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Does subjective social status predict depressive symptoms in Chinese elderly? A longitudinal study from Hong Kong
  1. Elizabeth Kwong1,
  2. Timothy T Y Kwok2,
  3. Timothy S Sumerlin1,
  4. William B Goggins1,
  5. Jason Leung2,
  6. Jean H Kim1
  1. 1Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
  2. 2Faculty of Medicine Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
  1. Correspondence to Jean H Kim, Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong; JHKim{at}


Background Subjective social status (SSS), one’s self-perceived social status, has been gaining interest among researchers as a risk/protective factor of many health outcomes. SSS encompasses both socio-economic factors (eg, income) and intangible aspects of status (eg, esteem from peers). This study’s main objective was to examine the association between SSS and future risk of depression in elderly Chinese.

Methods Using data from the ongoing Mr/Mrs Os study, a longitudinal study of Hong Kong Chinese elderly, this study analysed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one’s own social network) as predictors of Geriatric Depression Scale (GDS) score at year 4 (n=3153). The models adjusted for baseline depression scores, socio-economic status indicators, demographic variables, clinical conditions and functional status variables.

Results Higher depression scores at follow-up were independently associated with lower SSS-Hong Kong (standardised β-coefficient= −0.040, p=0.017), lower SSS-Community (standardised β-coefficient= −0.057, p=0.001), in addition to older age, female gender and stroke history. After stratifying by dementia status, higher baseline SSS was associated with less depressive symptoms only in the non-dementia group. In the multivariable models that included both SSS variables, only SSS-Community was significantly associated with year 4 GDS score. However, both SSS variables were independently associated with year 4 depression status in the logistic regression analysis.

Conclusion In Chinese elderly, SSS captures aspects of social status that are not captured by traditional socio-economic indicators. SSS can be a useful supplementary tool for assessing future risk of developing mental health conditions.

  • Geriatrics
  • socio-economic
  • health behaviour
  • alcohol
  • depression
  • obesity
  • biostatistics
  • climate change
  • temperature
  • epidemiology
  • osteoporosis
  • adolescents cg
  • AIDS

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  • Contributors The initial concept for this paper was developed by TTYK and JHK. Statistical analysis was completed by WBG, EK, TSS and JL. The manuscript was written by EK, TTYK, WBG, JHK and TSS. The editing process included EK, TSS, JL and JHK, and other authors approved the final manuscript. The overall process was led by JHK.

  • Funding The study was funded by the National Institutes of Health R01 grant AR049439-01A1 and the Research Grants Council Earmarked Grant CUHK4101/02.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

  • Ethical statement All ethical safeguards in accordance with the Declaration of Helsinki have been met.

  • Data availability statement Data is available upon request by emailing the corresponding author.