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Assessing Mental Health and Its Association With Income and Resource Utilization in Old-Old Chinese in Hong Kong

Received April 8, 2003; revised November, 13, 2003, May 28, 2004; accepted June 2, 2004. From the Dept. of Medicine, The University of Chicago, Chicago, IL (JXZ), the Dept. of Community and Family Medicine, The Chinese University of Hong Kong, and the Dept. of Medicine and Therapeutics, The Chinese University of Hong Kong (SCH, JW). Address correspondence and reprint requests to James X. Zhang, Ph.D., M.S., Section of General Internal Medicine, Dept. of Medicine, The University of Chicago, 5841 S. Maryland Avenue (MC 2007), Chicago, IL 60637. e-mail: xzhang{at}medicine.bsd.uchicago.edu
© 2005 American Association for Geriatric Psychiatry

Objectives: The authors assessed mental health status and its association with income and resource utilization in old-old Chinese citizens in Hong Kong. Methods: Stratified disproportional random sampling in 1991–92 assembled a cohort of 1,696 elderly community-dwelling subjects who were age 70 or above, measuring the age and education adjusted mean level of cognitive functioning and geriatric depression, by income groups and further investigating the association between mental health and income by incorporating deficiencies in activities of daily living (ADL) and the presence of major chronic conditions in the multivariate regressions. The association between mental health and resource utilization, including physician visits and use of medication, was examined by multivariate regression analyses. Results: Better cognitive functioning was associated with higher income across groups. Lower geriatric depression was associated with higher income. Cognitive impairment was associated with the ADL deficiencies, and geriatric depression was associated with a number of major chronic conditions and higher resource utilization, including physician visits and medication use. Conclusions: Income was significantly associated with cognitive functioning and geriatric depression in elderly persons in Hong Kong. Mental health, ADL deficiency, major chronic conditions, and resource utilization are interrelated. The fact that aging in the population is associated with increasing cognitive impairment and geriatric depression presents new challenges in financing and delivering efficient and equitable health care in the region.

Key Words: Depression • Medical Comorbidity • Socioeconomic Status

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