Individual differences in the effects of disease and disability on depressive symptoms: the role of age and subjective health

Each person is affected by disease and disability differently. This study examined the role of age and subjective perception of health in determining the links of depressive symptoms with disease and disability among older adults of different ages. The hypothesized effects of age and subjective health were tested using 252 older adults divided into three age groups (i.e., 60s, 80s, and 100s). Two major findings emerged. First, individuals with advanced old age had higher levels of health problems, as expected. However, their perceptions of health and depressive symptoms were less affected by disability when compared to the younger old. Second, regardless of age, the effects of disease and disability on depressive symptoms were mediated through subjective health. Findings suggest age differences in the consequences of health problems, and the importance of subjective perception to bridge physical and mental health. Issues such as age differences within older populations, the resilience of centenarians, and the intervening roles of subjective health are further discussed.     

The mediating role of health perceptions in the relation between physical and mental health: a study of older residents in assisted living facilities

OBJECTIVE: Responding to the increased need for research on older residents in assisted living facilities (ALFs), this study assessed the connections between physical and mental health among 150 older residents in ALF settings. METHOD: The major focus of the study was to explore whether individuals' subjective perceptions of their own health mediate the associations between health-related variables (chronic conditions and functional disability) and depressive symptoms. RESULTS: The analyses showed that the adverse effects of chronic conditions and functional disability on depressive symptoms were not only direct but also indirect through negative health perceptions. DISCUSSION: The findings that health perceptions serve as an intervening step between physical and mental health provide important implications for promotion of mental well-being among older residents in ALFs. In addition to disease/disability prevention and health promotion efforts, attention should be paid to ways to enhance older individuals' positive beliefs and attitudes toward their own health and to promote healthful behaviors.     

Introduction

ABSTARCT

Objectives: The present study investigates the applicability of the behavioral model of health service use (Andersen, 1995) to the predicting of psychotherapy use among older adults.

Methods: Sample was obtained, using a random-digit dialing methodology, from the older Jewish population in Israel. The final sample consisted of 509 respondents with an average age of 74.08 (SD = 5.89). The telephone interviews were conducted in the first week of August 2011, by experienced interviewers, in Hebrew or Russian, using a structured questionnaire.

Results: After adjusting for age, gender, education, marital status, religiosity, health status, and economic status in the first step, binary logistic regression revealed that higher depressive symptoms, positive attitudes toward psychological treatment, primary physician referral, and accessibility of psychological services were all related to higher odds ratios for seeking psychological treatment.

Conclusions: The present study integrated previously identified precursors of mental health service use into one model predicting psychotherapy use among community-dwelling older adults. The model suggests that the point of entry to psychotherapy is not limited to one source and that individuals’ need, their attitudes, accessibility of services, and their primary physicians’ referral are all useful facilitators of psychotherapy use.     

Creating and maintaining purpose in life in old age: A meta-analysis

Purpose in life is a defining feature of mental health. In old age, maintaining high levels of purpose in life may become more difficult, due to increasing losses (e.g., widowhood, retirement). Meta-analysis was used to synthesize findings from 70 studies on purpose in life in middle age and old age. We found a small age-associated decline of purpose in life, which was stronger in older age-groups. Purpose in life showed a strong association with social integration, and with relational quality in particular. In addition, high purpose in life was related to better health, higher everyday competence, higher socioeconomic status, being employed, and being married. Furthermore, strong associations with psychological well-being and low levels of depressive symptoms were found. We conclude that relying on sources that have low or even no age-associated decline, such as social integration and previous attainments, counteract strong declines of purpose in life in old age. Martin Pinquart, Dr. habil., is an associate professor of Developmental Psychology, University of Jena (Germany). His research interests include subjective wellbeing in old age, planning and goals in later life, coping with cancer, intergenerational relations.     

The relationship between age, gender, historical change, and adults' perceptions of mental health and mental health services

The purpose of this study was to explore the impact of age, historical change, and gender on perceptions of mental health and mental health services. Using multidimensional measures to assess such perceptions among older adults (1977, 1991, 2000), and younger adults (1991, 2000), we expected that older adults would have less positive mental health perceptions than would younger adults, that more recently born cohorts of older persons would evidence more positive perceptions, and that women, especially those more recently assessed, would also evidence more positive perceptions. To an extent, we found positive historical shifts in mental health perceptions, though data also indicated that such views may have stabilized over the last decade for older persons, and interacted with age and gender in this respect. Age differences favoring younger persons were, in part, replicated across historical time, and women held more positive mental health perceptions than did men. Over historical time, older persons' mental health perceptions are, for the most part, increasingly positive, significant in light of the increasing proportion of older persons and changes in the mental health system itself. Our data suggest that efforts to reach older men should be given high priority.     

Attitudes of older Korean Americans toward mental health services

Given the increasing evidence that older ethnic minorities underuse mental health services, the present study assessed determinants of attitudes toward mental health services with a sample of older Korean Americans (N=472). Adapting Andersen's behavioral health model, predisposing factors (age, sex, marital status, education, length of residence in the United States), mental health needs (anxiety, suicidal ideation, depressive symptoms), and enabling factors (personal experiences and beliefs) were considered as potential predictors. Shorter residence in the United States and higher levels of depressive symptoms were associated with more-negative attitudes toward mental health services. Culture-influenced personal beliefs (knowledge about mental illness and stigmatism) were found to play a substantial role in shaping individuals' attitudes toward mental health services. Findings call attention to the need to investigate how culture influences the response to mental health needs and to develop community education and outreach programs to close the gaps between mental health needs and service utilization in older ethnic minority populations.     

The difference between self-perceived and chronological age in the elderly may correlate with general health,personality and the practice of good health behavior: A cross-sectional study

Background and objectiveFor the elderly, maintaining a young self-perceived age has a positive impact on physical and mental health. The purpose of this study was to investigate the impact of the discrepancy between self-perceived age and chronological age in regards to physical activity, instrumental activities of daily living, functional capacity, personality, general self-efficacy, depressive symptoms, and disease burden.MethodsParticipants were 3094 older adults from 2015 baseline data of the Keeping Active across Generations Uniting the Youth and the Aged study. The questionnaire was mailed to 8004 elderly people aged 65 years or older. Of the 3871 people who returned the questionnaire (collection rate, 48.3%), 3094 subjects were analyzed in this study (female, 52%). The questionnaire included aspects of physical activity, instrumental activity of daily living, functional capacity, personality traits, general self-efficacy, depressive symptoms, history of falls, fear of falling, communication with young people, medical history, and self-perceived age, as well as basic characteristics such as age, sex, living alone or not, and educational history.ResultsRegression analysis showed that the presence of high self-rated health, personality traits of extraversion and openness to experience, higher general self-efficacy, and the presence of fear of falling were positively associated with a younger self-perceived age.ConclusionsThe results identified personality and psychological factors related to of self-perceived age in community-dwelling elderly people. Therefore, changes in personality traits and subjective health accompanying aging affect the self-perceived age, which may also affect the extension of healthy life expectancy.     

The uniqueness of subjective ageing: convergent and discriminant validity

Although a large body of research has demonstrated the predictive power of subjective ageing for several decisive developmental outcomes, there remains some controversy about whether subjective ageing truly represents a unique construct. Thus, information about the convergent and discriminant validity of different approaches to measuring subjective ageing is still critically needed. Using data from the 2014 wave of the German Ageing Survey, we examined how three established subjective ageing measures (subjective age, global attitude toward own ageing, multidimensional ageing-related cognitions) were inter-related as well as distinct from general dispositions (optimism, self-efficacy) and well-being (negative affect, depressive symptoms, self-rated health). Using correlational and multivariate regression analysis, we found that the three subjective ageing measures were significantly inter-related (r = |.09| to |.30|), and that each measure was distinct from general dispositions and well-being. The overlap with dispositional and well-being measures was lowest for subjective age and highest for global attitudes towards own ageing. The correlation between global attitudes towards own ageing and optimism was particularly striking. Despite the high convergent validity of the different dimensions of ageing cognitions, we nevertheless observed stronger associations between specific dimensions of ageing cognitions with negative affect and self-rated health. We conclude that researchers should be aware of the multidimensional nature of subjective ageing. Furthermore, subjective age appears to be a highly aggregated construct and future work is needed to clarify its correlates and reference points.Electronic supplementary materialThe online version of this article (10.1007/s10433-019-00529-7) contains supplementary material, which is available to authorized users.     

Self-perception of aging among HIV-positive and HIV-negative participants in the Multicenter AIDS Cohort Study

ABSTRACT

Self-perception of aging is an important predictor of quality of life. Therefore, we sought to examine self-perceptions of aging (age discrepancy and aging satisfaction) between HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS). We included 835 HIV-negative and 784 HIV-positive men aged 50 years and older who had completed a survey about age discrepancy and aging satisfaction from the “Attitude toward own aging” subscale of the Philadelphia Geriatric Center Morale scale. Multinomial generalized logit models were generated to assess self-perception of aging by HIV-status. Most of the participants self-identified as white, former smokers, and had completed high school. HIV-positive individuals reported higher prevalence of comorbidities than HIV-negative individuals. After adjusting for covariates, positive age discrepancy (older subjective age) was positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. Low aging satisfaction was associated with being a current and former smoker and having depressive symptoms, diabetes, and no age and positive age discrepancy. Being black had decreased odds of low aging satisfaction. These findings should inform health care professionals to promote positive views of aging in the assessment and management of HIV, depression, and diabetes.     

Filial Piety and Parental Depressive Symptoms: All Children Matter – Evidence from Rural Northern China

Little research has considered all children while investigating adult children’s role in their older parents’ health and well-being. In this study, we examine the effect of filial piety across all children on parental depressive symptoms. A sample of 432 older parents with 1,223 adult children in a rural county in northern China rated the filial piety level for each child individually. Ratings were then combined across multiple children and organized into an ordinal variable of filial piety including three levels: all children being filial, some of the children being filial, and none of the children being filial. Ordinary least squares linear regression analyses were performed. The results reveal a significant and negative relationship between adult children’s filial piety levels and older parents’ depressive symptoms after controlling for age, gender, marital status, financial strain, chronic conditions, and social support from family and friends, respectively. That is, one level lower in the adult children’s filial piety corresponds to increase in level of older parents’ depressive symptoms. Filial piety seems to benefit older Chinese parents’ mental health net of social support from family and friends in this sample. Including information from all children in the analyses is informative for better understanding the psychological significance of filial piety for healthy aging in China.

     

Relationship between personality and physical capacities in older adults: The mediating role of subjective age,aging attitudes and physical self-perceptions

Walking speed and muscular strength are two main markers of health in adulthood. Previous studies have shown that personality traits may predict these two outcomes. However, little is known about the mechanisms underlying these relationships. Thus, the present study examined whether personality traits are associated with walking speed and muscular strength through the mediating role of subjective age (how young or old individuals experience themselves to be), attitudes toward aging and physical self-perceptions.Community-dwelling older women (N = 243; M_age = 73.0; SD_age = 6.5) were recruited. For reasons of recruitment feasibility, participants were only older women. They were requested to complete a questionnaire measuring personality, subjective age, attitudes toward aging and physical self-perceptions. Following this, their walking speed and their muscular strength were investigated. Data were analyzed using structural equation modeling. In line with the literature, we extended the associations between extraversion, neuroticism, conscientiousness and walking speed and between conscientiousness, neuroticism, openness and muscular strength. Physical self-perceptions appear to be a robust mediator between personality traits and walking speed whereas attitudes toward aging and subjective age mediated the personality traits/muscular strength relationship.This study provides evidence, for the first time, that the associations between personality traits and physical capacities are different according to the physical capacities investigated. Based on these results, it could be interesting to adapt physical activity interventions to the psychological profile of older adults.     

Depressive symptoms in the oldest-old: The role of sensory impairments

BackgroundWhile a fair amount of research has investigated the impact of sensory impairments on the mental health of young older adults (65–79 years of age), only a few studies have focused on the associations of sensory impairments with mental health outcomes in the oldest-old (80 years and older). To close this gap, this study examined the separate and combined effects of self-reported vision and hearing impairment for depressive symptoms in a sample of oldest-old individuals, controlling for other mental health risks (e.g., functional disability, health interference, and loneliness).MethodsCentenarians and near-centenarians (N = 119; average age = 99) were recruited from the community and geriatric healthcare organizations. In-person interviews were conducted at participants’ place of residence.ResultsVision impairment and its interaction with hearing impairment as well as functional disability, health interference with desired activities, and loneliness were significant predictors of depressive symptoms in hierarchical regression analyses. Hearing impairment alone was not associated with depressive symptoms, but follow-up analyses clarifying the interaction effect showed that individuals with poor vision had the highest levels of depressive symptoms, if they had a concurrent hearing impairment. Thus, a concurrent presence of poor vision and poor hearing resulted in an increased vulnerability for depressive symptoms.ConclusionsGiven that a majority of oldest-old has sensory impairments which can result in mental health issues, it is important to facilitate this population’s access to vision and audiological treatment and rehabilitation.     

Does negative information about aging influence older adults’ physical performance and subjective age?

This study investigated the way negative stereotypes influence older adults’ physical performance and how old they feel mentally and physically. Sixty-four older adults aged 65 years and older performed different physical tasks using a 3D optoelectronic system under a low or high stereotype threat condition. Self-perceptions of aging were considered as a moderator of the effects of threat. Overall, the effects of threat on physical performance were mostly not significant across tasks. However, threat condition influenced older adults' mental subjective age after they had performed the physical tests; people in the high-threat condition felt closer to their chronological age. Threat also influenced participants' physical subjective age, and this effect was moderated by self-perceptions of aging. More precisely, participants in the high-threat condition felt 7% physically older than their chronological age when they had more negative self-perceptions, while participants in the low-threat condition felt 13% younger. No differences emerged for participants who had more positive self-perceptions. The present findings suggest that performing physical tests under stereotype threat might worsen older people’s subjective experience of their own aging by making them feel older.     

Psychological and Sociocultural Adaptation: Acculturation,Depressive Symptoms,and Life Satisfaction Among Older Iranian Immigrants in Canada

Informed by Ward’s (1996) theory of psychological and sociocultural adaptation, this study identified links between acculturation and the mental health of older Iranian immigrants living in Canada (N = 103). According to Ward and colleagues, both psychological and sociocultural adaptation change at different rates and extend into later life. For this study, participants 50+ years of age and born in Iran completed questionnaires measuring life satisfaction, depressive symptoms, acculturation, and demographic and sociocultural variables (e.g., pre- and post-immigration occupational status). We collected study data anonymously in Persian to obtain responses from long-term residents of Canada as well as more recent immigrants who may not read or write English. We examined both life satisfaction and (the absence of) depressive symptoms as distinct forms of psychological adaptation; these emerged as independent predictors of acculturation. Contrary to theory, acculturation appears to predict life satisfaction, not vice versa; moreover, there seems to be no direct link between depressive symptoms and acculturation. Our findings suggest that integration within Canadian society is associated with higher life satisfaction. In contrast, sociocultural factors are indirectly associated with life satisfaction (except age) and acculturation (except ethnic diversity of social interactions). Involuntary migrants reported higher levels of depression, whereas loss of occupational status is associated with reduced life satisfaction. Implications for future research and health policy are discussed.     

Serious health events and their impact on changes in subjective health and life satisfaction: the role of age and a positive view on ageing

Various studies have pointed to the great importance of subjective health as an indicator for mortality in older age, while less is known about factors that contribute to changes of subjective (self-rated) health over time. Based on a nationwide longitudinal survey (German Ageing Survey, N = 1,286; initial age 40–85), two major findings emerged: first, the incidence of a serious health event caused greater changes in subjective health and life satisfaction in middle compared to older age. This was as expected because serious health events are less common in middle age and are correspondingly experienced more often as an “off-time event”. Secondly, the study extended previous findings on the impact of a positive view of ageing on health by showing that this optimistic view positively affects subjective health and life satisfaction even in the face of a serious health event. Overall, the study indicates that a positive view on ageing is an important psychological resource in the case of a serious health event, both when it occurs on-time or off-time from a developmental perspective.

Physical health,subjective health,and psychological distress in older adults: Reciprocal relationships concurrently and over time

This study addresses the reciprocal associations between physical health (objectively assessed and self-rated) and psychological distress among older adults. Psychological distress (both depressive symptoms and anxiety level) made a significant independent contribution to the prediction of concurrent and future negative perception of one’s health, over and above objective health. As anxious and depressive components of psychological distress intensify, a negative outlook on life includes an increased negative view of one’s health among older adults. Conversely, negative subjective health independently predicted both depressive symptoms and anxiety level, concurrently and over time, over and above objective health. It thus appears that negative health appraisal heralds psychological distress, manifested as depressive symptoms and also anxiety among older adults. Taken together these findings draw the picture of a vicious circle of negative health appraisal leading to depression and anxiety, these in turn leading to further negative perception of health. His research and teaching activities are in the domain of psychogerontology, especially clinical geropsychology. His research interests include the treatment of depression, and reminiscence and autobiographical memory. Sabine Sèvre-Rousseau, Psy.D., defended her thesis in developmental psychology at the University of Paris V, Sorbonne. She was the coordinator of the mental health division of the Quebec Research Network on Aging during this study. She is also teaching psychology and statistical sciences at the Universities of Montreal and Sherbrooke. His research and teaching activities are in the domain of clinical geropsychology. In terms of research, he has a special interest for the etiology, assessment, and treatment of agitation and depression. Michel Préville, Ph.D., is associate professor at the Université de Sherbrooke, and Researcher at the Research Center on Aging, Scherbrooke Geriatric University Institute. He is director of the Mental Health Division of the Quebec Research Network on Aging.     

Change of depressive symptoms in a French nine-year longitudinal study of aging: Gender differences and relationships between social support,health status and depressive symptoms

ObjectivesThe aims of this study were to examine the trajectory of depressive symptoms among older French people, to investigate the role of gender in the developmental trajectory of depressive symptoms and to explore whether the linear increase in depressive symptoms might be accentuated or attenuated at time points during which the older adults’ scores on social support and health satisfaction scales were higher than their individual averages.Methods/materialsData were used from a subsample of older adults living at home who participated in a longitudinal study initiated by researchers from the University of Tours. They were collected at five time points over a 9-year period (T1: 2003; T2: 2005; T3: 2007; T4: 2009; T5: 2011). This study included 707 participants, and multilevel growth curve analysis was used on measures of depressive symptoms, gender differences, social support and health satisfaction.ResultsResults indicated (1) a significant positive linear effect of age on depressive symptoms; (2) that women reported significantly higher scores of depressive symptoms than men at 63 years old (i.e., intercept) and that this gender difference remained constant across age; (3) that the slope of depressive symptoms appeared to increase at time points during which participants had higher levels of social support and to decrease when they had greater health satisfaction.ConclusionThis study provides pertinent information about the change of depressive symptoms in older people living at home and particularly highlights the interest in studying gender, social support and health satisfaction.     

Depressive symptoms among older residents in assisted living facilities

Responding to the dramatic growth in Assisted Living Facilities (ALFs), the present study focused on mental health among older residents in ALFs. We assessed the effects of physical health constraints (chronic conditions, functional disability, and self-rated health) and psychosocial resources (social network, sense of mastery, religiosity, and attitude toward aging) on depressive symptoms. A sample of 150 residents (Mage = 82.8, SD = 9.41) from 17 facilities in Florida was used for analyses. Higher levels of depressive symptoms were observed among older residents with a greater level of functional disability, poorer self-rated health, lower sense of mastery, less religiosity, and less positive attitude towards aging. In addition, the linkages between physical and mental health were modified by psychosocial resources. For older residents with more positive beliefs and attitudes (a higher sense of mastery, greater religiosity, and more positive attitudes toward aging), the adverse effects of functional disability or poorer self-rated health on depressive symptoms were attenuated. The protective roles of psychosocial resources against physical health constraints yield important implications for designing prevention and intervention strategies for the mental health of older populations in ALF settings.     

Mental Health Attitudes Among Rural and Urban Older Adults

This study compared samples of rural (n = 107) and urban older adults (n = 126), to explore differences in their attitudes toward mental health and mental health services. The moderating role that personality may play in accounting for rural versus urban differences in these variables was also explored. Each person completed a multidimensional measure of mental health attitudes and a trait measure of personality. Older adults in urban areas expressed more positive attitudes about mental health services than their rural counterparts, even when controlling for the poorer health of rural aged persons. In both groups, older adults who had sought mental health care held more positive views about such help than those who had not. There was an interaction between personality and the rural/urban dichotomy, such that NEO Neuroticism and, to a lesser extent, NEO Openness to Experience impacted mental health attitudes and help-seeking differentially among rural and urban older adults. These findings suggest that public policy makers and mental health providers should consider the interactive roles of culture-environment, personality, and attitudes toward mental health services when designing mental health programs for older adults.     

Psychological functioning among vertically infected HIV-positive children and their primary caregivers

The current study sought to explore the association between primary caregiver depressive symptoms and the psychological functioning in children vertically infected with human immunodeficiency virus (HIV) living in Eastern Cape, South Africa. A cross-sectional data were collected using the Beck Depression Inventory and Strength and Difficulties Questionnaire in a sample of 152 caregiver/child dyads. The results revealed that poorer psychological functioning in children was significantly associated with depressive symptoms in caregivers. This relationship existed whether or not the child was raised by a biological or non-biological caregiver as well as for both genders. Younger children's psychological functioning was more negatively influenced than that of older children raised by a caregiver with depressive symptoms. In the context of a large treatment gap for common mental disorders in South Africa, there is a need for interventions to address maternal mental health in families infected and affected by the HIV/AIDS pandemic as a mental health promotion strategy given that HIV-infected children are a particularly vulnerable population for poor mental and behavioural health outcomes.