Spirituality attenuates the association between depression symptom severity and meaning in life

Objectives: This cross-sectional study examined whether spirituality moderates the association between depression symptom severity and meaning in life among treatment-seeking adults.

Method: Participants were 55 adults (≥60 years of age) newly seeking outpatient mental health treatment for mood, anxiety, or adjustment disorders. Self-report questionnaires measured depression symptom severity (Patient Health Questionnaire-9), spirituality (Spirituality Transcendence Index), and meaning in life (Geriatric Suicide Ideation Scale-Meaning in Life subscale).

Results: Results indicated a significant interaction between spirituality and depression symptom severity on meaning in life scores (β = .26, p = .02). A significant negative association between depression symptom severity and meaning in life was observed at lower but not the highest levels of spirituality.

Conclusion: In the presence of elevated depressive symptomatology, those participants who reported high levels of spirituality reported comparable levels of meaning in life to those without elevated depressive symptomatology. Assessment of older adult patients’ spirituality can reveal ways that spiritual beliefs and practices can be can be incorporated into therapy to enhance meaning in life.     

Santa Clara Strength of Religious Faith Questionnaire: psychometric analysis in older adults

Objectives: To assist researchers and clinicians considering using the Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ) with older-adult samples, the current study analyzed the psychometrics of SCSRFQ scores in two older-adult samples.

Method: Adults of age 55 or older who had formerly participated in studies of cognitive-behavioral therapy for anxiety and/or depression were recruited to complete questionnaires. In Study 1 (N = 66), the authors assessed the relations between the SCSRFQ and other measures of religiousness/spirituality, mental health, and demographic variables, using bivariate correlations and nonparametric tests. In Study 2 (N = 223), the authors also conducted confirmatory and exploratory factor analyses of the SCSRFQ, as well as an item response theory analysis.

Results: The SCSRFQ was moderately to highly positively correlated with all measures of religiousness/spirituality. Relations with mental health were weak and differed across samples. Ethnic minorities scored higher than White participants on the SCSRFQ, but only in Study 2. Factor analyses showed that a single-factor model fit the SCSRFQ best. According to item response theory analysis, SCSRFQ items discriminated well between participants with low-to-moderate levels of the construct but provided little information at higher levels.

Conclusion: Although the SCSRFQ scores had adequate psychometric characteristics, the measure's usefulness may be limited in samples of older adults.     

Adult day services: A service platform for delivering mental health care

Objectives: The purpose of this study was to understand the degree to which mental health services targeting anxiety and depression disorders are offered by adult day services (ADS) centers in the US. In addition, researchers wanted to determine whether staffing and organizational characteristics are associated with the provision of medication management, individual counseling, and group counseling for participants with anxiety or depression.

Method: Data were drawn from the MetLife National Study of ADS. Hierarchical logistic regression analyses were conducted to determine which staffing and organizational factors were associated with the provision of services to treat anxiety and depression.

Results: Approximately, three in four adult day programs provided medication management for the treatment of anxiety and depression while 38% provided individual counseling and almost 30% group counseling. Programs offering medication management were more likely to have more registered nurse (RN) service hours available per shift and higher costs. Programs that provided individual and group counseling for participants with anxiety or depression were more likely to have more hours of RN and social work services available and a lower percentage of participants who pay privately for services.

Conclusion: The results suggest that ADS are well positioned to act as a platform for delivering mental health care to older persons with anxiety or depression.     

The moderating effect of religiosity on caregiving burden and depressive symptoms in caregivers of patients with dementia

Objectives: This study explored whether religiosity/spirituality has a protective role against negative caregiving outcomes, in a large multicenter nationwide sample of caregivers of patients with dementia in South Korea. Additionally, this study was the first to examine whether religiosity/spirituality could affect caregiving outcomes according to the various religious affiliations of caregivers.

Methods: The study was conducted on a sample of 476 caregivers of patients with dementia participated in the Clinical Research Center for Dementia of South Korea (CREDOS). We examined the moderating effect of each of the three dimensions of religiosity/spirituality (organizational religious activity, ORA; non-organizational religious activity, NORA; intrinsic religiosity, IR) on the relationship between activities of daily living (ADL) of patients with dementia and caregiving burden and depressive symptoms of caregivers, using a series of hierarchical regression analyses. In addition, these analyses were conducted according to the religious affiliations of the caregivers.

Results: ORA, NORA, and IR of religiosity/spirituality alleviated the effect of ADL of patients on caregiving burden. ORA and IR moderated the relationship between ADL of patients and depressive symptoms of caregivers. These moderating effects of religiosity on caregiving outcomes were different according to various religious groups.

Conclusion: We have identified religiosity/spirituality as a protective factor for caregivers of patients with dementia. The sub-dimensions of religiosity as moderators were different by religious affiliations of caregivers. Further studies are needed to investigate the specific religiosity-related factors which could positively impact the mental health of the caregivers of patients with dementia by religions.     

Anxious depression among Puerto Rican and African-American older adults

Objectives: To determine racial/ethnic differences in the prevalence and impact of anxious depression (i.e. major depressive disorder, MDD, occurring concomitant with generalized anxiety symptoms) among older adults.

Method: Interviews were conducted with 218 Puerto Rican and 206 African American older (age ≥60) urban senior housing residents. Data were collected on diagnostic status, depression severity and psychosocial functioning.

Results: Results indicated a higher prevalence of MDD and anxious depression among Puerto Rican participants. Anxious depression was associated with more severe ratings of distress and suicidality compared with MDD alone, and the impact of depression and anxiety was most pronounced for the Puerto Rican participants. Puerto Rican participants also reported poorer subjective health and more substantial disability; however, these effects were independent of depression or anxiety status.

Conclusions: Anxious depression is common among older ethnic minority adults and the impact of these symptoms differs by race/ethnicity. These results highlight the importance of conducting culturally sensitive assessments of depression and anxiety among older adults.     

Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

Objectives: There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach.

Method: Patients attended six sessions of a manualised cognitive-behavioural group. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and six-week follow-up from patients, who also rated the alliance and their anxiety/depression at each group session. Staff rated patients regarding their functioning at assessment, termination and six-week follow-up. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression.

Results: Eight groups were completed with 34 patients, with a drop-out rate of 17%. Staff and patient rated outcome measures showed significant improvements (with small effect sizes) in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47%) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression with the alliance in groups stable over time.

Conclusion: The intervention evaluated shows clinical and organisational promise. The group approach needs to be further developed and tested in research with greater methodological control.     

Patient reported outcome measures (PROMs): examination of the psychometric properties of two measures for burden of symptoms and quality of life in patients with depression or anxiety

Introduction: Patient-reported outcome measures (PROMs) for anxiety and depressive disorders are an important aspect of measurement-based care.

Aim: The aim of the study was to perform a clinimetric analysis of two PROMs scales in patents with depression and anxiety.

Methods: Patients completed a 10-item version (SCL-10) of the Symptom Checklist to measure burden of symptoms and a brief 5-item version of World Health Organization Well-being scale (WHO-5) to measure quality of life. T-scores were used to standardize the SCL-10 and WHO-5 in terms of being in need of treatment. The coefficient of alpha and the coefficient of homogeneity were used to evaluate the internal consistency or scalability respectively of SCL-10 and WHO-5. Effect size statistics and Spearman correlation coefficients were used to measure the effect of gender and age, respectively.

Results: A total of 801 patients were recruited from two Danish mental health centers with anxiety or depression. The standardization of the SCL-10 and WHO-5 by T-scores indicated that a T-score of 65 corresponding to being moderately in need of treatment and a T-score of 75 to be severely in need of treatment. The coefficient of alpha and the coefficient of homogeneity were both found acceptable for SCL-10 and WHO-5. No gender or age factors were found being in operation.

Conclusion: The results from the current study supported the use of the SCL-10 and WHO-5 as potential PROMs to capture symptom burden and quality of life within groups of people with anxiety or depression undergoing psychotherapy treatment.     

Spiritual belief, social support, physical functioning and depression among older people in Bulgaria and Romania

Objectives: An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity.

Methods: In both countries, interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The Hospital Anxiety and Depression-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later, follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included.

Results: The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample (Bulgarian mean 29.7 (SD?=?19.1), Romanian mean 47.6 (SD?=?11.2), t?=?10.2, p?t?=?9.3, p?

Conclusions: Much of Eastern Europe displays high rates of depression among its older population and provides opportunities for investigation of the role of religious belief and practice in preventing and coping with depression. Further research is encouraged in populations of diverse religiosity.     

The role of coping humor in the physical and mental health of older adults

Objectives: This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults.

Method: Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.

Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures.

Conclusion: The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.     

Establishing community partnerships to support late-life anxiety research: lessons learned from the Calmer Life project

Objectives: This article outlines the development of the Calmer Life project, a partnership established between researchers and faith-based and social service organizations to examine the effectiveness of cognitive behavioral therapy (CBT) incorporating religious/spiritual components for older African Americans in low-income communities.

Method: The program was designed to bypass several barriers to delivery of CBT within the specified community; it allows multimodal delivery (in person or by telephone) that occurs outside traditional mental health settings through faith-based organizations and neighborhood community centers. It includes religion/spirituality as an element, dependent upon the preference of the participant, and is modular, so that people can select the skills they wish to learn. Established relationships within the community were built upon, and initial meetings were held in community settings, allowing feedback from community organizations.

Results: This ongoing program is functioning successfully and has strengthened relationships with community partners and facilitated increased availability of education and services in the community. The lessons learned in establishing these partnerships are outlined.

Conclusions: The growth of effectiveness research for late-life anxiety treatments in underserved minority populations requires development of functional partnerships between academic institutions and community stakeholders, along with treatment modifications to effectively address barriers faced by these consumers. The Calmer Life project may serve as a model.     

Medical conditions and depressive,anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder

Objective: The objective of this study was to examine medical illness and anxiety, depressive, and somatic symptoms in older medical patients with generalized anxiety disorder (GAD).

Method: A case-control study was designed and conducted in the University of California, San Diego (UCSD) Geriatrics Clinics. A total of fifty-four older medical patients with GAD and 54 matched controls participated.

Measurements: The measurements used for this study include: Brief Symptom Inventory–18, Mini International Neuropsychiatric Interview, and the Anxiety Disorders Interview Schedule.

Results: Older medical patients with GAD reported higher levels of somatic symptoms, anxiety, and depression than other older adults, as well as higher rates of diabetes and gastrointestinal conditions. In a multivariate model that included somatic symptoms, medical conditions, and depressive and anxiety symptoms, anxiety symptoms were the only significant predictors of GAD.

Conclusion: These results suggest first, that older medical patients with GAD do not primarily express distress as somatic symptoms; second, that anxiety symptoms in geriatric patients should not be discounted as a byproduct of medical illness or depression; and third, that older adults with diabetes and gastrointestinal conditions may benefit from screening for anxiety.     

The importance of personality and life-events in anxious depression: from trait to state anxiety

Objectives: Anxious depression is associated with severe impairment and bad prognoses. We hypothesize that recent life-events are associated with more anxiety in late-life depression and that this is conditional upon the level of certain personality traits.

Method: Baseline data of the Netherlands Study of Depression in Older Persons (NESDO) were used. In 333 patients (≥60 years) suffering from a major depressive disorder, anxiety was assessed with the BAI, personality traits with the NEO-FFI and the Mastery Scale, and life-events with the Brugha questionnaire. Multiple linear regression analyses were applied with anxiety severity as dependent and life-events and personality traits as independent variables.

Results: 147 patients (44.1%) had recently experienced one or more life-events. The presence of a life-event is not associated with anxiety (p = .161) or depression severity (p = .440). However, certain personality traits interacted with life-events in explaining anxiety severity. Stratified analyses showed that life-events were associated with higher anxiety levels in case of high levels of neuroticism and openness and low levels of conscientiousness or mastery.

Conclusions: In the face of a life-event, personality traits may play a central role in increased anxiety levels in late-life depression.     

Poor sleep quality is observed in mild cognitive impairment and is largely unrelated to depression and anxiety

Background: Individuals with mild cognitive impairment (MCI) commonly experience a number of sleep quality related issues. However, it remains unclear if these issues are specific to MCI or are simply attributed to the elevated levels depression and anxiety symptoms frequently observed among those with MCI. The present study sought to examine group differences between participants with MCI and matched controls on self-reported measures of sleep quality while controlling for depression and anxiety levels.

Methods: Participants with MCI (N = 48) and demographically matched controls (N = 48) were administered with self-reported measures of anxiety, depression and sleep quality. Sleep quality between both groups were first analyzed using a Multivariate Analysis of Variance, and then subsequently a Multivariate Analysis of Covariance incorporating depression and anxiety scores as covariates.

Results: The MCI group had significantly higher levels of depression and anxiety than the controls. On the sleep-related measures, the MCI group had significantly worse outcomes in sleep duration, disturbances, latency, efficiency, quality and daytime dysfunction. After controlling for depression and anxiety levels, with the exception of daytime dysfunction, all other differences remain significant, and are also associated with moderate to large effect sizes.

Conclusion: The results suggest that sleep quality issues are present in MCI and are largely independent of depression and anxiety.     

Trichotillomania and its clinical relationship to depression and anxiety

Objective: Trichotillomania (TTM) is associated with high rates of co-occurring depression and anxiety disorders. What the co-occurrence of TTM, depression or anxiety disorders means clinically and cognitively, however, has garnered little research attention.

Methods: About 530 adults with TTM were examined on a variety of clinical measures including symptom severity, psychosocial measures of functioning, psychiatric comorbidity and neurocognitive testing assessing motor inhibition and cognitive flexibility. Clinical features and cognitive functioning were compared between TTM patients with current comorbid major depressive disorder (MDD), a current anxiety disorder, both MDD and an anxiety disorder, or neither.

Results: Of 530 participants, 58 (10.3%) had MDD only, 97 (18.3%) had an anxiety disorder only, 58 (10.3%) had both MDD and an anxiety disorder, and 317 (59.8%) had neither. For almost all clinical measures, those with MDD only reported worse symptoms than those with an anxiety disorder only, and the combination of MDD and an anxiety disorder reported the worst level of symptom severity.

Conclusions: These results suggest that adults with TTM and co-occurring MDD and anxiety disorders exhibit unique clinical differences. The clinical differences may also have treatment implications.     

Does coping mediate the relationship between familism and caregiver outcomes?

Objectives: The sociocultural model of stress and coping, which despite receiving support from several studies conducted with diverse ethnic groups, has yet to be tested longitudinally or used within the context of positive caregiver outcomes. The aim of the current study was to test a specific component of the model, which posits that caregiver coping will be influenced by the cultural value of familism (feelings of solidarity and loyalty among family members), which will in turn affect caregiver outcomes.

Method: A questionnaire was completed by 123 family caregivers in the UK assessing familism, use of coping strategies, caregiver gains, anxiety and depression at three time points over nine months.

Results: Mediation analysis followed guidelines proposed by Baron and Kenny. Religious coping and positive reframing at time 2 (T2) were found to significantly mediate between familism values at time 1 (T1) and caregiver gains at time 3 (T3). Behavioural disengagement at T2 was found to mediate between familism at T1 and caregiver depression atT3. Additionally familism was found to be positively associated with both negative and positive aspects of caregiving.

Conclusion: Our longitudinal findings suggest that interventions and services acknowledging caregiver values and the associated coping responses may prove beneficial.     

Abide with me: religious group identification among older adults promotes health and well-being by maintaining multiple group memberships

Objectives: Aging is associated with deterioration in health and well-being, but previous research suggests that this can be attenuated by maintaining group memberships and the valued social identities associated with them. In this regard, religious identification may be especially beneficial in helping individuals withstand the challenges of aging, partly because religious identity serves as a basis for a wider social network of other group memberships. This paper aims to examine relationships between religion (identification and group membership) and well-being among older adults. The contribution of having and maintaining multiple group memberships in mediating these relationships is assessed, and also compared to patterns associated with other group memberships (social and exercise).

Method: Study 1 (N = 42) surveyed older adults living in residential care homes in Canada, who completed measures of religious identity, other group memberships, and depression. Study 2 (N = 7021) longitudinally assessed older adults in the UK on similar measures, but with the addition of perceived physical health.

Results: In Study 1, religious identification was associated with fewer depressive symptoms, and membership in multiple groups mediated that relationship. However, no relationships between social or exercise groups and mental health were evident. Study 2 replicated these patterns, but additionally, maintaining multiple group memberships over time partially mediated the relationship between religious group membership and physical health.

Conclusion: Together these findings suggest that religious social networks are an especially valuable source of social capital among older adults, supporting well-being directly and by promoting additional group memberships (including those that are non-religious).     

Religiosity, authoritarianism, and attitudes toward psychotherapy in later life

Objective: This study explores whether intrinsic religiosity in older adults is associated with attitudes toward psychotherapy (perceived need, stigma tolerance, interpersonal openness, and confidence in mental health practitioners) when controlling for authoritarianism.

Method: Interviews were conducted with a sample of 307 community-residing adults aged 65–82. Data were collected from 164 Black and 142 White older adults about their intrinsic religiosity, authoritarianism, and mental health help-seeking attitudes.

Results: Intrinsic religiosity was associated with stigma tolerance and interpersonal openness after controlling for authoritarianism.

Conclusion: Intrinsic religiosity and authoritarianism appear to be independently related to psychotherapy attitudes. Religious older adults may prefer to seek help in religious contexts, while the association of authoritarianism to less favorable psychotherapy attitudes toward psychotherapy may be explained by a fear of external perspectives. Results on the whole reinforce the importance of including religiousness and authoritarianism in models of mental health help-seeking.     

Depression and anxiety after total joint replacement among older adults: a meta-analysis

Objective: Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature.

Methods: Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively.

Results: Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this.

Conclusions: TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.     

A pilot trial of acceptance and commitment therapy for symptoms of depression and anxiety in older adults residing in long-term care facilities

Objectives: The aim of this study was to evaluate the efficacy and acceptability of a psychological intervention based on acceptance and commitment therapy (ACT) to improve symptoms of depression and anxiety among older adults living in long-term care.

Method: Forty one residents aged between 63 and 97 years (M = 85.3 years) participated in this study. Residents were allocated to receive either a 12 session ACT intervention implemented by trainee psychology therapists or a wait-list control group. Measures of depression and anxiety were collected at baseline and 8 week post-intervention, and residents who received the intervention were tracked for three months. A treatment satisfaction questionnaire was administered to residents who received the intervention and a sample of 10 facility staff members.

Results: Using an intention to treat approach and controlling for baseline scores, scores on depression measures were significantly lower after the ACT intervention than after the wait-list control. These outcomes were maintained at three-month follow-up. Treatment satisfaction was rated highly by both residents and their care staff.

Conclusion: This preliminary trial suggests that ACT shows promise as a therapeutic approach to address symptoms of depression in long-term care.     

Physiological reactivity during autobiographical narratives in older adults: the roles of depression and anxiety

Objectives: Physiological reactivity (PR) describes the change in physiological functioning (e.g., heart rate, blood pressure, pulse pressure) that occurs after the induction of a stressful task. This study aims to understand the influence of mental health symptoms on patterns of PR during autobiographical narratives in an older adult sample.

Method: Eighty older adults completed self-report measures regarding their symptoms of depression and anxiety. Next, their blood pressure was recorded while they completed two verbal autobiographical narratives.

Results: During the positive narrative, anxiety was positively associated with increased PR while depression was negatively associated with PR. During the negative narrative, a significant interaction occurred whereby anxiety was significantly positively associated with PR for those participants low in depression.

Discussion: The above results are explained in the context of the Tripartite Model of Depression and Anxiety, which predicts different patterns of PR as a function of mental health symptoms. Limitations and future directions are also discussed.