is expected with participation in indigenous clubs. This matching hypothesis links the type of community participation with the defining cultural characteristics of each ethnic group. Differences are not expected with respect to the role played by structural dimensions. For both nonindigenous and Aymara participants, a significant association between network size or contact frequency and symptoms of depression is not anticipated. In contrast, satisfaction with social relationships is expected to be the dimension that plays a significant role. Again, to specify differences according to ethnic group, satisfaction according to source is taken into consideration, with a significant effect for satisfaction with partner, child and—to a lesser degree—friend interaction anticipated for the nonindigenous population. For the Aymara population, a significant association is only expected for satisfaction with partner and child relationships. Method Participants and Procedure The sample was composed of 493 elderly Chilean people resident in the Arica-Parinacota region, in northern Chile. The minimum age for participation
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in the study was 60 years at the time of completing the questionnaire. To ensure that the questionnaire reflected the characteristics of the population and met the aims of the study, different socio-demographic and community participation variables were considered, ensuring a minimum number in each analysis category with significance for the aims of the study. In this regard, 147 people were Aymara Chileans and 346 were nonindigenous Chileans. Of the people included in the sample, 86% were between 60 and 79 years of age (average age of 71.45 years; range 60–92). Women comprised 67% of the sample and 51% had basic educational qualifications. The sample included people resident in urban areas (86%) and in rural areas in the foothill valleys and highland areas of the Andes. Participants of Aymara ethnicity, originating from the Andes territory of Chile, comprised 30% of the sample. Table 1 offers detailed information, differentiating ethnic groups and showing sample distribution according to age, gender, educational level, marital status, and family structure. The participants’ characteristics are an accurate reflection of the demographic and social composition of elderly people aged 60 and above in the Arica-Parinacota region. The questionnaire was administered through personal interviews, having first obtained the informed consent of participants. The fundamental difficulty consisted of the need to ensure that the sample was sufficient to compare the Aymara population with the nonindigenous one, including participants resident in the highland areas of the Andes. To overcome this problem, contact was made with the governmental institution for elderly people (Servicio Nacional de Adultos Mayores), which assisted in the administration of the questionnaires, providing information on the composition of the population and the principal groups of elderly people in the region. Further, the administration of the questionnaire in rural and highland areas involved serious difficulties, such as accessing settlements (due to the lack of asphalt roads) and the existence of limited hours of public and domestic electricity in certain locations (hence, having limited time to administer the questionnaire). In the specific case of highland locations, the interviewer could face additional difficulties in physical terms (due to geographical altitude) and in terms of the cultural tendency to mistrust outsiders, it being essential to obtain the support of a social agent from the area. For these reasons, key social agents (in elderly people’s clubs, parishes and municipalities) were contacted in rural and highland areas. The questionnaire was administered in four different locations (Arica, Putre, Socoroma, and Codpa), thereby ensuring that the sample reflected the ethnic and socio-demographic composition of the area. The questionnaire was administered through personal interview in every case. Five interviewers participated in the study, all recent graduates of the Department of Philosophy and Psychology at the University of Tarapac´a (Arica, Chile). To reduce the interviewer variability effect on information gathering, all interviewers underwent a training program with two fundamental aims: ensuring the interviewers had the skills and knowledge to correctly carry out interviews, and providing sufficient information on the general aims of the study. This involved specific training on the research questionnaire. A maximum of five interviews per day
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TABLE 1. Participants’ Social and Demographic Characteristics
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Total Aymara (indigenous) Non-indigenous (n = 493) n (%) (n = 147) n (%) (n = 346) n (%) Age 60–69 207(42%) 70–79 216(43.8%) 80–89 63(12.8%) 90 + 7(1.4%) Mean age (SD) 71.45(6.47) Gender Women 330(66.9%) Men 163(33.1%) Education Primary school 211(42.8%) incomplete Primary school 152(30.8%) High school 82(16.6%) Higher education 48(9.8%) Marital status Married 243(49.3%) Cohabiting 22(5.3%) Single 52(10.5%) Widow 119(24.2%) Divorced 53(10.7%) Family structure (current) One-person household 67(13.6%) Nuclear – with children 124(25.2%) Nuclear – no children 71(14.4%) Extended 192(39%) Others 39(7.8%) Ethnicity Aymara (indigenous) 147(30%) Non-indigenous 346(70%)
57(38.8%) 67(45.6%) 18(12.2%) 5(3.4%) 71.67(7.10)
150(43.4%) 149(43.1%) 45(13%) 2(0.5%) 71.35(6.19)
99(67.3%) 48(32.7%)
231(66.8%) 115(33.2%)
88(59.9%)
123(35.5%)
34(23.1%) 17(11.6%) 8(5.4%)
118(34.1%) 65(18.8%) 40(11.6%)
74(50.3%) 5(3.4%) 18(12.2%) 33(22.4%) 17(11.5%)
169(48.8%) 21(6.1%) 34(9.8%) 86(24.9%) 63(10.4%)
30(20.4%) 35(23.8%) 23(15.6%) 52(35.4%) 7(4.8%)
37(10.7%) 89(25.7%) 48(13.9%) 140(40.5%) 32(9.2%)
aimed to avoid possible work overload effects. Similarly, particular attention was paid to the design of the questionnaire with the aim of reducing misinterpretation of information by interviewers. The pilot study described below allowed the questionnaire to be refined such that the interviewers were provided with clear instructions and definitions for the application of the measurement instruments. Last, performances in the first interviews completed in rural and highland areas were monitored, given their particular features and difficulties (as previously described). All interviewers were properly remunerated for their work. Participants were contacted in one of two ways. When possible and desirable, the research
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team initiated direct contact and agreed a date for interview. Key social agents, such as municipal operational staff or the more important community leaders, initiated contact when greater difficulties were involved. In both cases the interviewer attended the agreed location for the interview, which took approximately 40 minutes to complete. Measures As the aims of this study require the collection and comparison of information on persons of Aymara ethnicity and nonindigenous persons (white, Caucasian, and mestizos), it was essential to ensure that all members of the sample clearly and consistently understood the content of the different measurement instruments. To that end, a pilot measure was taken from a group of 65 people (19 Aymara and 46 nonindigenous). None of the participants had difficulty understanding the different measures included in the questionnaire. Furthermore, the pilot study demonstrated the need to apply the measures described through structured personal interview, as well as to establish prior contact through social agents important within the social environment of the participant, as described. The participants in the pilot study were not included as part of the 493 participants of the study. Depression The Geriatric Depression Scale (GDS) of Brink et al. (1982) was used. The original version contains 30 questions, but our study used the abbreviated version, which includes 15 (e.g. “Have you dropped many of your activities and interests?”; “Do you think that most people are better off than you are?”). The abbreviated version retains the effectiveness of the original scale, improving ease of management. It registers the presence of 15 symptoms of depression, providing a resulting score varying from 0 to 15, is a widely used instrument to evaluate depression in elderly people, and has been translated and validated in various languages, including Spanish (Baker & Espino, 1997). A score of 5 or more suggests the existence of depression, this being the cut-off point with the best specificity/sensitivity relationship. Hoyl, Valenzuela, and Mar´ın (2000) have successfully used the scale for the Chilean population. The internal consistency index calculated on our data (Cronbach’s alpha) was 0.77. Social Support As stated in our analysis of previous research, the literature suggests the need to take into account both structural and functional dimensions of social support. This derives from the different meaning and impact of the structural and functional dimensions in measures of well-being found in previous research. As such, two measures of social support were used. The first was the Inventory of Social Resources for Elderly People (ISR) developed by D´ıaz Veiga (1987; see S´anchezMoreno & Barr´on, 2003). This instrument allows the measurement of structural
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aspects of social networks (size and frequency of contact) and satisfaction with relationships established within the framework of said networks, differentiated by source. It is important to emphasize that this instrument was specifically designed for the geriatric population, for which reason it is widely recommended in the literature regarding elderly people (Fern´andez-Ballesteros, 2000, 2002) and in general represents a widely validated instrument for the Spanish-speaking population (S´anchez-Moreno & Barr´on). Specifically, this questionnaire measured size of social network (number of members composing the significant network), frequency of weekly contact (number of significant interactions, e.g., “How many times a week do you see your friends?”) and satisfaction (e.g., “After seeing/talking to your children, do you generally feel satisfied with your relationship?,” on a Likerttype scale ranging from 0 to 5 as regards four sources of support, namely, partner, children, other family, and friends. In the latter case (satisfaction), the internal consistency index (Cronbach’s alpha) was 0.81. Second, the Perceived Social Support Questionnaire (PSSQ) (Gracia, Herrero, & Musitu, 2002) evaluated the functional dimensions of support (emotional, instrumental, and informational). The instrument comprised 12 items with questions on the source and level of social support perceived from partner, children, family, and friends. For each source, items were included to measure emotional support (e.g., “Could you freely express and share your emotions with this person?”), instrumental support (e.g., “If you were sick or needed to be taken to the doctor, would this person be of any help?”), and advisory support or guidance (e.g., “Would this person be of any help if you should have to make an important decision?”). The corresponding scale for each item ranged from 0 to 5, and the resulting sum (higher scores representing higher levels of social support provision) is standardized to a 0–30 range. The PSSQ is a widely used instrument in Spanish-speaking populations, having been validated in various contexts (residential, general, hospital) (Gracia & Herrero, 2004). This instrument provides separate scores for the different aforementioned sources of social support. Scores for the items corresponding to each source and representing the different types of support (emotional, instrumental, advisory) were combined to produce a composite functional support score for each source considered. The factorial analysis undertaken supported this strategy (χ 2 = 344.51; CMIN/DF = 2.778; AGFI = .905; RMSEA = .060, p = .14), allowing for the consideration of a total of four factors, namely partner functional support, children functional support, other family functional support, and friend functional support. The internal consistency index (Cronbach’s alpha) calculated on our data was 0.93. Community Participation This research used three variables reflecting the principal elements of community life in the population studied. First, the participants were asked about their participation in religious activities, given the importance of such participation in
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the social context under consideration. The resulting variable was coded 0 (absence of participation) and 1 (participation), thus constituting a dummy variable. To include an individual in the participation category, they not only had to regularly attend religious ceremonies (such as Sunday Mass), being also necessary an active participation in other types of religious activities or religious organizations’ community support activities (religious education, social volunteering, community development activities). Second, participation in elderly people’s clubs was considered as an indicator of community participation. Again, the result was a dummy variable, in which category 0 indicates absence of participation in this type of organization and category 1 indicates not only belonging to this type of organization but also systematic and regular (at least weekly) participation in club activities (participation in club meetings, leisure activities, excursions, neighborhood activities). Last, for Aymara participants, belonging to indigenous organizations was considered as an indicator of community participation. As with the previous variables, for an individual to be included in the participation category, systematic and regular (at least weekly) participation in activities organized by the entity was required (religious dances, local dances, workshops, and formal meetings). Results In Table 2 we report the means, standard deviations, and ranges for our study variables (depression, structural social support, satisfaction with social contacts, and perceived social support). We also include the distribution of variables relating to community participation (religious participation, participation in elderly people’s clubs, and participation in indigenous organizations). Furthermore, Table 3 and Table 4 contain the correlation matrix for scores for depression and variables related to social support, differentiating between the two ethnic groups considered in our study. Belonging to an Ethnic Group and Characteristics of Social Support To meet our first research aim, we analyzed the characteristics of social support among participants, taking into account the ethnic differences. Table 2 shows that belonging to the Aymara ethnic group is related to a larger size of support network, less partner support, and more support from children. Ethnic group is not related to significant differences in community participation. The role played by gender and marital status was explored specifically and separately for the two ethnic groups considered. Aymara women report higher scores than men for frequency of contact, t(145) = 2.619, p < .01—an association not found in the case of nonindigenous women. The latter receive less partner support, t(344) = 2.924, p < .01, and more support from friends, t(344) = 1.798, p < .05 than men, differences not found in the Aymara subsample. As regards marital status, in the Aymara subsample it was found that people without partner scored more highly for
4.80(2.47) 2.28(1.35) 12.29(3.01) 2.76(.58) 2.66(.70) 2.48(.66) 2.29(.51) 18.63(5.44) 13.23(8.04) 11.54(7.02) 9.76(3.06) Aymara (indigenous) Active participation (%) 59.2 53.1 29.3
2.80(.41) 2.58(.53) 2.56(.51)
21.22(6.21) 12.16(7.11) 11.34(6.70) 10.14(4.36) All participants Active participation (%) 59.8 50.7 –
Aymara (indigenous) Mean (SD)
4.24(2.10) 2.09(1.22) 12.19(3.26) 2.73(.51)
Note. PSS: Perceived Social Support; ∗ p < .05. ∗∗ p < .01.
Clubs for the elderly Religious community involvement Clubs for older indigenous adults
Depression Social network size Contact frequency (weekly) Satisfaction with partner contact Satisfaction with children contact Satisfaction with family contact Satisfaction with friends contact PSS – partner PSS – children PSS – family/relatives PSS – friends
All participants Mean (SD)
–
22.56(7.32) 11.70(6.66) 11.25(6.56) 10.30(4.03) Non-indigenous Active participation (%) 60.1 49.7
2.41(.78)
2.55(.60)
2.68(.71)
3.99(1.95) 2.01(1.15) 12.14(3.36) 2.68(.53)
Non-indigenous Mean (SD)
TABLE 2. Descriptive Statistics for Depression, Dimensions of Social Support, and Community Involvement
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0–5
.361
n 493 402
χ 2 value .037 .381
147
0–30 0–30 0–30 0–30
2.751∗∗ 1.907∗ .473 1.439
–
0–5
1.482
0–5
0–15 0–8 0–18 0–5
2.563∗∗ 2.257∗ .470 .007
1.180
Range
t value
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.015 .031 −.186∗∗ .027 −.010 .006 −.168∗∗ .026 −.032 .053
1
.048 −.002 −.085 .035 .092 .031 .536∗∗ .479∗∗ .219∗∗
2
3
.397∗∗ .287∗∗ .281∗∗ .380∗∗ .306∗∗ .113∗ −.074 −.108∗
Note. PSS: Perceived Social Support. ∗ < .05. ∗∗ p < .01.
1. Depression 2. Network size 3. Contact frequency 4. Satisfaction partner 5. Satisfaction children 6. Satisfaction family 7. Satisfaction friends 8. PSS – partner 9. PSS – children 10. PSS – family 11. PSS – friends
Variables
.226∗∗ −.006 .021 .518∗∗ −.129∗ −.231∗∗ −.164∗∗
4
.147∗∗ −.026 .207∗∗ .196∗∗ −.311∗∗ −.197∗∗
5
.219∗∗ −.008 .087 .099 −.026
6
.007 −.038 .070 .150∗∗
7
−.152∗∗ −.258∗∗ −.201∗∗
8
−.113∗ −.244∗∗
9
.122∗
10
TABLE 3. Pearson’s Correlation Coefficients Among Depression and Social Support Dimensions: Non-Indigenous Participants Only (n = 346)
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−.130 .024 .009 .024 −.069 .026 −.038 −.074 −.088 .114
1
−.054 −.039 −.008 −.052 .144 .010 .522∗∗ .475∗∗ .079
2
3
.452∗∗ .256∗∗ .284∗∗ .202∗ .330∗∗ .141 −.151 −.194∗
Note. PSS: Perceived Social Support. ∗ p < .05. ∗∗ p < .01.
1. Depression 2. Network size 3. Contact frequency 4. Satisfaction partner 5. Satisfaction children 6. Satisfaction family 7. Satisfaction friends 8. PSS – partner 9. PSS – children 10. PSS – family 11. PSS – friends
Variables
.240∗∗ .093 .022 .425∗∗ .015 −.226∗∗ −.208∗
4
.046 −.004 .201∗ .266∗∗ −.350∗∗ −.163∗∗
5
.081 .037 −.049 .179∗ −.092
6
.147 −.043 .057 .053
7
−.057 −.182∗ −.178∗
8
−.143 −.285∗∗
9
−.072
10
TABLE 4. Pearson’s Correlation Coefficients Among Depression and Social Support Dimensions: Aymara (Indigenous) Participants Only (n = 147)
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support from friends, t(145) = 2.661, p
ISSN: 0022-3980 (Print) 1940-1019 (Online) Journal homepage: http://www.tandfonline.com/loi/vjrl20
Ethnicity, Social Support, and Depression Among Elderly Chilean People Lorena P. Gallardo-Peralta, Esteban Sánchez-Moreno, Ana Barrón López De Roda & Andrés Arias Astray To cite this article: Lorena P. Gallardo-Peralta, Esteban Sánchez-Moreno, Ana Barrón López De Roda & Andrés Arias Astray (2015) Ethnicity, Social Support, and Depression Among Elderly Chilean People, The Journal of Psychology, 149:6, 601-629, DOI: 10.1080/00223980.2014.946462 To link to this article: http://dx.doi.org/10.1080/00223980.2014.946462
Published online: 30 Aug 2014.
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Date: 05 November 2015, At: 21:13
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Ethnicity, Social Support, and Depression Among Elderly Chilean People LORENA P. GALLARDO-PERALTA University of Tarapac´a ´ ESTEBAN SANCHEZ-MORENO ´ LOPEZ ´ ANA BARRON DE RODA ´ ARIAS ASTRAY ANDRES Complutense University of Madrid
ABSTRACT. Recent evidence regarding the relationship between social support and depression in elderly people shows the important role of ethnicity. This research describes the characteristics of social support in a sample of elderly people aged 60 and above living in northern Chile (n = 493), and analyzes the differences in the relationship between social support and depression between an indigenous group (Aymara population, n = 147) and a nonindigenous group (white, Caucasian, mestizo, n = 346). Various dimensions of social support were considered: structural elements, functional social support according to source, and community participation. The results show the existence of significant differences in the characteristics and dimensions of social support depending on sex, ethnicity, and marital status. Further, the central role of the family group is observed for both Aymara and nonindigenous elderly people. The hierarchical regression models obtained result in notable differences in the role of the structural, functional, and community elements of support in explaining depression for the ethnic groups considered. Keywords: depression, elderly people, ethnicity, indigenous groups, social support
DECADES OF RESEARCH HAVE DEMONSTRATED the existence of a complex relationship between social support and depression in elderly people (Altintas, Gallouj, & Guerrien, 2012; Antonucci, Lansford, & Akiyama, 2001; Vanderhorst & McLaren, 2005). An increasing amount of research considers this complexity within the contextual framework of ethnicity (Chappell & Funk, 2011). Ethnic identity and different culturally associated values influence the consideration of
Address correspondence to Lorena P. Gallardo-Peralta, 18 de Septiembre 222, Arica, Chile; [email protected] (e-mail). 601
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relationships of support and mutual exchange, especially in the family environment (Tomaka, Thompson, & Palacios, 2006), affecting the experience and consequences of social isolation and loneliness (Fokkema, de Jong, & Dykstra, 2012). Ethnicity thus constitutes a fundamental element in accounting for the relationship between social support and the well-being of elderly people. Practically all published research concerns the particular characteristics of ethnic minorities formed as a consequence of migratory processes. The available empirical evidence hence focuses on the relationships between social support and psychological deterioration for ethnic groups placed in social contexts outside their social and cultural origins. This article concerns the relationships between ethnicity, social support, and depression, with a distinctive feature. Following the suggestion of Berkman, Glass, Brissette, and Seeman (2000), our research seeks to analyze the aforementioned processes in a specific area of a country (the two groups considered in this study live in their natural social and geographical environments), and for clearly defined and differentiated ethnic groups. Specifically, our study analyzes the association existing between different dimensions of social support and depression in the Arica-Parinacota region (Chile), comparing relationship patterns between elderly people of Aymara ethnicity (indigenous) and nonindigenous elderly people. This latter group comprises the sum of various nonnative groups, principally including Caucasians, whites, and mestizos, descendants of European immigrants and the Creole population. On the other hand, the Aymara are one of the native ethnic groups in the country; to be precise, the second largest. Though a native ethnic group, the Aymara do not live in isolation from the general population. They share language (all speak Spanish as a vehicular language, but make equal use of the Aymara language) and a broad range of social and economic activities particular to the region in which they are resident. For example, a significant part of the Aymara population identify themselves as Catholic and their daily activities involve systematic interaction with the non-Aymara population. Yet, importantly for this study, cultural aspects that characterize and distinguish the group do exist. Among others, the family-centered nature of their community (the family being part of the community) and their highly religious and ritualistic characteristics stand out. In this regard, their social links are based around reciprocity toward the community, with the nuclear and extended family developing this process of social exchange. It is important to emphasize that the fundamental actor in community life is not the individual but the family, which is also the lead protagonist in economic terms. The ethnic group in question is thus strongly collectivist, its intensity constituting a fundamental difference with respect to the nonindigenous population. This intense collectivism reduces the importance of the individual as a social actor in the context of the community. Our study contemplates two research aims. First, to describe the characteristics and dimensions of social support for elderly people resident in northern Chile, analyzing the ethnic differences. The dimensions of support considered in
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this study are as follows: structural elements of the support network (size and frequency of contact), satisfaction with relationships established within the context of said network, functional (emotional, instrumental, informational–guidance) social support (perceived) according to source (partner, children, other family, and friends), and participation in community activities likely to generate integration and support (elderly people’s clubs, religion, and participation in indigenous associations). The literature in this area emphasizes the role played by family networks in the case of elderly people (Antonucci, Birditt, Sherman, & Trinh, 2011), a repeated finding in studies undertaken in Chile (Herrera, Barros, & Fern´andez, 2011). Consequently, it is expected that the fundamental source of support for elderly people will be the partner. In situations where the partner is absent—typically due to death—the remaining family sources are expected to occupy this leading role (Seeman & Berkman, 1988) in the provision of social support to elderly people. Furthermore, various studies suggest the existence of gender-dependent differences in social support provision from the different available sources (Scott & Wenger, 1995). In comparison with men, women are thus expected to perceive less partner support and report lower levels of satisfaction with that support, and to perceive more support from children and other family members. The second aim consists of comparing the group of associations existing between the different dimensions of social support considered in our study and scores for depression for the two ethnic groups under consideration. The empirical evidence suggests that the impact on depression of structural dimensions of support, such as size of network and frequency of contact, is determined by how elderly people appraise such interaction and by the levels of satisfaction with the links established (Antonucci & Akiyama, 1987; Moos, Brennan, Schutte, & Moos, 2010). Similarly, the empirical record demonstrates the great importance of functional aspects of support as protective factors against psychological distress, in general, and depression, in particular. In this regard, ample research shows that functional aspects have a greater impact on depression than structural factors (Antonucci, Fuhrer, & Dartigues, 1997; Murrell, Norris, & Chipley, 1992; Robitaille, Orpana, & McIntosh, 2012). Functional support perceived by elderly people will have different effects on depression, with differing intensities, depending on the source of support. S. Cohen and McKay (1984) indicated in their classic matching model that not all sources would have the same effectiveness when buffering stress, emphasizing the role of similar others. It is reasonable to argue that support from diverse sources is related with elderly people exhibiting a lower incidence of depressive symptoms (Dean, Kolody, & Wood, 1990), particularly bearing in mind the importance of processes of substitution of significant sources for advanced ages. These processes would increase the protective role of available networks that are not exclusively family-oriented (Fiori, Antonucci, & Cortina, 2006). Yet, these results may not be capable of generalization across all cultural contexts, instead varying depending on the ethnic groups considered (Antonucci et al., 2011).
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The same argument is applicable to the potential influence of integration and community participation on the mental health of elderly people (Bukov, Maas, & Lampert, 2002; Mackean & Abbott-Chapman, 2012). The empirical evidence shows that religion-based community participation tends to reduce levels of depression (Alvarado, Temper, Bresler, & Thomas-Dobson, 1995; Yoon, 2008). Integration and community participation are particularly susceptible to being influenced and delineated by cultural content specific to ethnic groups. As previously indicated, the very idea of community is contextually and culturally constructed, meaning that community environments with a potential impact on measurements of depression will vary in significance and intensity among different ethnic groups. In the context of this study, the findings of Herrera et al. (2011) suggest that support from family sources is pivotal to psychological wellbeing for elderly people in Chile. However, previous research concerning the specificity of indigenous ethnic groups not being available, it is difficult to formulate a hypothesis. Given Aymara cultural characteristics, one may expect the principal differences in the relationship between social support and depression to arise in measures of functional support according to source. A negative association with the depression measure for functional support emanating from partner, children, and friends is expected for nonindigenous participants, with the hypothesis that such association will be significantly less intense for the latter source. In the case of Aymara (indigenous) participants, it is expected that a negative association will be found exclusively for support from partner and children, and not from other family or friends. As regards community integration, participation in religion-based community activities is expected to be more intensely associated with depression scores for nonindigenous persons than for Aymara, for whom a stronger association is expected with participation in indigenous clubs. This matching hypothesis links the type of community participation with the defining cultural characteristics of each ethnic group. Differences are not expected with respect to the role played by structural dimensions. For both nonindigenous and Aymara participants, a significant association between network size or contact frequency and symptoms of depression is not anticipated. In contrast, satisfaction with social relationships is expected to be the dimension that plays a significant role. Again, to specify differences according to ethnic group, satisfaction according to source is taken into consideration, with a significant effect for satisfaction with partner, child and—to a lesser degree—friend interaction anticipated for the nonindigenous population. For the Aymara population, a significant association is only expected for satisfaction with partner and child relationships. Method Participants and Procedure The sample was composed of 493 elderly Chilean people resident in the Arica-Parinacota region, in northern Chile. The minimum age for participation
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in the study was 60 years at the time of completing the questionnaire. To ensure that the questionnaire reflected the characteristics of the population and met the aims of the study, different socio-demographic and community participation variables were considered, ensuring a minimum number in each analysis category with significance for the aims of the study. In this regard, 147 people were Aymara Chileans and 346 were nonindigenous Chileans. Of the people included in the sample, 86% were between 60 and 79 years of age (average age of 71.45 years; range 60–92). Women comprised 67% of the sample and 51% had basic educational qualifications. The sample included people resident in urban areas (86%) and in rural areas in the foothill valleys and highland areas of the Andes. Participants of Aymara ethnicity, originating from the Andes territory of Chile, comprised 30% of the sample. Table 1 offers detailed information, differentiating ethnic groups and showing sample distribution according to age, gender, educational level, marital status, and family structure. The participants’ characteristics are an accurate reflection of the demographic and social composition of elderly people aged 60 and above in the Arica-Parinacota region. The questionnaire was administered through personal interviews, having first obtained the informed consent of participants. The fundamental difficulty consisted of the need to ensure that the sample was sufficient to compare the Aymara population with the nonindigenous one, including participants resident in the highland areas of the Andes. To overcome this problem, contact was made with the governmental institution for elderly people (Servicio Nacional de Adultos Mayores), which assisted in the administration of the questionnaires, providing information on the composition of the population and the principal groups of elderly people in the region. Further, the administration of the questionnaire in rural and highland areas involved serious difficulties, such as accessing settlements (due to the lack of asphalt roads) and the existence of limited hours of public and domestic electricity in certain locations (hence, having limited time to administer the questionnaire). In the specific case of highland locations, the interviewer could face additional difficulties in physical terms (due to geographical altitude) and in terms of the cultural tendency to mistrust outsiders, it being essential to obtain the support of a social agent from the area. For these reasons, key social agents (in elderly people’s clubs, parishes and municipalities) were contacted in rural and highland areas. The questionnaire was administered in four different locations (Arica, Putre, Socoroma, and Codpa), thereby ensuring that the sample reflected the ethnic and socio-demographic composition of the area. The questionnaire was administered through personal interview in every case. Five interviewers participated in the study, all recent graduates of the Department of Philosophy and Psychology at the University of Tarapac´a (Arica, Chile). To reduce the interviewer variability effect on information gathering, all interviewers underwent a training program with two fundamental aims: ensuring the interviewers had the skills and knowledge to correctly carry out interviews, and providing sufficient information on the general aims of the study. This involved specific training on the research questionnaire. A maximum of five interviews per day
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TABLE 1. Participants’ Social and Demographic Characteristics
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Total Aymara (indigenous) Non-indigenous (n = 493) n (%) (n = 147) n (%) (n = 346) n (%) Age 60–69 207(42%) 70–79 216(43.8%) 80–89 63(12.8%) 90 + 7(1.4%) Mean age (SD) 71.45(6.47) Gender Women 330(66.9%) Men 163(33.1%) Education Primary school 211(42.8%) incomplete Primary school 152(30.8%) High school 82(16.6%) Higher education 48(9.8%) Marital status Married 243(49.3%) Cohabiting 22(5.3%) Single 52(10.5%) Widow 119(24.2%) Divorced 53(10.7%) Family structure (current) One-person household 67(13.6%) Nuclear – with children 124(25.2%) Nuclear – no children 71(14.4%) Extended 192(39%) Others 39(7.8%) Ethnicity Aymara (indigenous) 147(30%) Non-indigenous 346(70%)
57(38.8%) 67(45.6%) 18(12.2%) 5(3.4%) 71.67(7.10)
150(43.4%) 149(43.1%) 45(13%) 2(0.5%) 71.35(6.19)
99(67.3%) 48(32.7%)
231(66.8%) 115(33.2%)
88(59.9%)
123(35.5%)
34(23.1%) 17(11.6%) 8(5.4%)
118(34.1%) 65(18.8%) 40(11.6%)
74(50.3%) 5(3.4%) 18(12.2%) 33(22.4%) 17(11.5%)
169(48.8%) 21(6.1%) 34(9.8%) 86(24.9%) 63(10.4%)
30(20.4%) 35(23.8%) 23(15.6%) 52(35.4%) 7(4.8%)
37(10.7%) 89(25.7%) 48(13.9%) 140(40.5%) 32(9.2%)
aimed to avoid possible work overload effects. Similarly, particular attention was paid to the design of the questionnaire with the aim of reducing misinterpretation of information by interviewers. The pilot study described below allowed the questionnaire to be refined such that the interviewers were provided with clear instructions and definitions for the application of the measurement instruments. Last, performances in the first interviews completed in rural and highland areas were monitored, given their particular features and difficulties (as previously described). All interviewers were properly remunerated for their work. Participants were contacted in one of two ways. When possible and desirable, the research
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team initiated direct contact and agreed a date for interview. Key social agents, such as municipal operational staff or the more important community leaders, initiated contact when greater difficulties were involved. In both cases the interviewer attended the agreed location for the interview, which took approximately 40 minutes to complete. Measures As the aims of this study require the collection and comparison of information on persons of Aymara ethnicity and nonindigenous persons (white, Caucasian, and mestizos), it was essential to ensure that all members of the sample clearly and consistently understood the content of the different measurement instruments. To that end, a pilot measure was taken from a group of 65 people (19 Aymara and 46 nonindigenous). None of the participants had difficulty understanding the different measures included in the questionnaire. Furthermore, the pilot study demonstrated the need to apply the measures described through structured personal interview, as well as to establish prior contact through social agents important within the social environment of the participant, as described. The participants in the pilot study were not included as part of the 493 participants of the study. Depression The Geriatric Depression Scale (GDS) of Brink et al. (1982) was used. The original version contains 30 questions, but our study used the abbreviated version, which includes 15 (e.g. “Have you dropped many of your activities and interests?”; “Do you think that most people are better off than you are?”). The abbreviated version retains the effectiveness of the original scale, improving ease of management. It registers the presence of 15 symptoms of depression, providing a resulting score varying from 0 to 15, is a widely used instrument to evaluate depression in elderly people, and has been translated and validated in various languages, including Spanish (Baker & Espino, 1997). A score of 5 or more suggests the existence of depression, this being the cut-off point with the best specificity/sensitivity relationship. Hoyl, Valenzuela, and Mar´ın (2000) have successfully used the scale for the Chilean population. The internal consistency index calculated on our data (Cronbach’s alpha) was 0.77. Social Support As stated in our analysis of previous research, the literature suggests the need to take into account both structural and functional dimensions of social support. This derives from the different meaning and impact of the structural and functional dimensions in measures of well-being found in previous research. As such, two measures of social support were used. The first was the Inventory of Social Resources for Elderly People (ISR) developed by D´ıaz Veiga (1987; see S´anchezMoreno & Barr´on, 2003). This instrument allows the measurement of structural
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aspects of social networks (size and frequency of contact) and satisfaction with relationships established within the framework of said networks, differentiated by source. It is important to emphasize that this instrument was specifically designed for the geriatric population, for which reason it is widely recommended in the literature regarding elderly people (Fern´andez-Ballesteros, 2000, 2002) and in general represents a widely validated instrument for the Spanish-speaking population (S´anchez-Moreno & Barr´on). Specifically, this questionnaire measured size of social network (number of members composing the significant network), frequency of weekly contact (number of significant interactions, e.g., “How many times a week do you see your friends?”) and satisfaction (e.g., “After seeing/talking to your children, do you generally feel satisfied with your relationship?,” on a Likerttype scale ranging from 0 to 5 as regards four sources of support, namely, partner, children, other family, and friends. In the latter case (satisfaction), the internal consistency index (Cronbach’s alpha) was 0.81. Second, the Perceived Social Support Questionnaire (PSSQ) (Gracia, Herrero, & Musitu, 2002) evaluated the functional dimensions of support (emotional, instrumental, and informational). The instrument comprised 12 items with questions on the source and level of social support perceived from partner, children, family, and friends. For each source, items were included to measure emotional support (e.g., “Could you freely express and share your emotions with this person?”), instrumental support (e.g., “If you were sick or needed to be taken to the doctor, would this person be of any help?”), and advisory support or guidance (e.g., “Would this person be of any help if you should have to make an important decision?”). The corresponding scale for each item ranged from 0 to 5, and the resulting sum (higher scores representing higher levels of social support provision) is standardized to a 0–30 range. The PSSQ is a widely used instrument in Spanish-speaking populations, having been validated in various contexts (residential, general, hospital) (Gracia & Herrero, 2004). This instrument provides separate scores for the different aforementioned sources of social support. Scores for the items corresponding to each source and representing the different types of support (emotional, instrumental, advisory) were combined to produce a composite functional support score for each source considered. The factorial analysis undertaken supported this strategy (χ 2 = 344.51; CMIN/DF = 2.778; AGFI = .905; RMSEA = .060, p = .14), allowing for the consideration of a total of four factors, namely partner functional support, children functional support, other family functional support, and friend functional support. The internal consistency index (Cronbach’s alpha) calculated on our data was 0.93. Community Participation This research used three variables reflecting the principal elements of community life in the population studied. First, the participants were asked about their participation in religious activities, given the importance of such participation in
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the social context under consideration. The resulting variable was coded 0 (absence of participation) and 1 (participation), thus constituting a dummy variable. To include an individual in the participation category, they not only had to regularly attend religious ceremonies (such as Sunday Mass), being also necessary an active participation in other types of religious activities or religious organizations’ community support activities (religious education, social volunteering, community development activities). Second, participation in elderly people’s clubs was considered as an indicator of community participation. Again, the result was a dummy variable, in which category 0 indicates absence of participation in this type of organization and category 1 indicates not only belonging to this type of organization but also systematic and regular (at least weekly) participation in club activities (participation in club meetings, leisure activities, excursions, neighborhood activities). Last, for Aymara participants, belonging to indigenous organizations was considered as an indicator of community participation. As with the previous variables, for an individual to be included in the participation category, systematic and regular (at least weekly) participation in activities organized by the entity was required (religious dances, local dances, workshops, and formal meetings). Results In Table 2 we report the means, standard deviations, and ranges for our study variables (depression, structural social support, satisfaction with social contacts, and perceived social support). We also include the distribution of variables relating to community participation (religious participation, participation in elderly people’s clubs, and participation in indigenous organizations). Furthermore, Table 3 and Table 4 contain the correlation matrix for scores for depression and variables related to social support, differentiating between the two ethnic groups considered in our study. Belonging to an Ethnic Group and Characteristics of Social Support To meet our first research aim, we analyzed the characteristics of social support among participants, taking into account the ethnic differences. Table 2 shows that belonging to the Aymara ethnic group is related to a larger size of support network, less partner support, and more support from children. Ethnic group is not related to significant differences in community participation. The role played by gender and marital status was explored specifically and separately for the two ethnic groups considered. Aymara women report higher scores than men for frequency of contact, t(145) = 2.619, p < .01—an association not found in the case of nonindigenous women. The latter receive less partner support, t(344) = 2.924, p < .01, and more support from friends, t(344) = 1.798, p < .05 than men, differences not found in the Aymara subsample. As regards marital status, in the Aymara subsample it was found that people without partner scored more highly for
4.80(2.47) 2.28(1.35) 12.29(3.01) 2.76(.58) 2.66(.70) 2.48(.66) 2.29(.51) 18.63(5.44) 13.23(8.04) 11.54(7.02) 9.76(3.06) Aymara (indigenous) Active participation (%) 59.2 53.1 29.3
2.80(.41) 2.58(.53) 2.56(.51)
21.22(6.21) 12.16(7.11) 11.34(6.70) 10.14(4.36) All participants Active participation (%) 59.8 50.7 –
Aymara (indigenous) Mean (SD)
4.24(2.10) 2.09(1.22) 12.19(3.26) 2.73(.51)
Note. PSS: Perceived Social Support; ∗ p < .05. ∗∗ p < .01.
Clubs for the elderly Religious community involvement Clubs for older indigenous adults
Depression Social network size Contact frequency (weekly) Satisfaction with partner contact Satisfaction with children contact Satisfaction with family contact Satisfaction with friends contact PSS – partner PSS – children PSS – family/relatives PSS – friends
All participants Mean (SD)
–
22.56(7.32) 11.70(6.66) 11.25(6.56) 10.30(4.03) Non-indigenous Active participation (%) 60.1 49.7
2.41(.78)
2.55(.60)
2.68(.71)
3.99(1.95) 2.01(1.15) 12.14(3.36) 2.68(.53)
Non-indigenous Mean (SD)
TABLE 2. Descriptive Statistics for Depression, Dimensions of Social Support, and Community Involvement
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0–5
.361
n 493 402
χ 2 value .037 .381
147
0–30 0–30 0–30 0–30
2.751∗∗ 1.907∗ .473 1.439
–
0–5
1.482
0–5
0–15 0–8 0–18 0–5
2.563∗∗ 2.257∗ .470 .007
1.180
Range
t value
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.015 .031 −.186∗∗ .027 −.010 .006 −.168∗∗ .026 −.032 .053
1
.048 −.002 −.085 .035 .092 .031 .536∗∗ .479∗∗ .219∗∗
2
3
.397∗∗ .287∗∗ .281∗∗ .380∗∗ .306∗∗ .113∗ −.074 −.108∗
Note. PSS: Perceived Social Support. ∗ < .05. ∗∗ p < .01.
1. Depression 2. Network size 3. Contact frequency 4. Satisfaction partner 5. Satisfaction children 6. Satisfaction family 7. Satisfaction friends 8. PSS – partner 9. PSS – children 10. PSS – family 11. PSS – friends
Variables
.226∗∗ −.006 .021 .518∗∗ −.129∗ −.231∗∗ −.164∗∗
4
.147∗∗ −.026 .207∗∗ .196∗∗ −.311∗∗ −.197∗∗
5
.219∗∗ −.008 .087 .099 −.026
6
.007 −.038 .070 .150∗∗
7
−.152∗∗ −.258∗∗ −.201∗∗
8
−.113∗ −.244∗∗
9
.122∗
10
TABLE 3. Pearson’s Correlation Coefficients Among Depression and Social Support Dimensions: Non-Indigenous Participants Only (n = 346)
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−.130 .024 .009 .024 −.069 .026 −.038 −.074 −.088 .114
1
−.054 −.039 −.008 −.052 .144 .010 .522∗∗ .475∗∗ .079
2
3
.452∗∗ .256∗∗ .284∗∗ .202∗ .330∗∗ .141 −.151 −.194∗
Note. PSS: Perceived Social Support. ∗ p < .05. ∗∗ p < .01.
1. Depression 2. Network size 3. Contact frequency 4. Satisfaction partner 5. Satisfaction children 6. Satisfaction family 7. Satisfaction friends 8. PSS – partner 9. PSS – children 10. PSS – family 11. PSS – friends
Variables
.240∗∗ .093 .022 .425∗∗ .015 −.226∗∗ −.208∗
4
.046 −.004 .201∗ .266∗∗ −.350∗∗ −.163∗∗
5
.081 .037 −.049 .179∗ −.092
6
.147 −.043 .057 .053
7
−.057 −.182∗ −.178∗
8
−.143 −.285∗∗
9
−.072
10
TABLE 4. Pearson’s Correlation Coefficients Among Depression and Social Support Dimensions: Aymara (Indigenous) Participants Only (n = 147)
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support from friends, t(145) = 2.661, p
