What contributes to perceived stress in later life? A recursive partitioning approach

Age Differences Among Different Sources of Stressor Related Negative Affect

We examine age differences in the relationship between negative affect (NA) and different indicators of daily stress (interpersonal, health, and financial stressors and perceived stress). Participants completed 56 days of daily diary surveys from Wave 1 of the Notre Dame Study of Health & Well-being. Multi-level modeling allowed us to assess the within-person relationships between daily stress and NA and the cross-level interactions between these daily relationships and cross-sectional age. Each type of stress additively related to daily NA. Older age related to an exacerbated relationship between daily interpersonal stressors and NA, but a weaker relationship between daily perceived stress and NA. Interventions focused on enhancing daily well-being can encourage older adults to ensure they do not have overpacked schedules in regards to social relationships, and encourage midlife and younger adults to engage in activities that disrupt the link between perceived stress and NA.

Estimating the causal effects of work-related and non-work-related stressors on perceived stress level: A fixed effects approach using population-based panel data

OBJECTIVES

Prolonged or excessive stress can have a negative impact on health and well-being, and stress therefore constitutes a major public health issue. A central question is what are the main sources of stress in contemporary societies? This study examines the effects of work-related and non-work-related stressors and perceived social support on perceived stress within a causal framework.

METHODS

Panel data were drawn from two waves (2013 and 2017) of the population-based health survey "How are you?" conducted in the Central Denmark Region. The analytical sample comprised 9,194 subjects who had responded to both surveys. Work-related and non-work-related stressors included major life events, chronic stressors, daily hassles and lack of social support. Perceived stress was measured with the 10-item Perceived Stress Scale (PSS). Data were analysed using fixed effects regression in a fully balanced design.

RESULTS

The largest effects on PSS were seen in own disease, work situation and lack of social support. Other stressors affecting the perceived stress level were financial circumstances, relationship with partner, relationship with family and friends, and disease among close relatives. Most variables had a symmetrical effect on PSS.

CONCLUSIONS

The results point to the need for comprehensive policies to promote mental health that span life domains and include both the individual and the group as well as organizational and societal levels. The study indicates that there are multiple potential entry points for stress prevention and stress management. However, it also shows that disease, work situation and social support weigh heavily in the overall picture. This points to the healthcare system and workplace as key institutional venues for action.

Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults?

OBJECTIVE

Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress.

METHODS

This cross-sectional study included 7,679 community-dwelling older adults (≥ 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role.

RESULTS

The frailty prevalence was 22%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship.

CONCLUSION

Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.

Effect of horticultural activities on quality of life, perceived stress, and working memory of community-dwelling older adults

This study sampled 86 community-dwelling older adults to investigate the effect of horticultural activities on their quality of life, perceived stress, and working memory. The results demonstrated that after 8 weeks of horticultural activities, the effect sizes (Cohen's d) of their quality of life, perceived stress, and working memory were 0.92, -1.32, and 0.62, respectively. Among the four domains of quality of life, the social relationships domain improved the most. For perceived stress, the score of the experimental group decreased from 1.70 (0.48) to 1.29 (0.58). For working memory, the score increased from 3.43 (1.13) to 4.14 (1.27), whereas the score of the control group did not change substantially. Statistical analysis conducted using a generalized estimating equation revealed a significant interaction effect between group and time (P < 0.001). This study provides a reference for improving the quality of life, perceived stress, and working memory in older people.

Depressive symptoms in older adults with and without a history of incarceration: A matched pairs comparison

OBJECTIVES

Previous research has found that many incarcerated individuals have mental health conditions and that incarcerated women may be at elevated risk. These individuals have been shown to experience mental health concerns shortly after their release, but little is known about their mental health later in life. This study compared depressive symptoms in older adults with and without a history of incarceration and examined the impact of gender on this relationship.

METHOD

Data from 160 pairs of adults aged 65 or older (82.5% male, mean age = 73.4 years) who participated in the 2012 wave of the Health and Retirement Study (HRS) was utilized. Older adults with a history of incarceration were matched to those without based on age, gender, race, and education level. Depressive symptoms (CES-D) of older adults with and without a history of incarceration were compared using a repeated-measures ANOVA.

RESULTS

The main effect of incarceration history (p=.001, partial eta²=.07) and the interaction between incarceration history and gender (p=.01, partial eta²=.04) were significant. Follow-up analyses revealed that the difference between depressive symptoms for older women with and without a history of incarceration was significant (p=.02, d = 0.69), whereas the difference for older men was not significant (p=.19, d = 0.16).

CONCLUSIONS

Findings suggest older adults with a history of incarceration report more depressive symptoms than those without and that the effect is seen among older women. Negative effects of incarceration on mental health may therefore persist into later life, highlighting the importance of pre- and post-release mental health services.

Exercise interventions for stress reduction in older adult populations: a systematic review of randomized controlled trials

Background and Objectives

To assess which forms of supervised exercise are effective in reducing psychological stress in older adults.

Research Design

Systematic Review.

Methods

Four electronic databases (PubMed, Web of Science, PsycInfo, and SportDiscus) were searched in February of 2021. Randomised controlled trials (RCTs) investigating supervised exercise interventions for psychological stress reduction in adults aged 50 + were included in this review. Data on type, intensity, and duration of the intervention were also extracted.

Results

854 studies were identified by the search strategy. Twelve RCTs met inclusion criteria. Trials involving low-intensity qigong and trials combining aerobic and anaerobic or aerobic and nutrition/diet education demonstrated the strongest evidence for stress reduction.

Discussion and Implications

Exercise may reduce stress in older adults. Suitable duration of programme ranges from 3 months to 1 year. Light to moderate activity is recommended for best results, with qigong being the most consistent and common exercise.

Suicidal ideation and social integration in three Canadian provinces: The importance of social support and community belonging

Extending recent developments in the neo-Durkheimian analysis of suicidality as an indicator of social pathology, this paper analyses individual level survey data on suicidal ideation, perceptions of social support, and the sense of belonging from three Canadian provinces drawn from the Canadian Community Health Survey (2015-16). We ask whether or not social support and a sense of belonging affect suicide ideation differently. In answering this question, we pay attention to both subjective and objective indicators of integration, and how subjective indicators independently affect suicide ideation. Results show that a higher level of social support had the largest effect on suicidal ideation and that the effect of a sense of belonging disappeared when measures of social support are accounted for. These findings are consistent with Durkheim's general theory of suicide and previous studies on mental health, highlighting the importance of regular, proximate social interaction as a prophylactic against suicidality.

Coping repertoires and psychological well-being of Chinese older immigrants in the United States

OBJECTIVES

This study examines (1) the overall structures of multifaceted coping resources, that is, coping repertoires, among Chinese older immigrants in the United States, (2) the optimal coping repertoire that is associated with best psychological outcomes of these older immigrants, and (3) the most effective coping repertoire in different adversities.

METHOD

Using data from 2,923 Chinese older immigrants in Chicago, Latent Class Analysis (LCA) was performed to identify the overall coping repertoires of U.S. Chinese older adults. Negative binomial and logistic regressions were used to examine associations between coping repertoires and depression and Quality of Life (QoL), respectively. We further tested whether coping repertories moderate the relationships between adversities in health, economic, and social domains, and the two psychological outcomes.

RESULTS

LCA revealed four types of coping repertories: low-resource (43%), spouse-oriented (32%), community-oriented (15%), and multi-source coping (10%). Overall, Chinese older immigrants who had the multi-source coping repertoire reported the best psychological outcomes. The community-oriented and multi-source coping repertories had significantly stronger buffering effects on psychological well-being among individuals with IADL difficulties or low acculturation. However, spouse-oriented coping intensified the association between ADL difficulties and depression, and community-oriented coping intensified the association between poorer subjective health and lower quality of life.

CONCLUSION

This study revealed overall low coping repertories of Chinese older immigrants, suggesting the most optimal coping repertories should consist of both intrinsic and extrinsic coping sources. The findings further show that relying on limited sources might be harmful to older immigrants' mental health.

Psychological impacts and online interventions of social isolation amongst older adults during COVID-19 pandemic: A scoping review

AIM

To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation.

DESIGN

A scoping review was performed.

DATA SOURCES

A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar.

REVIEW METHODS

Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes.

RESULTS

Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention.

CONCLUSION

The COVID-19 pandemic has taken an emotional toll on older adults' psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions.

IMPACT

With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.

Correlates of perceived stress among community-dwelling older African Americans

BACKGROUND

The purpose of this study was to identify correlates of perceived stress among older African Americans.

METHODS AND FINDINGS

Guided by the National Institute on Aging's (NIA) Health Disparities Research Framework, we grouped correlates into four levels-environmental, sociocultural, behavioral, and biological, and performed a cross-sectional analysis using ordinal logistic regression models. Participants included 722 African Americans [mean age = 73.61 years (SD = 6.33)] from the Minority Aging Research Study (MARS). Several protective correlates from environmental (e.g., larger life space), sociocultural (e.g., larger social network size), behavioral (e.g., more purpose in life), and biological (e.g., higher global cognition) levels were associated with a lower odds of having higher levels of perceived stress.

CONCLUSIONS

Perceived stress was associated with established and novel correlates from every level. Future research is needed to examine how changes in these correlates may impact perceived stress in older African Americans.

COVID-19 Associated Suicidal Ideation in Older Adults: Two Case Reports With a Review of the Literature

The COVID-19 pandemic may profoundly harm the mental health and emotional well- being of many older adults. Public health interventions to minimize the spread of the virus have had the unintended consequences of worsening social isolation, financial stress, and unemployment. Results of early research efforts assessing the impact of these interventions on the mental health of older adults have been mixed. Available findings suggest that a subset of community-dwelling older adults have been less negatively impacted than younger adults, while people of color, the poor, residents of nursing homes and other communal living environments, and those living with dementia and their caregivers are more likely to suffer from COVID-related health problems. This manuscript describes two older adults for whom COVID-19 associated stresses caused significant worsening in their psychiatric illnesses, including the emergence of suicidal ideation, summarizes the literature on the impact of interactions between psychosocial stresses and biological factors on the mental health and well-being of older adults, and discusses interventions to help older adults whose mental health has worsened due to COVID-19. Timely and accurate diagnosis, prompt provision of individualized care using both pharmacologic and psychotherapeutic interventions, adoption of new technologies that permit care to be provided safely at a distance and which allow for virtual social interactions, coupled with ongoing advocacy for policy changes that address significant health care disparities and provide older adults continued access to health care and relief from financial hardship, will help older adults remaining as healthy as possible during the pandemic.

The relative importance of work-related and non-work-related stressors and perceived social support on global perceived stress in a cross-sectional population-based sample

Background

High levels of perceived stress have a negative bearing on health and well-being, and stress is a major public health issue. According to the Stress Process Model, stressors are socially patterned and combine to produce strain. Despite this, most studies on stress have focused on work-related stressors leaving non-work determinants under-investigated. The aim of the present study was to determine the relative importance of work-related and non-work-related stressors and perceived social support for the overall perceived stress level.

Methods

Self-reported data were drawn from the 2017 population-based health survey “How are you?” conducted in the Central Denmark Region (N = 32,417). Data were linked with data drawn from national administrative registers. Work- and non-work-related stressors assessed included major life events, chronic stressors and daily hassles. Perceived social support was assessed using a single question. Overall perceived stress was assessed by the 10-item Perceived Stress Scale. We conducted dominance analyses based on a multiple linear regression model to determine the most important explanatory variables of overall perceived stress. Analyses were weighted and adjusted.

Results

Work- and non-work-related stressors along with perceived social support explained 42.5% of the total variance (R²) in overall perceived stress. The most important explanatory variables were disease, perceived social support and work situation. The stratified analyses produced slightly varying results (“dominance profiles”) of perceived stress between subgroups. Work situation was the most important explanatory variable in the employed group. However, adding non-work-related explanatory variables to the analysis tripled the explained variance.

Conclusions

The overall level of perceived stress can be statistically explained by a combination of work- and non-work-related stressors and perceived social support both at population level and in subgroups. The most important explanatory variables of overall perceived stress are disease, perceived social support and work situation. Results indicate that public health strategies aiming to reduce stress should take a comprehensive approach and address a variety of stressor domains rather than focus on a single domain.

Trial registration

The study was approved by the Danish Data Protection Agency (r. no. 2012-58-0006) and registered in the Central Denmark Region (r. no. 1-16-02-593-16).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10594-2.

Loneliness, Circulating Endocannabinoid Concentrations, and Grief Trajectories in Bereaved Older Adults: A Longitudinal Study

Background: Loneliness is one of the most distressing grief symptoms and is associated with adverse mental health in bereaved older adults. The endocannabinoid signaling (ECS) system is stress-responsive and circulating endocannabinoid (eCB) concentrations are elevated following bereavement. This study examined the association between loneliness and circulating eCB concentrations in grieving older adults and explored the role of eCBs on the association between baseline loneliness and grief symptom trajectories. Methods: A total of 64 adults [grief with high loneliness: n = 18; grief with low loneliness: n = 26; and healthy comparison (HC): n = 20] completed baseline clinical assessments for the UCLA loneliness scale. In grief participants, longitudinal clinical assessments, including the Inventory of Complicated Grief and 17-item Hamilton Depression Rating scales, were collected over 6 months. Baseline circulating eCB [N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG)] concentrations were quantified in the serum using isotope dilution, liquid chromatography-mass spectrometry; cortisol concentrations were measured in the same samples using radioimmunoassay. Results: Circulating AEA concentrations were higher in severely lonely grieving elders than in HC group; cortisol concentrations were not different among the groups. Cross-sectionally, loneliness scores were positively associated with AEA concentrations in grievers; this finding was not significant after accounting for depressive symptom severity. Grieving individuals who endorsed high loneliness and had higher 2-AG concentrations at baseline showed faster grief symptom resolution. Conclusions: These novel findings suggest that in lonely, bereaved elders, increased circulating eCBs, a reflection of an efficient ECS system, are associated with better adaptation to bereavement. Circulating eCBs as potential moderators and mediators of the loneliness-grief trajectory associations should be investigated.

Association between physical function and perceived stress among U.S. Chinese older adults

Objectives

Physical function impairment can cause great stress to older adults. The purpose of the study is to investigate the association between self-reported and directly-observed physical function on perceived stress among U.S. Chinese older adults.

Methods

Data were from the Population Study of Chinese Elderly in Chicago (PINE) of 3,157 Chinese older adults who were 60 and above in the Greater Chicago Area. Self-reported and directly-observed physical function measures, and Perceived Stress Scale were used.

Results

Participants had a mean age of 72.8 ± 8.3 years old (range 60–105). Higher scores of Katz activities of daily living impairments (odds ratio [OR]=1.77), Lawton instrumental activities of daily living impartments (OR=1.10, p<0.01), Rosow–Breslau index of mobility scale (OR=1.39, p<0.05), and Nagi index of basic physical activities scale (OR=1.19, p<0.001) were associated with higher levels of perceived stress. In addition, higher scores of directly-observed physical function measurements, including chair stand (OR=0.93), tandem stand (OR=0.71, p<0.05), timed walk (OR=0.73, p<0.001), and the overall measurement (OR= 0.87, p<0.01) were associated with lower level of perceived stress.

Discussion

Findings suggested that poor physical function was associated with perceived stress among U.S. Chinese older adults. Longitudinal studies are needed to obtain a more comprehensive understanding of the pathways between physical function and perceived stress.

Implications for practice

Health care professionals could provide personalized physical activity interventions to encourage older adults to engage in regular exercise in order to maintain and promote older adults’ physical function and psychological well-being.

Special Issue: Race and Mental Health Among Older Adults: Do Depressive Symptoms Shape Blacks' Perceptions of Stress Over Time?

Background and Objectives

Previous studies have linked stress to multiple negative mental health outcomes, including depression. This established stress–depression association is typically examined in one direction and cross-sectionally. This study examined the bidirectional relationships between depressive symptoms and changes in perceived stress over time in Blacks.

Research Design and Methods

The present study uses a community-dwelling sample of 450 Black adults, aged 51–96 years old, who participated in the Baltimore Study of Black Aging—Patterns of Cognitive Aging. Perceived stress—measured by the Perceived Stress Scale—and depressive symptoms—measured using the Center for Epidemiologic Studies Depression scale—were both assessed at baseline and follow-up 33 months later. Ordinary least squares regression was used to examine 2 bidirectional longitudinal relationships between (1) stress–depression and (2) depression–stress, and whether these associations are modified by age.

Results

Initial analyses testing the typical stress–depression relationship showed an effect in the expected direction, that is stress leading to more depressive symptoms over time, adjusting for model covariates, but the effect was not statistically significant (b = 0.014, p = .642). After accounting for baseline perceived stress level, age, sex, education, and chronic health conditions, depressive symptoms were positively associated with follow-up stress (b = 0.210, p < .000). The depression–stress association further varied by age group such that the impact of baseline depression on changes in perceived stress was greatest in Blacks in their 60s versus those in their 50s (b = 0.267, p = .001), controlling for model covariates.

Discussion and Implications

Contrary to previous work, the results suggest that an individual’s mental health shapes his/her perception of stressful events and this relationship varies by age group. While the typical finding (stress impacting depression) was not significant, the findings reported here highlight the importance of considering the possible bidirectional nature of the relationships between psychosocial measures of stress and mental health in later life among Blacks.

The Extent of Psychosocial Distress among Immigrant and Non-Immigrant Homecare Nurses-A Comparative cross Sectional Survey

In times of demographic change, most developed countries are increasingly looking to cover the growing domestic demand for healthcare by hiring nurses from abroad. The evidence concerning the health of immigrant care workers is inconsistent since studies report that it is either better or more impaired than that of their non-immigrant counterparts. This study compared the extent of occupational psychosocial stressors and resources affecting immigrant and non-immigrant homecare nurses. The cross-sectional survey was conducted in the homecare nursing service sector in Hamburg. Psychosocial distress, depressive symptomatology, generalized anxiety, somatic symptom burdens, homecare-specific qualitative stressors, as well as resources, have been measured using a standardized questionnaire. There was no significant difference in the extent of psychosocial distress experienced by immigrant and non-immigrant homecare nurses. Somatic symptom burdens most strongly predicted nurses’ psychosocial distress, in general. For immigrant nurses, greater influence and freedom at work, as well as fixed-term employment, was related to increased levels of distress, while age, working full time, and working overtime predicted distress in non-immigrant nurses. A functioning relationship with colleagues and superiors had a declining effect on immigrant nurses’ psychosocial distress, while shift work arrangements benefitted non-immigrant nurses. Even though the extent of psychosocial distress experienced by immigrant and non-immigrant nurses did not significantly differ, the nurse’s individual explanatory model of psychosocial health should be considered in every occupational and political context.

Psychosocial Factors and Personality Traits and the Prevalence of Arterial Hypertension Among 35- and 55-Year-Old Men and Women in Sweden and Estonia: a SWESTONIA Longitudinal Study

INTRODUCTION

Psychosocial factors influence the risk of developing hypertension. Personality traits have a modulating effect against the harmful influences of psychosocial factors.

AIM

Through a longitudinal clinical study consisting of men and women aged 35 and 55 at the baseline in Estonia and Sweden, to assess the influence of psychosocial factors and personality traits resulting in arterial hypertension.

METHODS

Data analysis based on the cross-sectional study with 2 assessments over 13 years of a sample comprising 158 individuals from Estonia and 213 individuals from Sweden. The Pearlin Mastery Scale, Rosenberg Self-esteem Scale, Depression Model and Gothenburg Quality of Life Instrument were used.

RESULTS

Throughout the follow-up period, a higher depressive mood and lower self-assessed quality of life score prevailed among the 35-year-old and 55-year-old Estonians compared with the Swedish study participants (p < 0.001). Among the 55-year-old Estonian study participants with diagnosed hypertension, but not among the Swedish, negative stressful life events had a significantly stronger effect (p < 0.001) on the risk of developing hypertension. In addition, lower mastery (p < 0.05) dominated among study participants diagnosed with hypertension.

CONCLUSIONS

The combined effects of psychosocial factors and personality traits are important variables in predicting the risk of developing arterial hypertension. The study results are relevant to clinical practice and provide suggestions for employing successful preventive measures.

Longitudinal Stress-Buffering Effects of Social Integration for Late-Life Functional Health

Stress can negatively affect multiple aspects of health, including functional health, among older adults, who are likely to face unique, age-related stressful experiences. Previous research has addressed the protective effects of social relations (i.e., social ties, social participation, and social integration) for physical and mental health outcomes, yet few studies have examined functional health. This study aimed to investigate the longitudinal stress-buffering effects of social integration on late-life functional health. Using three-wave data from 399 older adults (aged older than 60 years), two-level hierarchical linear modeling analysis was conducted and the results indicated that in addition to its main effect on functional (activity of daily living) limitations, social integration moderated the negative effect of stress on the longitudinal trajectory of functional limitations. The findings suggest important directions of future research to identify the mechanisms of such buffering effects over time and develop effective interventions to enhance late-life functional health while promoting social integration.

Loneliness in the United States: A 2018 National Panel Survey of Demographic, Structural, Cognitive, and Behavioral Characteristics

Purpose:

To inform health behavior intervention design, we sought to quantify loneliness and its correlates, including social media use, among adults in the United States.

Design:

Cross-sectional research panel questionnaire.

Setting:

Responses were gathered from individuals in all 50 states surveyed via Internet from February 2018 to March 2018.

Participants:

A total of 20 096 US panel respondents aged 18+.

Measures:

The University of California at Los Angeles (UCLA) Loneliness Scale (theoretical score range = 20-80) was administered along with demographic, structural, cognitive, and behavioral items.

Analysis:

After calibrating the sample to population norms, we conducted multivariable linear regression analysis.

Results:

The overall mean survey-weighted loneliness score was 44.03 (standard error = 0.09). Social support (standardized β [sβ] = −0.19) and meaningful daily interactions (sβ = −0.14) had the strongest associations with lower loneliness, along with reporting good relationships, family life, physical and mental health, friendships, greater age, being in a couple, and balancing one’s daily time. Social anxiety was most strongly associated with greater loneliness (sβ = +0.20), followed by self-reported social media overuse (sβ = +0.05) and daily use of text-based social media (sβ = +0.03).

Conclusion:

Our findings confirm that loneliness decreases with age, and that being in a relationship as well as everyday behavioral factors in people’s control are most strongly related to loneliness. Population health promotion efforts to reduce loneliness should focus on improving social support, decreasing social anxiety, and promoting healthy daily behaviors.

Does Inside Equal Outside? Relations Between Older Adults' Implicit and Explicit Aging Attitudes and Self-Esteem

Attitudes toward one's own aging and self-esteem are crucial variables in predicting older adults' physical and mental health and can significantly affect their will to live, cognitive judgement and acceptance of medical treatment. However, little is known about the relation between the implicit attitude toward one's own aging and implicit self-esteem. This research explored consistencies between implicit and explicit attitudes toward one's own aging and between implicit and explicit self-esteem and explored their relations in 70 older adults aged 60–91 years old using the word and picture versions of the Implicit Association Test and standardized scales. The results showed that (a) the explicit and implicit attitudes toward one's own aging represented independent structures, and the implicit and explicit self-esteem also represented independent structures; (b) subjects generally showed positive explicit attitudes toward their own aging and negative implicit attitudes toward their own aging while also showing high explicit self-esteem and relatively low implicit self-esteem; (c) subjects' implicit attitudes toward their own aging and implicit self-esteem were positively correlated, and explicit attitudes toward their own aging and explicit self-esteem were also positively correlated. The more positive the subjects' explicit attitudes toward their own aging, the higher their explicit self-esteem levels were. The more negative their implicit attitudes toward their own aging, the higher their implicit self-esteem levels were. We concluded that older adults' explicit and implicit attitudes toward their own aging and self-esteem are independent structures; older adults' explicit and implicit attitudes toward their own aging have predictive effects on their explicit and implicit self-esteem in different directions, respectively.

Social Context of Depressive Distress in Aging Transgender Adults

This study investigates the relationship between discrimination and mental health in aging transgender adults. Survey responses from 61 transgender adults above 50 ( Mage = 57.7, SD = 5.8; 77.1% male-to-female; 78.7% White non-Hispanic) were analyzed. Multivariable logistic regression models examined the relationship between gender- and age-related discrimination, number of everyday discrimination experiences, and past-week depressive distress, adjusting for social support, sociodemographics, and other forms of discrimination. The most commonly attributed reasons for experiencing discrimination were related to gender (80.3%) and age (34.4%). More than half of participants (55.5%) met criteria for past-week depressive distress. In an adjusted multivariable model, gender-related discrimination and a greater number of everyday discrimination experiences were associated with increased odds of past-week depressive distress. Additional research is needed to understand the effects of aging and gender identity on depressive symptoms and develop interventions to safeguard the mental health of this vulnerable aging population.

Assessing the relative importance of correlates of loneliness in later life. Gaining insight using recursive partitioning

OBJECTIVES

Improving the design and targeting of interventions is important for alleviating loneliness among older adults. This requires identifying which correlates are the most important predictors of loneliness. This study demonstrates the use of recursive partitioning in exploring the characteristics and assessing the relative importance of correlates of loneliness in older adults.

METHOD

Using exploratory regression trees and random forests, we examined combinations and the relative importance of 42 correlates in relation to loneliness at age 68 among 2453 participants from the birth cohort study the MRC National Survey of Health and Development.

RESULTS

Positive mental well-being, personal mastery, identifying the spouse as the closest confidant, being extrovert and informal social contact were the most important correlates of lower loneliness levels. Participation in organised groups and demographic correlates were poor identifiers of loneliness. The regression tree suggested that loneliness was not raised among those with poor mental wellbeing if they identified their partner as closest confidante and had frequent social contact.

CONCLUSION

Recursive partitioning can identify which combinations of experiences and circumstances characterise high-risk groups. Poor mental wellbeing and sparse social contact emerged as especially important and classical demographic factors as insufficient in identifying high loneliness levels among older adults.

Perceived loneliness among home-dwelling older adults with and without memory disorder: A population-based study

The aim of this population-based cross-sectional study was to describe and compare the prevalence and features of perceived loneliness among home-dwelling older adults with ( n = 129) and without ( n = 244) memory disorder. The latter group was randomly resampled from 789 respondents stratified by age to obtain a standardized control group. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale, and perceived stress using Cohen, Kamarck and Mermelstein’s 10-item Perceived Stress Scale. Results show that severe loneliness was common among the home-dwelling older adults, especially those with memory disorder, who also perceived stress more frequently than those without memory disorder. Both groups, but again more frequently those with memory disorder, were more likely to be emotionally than socially lonely. Thus, when planning social and healthcare services and interventions to mitigate loneliness among older adults living at home, memory problems and emotional loneliness require particular consideration.

Prayer, Attachment to God, and Changes in Psychological Well-Being in Later Life

OBJECTIVE

The aim of this study was to investigate the effects of prayer and attachment to God on psychological well-being (PWB) in later life.

METHOD

Using data from two waves of the nationwide Religion, Aging, and Health Survey, we estimate the associations between frequency of prayer and attachment to God at baseline with cross-wave changes in three measures of PWB: self-esteem, optimism, and life satisfaction.

RESULTS

Prayer does not have a main effect on PWB. Secure attachment to God is associated with improvements in optimism but not self-esteem or life satisfaction. The relationship between prayer and PWB is moderated by attachment to God; prayer is associated with improvements in PWB among securely attached individuals but not those who are insecurely attached to God.

DISCUSSION

These findings shed light on the complex relationship between prayer and PWB by showing that the effects of prayer are contingent upon one's perceived relationship with God.

Perceived Organizational Support for Enhancing Welfare at Work: A Regression Tree Model

When trying to examine outcomes such as welfare and well-being, research tends to focus on main effects and take into account limited numbers of variables at a time. There are a number of techniques that may help address this problem. For example, many statistical packages available in R provide easy-to-use methods of modeling complicated analysis such as classification and tree regression (i.e., recursive partitioning). The present research illustrates the value of recursive partitioning in the prediction of perceived organizational support in a sample of more than 6000 Italian bankers. Utilizing the tree function party package in R, we estimated a regression tree model predicting perceived organizational support from a multitude of job characteristics including job demand, lack of job control, lack of supervisor support, training, etc. The resulting model appears particularly helpful in pointing out several interactions in the prediction of perceived organizational support. In particular, training is the dominant factor. Another dimension that seems to influence organizational support is reporting (perceived communication about safety and stress concerns). Results are discussed from a theoretical and methodological point of view.

Cause and context: place-based approaches to investigate how environments affect mental health

OBJECTIVES

Our surroundings affect our mood, our recovery from stress, our behavior, and, ultimately, our mental health. Understanding how our surroundings influence mental health is central to creating healthy cities. However, the traditional observational methods now dominant in the psychiatric epidemiology literature are not sufficient to advance such an understanding. In this essay we consider potential alternative strategies, such as randomizing people to places, randomizing places to change, or harnessing natural experiments that mimic randomized experiments.

METHODS

We discuss the strengths and weaknesses of these methodological approaches with respect to (1) defining the most relevant scale and characteristics of context, (2) disentangling the effects of context from the effects of individuals' preferences and prior health, and (3) generalizing causal effects beyond the study setting.

RESULTS

Promising alternative strategies include creating many small-scale randomized place-based trials, using the deployment of place-based changes over time as natural experiments, and using fluctuations in the changes in our surroundings in combination with emerging data collection technologies to better understand how surroundings influence mood, behavior, and mental health.

CONCLUSIONS

Improving existing research strategies will require interdisciplinary partnerships between those specialized in mental health, those advancing new methods for place effects on health, and those who seek to optimize the design of local environments.

Finding structure in data using multivariate tree boosting

Technology and collaboration enable dramatic increases in the size of psychological and psychiatric data collections, but finding structure in these large data sets with many collected variables is challenging. Decision tree ensembles such as random forests (Strobl, Malley, & Tutz, 2009) are a useful tool for finding structure, but are difficult to interpret with multiple outcome variables which are often of interest in psychology. To find and interpret structure in data sets with multiple outcomes and many predictors (possibly exceeding the sample size), we introduce a multivariate extension to a decision tree ensemble method called gradient boosted regression trees (Friedman, 2001). Our extension, multivariate tree boosting, is a method for nonparametric regression that is useful for identifying important predictors, detecting predictors with nonlinear effects and interactions without specification of such effects, and for identifying predictors that cause 2 or more outcome variables to covary. We provide the R package "mvtboost" to estimate, tune, and interpret the resulting model, which extends the implementation of univariate boosting in the R package "gbm" (Ridgeway, 2015) to continuous, multivariate outcomes. To illustrate the approach, we analyze predictors of psychological well-being (Ryff & Keyes, 1995). Simulations verify that our approach identifies predictors with nonlinear effects and achieves high prediction accuracy, exceeding or matching the performance of (penalized) multivariate multiple regression and multivariate decision trees over a wide range of conditions. (PsycINFO Database Record

The evaluation of perceived stress and associated factors in elderly caregivers

OBJECTIVE

Factors associated with perceived stress in older people have been studied previously, but this investigation in elderly caregivers is still scarce in the literature. Our aim was to assess factors that are associated with perceived stress in a sample of elderly caregivers.

METHODS

This cross-sectional investigation assessed 341 elderly caregivers who cared for a dependent older person at home. They answered questionnaires including the Perceived Stress Scale (PSS-14), a sociodemographic and care characterization, health and cognitive status, and burden related to care.

RESULTS

The mean score in PSS-14 was 18.5±9.9. Self-reported pain, difficult to sleep, "very poor/poor" self-rated health, impaired cognitive status, more people living in the house and higher levels of burden related to care were associated with higher levels of perceived stress.

DISCUSSION

The results highlight the importance of the development of stress-reduced interventions directed to elderly caregivers focusing on the associated variables in this study. Attention should be given to cognitive decline prevention and strategies to avoid or reduce burden in the elderly caregivers.

Do levels of perceived stress increase with increasing age after age 65? A population-based study

BACKGROUND

psychological and health-related stressors often occur in advanced ages, but little is known about perceived stress in adults aged 65 and over. This study aimed to test the hypothesis that levels of perceived stress increase with increasing age and to detect factors that may account for the association.

METHODS

a dementia-free cohort of 1,656 adults aged 66-97 years living at home or in institutions, participating in the Swedish National Aging and Care study, Kungsholmen (SNAC-K) was assessed for levels of perceived stress using the 10-item perceived stress scale (PSS).

RESULTS

prevalence of high stress according to the top tertile of the population (PSS score 20+) was 7.8% in adults aged 81+ years, 7.5% in adults aged 72-78 and 6.2% in adults aged 66 years (P = 0.020). More women than men reported high stress, 8.3 versus 5.4% (P = 0.001). Levels of stress increased with increasing age (P = 0.001) in the linear regression model. This association remained after adjustment for demographic and psychosocial factors, but no longer was present after adjusting for health-related factors.

CONCLUSION

health-related stress is highly prevalent in older adults and seems to play an important role in the association between levels of perceived stress and age in older adults.

Influence of home care on life satisfaction, loneliness, and perceived life stress

Strong evidence has established the medical and health services utilization benefits of home care services for older adults. However, sparse research has been conducted on potential psychosocial benefits. Older adults (65 and over) receiving home care with their needs met are compared with persons who have unmet needs (whether they received home care or not) on three key indicators of quality of life – life satisfaction, loneliness, and perceived life stress. Data are drawn from the 2008-2009 Canadian Community Health Survey respondents who met the study criteria (n = 3,244). Regression analyses showed that older adults who had their home care needs met reported higher levels of life satisfaction, and lower levels of loneliness and perceived life stress, than those with unmet needs, net of co-variates. The results suggest that filling this home care gap would significantly raise quality of life by increasing social and environmental resilience to age in place.

Functional disability and depressive symptoms: longitudinal effects of activity restriction, perceived stress, and social support

OBJECTIVES

This longitudinal study investigates how activity restriction, perceived stress, and social support affect the relationship between functional disability and depressive symptoms.

METHOD

This longitudinal study of a Taiwan population analyzed a nationally representative sample of 1268 subjects aged 60 years and over. Path analysis was used to assess interrelations among functional disability, activity restriction, perceived stress, social support, and depressive symptoms over time.

RESULTS

The analytical results supported the following relationships: (a) high functional disability were associated with high activity restriction, low social support, and high perceived stress over time, (b) high functional disability, high activity restriction, low social support, and high perceived stress were associated with high levels of depressive symptoms over time, (c) among the four factors, perceived stress exerted the strongest cross-sectional and longitudinal effect on depressive symptoms, and (d) the significant effect of prior functional disability on subsequent depressive symptoms substantially contributed to indirect changes in activity restriction, perceived stress, and social support between waves.

CONCLUSION

The findings indicate that functional disability may contribute to subsequent depressive symptoms by reducing activities and social support. Decreased activities and social support increased perceptions of stress, which then increased depressive symptoms during the 8-year follow-up study.

Loneliness and self-rated health among church-attending African Americans

OBJECTIVES

To explore relations between loneliness and self-rated health among African-American adults of diverse ages.

METHODS

Associations between loneliness and self-rated health were investigated using covariate-adjusted linear regression models. Perceived social support was examined as a moderator. The potential indirect effects of stress and/or depressive symptoms were examined using nonparametric bootstrapping procedures.

RESULTS

Greater loneliness was associated with poorer self-rated health (p = .008), and social support did not moderate. Stress and depressive symptoms yielded significant indirect effects in single and multiple mediator models (p values ≤ .05).

CONCLUSIONS

Loneliness may contribute to poorer health among African Americans. Results suggest that greater stress and depressive symptoms might underlie these associations, but longitudinal studies are needed to assess causal relations.

Combinations of stressors in midlife: examining role and domain stressors using regression trees and random forests

OBJECTIVES

Global perceptions of stress (GPS) have major implications for mental and physical health, and stress in midlife may influence adaptation in later life. Thus, it is important to determine the unique and interactive effects of diverse influences of role stress (at work or in personal relationships), loneliness, life events, time pressure, caregiving, finances, discrimination, and neighborhood circumstances on these GPS.

METHOD

Exploratory regression trees and random forests were used to examine complex interactions among myriad events and chronic stressors in middle-aged participants' (N = 410; mean age = 52.12) GPS.

RESULTS

Different role and domain stressors were influential at high and low levels of loneliness. Varied combinations of these stressors resulting in similar levels of perceived stress are also outlined as examples of equifinality. Loneliness emerged as an important predictor across trees.

DISCUSSION

Exploring multiple stressors simultaneously provides insights into the diversity of stressor combinations across individuals--even those with similar levels of global perceived stress--and answers theoretical mandates to better understand the influence of stress by sampling from many domain and role stressors. Further, the unique influences of each predictor relative to the others inform theory and applied work. Finally, examples of equifinality and multifinality call for targeted interventions.