Recent demographic trends and work patterns may be contributing to a situation where
older Thai people find themselves isolated after a lifetime in a culture that stresses the value
of the extended family and family support. With the migration of people of working age to
the cities, many Thai elders find themselves in communities with disproportionate numbers
of older people and young children, and a shortage of fit adult carers. Jongudomkarn and
Camfield36 found that many older people fear being left without economic support when
times get tough. Thus there is probably a valid reason for them to feel depressed, particularly
when they live alone with chronic disease and the lack of a caregiver. Feelings of
abandonment appear to result in lower quality of life in terms of psychological factors,
including overall enjoyment of life, having a meaningful life, and feelings of despair, anxiety
and depression37. Thus this group may be locked into a downward cycle where stress and
excessive alcohol use fuels depression, and where depressive illness adds to the inability to
cope with stress or stop drinking.