Depression rates in Hong Kong have recently reached high levels, with severe depression skyrocketing by over 30% compared to 2020 .Most concerning is that 44% of young respondents aged 18 to 24 now experience moderate to severe depressive symptoms . As Hong Kong society develops, uncertainty about future prospects becomes increasingly apparent among young people. Though it may seem obvious, depression affects all age groups, including older adults who face unique challenges. While depression receives extensive coverage, some lesser-talked-about forms of depression are worthy of discussion as well: depression in the elderly, high-functioning depression, and smiling depression.
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What is Depression and How is it Related to You?
Depression is a common, severe mental disorder that negatively affects how you feel, think, and act. Unlike temporary sadness, clinical depression persists and significantly impairs daily functioning. Key depression symptoms include persistent sadness, losing interest in activities you once enjoyed, significant appetite changes, sleep disturbances, fatigue, and feelings of worthlessness.
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Depression stems from various factors, including family dynamics, workplace stress, academic pressure, and social relationships. Those who have experienced abuse, severe losses, or chronic stressful events face a higher risk. In Hong Kong's high-pressure environment, many working professionals encounter multiple triggers simultaneously.
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Depression may already be affecting your life directly. Whether you're experiencing symptoms yourself, concerned about a family member, or noticing changes in a colleague. In Hong Kong's demanding work culture, approximately 1 in 4 adults have experienced anxiety or depressive symptoms , making it likely that you or someone close to you will encounter this condition.
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Depression in Older Adults and the Elderly
Many older adults mistakenly believe depression is a natural part of aging, poor health, or dementia. This misconception prevents or delays proper treatment and worsens outcomes.
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Elder depression often results from traumatic life events such as spousal death, loss of independence, or significant health diagnoses. Additional contributing factors include limited mobility, social isolation, facing mortality, and medication side effects. Signs of depression in the elderly differ from younger populations. Rather than expressing sadness directly, older adults may report persistent physical complaints, memory problems, or loss of appetite. Some elders refuse to discuss emotional struggles due to cultural stigma surrounding mental health, making detection more difficult.
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What is the Geriatric Depression Scale (GDS)?
The Geriatric Depression Scale is an extensively tested questionnaire specifically designed to identify possible depression in older adults. This validated screening tool addresses unique presentation patterns in elderly populations and avoids age-related physical symptoms that might confuse diagnosis.
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The GDS comes in two versions: a comprehensive 30-question long form and a practical 15-question short form. Healthcare providers typically use the short form as the longer version proves time-consuming and difficult for some patients to complete. Within the 15-item version, 10 questions indicate depression when answered positively, while 5 indicate depression when answered negatively .
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In Hong Kong, the GDS has been widely used to provide valuable insights into our community’s mental health landscape. A 2018 study by Baptist Oi Kwan Social Service found that 15% of Hong Kong participants scored 6 or above , indicating a borderline depressed state, highlighting the significant prevalence of elder depression in our community.
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High-Functioning Depression
High-functioning depression represents a deceptive form where individuals maintain outward success while experiencing internal turmoil. These patients appear productive, meeting all daily and life responsibilities, and seem well-adjusted to colleagues and family members. Beneath the surface, they struggle with persistent depressive symptoms.
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People with high-functioning depression experience similar symptoms to major depression, such as persistent sadness, hopelessness, fatigue, and diminished interest, but develop sophisticated masking strategies. They maintain work performance, fulfil social obligations, and project competence. This creates the illusion that everything is under their control and well-managed.
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In Hong Kong's achievement-oriented culture, high-functioning depression is particularly common among professionals who fear career consequences of appearing vulnerable. Social media exacerbates this by showcasing curated happiness while concealing the authentic struggles that lie beneath. The constant pressure to maintain appearances prevents many from seeking necessary treatment.
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Smiling Depression
While not officially listed in mental health diagnostic manuals, smiling depression describes individuals who appear happy externally while experiencing significant internal depression. Medical professionals increasingly recognize this presentation pattern, particularly in cultures with high mental health stigma.
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Those with smiling depression maintain cheerful expressions while feeling profound sadness, hopelessness, or emptiness internally. They may often tell others that they feel fine and actively project happiness through social interactions, professional demeanor, and social media presence.
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Cultural factors significantly influence smiling depression prevalence. In societies where mental illness carries heavy stigma, individuals may feel compelled to hide authentic emotions to maintain social standing. Perfectionists and those fearing perceived weakness are particularly susceptible. Though it might be hard to identify, there are signs one may see within someone who is experiencing smiling depression. A mismatch between expressed mood and behavior, excessive people-pleasing, reluctance to discuss personal struggles, and perfectionist tendencies are all signs that may signify someone is going through smiling depression.
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Unveiling Depression's Many Faces
Depression isn’t always what we expect. High-functioning individuals can continue to excel professionally while battling internal turmoil, whereas others maintain a constant cheerfulness to avoid stigma or appear strong. Meanwhile, older adults may suffer in silence, believing their symptoms are inevitable parts of aging rather than treatable conditions.
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Understanding these forms of depression as friends or family members is crucial, as untreated depression worsens over time, affecting not just the individual but their families, workplaces, and communities. If you recognize these patterns in yourself or others, seeking professional help is a crucial step toward genuine healing and well-being.
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Sources:
1. Hong Kong depression rates reach new highs. (2024). The Standard. Available from: https://www.thestandard.com.hk/breaking-news/article/213040/Hong-Kong-depression-rates-reach-new-highs
2. What is Depression?. (2024). American Psychiatric Association. Available from: https://www.psychiatry.org/patients-families/depression/what-is-depression
3. Depressive disorder (depression). (2023). WHO. Available from: https://www.who.int/news-room/fact-sheets/detail/depression
4. Depression in older people. (2023). Health Direct. Available from: https://www.healthdirect.gov.au/depression-in-older-people
5. Your Guide to Understanding Depression in Elderly and Older Adults. (2025). Healthline. Available from: https://www.healthline.com/health/depression/elderly
6. Geriatric Depression Scale (GDS). (2020). American Psychological Association. Available from: https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression
7. The Geriatric Depression Scale (GDS). (N.D). HIGN. Available from: https://hign.org/consultgeri/try-this-series/geriatric-depression-scale-gds
8. 社區長者情緒健康調查－報告摘要. (2017). Baptist Oi Kwan Social Service. Available from:
10. What Is High-Functioning Depression? Signs and Symptoms. (2024). Cleveland Clinic. Available from: https://health.clevelandclinic.org/high-functioning-depression
11. 7 Signs You’re Dealing with High-Functioning Depression. (2024). Redoak Recovery. Available from: https://www.redoakrecovery.com/addiction-blog/7-signs-youre-dealing-with-high-functioning-depression/
12. Smiling Depression: What You Need to Know. (2024). WebMD. Available from: https://www.webmd.com/depression/smiling-depression-overview
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