Table 4.

Impact of Depressive Symptoms on Health and Well-being

Themes	Subthemes	Sample statements
Overall health	Worsening of health conditions	“Seniors need to be healthy psychologically, that is, if seniors are distressed, their health will be in trouble. Their distress would cast a toll on their general well-being.” “The older we get, the more self-centered and opportunistic we become. I think the sad mood we have will soon make us suffer more from illnesses.”
	Physical function decline	“We need to keep a calm mind. That will keep us happy, and fit. If not, then we might feel that even a minor ailment would turn out to be a big problem that leads to more functional decline.” “Our mindset needs to be nice and sound. If our mindset is depressed, then our body function suffers.”
	Cognitive function impairment	“My husband’s brother-in-law had dementia. His family members did not send him to a nursing home. No one accompanied him to a doctor’s office. He was very sad. He was not properly cared for. I think his depression may make the situation worse.”
	Abnormal weight changes	“At the time when I was unhappy, I ate a lot. I couldn’t help it. I was much larger than I am now.”
Worsening social isolation	Psychological distress may impact social well-being	“I think for those who are depressed, our apartment manager may provide help. Whoever has a problem he can seek help. But for most of the cases I know of, these people would just sit at home and not talk about it or seek help.” “When old people have a problem, they won’t tell anybody. Maybe because their children have to go to work. You need to take care of yourself. Don’t feel isolated.”
Suicidal ideation	Having suicidal thoughts and attempts	“You might not agree with me. But sometimes when I feel bad about things I would rather swallow a pill and die as long as it is not too painful.” “I didn’t want to live. I wanted to die. I didn’t know what to do with myself. I felt trapped here.”
Elder mistreatment	Depressed older adults may suffer from mistreatment	“My thought is that unhappy seniors may sit at home, not wanting to talk to anyone. What if then they are ill-treated by their children? That would make the situation even alarming. So I think it is important to let the old people vent and voice their complaints. It helps them to have an outlet.”
Barriers to health services utilization	Older adults may be hesitant to reach out to formal health care services	“The psychiatrist cannot do too much. How can one advise unhappy people? How much change would that bring?” “Many people would not seek formal help. Feeling depressed is shameful. So they do not want others to know about their shameful situations.”