PLOS ONE · 11 authors, 5 centres
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This community-based study of 1462 older adults in Taiwan found that perceived receipt of filial piety (PRFP) mediates the relationship between lung function and depressive symptoms differently by gender. In older women, PRFP completely mediated the association, while in older men it partially mediated the link. These findings suggest that enhancing filial support, particularly for elderly women with worse lung function, may help reduce depression risk.
**Background:** Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, and depression is common in COPD patients. Filial piety, a traditional Asian value representing family support, is associated with depressive symptoms in older adults. However, gender differences in how filial piety mediates the relationship between lung function and depression have not been studied. This study aimed to investigate whether filial piety (expectation and perceived receipt) mediates the association between lung function (FEV1) and depressive symptoms in older men and women.
**Methods:** Data were from the Healthy Aging Longitudinal Study in Taiwan (HALST), a community-based study. Participants aged 55+ were recruited from seven communities; this analysis included 1462 participants (727 men, 735 women) from the second wave (2016-2019) who had pulmonary function tests. Pulmonary function was measured by spirometry (FEV1, FVC). Filial piety was assessed using two scales: filial piety expectation (FPE) and perceived receipt of filial piety (PRFP), each scored 6-30. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Linear regression and mediation analysis (SAS CAUSALMED) were used, stratified by sex, adjusting for age, waist circumference, education, smoking, hypertension, stroke, and MMSE.
**Key Results:** Mean age was 74.0±7.6 years; 86.3% were ≥65. FEV1 was significantly lower in women (1.58±0.41 L) than men (2.16±0.62 L, p<0.001). Women had higher FPE (18.77±5.24 vs. 17.33±5.05, p<0.001) and higher PRFP (20.38±4.92 vs. 19.41±4.78, p<0.001). In men, FEV1 was inversely correlated with depressive symptoms (β=-0.1281, p=0.004) with no mediation by FPE. PRFP partially mediated the relationship: FEV1 was negatively associated with PRFP, and PRFP reduced depressive symptoms (β=-0.1354, p<0.001). In women, FEV1 was negatively associated with FPE, but FPE did not significantly increase depressive symptoms (β=0.0605, p=0.12). PRFP completely mediated the association: FEV1 was negatively associated with PRFP, and PRFP reduced depressive symptoms (β=-0.2246, p<0.001); the direct effect of FEV1 on CES-D became non-significant (β=-0.0397, p=0.356). Sensitivity analyses in those ≥65 years and those with COPD (N=362) showed similar patterns.
**Clinical Implications:** This study demonstrates that perceived receipt of filial piety (PRFP) is a key mediator of the link between worse lung function and depressive symptoms, especially in older women. In women, PRFP completely mediated the association, suggesting that feeling supported by children may protect against depression even when lung function declines. In men, PRFP partially mediated the relationship. These findings highlight the importance of family support in mental health among older adults with COPD, and suggest that interventions to enhance filial care—particularly for elderly women—may reduce depression risk. Clinicians should consider gender-specific psychosocial factors when managing COPD-related depression.