Archives of Gerontology and Geriatrics 55 (2012) 574579

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Archives of Gerontology and Geriatrics

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Family functioning and social support for older patients with depression in an
urban area of Shanghai, China
Jikun Wang *, Xudong Zhao
Department of Psychiatry, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, China

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 8 February 2012
Received in revised form 31 May 2012
Accepted 18 June 2012
Available online 6 July 2012

Purpose: Geriatric depression is now very common and leads to signicant economic costs and family
burden in China. Families with a depressed patient often report problematic family functioning in
Western samples, and lack of social support is strongly associated with geriatric depression. However, the
relationship between geriatric depression, family functioning and social support in mainland China has
not been well studied.
Materials and methods: This study compared family functioning and social support in a Chinese sample of
elderly patients with major depression and non-depressed elderly people, and evaluated the impact of
family functioning, social support and socio-demographic factors on depression. A questionnaire was
administered to 102 elderly patients with major depression and 107 non-depressed elderly people.
Results: The elderly patients with major depression had worse family functioning and lower social
support than elderly individuals without depression. Multivariate linear regression analysis showed
associations between depressive symptoms and unhealthy family functioning, lower social support and
single marital status.
Conclusions: The ndings suggest that family interventions and improvement of social support are
important in reducing depression among elderly patients. In addition, strategies to alleviate geriatric
depression should be considered by the whole society, the community, family members and the
depressed elderly patients themselves.
2012 Elsevier Ireland Ltd. All rights reserved.

Keywords:
Chinese
Geriatric depression
Family functioning
Family Assessment Device
Social support

1. Introduction
With the rapidly aging population in China, increasing attention is
being paid to the mental and physical health of older people.
Depression is very common and represents a major mental disorder
in those who are older (Back & Lee, 2011), adversely affecting daily
functioning and quality of life worldwide (Wada et al., 2005).
Geriatric depression puts an immense burden on patients, their
families and society as a whole (Chen et al., 2005). In addition,
depression is a very costly disorder in China (Hu, He, Zhang, & Chen,
2007). Providing effective treatment could result in a signicant
reduction in the total burden associated with depression. Therefore, it
is imperative to explore factors inuencing the prognosis of geriatric
depression in China and improve treatment strategies. Family factors
and social support are two important aspects associated with health
in aging people (Leung, Chen, Lue, & Hsu, 2007).
Family impairment refers to a familys inability to accomplish
tasks that are important for their well being (Miller, Ryan, Keitner,

* Corresponding author at: P.O. Box 244, Tongji University, Siping Road 1239,
Shanghai 200092, China. Tel.: +86 21 65988874; fax: +86 21 65988874.
E-mail address: liwangjk@gmail.com (J. Wang).
0167-4943/$ see front matter 2012 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.archger.2012.06.011

Bishop, & Epstein, 2000). Accumulating evidence has found that

impaired family functioning is strongly associated with the course
of depression in older people. For example, some research has
demonstrated that depression damages the mental and physical
heath of the elderly, and contributes to risk of suicide (Kaneko,
Motohashi, Sasaki, & Yamaji, 2007). In addition, the caregivers of
older people with depression report a signicant burden (Xie,
Zhang, Peng, & Jiao, 2010) and are likely to have depressive
symptoms, which can result in the impairment of family
functioning. One study found that family involvement had an
easing effect on psychological symptoms for people with medical
diseases, and elderly people with mental problems beneted from
family interventions (Leung et al., 2007). Depressed men and
women in a community have poorer family functioning than nondepressed individuals, and depression has a strong relationship
with poorer marital functioning, suggesting that targeting only
depressive symptoms in treatment may not be enough to resolve
marital difculties that persist even when depressive symptoms
remit (Herr, Hammen, & Brennan, 2007). Moreover, family
functioning and depression may interact with each other, which
means depression could affect family functioning, and family
functioning could affect the prognosis of depression (Restifo &
Bogels, 2009).

J. Wang, X. Zhao / Archives of Gerontology and Geriatrics 55 (2012) 574579

The relationship between geriatric depression and social support

has also received attention. For example, social support was found to
have a signicant impact on mental health among elderly people in
Chinese rural districts (Xie et al., 2010). The buffering effects of social
support are considered to be dependent on the type of stress and
support (Bisschop, Kriegsman, Beekman, & Deeg, 2004; Bisschop,
Kriegsman, Deeg, Beekman, & van Tilburg, 2004). Another study
indicated that less emotional support is associated with more
depressive and anxiety symptoms in older people (Leung et al.,
2007). Particularly, low social support can be dangerous for elderly
individuals (Mazzella et al., 2010). A poor social network can lead to
vulnerability and even death in this population (Clausen, Wilson,
Molebatsi, & Holmboe-Ottesen, 2007).
In summary, considerable research has shown that depression
has a strong relationship with impaired family functioning and
lack of social support. However, most research on the association
between geriatric depression and family functioning has been
conducted with Western samples. Few studies have explored
family functioning among Chinese older patients with depression.
Culture is related to experiences and coping styles associated with
depression (Kleinman, 2004; Ryder et al., 2008). Furthermore,
healthy and unhealthy family functioning may vary in different
cultures (Keitner et al., 1991). Previous research on the relationship
between social support and geriatric depression has mainly
emphasized instrumental and emotional social support (Leung
et al., 2007) as well as subjective and objective social support and
support utilization (Xie et al., 2010). However, studies have not
examined which aspects of social support come from individuals
such as family, friends and signicant others.
Thus, it is important to explore the characteristics of family
functioning and specic sources of social support for depressed
elderly patients compared to non-depressed elderly people in
China. In addition, the association between depression and family
impairment and social support in Chinese elderly patients with
major depression should be examined. For the purpose of
improving the prognosis and quality of life of those with geriatric
depression, we designed a cross-sectional questionnaire survey
aimed at (a) exploring the characteristics of perceived family
functioning and social support in elderly patients with major
depression and non-depressed elderly people in mainland China,
(b) evaluating the association between depression and family
functioning, social support and socio-demographic factors among
elderly patients with major depression, and (c) exploring factors
predicting depression among elderly depressed patients.

575

2.2. Instruments
The GDS, Family Assessment Device (FAD) (Epstein, Baldwin, &
Bishop, 1983; Miller, Epstein, Bishop, & Keitner, 1985), Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet, Powell,
Farley, Werkman, & Berkoff, 1990) and a self-designed questionnaire
for collecting demographic data were used in the study.
2.2.1. The GDS
Depression in the older patients was assessed by the GDS, an
instrument used to assess depression in the elderly. It consists of
30 items. Subjects are asked to respond based on their feelings in
the previous one week. Each item includes two answer choices:
Yes or No, with each answer indicating depression assigned
one point. Scores range from 0 to 30, with higher scores indicating
higher levels of depression. The GDS has an internal consistency of
a = 0.85. Scores from 0 to 10 are considered in the normal range.
Scores from 11 to 20 are considered to represent minimal to mild
depression, and moderate to severe depression is indicated by
scores of 2130.
2.2.2. The FAD
Family functioning was assessed using the Chinese version of
the Family Assessment Device (FAD-CV). The FAD is a 60-item self
report inventory that measures family members perceptions of
various aspects of family functioning according to the McMaster
Model of Family Functioning (MMFF) (Miller et al., 2000). The
MMFF assesses six dimensions of family functioning: Problem
Solving (the ability of the family to resolve problems that
maintains effective family functioning); communication (how
family members exchange information with each other); roles
(how the family assigns responsibilities in the family to ensure
fulllment of family functions); Affective Responsiveness (whether the family members respond with a full spectrum of feelings
experienced by human beings); Affective Involvement (the
familys ability to be interested in each other); behavior control
(rules that the family adopts to handle dangerous situations, to
meet psychobiological needs and interpersonal socializing behavior within and outside the family); and overall General Functioning. Health pathology cutoff scores have been established for the
FAD for each dimension of family functioning (Miller et al., 1994).
Higher scores indicate worse family functioning. The validity and
reliability of the Chinese FAD has been demonstrated (Shek, 2001,
2002). The testretest reliability is 0.530.81, and coefcient
alphas range from 0.53 to 0.94.

2. Materials and methods

2.1. Sample
The sample comprised 102 older Chinese patients who met
DSM-IV-TR criteria (American Psychiatric Association, 2000) for
major depressive disorder and 107 non-depressed elderly people
in the community. The patients came from the Psychiatry
Department of Shanghai East Hospital afliated with Tongji
University in Shanghai, China. Depressive symptoms were
assessed using the Geriatric Depression Scale (GDS) (Yesavage
et al., 1983), with a score above 10 indicating depressed
individuals. The non-depressed elderly people were recruited in
the community through a neighborhood committee. Exclusion
criteria for all subjects included neurological disorders, severe
physical problems and substance abuse or dependence within the
3 months prior to the study. Control subjects did not have a current
psychiatric disorder. This study was approved by the local
Institutional Review Board of Tongji University. Written informed
consent was obtained from all volunteer subjects after an
explanation of the study was provided.

2.2.3. The MSPSS

The MSPSS is a 12-item self-report instrument with a sevenpoint scale (from 1 = strongly disagree to 7 = strongly agree) that
measures perceptions of social support from friends, family and
signicant others. Higher scores indicate lowerer perceived
support. The psychometric properties of the MSPSS were
previously investigated in a Chinese sample in Hong Kong (Chou,
2000). The MSPSS was used to assess social support in this study
because of several advantages offered by it. First, it focuses on the
subjective feeling of social support that plays a signicant role in
depression. In addition, it evaluates three sources of social support
including family, friends and signicant others. Finally, a 12-item
scale is easy to use (Chou, 2000).
2.3. Data analysis
Descriptive statistics were carried out for socio-demographic
data. Independent t-tests and x2 tests were used to analyze
sociodemographic characteristics of the subjects between groups.
Independent t-tests were used to compare the FAD scores and

J. Wang, X. Zhao / Archives of Gerontology and Geriatrics 55 (2012) 574579

576

Table 1
Sociodemographic data of the depressed and non-depressed elderly groups,
mean  SD or n (%).
Variables

Depressed
elderly

Not-depressed
elderly

Number
Age (years)
Gender
Male
Female
Education (years)
Educational level
Primary school
Secondary school
High school
University
Marital status
Married (remarried)
Single (never married,
divorce or widowed)
GDS
Mild
Moderate/severe

102
64.5  2.86

107
63.8  2.84

46 (45.1)
56 (54.9)
10.2  2.51

52 (48.6)
55 (51.4)
10.7  2.18

12
45
38
6

7
40
55
5

(11.8)
(44.1)
(37.3)
(5.9)

88 (86.3)
12 (13.7)

p=

0.061
0.356

0.136

(6.5)
(37.4)
(51.4)
(4.7)

102 (95.3)
5 (4.7)

30 (29.4)
72 (70.6)

MSPSS scores between depressed elderly patients and nondepressed elderly people. Pearsons correlation was used to assess
the association between depression scores, FAD scores and social
support scores among depressed elderly patients. We used
multiple linear regression with stepwise analysis to study the
signicant factors predictive of depression. All data were
performed using the SPSS 13.0 statistical software package.
3. Results
3.1. General data
The distribution of socio-demographic characteristics of the
209 subjects is shown in Table 1. The resulting data represented
102 depressed and 107 non-depressed elderly people. Subjects
ranged in age from 60 to 80 years. The depressed elderly patients
had the following characteristics: 46 (45.1%) were male and 56
(54.9%) were female; their mean age was 64.5 years (SD = 2.86);
they had a mean of 10.2 years of schooling (SD = 2.51), and most
patients (81.4%) had an educational level of secondary or high
school. The non-depressed elderly people had the following
characteristics: 52 (48.6%) were male and 55 (51.4%) were female;
their mean age was 63.8 years (SD = 2.84); they had a mean of 10.7
years of schooling (SD = 2.18), and most patients (88.8%) had an
educational level of secondary or high school. The t-test and x2 test
showed that there were no signicant differences between

depressed elderly patients and non-depressed elderly people in

gender, age or educational level (p > 0.05) (Table 1). Depression
scores for depressed elderly patients ranged from 30 (29.4%),
indicating a mild level of depression, to 72 (70.6%), indicating
moderate or severe depression.
3.2. FAD and MSPSS scores in the depressed patients
Table 2 lists the FAD and MSPSS scores for the depressed elderly
patients with mild or severe depression. Results of independent ttests showed signicant differences in FAD scores for Problem
Solving and Affective Involvement dimensions as well as MSPSS
scores between the two groups. The elderly patients with severe
depression had worse family functioning and lower social support
from family, friends and signicant others (p < 0.01) than those
with mild depression (Table 2). All scores for FAD dimensions were
in the unhealthy range for depressed elderly patients with mild or
severe depression.
3.3. FAD and MSPSS scores in the study groups
Table 3 lists the FAD and MSPSS scores for the depressed elderly
patients and non-depressed elderly people. Results of independent
t-tests showed signicant differences in scores on the FAD and
MSPSS between the two groups, except for the Roles dimension on
the FAD. The depressed elderly patients had worse family
functioning (p < 0.01) and lower social support from family,
friends and signicant others (p < 0.01) (Table 3). All dimensions
of the FAD (represented by subscale scores) for depressed elderly
patients were in the unhealthy range. For non-depressed elderly
people, only the Behavioral Control score on the FAD was in the
unhealthy range.
3.4. Relationship between depression, family functioning and
social support
In our study, depression measured by the GDS was signicantly
positively correlated with negative family functioning, which
inuenced the depression scores directly, and was positively
related to lower social support from family, friends and signicant
others (p < 0.05) (Table 4).
3.5. Socio-demographic factors, family functioning and social support
predicting the level of depression among elderly depressed patients
Table 5 shows the results of multivariate linear regression of
depression with socio-demographic variables, family functioning

Table 2
Statistical comparison of parameters in the depressed group by independent t-tests, mean  SD.
Mild depression (n = 30)
Family functioning
PS
CM
RL
AR
AI
BC
GF
Social support
Total support
Family
Friends
Signicant others

Severe depression (n = 72)

2.42  0.26
2.39  0.34
2.32  0.58
2.39  0.36
2.10  0.30
2.60  0.20
2.26  0.29

2.63  0.57
2.48  0.29
2.34  0.28
2.47  0.59
2.27  0.57
2.72  0.57
2.30  0.54

2.596
0.883
0.256
0.786
2.107
1.551
0.417

0.011*
0.379
0.799
0.434
0.038*
0.124
0.677

46.68  12.20
13.22  5.22
21.69  4.59
11.76  5.06

55.90  13.79
16.53  5.61
24.17  2.59
15.20  6.33

3.345
2.854
2.766
2.896

0.001**
0.005**
0.007**
0.005**

Notes: PS, Problem Solving; CM, Communication; RL, Roles; AR, Affective Responsiveness; AI, Affective Involvement; BC, Behavioral Control; GF, General Functioning.
Unhealthy scores of FAD are underlined. High scores of FAD indicate worse family functioning and high scores of MSPSS indicate lower social support.
*
p < 0.05.
**
p < 0.01.

J. Wang, X. Zhao / Archives of Gerontology and Geriatrics 55 (2012) 574579

577

Table 3
Statistical comparison of parameters in the two groups by independent t-tests, mean  SD.
Depressed elderly
Family functioning
PS
CM
RL
AR
AI
BC
GF
Social support
Total support
Family
Friends
Signicant others

Normal elderly

2.46  0.46
2.39  0.51
2.30  0.45
2.38  0.50
2.20  0.30
2.61  0.44
2.25  0.44
49.08  13.29
14.08  5.53
22.34  4.25
12.66  5.63

2.04  0.35
2.10  0.29
2.22  0.20
2.12  0.36
2.08  0.54
2.22  0.27
1.96  0.26

7.328
5.055
1.774
4.435
1.980
7.881
5.669

0.0001**
0.0001**
0.077
0.0001**
0.049*
0.0001**
0.0001**

25.59  9.18
7.50  3.06
9.79  3.32
8.21  3.38

14.927
10.638
23.712
6.914

0.0001**
0.0001**
0.0001**
0.0001**

Notes: PS, Problem Solving; CM, Communication; RL, Roles; AR, Affective Responsiveness; AI, Affective Involvement; BC, Behavioral Control; GF, General Functioning.
Unhealthy scores of FAD are underlined. High scores of FAD indicate worse family functioning and high scores of MSPSS indicate lower social support.
*
p < 0.05.
**
p < 0.01.
Table 4
Correlation between depression, family functioning and social support.
Parameters

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

1. Depression
2. PS
3. CM
4. RL
5. AR
6. AI
7. BC
8. GF
9. Family support
10. Friends support
11. Signicant others support

0.334**
0.189
0.112
0.209*
0.404**
0.253*
0.174
0.396**
0.347**
0.391**

0.737**
0.752**
0.783**
0.696**
0.848**
0.809**
0.302**
0.214*
0.322**

0.792**
0.804**
0.587**
0.729**
0.822**
0.368**
0.259**
0.358**

0.819**
0.636**
0.745**
0.907**
0.459**
0.286**
0.481**

0.555**
0.734**
0.889**
0.519**
0.336**
0.501**

0.709**
0.644**
0.302**
0.082
0.303**

0.801**
0.273**
0.252**
0.270**

0.515**
0.256**
0.509**

0.380**
0.961**

0.389**

Notes: PS, Problem Solving; CM, Communication; RL, Roles; AR, Affective Responsiveness; AI, Affective Involvement; BC, Behavioral Control; GF, General Functioning.
*
p < 0.05.
**
p < 0.01.

Table 5
Multivariate linear regression with the GDS as the dependent variable among the depressed elderly patients.

Constant
PS
CM
RL
AR
AI
BC
GF
Family support
Friend support
Other support
Marital status

p<

95% CI

Adjusted R2

R2

31.725
4.374
0.682
3.519
1.160
2.784
0.216
2.976
0.243
0.229
0.049
1.914

0.004**
0.533
0.049*
0.422
0.001**
0.895
0.202
0.180
0.002**
0.778
0.036*

1.629 to 7.492
1.484 to 2.849
0.346 to 7.255
1.698 to 4.018
1.278 to 4.497
3.035 to 3.467
1.623 to 7.574
0.599 to 0.114
0.091 to 0.369
0.391 to 0.294
0.181 to 3.069

0.455

0.514

Notes: PS, Problem Solving; CM, Communication; RL, Roles; AR, Affective Responsiveness; AI, Affective Involvement; BC, Behavioral Control; GF, General Functioning. Total
n = 102.
*
p < 0.05.
**
p < 0.01.

and social support. Five variables entered into the regression

model. Problem Solving, Roles and Affective Involvement dimensions of family functioning as well as social support from friends
were positively related to level of depression, and marital status
(including never married, divorced or widowed) was negatively
associated with level of depression (Table 5).
4. Discussion
The health of older people in developed countries is considered
a signicant issue, and considerable research has focused on

psychological and physical health among the aging population

(Chalise, Saito, Takahashi, & Kai, 2007). Old age is related to
physical as well as psychological health issues, including loneliness
and depression (Carruth & Logan, 2002). Depression has been
shown to be strongly associated with family dysfunction in
Western countries. China has experienced rapid economic
development, and the population has been aging rapidly over
recent years (Dong, Beck, & Simon, 2010). Depression is one of the
most common psychiatric disorders in elderly people in Chinese
rural districts (Xie et al., 2010). Less social support, worse family
functioning and a higher level of depression may be related to

578

J. Wang, X. Zhao / Archives of Gerontology and Geriatrics 55 (2012) 574579

quality of life among older people. Therefore, focusing on the

relationship between family functioning and social support among
older patients with depression is helpful in formulating effective
interventions to improve the prognosis of geriatric depression in
China.
Some research has found that the severity of depression is
related to impairment of family functioning. The current study
showed that the older patients with severe depression perceived
more severe family impairment and lower social support from
family, friends and other signicant people in their lives. This
nding suggests that clinicians should pay more attention to
family interventions for older patients with more severe depression.
Family functioning is strongly associated with depression, with
an interaction between the two. For example, less psychological
distress has been reported by elderly people perceiving more
family involvement (Leung et al., 2007). Therefore, there is a great
need for research on the role of family functioning in the course of
geriatric depression. In our study, scores on most dimensions of
family functioning for elderly depressed patients were higher than
those for the non-depressed elderly people, except for Roles. In
addition, all scores on dimensions of the FAD for depressed elderly
patients were in the unhealthy range. All ndings indicated
unhealthy family functioning among depressed elderly patients,
suggesting that the treatment of geriatric depression should
include family interventions. Family is considered a signicant
source of support for elderly people in China because the culture
emphasizes the whole family system including nuclear and
extended family, as well as collectivism (Leung et al., 2007). In
addition, FAD scores for Behavioral Control among non-depressed
elderly people were also in the unhealthy range. Traditional
Chinese values emphasize that the rules of the family should
conform to hierarchical rules such as submissiveness of wife to
husband and son to father. However, industrialization and
urbanization have led to social changes that have signicantly
inuenced the traditional values of Chinese families (Tam &
Neysmith, 2006). Thus, the unhealthy scores for Behavioral Control
may indicate the impact of social adjustment and adaptation on
the rules of the family.
The results of the current study also indicated that social
support from family, friends and signicant others of elderly
depressed patients was signicantly lower than that for nondepressed elderly people. Social support can modulate the
inuence of stressful events on mental health. For example, better
social support can reduce the effect of stressful events on
psychological health and decrease the incidence of depression
(Mohr & Genain, 2004). In addition, social support is positively
related to psychological and physical health (Huo & Zhang, 2007).
Some research has indicated that the empty nest elderly in Chinese
rural districts experience a lack of social support (Xie et al., 2010).
With the development of the Chinese economy, there is limited
social support for elderly people because their children may depart
to study or work earlier than before (Wang & Zhao, 2012). Thus,
elderly people with depression may experience a lack of emotional
support from their children. This nding suggests that it is
important for older depressed patients to receive more social
support from the community, friends and other family members.
In this study, depression was signicantly correlated with
family functioning and social support. Depression, as measured by
the GDS, was positively associated with social support scores and
FAD scores. Research studies have repeatedly found that family
functioning is strongly correlated with the development and
prognosis of depression. Improving family functioning could
improve the prognosis of geriatric depression. Social support
plays a signicant role in the incidence of depression (Peirce, Frone,
Russell, Cooper, & Mudar, 2000). Therefore, improved family

functioning and increased social support could minimize the

occurrence of depression.
To develop effective measures to reduce depression levels
among elderly people, factors predicting the level of depression
should be identied. Some research has found that female gender,
single status, functional impairment, physical disease, lack of
social support, lack of religious beliefs and low economic status are
risk factors for geriatric depression (Avila-Funes, Garant, & AquilarNavarro, 2006; Beekman et al., 2001; Bruce & Hoff, 1994; Prince,
Harwood, Thomas, & Mann, 1998; Xie et al., 2010). In our study,
multivariate linear regression analysis indicated that Problem
Solving, Roles and Affective Involvement dimensions of family
functioning as well as social support from friends were positively
associated with depression. The elderly depressed patients had
worse family functioning and lower social support. Unhealthy
family functioning may increase the level of depression in the
elderly because mental and physical disorders make social
activities difcult (Xie et al., 2010), and elderly patients are
reluctant to keep contact with friends, neighbors and other family
members. Furthermore, the spouses of depressed elderly patients
may have a considerable burden due to taking care of their
depressed family member. In families with a depressed elderly
patient, it can be very difcult to solve many family problems and
marital conicts, and family members may nd it difcult to cope
with the household responsibilities. Additionally, the most
important source of social support from family for elderly patients
is often the spouse. However, because of the long-term burden on
them, the spouses of elderly patients may not continue to
emphasize the Affective Involvement and interests of their spouse.
Thus, poor family functioning in regard to Problem Solving, Roles
and Affective Involvement can be predictive factors for geriatric
depression. Moreover, social support from other sources including
friends, social resources and other relatives could be important in
improving the prognosis of geriatric depression. Thus, social
support from friends could be considered another predictive factor
for depression among elderly patients.
Consistent with a previous study (Xie et al., 2010), the results of
the current study revealed that single marital status (never
married, divorced or widowed) was related to a higher level of
depression among elderly patients. Being married or cohabiting
can contribute signicantly to being socially connected, and social
support from family, friends, neighbors, the community and other
social groups are signicant inuencing factors on life satisfaction
in elderly people (Enkvist, Ekstrom, & Elmstahl, 2012). Thus, for
single elderly patients with depression, more attention should be
paid to social support from family members and the community.
5. Study limitations
Some limitations of the present study must be acknowledged.
First, it is a cross-sectional design. Longer term follow-up studies
are needed to explore the specic impact of family functioning and
social support on geriatric depression. Second, because the
research is based on Chinese elderly patients with depression in
Shanghai, there is a need to replicate and assess the ndings in
different Chinese districts. Third, the study sample included only
outpatients. Future studies should use larger samples and include
inpatients. Last, only one family member completed the FAD in this
study. The results reect an individual not a family perspective on
family functioning, and future studies might include other
methods (e.g., objective assessment of family functioning) as well.
6. Conclusions
The results of the current study indicate that elderly patients
with major depression had worse family functioning and lower

J. Wang, X. Zhao / Archives of Gerontology and Geriatrics 55 (2012) 574579

social support than non-depressed elderly people, and there were

correlations between depression and family functioning as well as
social support. Problem Solving, Roles and Affective Involvement
dimensions of family functioning, social support from friends and
marital status were signicant predictors of depression in elderly
patients. To reduce depression in this population, more family
interventions should be undertaken. Multidimensional societal
strategies to reduce the depression of elderly patients should be
considered involving social support from friends, other family
members and social groups (Xie et al., 2010).
Conict of interest statement
None.
Acknowledgements
This study was supported by a grant from the Ministry of
Science and Technology (2009BAI77B05). The authors wish to
thank all of the people who assisted them in the study.
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