Depressionen im höheren Lebensalter, Teil 2

Grief and loss in old age: Exploration of the association between grief and depression

BACKGROUND

The proportion of older adults is increasing due to demographic changes. Depression belongs to the most common mental disorders in late life. The loss of an emotionally significant person is a risk factor for the development of depression. The aim of this study is to analyze the association between depression and grief burden resulting from loss. Based on prior evidence, we examined loneliness as a possible mediator and social support as possible moderator of this association.

METHODS

The cross-sectional analyses are based on a sample (N = 863) of study participants aged 75+ (M = 81.4 years, SD = 4.4, 62.2% female) with loss experience deriving from the multicenter prospective German cohort study AgeMooDe. Regression analyses (moderated mediation) were performed.

RESULTS

With increasing age (β = 0.10, p = .005) and grief burden (β = 0.33, p <. 001) depression severity increased. There was an indirect mediating effect of loneliness on the correlation of grief burden and depression (b = 0.04, CI [0.03, 0.05]), but no moderating effect of social support on the correlation of grief burden and loneliness. People living alone had a significantly higher risk of depression, increased loneliness and lack of social support.

LIMITATIONS

Assessments were based on self-reporting and recorded dimensionally. The cross-sectional design limits conclusions about directions and causality of associations. Sampling bias cannot be completely excluded.

CONCLUSION

The study provides empirical evidence and a better understanding of the association between grief and depression among the very old and the mediating role of loneliness.

[Multiprofessional outpatient psychosocial treatment for elderly patients with mental disorders]

Mental disorders contribute substantially to the loss of quality of life and life expectancy in old age. Life expectancy is reduced especially by the bidirectional interaction with heart diseases, diabetes mellitus as well as the depression-specific risk of suicide. Depression in old age is a strong risk factor for nursing home placement, which is usually an undesired outcome for older people. Utilization of mental health services is hindered by self-stigmatization and prejudice; however, according to recent surveys older people increasingly value psychotherapeutic services. Shortcomings in the diagnostics and therapy in the primary treatment of old age depression have stimulated research in low-threshold options in primary care and collaborative multiprofessional outpatient interventions in many countries. The core features of collaborative care approaches are improved diagnostics, stepped-care protocols, continuous disease monitoring, and access to psychiatric and psychotherapeutic supervision or services. Collaborative multiprofessional outpatient approaches have been shown to be superior for the treatment of old age depression compared to treatment as usual.