GENDER DIFFERENCE ON THE MEDIATION EFFECTS OF FILIAL PIETY ON THE ASSOCIATION BETWEEN CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DEPRESSIVE SYMPTOMS IN OLDER ADULTS
Authors: Chang *Cheng-Chen , Chen Chun-Min , Wu I-Chien , Hsiung Agnes C , Chang Hsing-Yi 
Published: February 2025

Abstract

Background
Filial piety is viewed as a strong family support for Chinese people and is strongly associated with depressive symptoms. It is unknown if gender and filial piety could mediate the relationship between chronic obstructive pulmonary disease (COPD) and depression. There is a strong association between COPD and depressive symptoms; however, the mediating effect of filial piety, a form of social support, on this association is unknown. Since deterioration of lung function can be an indicator of COPD and there is a gender difference in the effects of social support, we hypothesized that pulmonary function is inversely related to depression, and the relationship is mediated by filial piety differently by gender.

Aims & Objectives
We aim to investigate whether filial piety mediates the association between lung function and depression in community-dwelling older people by using the Data from The Healthy Aging Longitudinal Study in Taiwan (HALST).

Method
Data for this study were from the HALST, which is a longitudinal study recruiting people aged 55 and above from seven selected communities in Taiwan. A total of 5664 participants were enrolled in the first wave of the study since October 2008. We analyzed data from the second wave which started in 2013. Pulmonary function was taken between 2016 and 2019; only Community dwelling adults aged 65 and above were analyzed in this study. Pulmonary function, depressive symptoms, and filial piety expectation (FPE) and receipt of filial piety (RFP) were collected. The interaction and mediation of filial piety between lung function and depression was analyzed.

Results
In older men, forced expiratory volume in the first second (FEV1) was inversely correlated with depression (β = -0.1452, p = 0.001) with no mediation effect of FPE. In older women, FEV1 was negatively associated with FPE, but FPE did not increase the risk of depression (β = 0.0713, p = 0.07). In both older men and women, FEV1 was negatively associated with RFP, while RFP reduced the risk of depression (p&lt; 0.001). In older women, the correlation between FEV1 and depression was not statistically significant with complete mediation of RFP.

Discussion & Conclusion
This is the largest study to assess gender difference of mediation effect of filial piety on the relationship between lung function and depressive symptoms in a community-dwelling elderly population. Our results suggested that PRFP independently modified the association of FEV1 and depression in both sexes. After controlling for possible covariates, PRFP was negatively correlated with depression symptoms. In older men, PRFP had a partial mediation effect on the relationship between FEV1 and depression, whereas PRFP had a complete mediation effect on older women. Feelings of insufficient filial piety may increase the likelihood of depression, especially in older women with worse lung function.