Exploring the factors associated with depressive symptoms and understanding stigma associated with living in a care home among older adults residing in care homes in Thailand

Background: Thai culture venerates caring for elders, thus care homes are stigmatised as the domain of poor older adults with no family. This impacts negatively on the psychological wellbeing of older residents and the high prevalence of depression reported among them. However, little is understood about the key factors influencing the depressive symptoms and how such stigma is experienced among care home residents. This study explored factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among residents from the perspectives of residents and staff. Methods: Mixed methods research (convergent parallel design) was conducted in two care homes in northeast Thailand using a cross-sectional questionnaire, in-depth interview and non-participant observation. A cross-sectional questionnaire study was conducted with 128 older care home residents (with a response rate of 98.46%) using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and a Coping Strategies Inventory Short Form. Qualitative interviews were conducted with 30 older residents and 20 care home staff purposively sampled from both care homes. Non-participant observation was conducted in various public spaces of the care homes in both care homes for one month. Quantitative data was analysed using the Statistical Package for Social Science (SPSS) IBM PASW Version 22.0 for Windows. Thematic analysis was used to analyse the qualitative data. Results: Depressive symptoms were significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574, -0.333; p< 0.001), respectively. Perceived internalised stigma of living in a care home was the strongest predictor of care home residents reporting depressive symptoms (odds ratio=9.165). In addition, the qualitative research explained the dynamics of the process of stigma related to three elements: the causes of stigma, the manifestation of stigma and the mitigating factors. Negative beliefs about care homes and people who live in them, coupled with negative attitudes and stereotypes toward older people, are the causes of stigma which are dominated by negative societal attitudes towards care homes. In addition, care home features contributing to stigma and staff issues are negative perceptions and experiences among residents whilst living in care homes. These factors trigger residents exhibiting negative emotions and behaviours (including depressive symptoms). However, the mitigating factors help to diminish or control the manifestation of stigma. These include coping strategies, social support and activities provided in care homes. Conclusion: Older adults who perceived high internalised stigma of LiCH were over nine times as likely to report experiencing depressive symptoms. This was related to the dynamics of the process of stigma with three elements (the causes, the manifestation and the mitigating factors of stigma). The causes of stigma are the factors creating the negative emotions and behaviours among residents living in Thai care homes. In addition, the mitigating factors help to diminish the manifestations of stigma. The most compelling need to improve the physical and mental wellbeing of elderly residents of care homes in Thailand is to combat the societal and cultural stigma associated with this population. This may be achieved through media collaboration, educational interventions in the care home setting and organising social activities for residents and their families

Predictors of depressive symptoms in older adults living in care homes in Thailand

Background: Most Thai people reject the idea of letting their ageing parents live in a care home due to the belief that a care home is a place for poor older adults who have no family. These beliefs could influence the perception of living in a care home among older residents and result in low self-esteem, isolation, self-harm and depression. Therefore, this study explored the factors associated with depressive symptoms and other variables among older adults residing in a care home in Thailand. Method/Design: 128 older residents were recruited from two care homes in the northeast of Thailand and data was collected using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and a Coping Strategies Inventory Short Form. Results: Depressive symptoms were found to be significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574 and -0.333) (p< 0.001), respectively. Perceived internalised stigma of living in a care home is the strongest predictor of reporting experiencing some level of depressive symptoms, resulting in an odds ratio of 9.165. Discussion: Perceived internalised stigma is significantly positively correlated with depressive symptoms and is the strongest predictor of the risk of depressive symptoms. By understanding and improving the knowledge of internalised stigma of living in a care home could inform strategy, intervention and guidelines for appropriate care for older adults residing in a care home

Psychometric properties of the Thai Internalised Stigma Scale (TIS-LCH) for care home residents

Objectives: Living in a care home is a source of stigma in Thai culture, although there is currently no measurement tool in the Thai language specifically designed to assess internalised stigma in care home residents. The Thai Version of Internalised Stigma of Living in a Care Home (TIS-LCH) scale was developed and tested for its psychometric properties among Thai older residents. Methods: The Thai version of Internalised Stigma of Mental Health Illness (ISMI) Scale was revised into the TIS-LCH by replacing the word of “mental health illness” to “living in a care home”. Content validity of the TIS-LCH was determined through expert review (n=6), and reliability testing was undertaken with older care home residents (n=128). Results: The TIS-LCH showed good internal consistency, with a Cronbach’s alpha of 0.87. Test-retest reliability coefficient of TIS-LCH was excellent for the full scale (ICC=.90). Conclusions: The Thai version of IS-LCH (TIS-LCH) is a valid and reliable measurement tool for assessing internalised stigma in Thai care home residents. Clinical Implications: The IS-LCH will be a useful research tool to assess internalised stigma in older adults living in care settings. Understanding stigma will help health and social care professionals to plan interventions aimed at reducing or preventing negative emotional reactions and negative behavioural responses toward stigma, which are known to be associated with mental illness and particularly depression among this population

Predictors of depressive symptoms in older adults living in care homes in Thailand

Background: Thai culture traditionally abhors elders living in care homes due to the belief that this represents a dereliction of filial piety by their children, thus care homes are stigmatized as the domain of poor older adults with no family. This may impact negatively on psychological wellbeing of residents, although little is known about the key factors influencing depressive symptoms. Therefore, this study explores factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among older adults residing in care homes in Thailand. Method/Design: A cross-sectional questionnaire study was conducted with 128 older residents recruited from two care homes in Northeast Thailand. Data were collected using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and the Coping Strategies Inventory Short-Form. Results: Depressive symptoms were significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574 and -0.333) (p< 0.001), respectively. Perceived internalised stigma of living in a care home was the strongest predictor of care home residents reporting depressive symptoms (odds ratio=9.165). Discussion: Older adults who perceived high internalised stigma of living in a care home were over nine times as likely to report experiencing depressive symptoms. Efforts to decrease or prevent perceived internalised stigma might help to reduce depressive symptoms. Interventions might include media collaboration, educational interventions in the care home setting and organising social activities for residents and their families

Understanding the Experience of Stigma in Care Homes: A Qualitative Case Study in Northeast Thailand

Introduction: Stigma associated with living in care homes is a known risk factor for depression among care home residents in Asia, including Thailand. However, little is understood about how such stigma is experienced among residents and care home staff. Aims: To examine older adults' perceptions of stigma and to understand how stigma associated with living in care homes causes or exacerbates depressive symptoms. Methods: A qualitative case study approach was used to gain an in-depth view of stigma, from two public care homes in northeast Thailand. Data were collected by in-depth interviews with 50 participants (30 older residents and 20 care home staff), and non-participant observation was conducted over one month. Thematic analysis was used to analyse the data. Results: The study identified three major themes of stigma, comprising the causes of stigma, reactions towards stigma, and mitigating factors. Discussion: Negative beliefs about care homes and residents, contribute to stigma. Residents exhibited negative emotions and behaviours, including depressive symptoms. Residents reported using particular coping strategies that helped them cope with their perceptions of stigma. Implications for Practice: Future research should focus on strategies or research to combat stigma in order to prevent depression, and reduce perceptions of stigma