Psychological Functioning and Living Arrangements among Older Thai People

Abstract

In the next two decades, one in three people in Thailand will be older adults aged 60 or over. Industrialization and socioeconomic development have encouraged the migration of young adults from rural to urban areas which has transformed the living arrangements of some older adults. Using culturally sensitive measures, this study investigates the association between living arrangements and psychological functioning net of personal and contextual factors. Data are from a survey of 638 Thai people aged 60 and over conducted in 2012. Results from multiple regression analyses indicate that personal and contextual factors are differentially associated with either psychological wellbeing or depressive symptoms. In contrast, living arrangements are associated with both outcomes. These results suggest that older persons in skipped-generation households (two-generation households consisting of grandparents and grandchildren) are more likely to have lower psychological wellbeing than those who live in multi- and one generational households (with no children living within walking distance), and have higher depressive symptoms than those who live only with their children. Findings indicate that tailored services and policies are needed for older adults in varied living arrangements, particularly those in skipped-generation households.

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Development and validation of psychological wellbeing measure in Thailand

An interdisciplinary team of Thai and American researchers (Ingersoll-Dayton et al. 2001, 2004) applied a bottom-up approach, integrating qualitative and quantitative methods to develop and validate a measure of psychological wellbeing (PWB). The research team first explored local meanings and identified dimensions of wellbeing through focus group discussions and in-depth interviews with a total of 67 Thai older persons aged 60 and above living in both rural and urban areas, identifying five dimensions of wellbeing.

Secondly, results from the first qualitative approach were used to develop closed-ended items (e.g., “In your family, people get along well together”) which were subsequently validated by four experts in gerontology or quality of life in Thailand. Using these items, the research team conducted a survey of 477 older persons living in Bangkok and three nearby provinces. Through the survey, a number of measurement issues were identified.

Third, in order to address these issues and improve the interview process, the research team conducted cognitive interviews with 30 Thai older persons to refine the measure, changed the wording of items and the response set, and identified culturally appropriate interviewing strategies. Fourth, the revised PWB measure was included in a second survey with 460 older Thai people and psychometrically assessed for its reliability and validity.

In sum, the PWB measure for Thai older persons consists of five domains (i.e., harmony, interdependence, acceptance, respect and enjoyment) which are distinctly different from domains of psychological wellbeing identified by researchers in the West (Ryff and Keyes 1995).

Modification and validation of Euro-D measure in Thailand

Several steps were taken by a team of British and Thai researchers to ensure the cultural sensitivity of this measure (Abas et al. 2009a). First, they conducted focus groups with older people to explore perceptions, attitudes, and beliefs about health, wellbeing, and depressive symptoms, as well as social and family supports. Second, the original EURO-D’s items were translated and back-translated into English by bilingual mental health professionals, social scientists, and English psychiatrists focusing on conceptual and semantic equivalence (Abas et al. 2009a). The translated EURO-D questions were pretested, and some wording was modified according to results from both the focus group discussions and pretesting with individuals (Abas et al. 2009a).

Based on these focus groups and the translations, the research team found that some words in the EURO-D such as concentration, depression and pessimism were difficult to translate. Subsequently, the team modified these words to make them more readily understood by older Thai people. For example, one question “Can you concentrate on entertainment or reading?” was modified to “Can you concentrate on daily activities that you like such as listening to the monk’s teaching, the radio or watching television?” Similarly, another question, “Have you been feeling depressed?” was changed to “Have you been feeling sad, gloomy or in despair?”

Furthermore, since most Thai people are Buddhist, revisions of the EURO-D were guided by Buddhist concepts. One such concept was karma. The law of karma holds that one’s future happiness and distress are a function of past and present deeds (Ingersoll 1966; Kirsch 1977; Pfanner and Ingersoll 1962; Podhisita 1998). To address the concept of karma, the research team examined EURO-D items related to future outcomes. For example, one item from the original EURO-D asked, ‘Do you think your future is going to be pessimistic?’ The Thai version of the EURO-D revised this question to ask, ‘Do you have any hope or think that in the near future good things might happen to you?’ Following these revisions to enhance the measure’s cultural sensitivity, the research team checked to ensure that items in the Thai revised EURO-D were understood and that there was conceptual equivalence with the original version of EURO-D (Abas et al. 2009a, 2009b, 2013; Jirapramukpitak et al. 2009).