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Wang Y, Xu X, He Y, Liu J, Lv Q, Chang H, Fu L, Zhao Y, Zhang X, Zang X. Latent transition of social participation and its effects on depression among older adults in China: A National Longitudinal Study. Prev Med 2024; 187:108122. [PMID: 39214336 DOI: 10.1016/j.ypmed.2024.108122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES As populations age, the issue of social participation among older adults has gained prominence. Studies indicate variability in social participation trajectories among this demographic, yet the transition patterns and their effects on depression remain unclear. This longitudinal study aims to explore the latent classes and transition patterns in social participation among older adults and to evaluate their effects on depression. METHODS Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014 (T1) and 2018 (T2) were analyzed, including 2293 older adults. Latent class analysis (LCA) and latent transition analysis (LTA) were employed to identify latent classes of social participation at T1 and T2, as well as the transition probabilities between these classes. Multinomial logistic regression was used to examine predictors of transitions, and depression levels at T2 were compared across transition patterns. RESULTS The LCA results supported a 3-class model labeled as low, moderate, and high social participation. The probabilities of remaining stable and transitioning to other classes were similar across the three classes (ranging from 0.50 to 0.54). Age, gender, and other baseline characteristics emerged as significant predictors of transition patterns. Older adults experiencing positive transitions exhibited reduced depression compared to those in their original class over time, while those with negative transitions showed increased depression. CONCLUSIONS This research prompts a deep understanding of social participation dynamics in older adults and their effects on depression. Identifying social participation classes and transition patterns could inform interventions to enhance social participation and reduce depression among older adults.
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Affiliation(s)
- Yaqi Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xueying Xu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yuan He
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Jingwen Liu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Hairong Chang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Li Fu
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China.
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China.
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Silva C, Ferreira R, Morgado B, Alves E, Fonseca C. Depression, Loneliness and Quality of Life in Institutionalised and Non-Institutionalised Older Adults in Portugal: A Cross-Sectional Study. NURSING REPORTS 2024; 14:2340-2354. [PMID: 39311182 PMCID: PMC11417865 DOI: 10.3390/nursrep14030174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/01/2024] [Accepted: 09/04/2024] [Indexed: 09/26/2024] Open
Abstract
Our study aims to estimate the prevalence of depressive symptomatology among older adults and to assess their association with loneliness and quality of life according to institutionalisation status in a Portuguese sample. BACKGROUND The World Health Organisation estimates that by 2050, the world's population over 60 will number two billion people, which poses complex challenges in terms of maintaining the mental health of older adults. The COVID-19 pandemic has increased the prevalence of depressive symptoms in this population, but the post-pandemic phase has not yet been studied much. METHODS A cross-sectional survey was carried out in 2023 among institutionalised and non-institutionalised older adults (total n = 525; institutionalised = 458; non-institutionalised = 67) who were selected by convenience sampling. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of depressive symptoms, the WHOQOL-BREF to assess perceived quality of life and the Loneliness Scale (UCLA) to assess negative feelings of loneliness. Unconditional logistic regression models were fitted to compute crude adjusted odds ratios (ORs) and the respective 95% confidence intervals (95%CIs) for the association between sociodemographic, clinical and psychosocial characteristics and depressive symptomatology, according to institutionalisation status. The final model was adjusted for sex, age, QoL and feelings of loneliness. RESULTS Of the 525 participants, 74.6% of the non-institutionalised participants had no or minimal depressive symptoms, while 55.4% of the institutionalised participants fell into this category. Mild to moderately severe depressive symptoms were present in 25.4% of the non-institutionalised participants. 26.9% of the institutionalised participants had mild symptoms, 11.8% had moderate symptoms, 3.9% had moderately severe symptoms, and 2.0% had severe depressive symptoms. Overall, a higher quality of life was associated with lower levels of depressive symptoms. Participants describing feelings of loneliness were more likely also to present depressive symptoms (OR = 78.10; 95%CI 2.90-2106.08 and OR = 3.53; 95%CI 1.72-6.91 for non-institutionalised and institutionalised older adults, respectively), independently of institutionalisation status. CONCLUSIONS The prevalence of depressive symptoms is high in older adults, which means that it has not decreased after the increase seen due to the COVID-19 pandemic. A lower perception of quality of life and the presence of negative feelings of loneliness are associated with the presence of depressive symptoms. These conclusions suggest that plans should be developed to intervene in the dimensions of depressive symptoms, perceived quality of life and negative feelings of loneliness.
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Affiliation(s)
- Celso Silva
- Higher School of Health, Polytechnic Institute of Beja, 7800-295 Beja, Portugal
- Instituto de Investigação e Formação Avançada, University of Evora, 7000-811 Evora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
| | - Rogério Ferreira
- Higher School of Health, Polytechnic Institute of Beja, 7800-295 Beja, Portugal
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
| | - Bruno Morgado
- Escuela de Doctorado, Universitat Rovira y Virgili, 43005 Tarragona, Spain
| | - Elisabete Alves
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
- São João de Deus School of Nursing, University of Evora, 7000-811 Evora, Portugal
| | - César Fonseca
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
- Nursing Department, University of Evora, 7000-811 Evora, Portugal
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Li L, Pan K, Li J, Jiang M, Gao Y, Yang H, Bian G. The associations of social isolation with depression and anxiety among adults aged 65 years and older in Ningbo, China. Sci Rep 2024; 14:19072. [PMID: 39154124 PMCID: PMC11330444 DOI: 10.1038/s41598-024-69936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024] Open
Abstract
Social isolation was associated with emotional problems (depression and anxiety) among older adults, however, little is known in China. Thus, we conducted a cross-sectional study including 6,664 ≥ 65 years older adults in Ningbo, China. We collected data on social isolation, depression, and anxiety by specific scales. The relationship between social isolation and emotional problems was estimated by multivariate-adjusted logistic regression models. The population-attributable risk percentage (PAR%) was used to explore the contribution of social isolation to emotional problems. Overall, the percentage of participants who had experienced social isolation, depression, and anxiety was 12.67%, 4.83%, and 2.63%. Compared with the elderly without social isolation, the adjusted odds ratios (95% confidence interval) of depression and anxiety with social isolation were 1.77 (1.25-2.51) and 1.66 (1.05-2.63), respectively. The PAR analysis showed that 10.66% of depression and 9.03% of anxiety could be attributable to social isolation. In the gender subgroup, ORs and PAR% were only significantly observed in female participants. In Chinese older adults, social isolation has been linked to depression and anxiety, suggesting the importance of taking effective and feasible interventions to reduce social isolation and emotional problems, especially among females.
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Affiliation(s)
- Lian Li
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, Zhejiang, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Kaijie Pan
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, Zhejiang, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Jincheng Li
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, Zhejiang, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Meiqin Jiang
- Fenghua District Center for Disease Control and Prevention, Ningbo, 315500, China
| | - Yan Gao
- Third People's Hospital of Xiangshan, Xiangshan Hospital of Traditional Chinese Medicine Group, Ningbo, 315725, China
| | - Hongying Yang
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, Zhejiang, China.
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China.
| | - Guolin Bian
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, Zhejiang, China.
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China.
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Ohta T, Kojima N, Osuka Y, Sasai H. Knee Extensor Muscle Strength Associated with the Onset of Depression in Older Japanese Women: The Otassha Study. Nutrients 2024; 16:2179. [PMID: 39064622 PMCID: PMC11279862 DOI: 10.3390/nu16142179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
We examined whether knee extensor muscle strength can predict the onset of depressive symptoms in older Japanese women living in Tokyo. A baseline comprehensive geriatric examination was conducted to evaluate isometric knee extensor muscle strength and depressive symptoms (using Geriatric Depression Scale [GDS]) in 2017-2019. A free of neurological disease participants received a series of follow-up examinations following an initial evaluation. A GDS score of ≥5 during follow-up marked the onset of depressive symptoms. A logistic regression model was established after adjustment of baseline GDS score for variables including age, body mass index, smoking, alcohol consumption, comorbidities, working status, hobbies, volunteering, years of education, and dietary variety. Of the 1845 recruited individuals, 1409 were eligible to be targeted for follow-up. Among them, 768 women provided two-year follow-up data and contributed the final analysis. After covariate adjustments, the odds ratios (95% confidence interval) for depressive symptoms were 0.68 (0.39, 1.20) and 0.48 (0.26, 0.91) for the middle and highest tertiles of muscle strength, respectively, using the lowest tertile as reference. A dose-response association between muscle strength and depression (p = 0.022) was identified. This study suggests an inverse dose-response relationship between knee extensor muscle strength and the onset of depressive symptoms in older Japanese women.
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Affiliation(s)
- Takahisa Ohta
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan (H.S.)
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan (H.S.)
| | - Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan (H.S.)
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan (H.S.)
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Ran Z, Wei J, Yang G, Yang C. Prevalence of social isolation in the elderly: A systematic review and meta-analysis. Geriatr Nurs 2024; 58:87-97. [PMID: 38781629 DOI: 10.1016/j.gerinurse.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Social isolation has become a global issue among the elderly, posing serious challenges to both social and public health. We assessed the prevalence of elderly social isolation and its related factors. Eight electronic databases were searched up to June 28th, 2023. A meta-analysis of the included literature was performed using Stata 16.0. The results showed that the incidence of social isolation in the elderly was 33 % [95 % CI (0.28, 0.38)]. The subgroup analysis revealed that people over 80, with a sample size under 500, assessed using the Lubben Social Network scale and Social Network Index scale, experienced higher social isolation, especially if they were living alone and lacked higher education. It is suggested to pay attention to the psychological well-being of elderly individuals living alone and lacking a high level of education. Early screening could help reduce the incidence of social isolation, and hence its implications, among the elderly.
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Affiliation(s)
- Zhenrong Ran
- Master's Degree, Nursing Department, Chongqing Traditional Chinese Medicine Hospital, Chongqing, PR China
| | - Jiajia Wei
- Undergraduate Degree, Nursing Department, Chongqing Traditional Chinese Medicine Hospital, Chongqing, PR China
| | - Guangjin Yang
- Undergraduate Degree, Nursing Department, Chongqing Traditional Chinese Medicine Hospital, Chongqing, PR China
| | - Chanjuan Yang
- Master's Degree, Nursing Department, Chongqing Traditional Chinese Medicine Hospital, Chongqing, PR China.
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Zhang Y, Liu M, Zhou C, Ye Z, Zhang Y, Yang S, He P, Gan X, Qin X. Social isolation, loneliness, and the risk of incident type 2 diabetes mellitus by glycemic status. DIABETES & METABOLISM 2024; 50:101517. [PMID: 38253174 DOI: 10.1016/j.diabet.2024.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/26/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
AIM The modifying effect of prediabetic status on the association of social isolation and loneliness with the risk of type 2 diabetes mellitus (T2DM) remains uncertain. We aimed to explore whether prediabetic status modifies the association of social isolation and loneliness with incident T2DM. METHODS 358,951 participants with random blood glucose < 11.1 mmol/l, hemoglobin A1c < 6.5 % and without diagnosis of diabetes from the UK Biobank were included. Prediabetes was defined by hemoglobin A1c level at 5.7-6.4 %. Social isolation and loneliness were assessed using self-reported questionnaires. The study outcome was incident T2DM. RESULTS During a median follow-up of 12.5 years, 13,213 (3.7 %) incident T2DM cases were documented. Social isolation and loneliness in subjects with normoglycemia (adjusted HR [95 %CI]: social isolation: 1.14 [1.07;1.23]; loneliness: 1.33 [1.20;1.47]) were more strongly associated with increased risk of T2DM than in those with prediabetes (adjusted HR [95 %CI]: social isolation: 0.97 [0.91;1.03]; loneliness: 1.04 [0.95;1.13]) (Both P for interaction < 0.001). Among individuals with prediabetes, alcoholic consumption (30.9 %), household income (23.3 %), healthy sleep (17.1 %), loneliness (14.9 %), and physical activity (12.6 %) mediated most of the variance in the association between social isolation and incident T2DM, while body mass index (17.9 %) and healthy sleep (17.6 %) mediated most of the variance in the association between loneliness and incident T2DM. CONCLUSION Social isolation and loneliness were independently associated with a higher risk of T2DM among individuals without prediabetes. Among those with prediabetes, the association of social isolation and loneliness with incident T2DM were mainly mediated by some socioeconomic and lifestyle factors.
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Affiliation(s)
- Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Xiaoqin Gan
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, China; National Clinical Research Center for Kidney Disease, China; State Key Laboratory of Organ Failure Research, China; Guangdong Provincial Institute of Nephrology, China; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China.
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Huang M, Liu K, Liang C, Wang Y, Guo Z. The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety. BMC Geriatr 2023; 23:506. [PMID: 37608361 PMCID: PMC10463962 DOI: 10.1186/s12877-023-04161-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms. METHODS This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms. RESULTS Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively). CONCLUSIONS Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.
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Affiliation(s)
- Mina Huang
- Department of Nursing, The Jinzhou Medical University, Jinzhou, China
| | - Kun Liu
- Department of Medical College, The Jinzhou Medical University, Jinzhou, China
| | - Chunguang Liang
- Department of Nursing, The Jinzhou Medical University, Jinzhou, China
| | - Yongzhu Wang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, No.2, Section 5, Renmin Street, Jinzhou, Liaoning, 121001, China
| | - Zhanpeng Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, No.2, Section 5, Renmin Street, Jinzhou, Liaoning, 121001, China.
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Makhoul M, Bartley EJ. Exploring the relationship between gratitude and depression among older adults with chronic low back pain: a sequential mediation analysis. FRONTIERS IN PAIN RESEARCH 2023; 4:1140778. [PMID: 37213708 PMCID: PMC10196463 DOI: 10.3389/fpain.2023.1140778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Gratitude has been identified as a key factor in a number of positive health-related outcomes; however, the mechanisms whereby gratitude is associated with well-being among older adults with chronic pain are poorly understood. Using the Positive Psychological Well-Being Model as a theoretical framework, the objective of the present study was to examine the serial mediating effects of social support, stress, sleep, and tumor necrosis factor-alpha (TNF-α) on the relationship between gratitude and depressive symptoms. Methods A total sample of 60 community-dwelling older adults with chronic low back pain (cLBP) provided blood samples for high-sensitivity TNF-α and completed the Gratitude Questionnaire, Perceived Stress Scale, and the PROMIS Emotional Support, Sleep Disturbance, and Depression forms. Descriptive statistics, correlation analyses, and serial mediation analyses were performed. Results Gratitude was negatively associated with perceived stress, sleep disturbance, and depression, and was positively associated with social support. No significant association was observed between gratitude and TNF-α. After controlling for age and marital status, analyses revealed that perceived stress and sleep disturbance sequentially mediated the association between gratitude and depressive symptoms. Conclusion Perceived stress and sleep disturbance may be potential mechanistic pathways by which gratitude impacts negative well-being. Targeting gratitude as a protective resource may be a potential therapeutic tool to improve psychological and behavioral outcomes in older adults with cLBP.
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Affiliation(s)
- Melissa Makhoul
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - E. J. Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
- Correspondence: E. J. Bartley
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