Effects of disability and bereavement on the mental health and recovery of older adults

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60-80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups.     

Longitudinal relationships between depressive symptoms and health in normal older and middle-aged adults

Comorbidity between health and depression is salient in late life, when risk for physical illness rises. Other community studies have not distinguished between the effects of brief and long-standing depressive symptoms on excess morbidity and mortality. S. Cohen and M. S. Rodriguez's (1995) differential hypothesis of pathways between depression and health was used to examine the relationships between health and depression in a prospective probability sample of 1,479 community-resident middle-aged and older adults. Findings suggest that different durations of depressive symptoms have different relationships to health. Health had an impact on short-term increases in depressive symptoms but depressive symptoms had a weaker impact on health. The reciprocal impact was indistinguishable from the health influence on depression. In contrast, longer term depressive symptoms had a clear impact on health. The results imply that physical illness can affect depressive states; depressive traits but not states can affect illness.     

The relationship of activity restriction and replacement with depressive symptoms among older adults

Activity restriction is known to mediate the disease-depression relationship. Data from 423 older Israeli adults showed that having to give up activities because of failing health was related to more depressive symptoms (DS), whereas satisfactorily replacing these activities was related to DS levels comparable to those of healthier older adults. Giving up and replacing activities mediated, in part, the effect of functional limitations on DS, after controlling for health status, demographics, and resources. Such questions about activities given up and replaced could contribute to the means of assessing the extent and impact of functional limitations on older adults.     

Chronic financial strain, social support, and depressive symptoms among older adults

The purpose of this study is twofold: one, to determine whether chronic financial strain is related to depressive symptoms among a random community sample of older adults, and two, to assess whether social support counterbalances or buffers the deleterious effects of financial strain. The findings suggest that elderly people suffering from financial strain are more likely to be depressed than are older adults with fewer financial problems. In addition, the data support the stress-buffering hypothesis, that is, that older people who have more informational support and who provide support to others, more often report fewer symptoms of depression as a result of financial strain than do elderly respondents who have less informational support and who do not provide support to others. Tangible and emotional support are found to be less effective coping resources when financial strain is present.     

Chronic stress and depressive disorders in older adults

Current and lifetime rates of Diagnostic and Statistical Manual (rev. 3rd ed.) disorders were compared in 86 older adults caring for a spouse with a progressive dementia and 86 sociodemographically matched control subjects. Dementia caregivers were significantly more dysphoric than non-care givers. The frequencies of depressive disorders did not differ between groups in the years before care giving, and there were no group differences in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 30% of care givers experienced a depressive disorder (major depression, dysthymia, or depression not otherwise specified) versus 1% of their matched controls in the same time period. Only two care givers who met criteria during care giving had met criteria for a depressive disorder before care giving, and family history was not even weakly related to the identification of at-risk care givers. In contrast to these group differences in depressive disorders, there were no significant differences in other Axis I disorders either before or during care giving. Thus, the chronic strains of care giving appear to be linked to the onset of depressive disorders in older adults with no prior evidence of vulnerability.     

The role of partner characteristics in attachment insecurity and depressive symptoms

Depression is associated with marital distress and attachment insecurity in romantic relationships. In this article, I propose an attachment‐theory model of depression, which links the characteristics of romantic partners to attachment insecurity and depression. I hypothesized that individuals who are avoidant of closeness and/or who devalue their spouses will be perceived as unresponsive to their spouses’ vulnerability, which will increase the spouse's attachment insecurity. Attachment insecurity was then proposed to contribute to depressive symptoms over time. A sample of married or cohabiting couples was recruited to complete questionnaires at an Internet Web site at 2 time points, approximately 3 months apart. Path analysis showed that for both husbands (N= 82) and wives (N= 99), avoidance of closeness in 1 partner was associated with perceived unresponsiveness to vulnerability and attachment insecurity in the other partner. In addition, for husbands, attachment insecurity at T1 predicted depressive symptoms at T2, above and beyond baseline levels of depression. These results provide encouraging support for an attachment‐theory approach to the study and treatment of depression, particularly among married or cohabiting men.     

Some everyday life consequences of disability and bereavement for older adults

The study analyzed daily event differences between groups experiencing the major stressors of conjugal bereavement and physical disability, and analyzed the association of everyday events with self-reports of mental health for different groups across a 3-month time span. Monthly interviews were conducted with 61 recently conjugally bereaved, 62 recently physically disabled, and 123 matched-comparison older adults between the ages of 60 and 80. The purpose of these interviews was to obtain a comprehensive assessment of the monthly frequencies of everyday life events. Self-reports of mental health were obtained from paper-and-pencil measures filled out after each interview. Causal models were used to analyze the best-fitting structure of event/mental health relationships for the first 3 monthly interviews. Undesirable events showed uniformly adverse effects on mental health. Desirable events benefited the psychological well-being of the disabled the most and had no positive effects on the mental health of the bereaved. The bereaved also evidenced less stability over time than other groups in the frequency of small undesirable events.     

Depressive symptoms and lymphocyte proliferation in older adults

In an 18-month prospective study, community-dwelling older adults, including both spousal caregivers of dementia patients and noncaregiving controls, were examined. Participants were selected on the basis of the presence or absence of chronic depressive symptoms that exceeded a cutoff score for clinically relevant depressive symptoms on a self-report symptom measure. Compared with nondepressed older adults, those with chronic, mild depressive symptoms had poorer T cell responses to 2 mitogens from baseline to follow-up. Additionally, among individuals with depressive symptoms, older age was associated with the poorest blastogenic response to the mitogens at follow-up. These findings extend the association between depression and immune function to community-dwelling older adults with chronic, mild depressive symptoms.     

Adult attachment,the transition to parenthood,and depressive symptoms

Testing a model suggested by J. Bowlby (1988), this study investigated how a personal vulnerability (attachment ambivalence) interacts with perceptions of deficient spousal support before and during a major life stressor (the transition to parenthood) to predict pre-to-postnatal increases in depressive symptoms. Highly ambivalent women who entered parenthood perceiving either less support or greater anger from their husbands experienced pre-to-postnatal increases in depressive symptoms at 6 months postpartum. The associations between these 2 prenatal interaction terms and pre-to-postnatal increases in depressive symptoms were mediated by perceptions of declining spousal support across the transition period. Moreover, for highly ambivalent women, the association between prenatal and postnatal depression scores was mediated by perceptions of the amount of support available from their husbands.     

Insecure attachment and depressive symptoms: Forgiveness of self and others as moderators

Most of the research on forgiveness has examined forgiveness of others, but not forgiveness of self even though researchers have argued that the latter deserves more attention. To fill this gap in the literature, and based on attachment theory's internal working models of self and others, this study examined forgiveness of self and others as moderators in the association between insecure attachment and depressive symptoms. A total of 403 undergraduate students participated in the study. Results supported the moderator role of forgiveness of self. Specifically, at high levels of forgiveness of self, the association between insecure attachment (i.e., anxiety and avoidant attachment) and depressive symptoms was not significant. The results did not support forgiveness of others as a moderator.     

Protective functions of health and self-esteem against depression in older adults facing illness or bereavement

Four functions were examined by which health and self-esteem could ward off depression over time in older adults. Adults (N = 1,074)--55 years and older--were interviewed 5 times at 6-month intervals. Demographic and prevent depression controls were included. Neither health nor self-esteem served as an interactive buffer. Both had direct negative effects on depression, independent of events, over 2 years. Neither illnesses nor bereavements had direct effects on depression; both had indirect effects through other events; illness also had indirect effects by weakening health. Health had stronger preventive effect on illnesses but was more vulnerable to undesirable events than was self-esteem. There was little support for the specificity hypothesis that a close match between event and resource would increase resource effects.     

Biased attention and dysphoria: Manipulating selective attention reduces subsequent depressive symptoms

Selective attention for dysphoric stimuli has been observed in individuals with depression and those at risk for depression. To date, no studies have investigated the effects of directly manipulating selective attention for dysphoric stimuli on depressive symptoms. Mild to moderately depressed college students (N=34) were randomly assigned to complete 4 sessions of either attention training (AT) or no training (NT) during a two-week period. Participants completed self-reported assessments of depressive symptoms at baseline, post-training, and follow-up. Participants in the AT condition had a significantly greater decrease in depressive symptoms from baseline to follow-up than participants in the NT condition. This group difference was mediated by change in attention bias. Our findings suggest that biased attention may have a causal role in the maintenance of depressive symptoms.     

Linking obsessional beliefs to OCD symptoms in older and younger adults

There are many open questions about the phenomenology of obsessive-compulsive disorder (OCD) in the elderly, and theories about the development of OCD have rarely been applied to older populations. The current study uses structural equation models to evaluate the relationship between obsessional beliefs and OCD symptoms across young and older adult age groups in a large community sample (aged 18-93; N=335), and to examine whether subjective concerns about cognitive decline partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relationships among subjective cognitive concerns, obsessional beliefs and OCD symptoms is invariant for younger and older adults, but older adults report relatively greater levels of subjective cognitive concerns.     

Neuroticism and attachment insecurity as predictors of bereavement outcome

Adult attachment dimensions as well as the personality trait neuroticism have been shown to be related to psychological adjustment after bereavement. No investigations so far have studied the relative contribution of these constructs to grief and depression. In our study of 219 bereaved parents, the two adult attachment dimensions, attachment anxiety and attachment avoidance, were compared to the personality trait neuroticism in predicting psychological adjustment. The attachment dimensions explained a unique part over and above neuroticism, but contrary to expectations, neuroticism explained more variance than attachment dimensions. Implications are discussed.     

Physical self-efficacy, perceived physical status, and depressive symptomatology in older adults

Perceptions of physical, general, and social self-efficacy were assessed in 200 residents of a retirement village. The subjects were administered the Depression Adjective Checklist (Lubin, 1967a) and the CES-D Depression Scale (Radloff, 1977) and were asked to rate their physical status (number of health problems, number of monthly physician visits, and health and activity levels). Pearson correlations suggested strong relationships between the self-efficacy measures and depressive symptomatology. Most important, physical self-efficacy was seen to be the strongest predictor of depressive symptoms, much stronger than the objective physical status variables.     

The contributions of interpersonal attachment and friendship group identification to depressive symptoms in a nonclinical sample

Drawing on previous literature from the separate areas of adult attachment and group processes, we explored attachment and group identification as predictors for depressive symptoms in a nonclinical sample. We found that attachment anxiety and friendship group identification predicted scores on the Beck Depression Inventory, such that higher attachment anxiety resulted in higher depressive symptoms, and greater friendship group identification resulted in lower depressive symptoms. Mediational analysis suggested that group identification partially mediated the effect of attachment avoidance on depressive symptoms, but did not mediate the effect of attachment anxiety on depressive symptoms.     

Insecure adult attachment style and depressive symptoms: Implications for parental perceptions of infant temperament

The current study tested associations between parental depressive symptoms, adult attachment styles, and perceptions of infant temperament among 319 mother–infant and 173 father–infant dyads. Depressive symptoms and insecure attachment style among the mothers and/or fathers were associated with perceptions of the infant as temperamentally more negatively and/or less positively tuned. Multivariate analyses of depressive symptoms and attachment styles with perceived temperament suggest that depressive symptoms and perceived temperament remain significantly associated, while the associations between attachment styles and perceived temperament, in most instances, were reduced to nonsignificance. We also tested whether secure attachment among the parents buffered any negatively and/or positively tuned depression‐related perceptions, but found no supporting evidence. Even though the study results await replication in longitudinal designs, they nevertheless underline the significance of parental depressive information processing in the perceiving of infant temperament. ©2004 Michigan Association for Infant Mental Health.