Unforgiveness, rumination, and depressive symptoms among older adults

Inner Peace needs of male psychiatric patients in post-war Croatia are associated with their needs to clarify open issues in their life and their needs for forgiveness

Background

More than 25 years after the end of the Balkan war, many people belonging to the post-war population are still traumatized by the war events and have been treated for post-traumatic stress disorder or other psychiatric diagnoses. We were interested in their Inner Peace needs, how these relate to indicators of mental health, and their needs to clarify open processes in their lives and to forgive and be forgiven.

Materials and methods

In a cross-sectional survey with standardized questionnaires (i.e., SpNQ, PCL-M, HADS, and BMLSS), 638 male patients who were treated in seven psychiatric centers in Croatia were enrolled. 68% were diagnosed with PTSD and 32% had other psychiatric diagnoses. Most had actively participated in the Balkan war (79%), and 60% for the whole war period.

Results

Strong needs to "immerse into beauty of nature" were stated by 47%, to "dwell at a place of quietness and peace" by 66%, and to "find inner peace" by 57%. These Inner Peace needs were highest in men treated with PTSD diagnoses as compared to men with other psychiatric diagnoses and were slightly lower in men who were active during the whole war period as compared to shorter phases of war participation. Regression analyses with Inner Peace needs as a dependent variable revealed that Clarification/Forgiveness needs were the best predictor, with further influences of PTSD symptoms and life satisfaction, explaining altogether 49% of the variance. The best predictors of their PTSD symptoms were life satisfaction, perceived burden, depressive symptoms, Inner Peace needs, religious trust, and duration of war participation, explaining 60% of the variance.

Conclusion

In Croatian male war participants in clinical treatment decades after the war, Inner Peace needs indicate their ongoing intention to let go of their disturbing experiences and to find states of inner peace, particularly at specific places of quietness and peace. These needs can be considered metaphors for longing for wholeness, integrity, and safety, in contrast to the ongoing impact of unresolved issues. Thus, apart from psychotherapeutic treatment, sheltered places of nature, inspiration, and reconciliation might be elements to improve the difficult situation of post-war victims still suffering from their experiences.

Forgive, Let Go, and Stay Well! The Relationship between Forgiveness and Physical and Mental Health in Women and Men: The Mediating Role of Self-Consciousness

BACKGROUND

The current study assessed forgiveness (positive forgiveness and reduced unforgiveness), self-consciousness (rumination and reflection), and physical and mental health. The aim of the study was to check if self-consciousness mediates the relationship between dispositional forgiveness and health.

METHODS

To address this link, we conducted 2 studies (N = 484 in Study 1 and N = 249 in Study 2). Data were collected separately for Study 1, as well as Study 2. We used in both studies the Heartland Forgiveness Scale and the Rumination-Reflection Questionnaire, and additionally, the General Health Questionnaire-28 in Study 1 and the Scales of Psychological Well-Being in Study 2.

RESULTS

The results indicated that rumination was an effective mediator between positive forgiveness and mental health (B = 0.14, CI95% = [0.064, 0.234]), reduced unforgiveness and physical health (B = -0.13, CI95% = [-0.182, -0.088]), and both rumination and reflection between reduced unforgiveness and mental health (B = 0.13 CI95% = [0.051, 0.226]), positive forgiveness (B = -0.09 CI95% = [-0.135, -0.052]), and physical health.

CONCLUSION

The mediating role of ruminations was more frequently observed in females. The study highlighted the indirect effect between forgiveness and health. Rumination and reflection are mediators between forgiveness and health.

The need to change: Is there a critical role of midlife adaptation in mental health later in life?

Although late-life depression (LLD) is a serious health problem and more common than dementia in people over 60, it is underdiagnosed and undertreated. The cognitive-emotional etiology of LLD is particularly poorly understood. This is in contrast to the now extensive literature from psychology and cognitive neuroscience on the characteristics of emotionally healthy aging. This research consistently shows a change in emotional processing in older adults that is modulated by prefrontal regulation. Lifespan theories explain this change in terms of neurocognitive adaptation to limited opportunities and resources that typically occur in the second half of life. Epidemiological data on an increase in well-being after a low point around age 50 suggest that the majority of people seem quite capable of making this adaptation, even though empirical evidence for a causal modulation of this so called 'paradox of aging' and for the role of the midlife dip is still lacking. Intriguingly, LLD is associated with deficits in emotional, cognitive, and prefrontal functions similar to those shown to be crucial for healthy adaptation. Suspected causes of these deficits, such as white matter lesions or affective instability, become apparent as early as midlife when internal and external changes as well as daily challenges set in. Based on these findings, we propose that some individuals who develop depression at older ages may not have been able to successfully implement self-regulatory adaptation at midlife. Here, we review the current evidence and theories on successful aging, the neurobiology of LLD, and well-being across the lifespan. Drawing on recent advances in lifespan theories, emotion regulation research, and cognitive neuroscience, we propose a model of successful versus unsuccessful adaptation that emphasizes the increasing need for implicit habitual control and resource-based regulatory choice during midlife.

Psychological flexibility in older adulthood: a scoping review

OBJECTIVES

Psychological flexibility/inflexibility (PF/PI) is a core component of the acceptance and commitment therapy (ACT) model, which is gaining more attention in the geropsychological literature. This scoping review examines the size and scope of the research on PF/PI in older adulthood related to age differences between older adult and younger samples, correlates relevant to psychological health, and changes with ACT.

METHODS

A systematic literature search was conducted using PubMed, CINAHL, and PsycINFO. Peer-reviewed articles available in English were included that: had a mean age ≥65 and a minimum age ≥60; and reported self-report measures of PF/PI. We categorized PF/PI into three domains: open, aware, and engaged.

RESULTS

Forty-six articles were included. Most studies measured open or aware domains; few measured the engaged domain. Older adults evidenced greater awareness compared to younger adults (9 of 13 analyses were significant). Openness and awareness consistently yielded medium to large correlations with anxiety and depression. PF/PI did not relate with positive affect and inconsistently correlated with quality of life measures.

CONCLUSION

Despite emerging trends, variability and limitations were evident in the literature. Specifically, measurement issues, lack of conceptual clarity, and the omission of values and behavioral measures require future attention.

Perceptions of Divine Forgiveness, Religious Comfort, and Depression in Psychiatric Inpatients: A Mixed Methods Study

Understanding how forgiveness relates to mental health outcomes may improve clinical care. This study assessed 248 adult psychiatric inpatients, testing associations of forgiveness, religious comfort (RC), religious strain (RS), and changes in depressive symptomatology from admission to discharge. Experiencing divine forgiveness and self-forgiveness was both directly associated with RC and inversely associated with RS. Using structural equation modeling, the path from divine forgiveness to depression through RC was significant, β =  - .106, SE = .046, z =  - 2.290, p = .022, bootstrapped 95% CI =  - .196 to - .015. Qualitative findings illustrated patients' changed perspectives on divine forgiveness during hospitalization.

The role of perceived social support and depressive symptoms in the relationship between forgiveness and life satisfaction among older people

OBJECTIVE

Forgiveness carries a different significance for individuals, especially older people. Few studies have focused on the effect of forgiveness on life satisfaction among older people and the mediating role of perceived social support and depressive symptoms. The current study tested the relationship between forgiveness and life satisfaction, and the mediating effects of perceived social support and depressive symptoms in the relationship.

METHOD

The sample of the study consisted of 713 older people (>56 years, M=64.89, SD=1.31)were recruited from Jiangsu province in China. Bootstrap estimation of multiple mediation analysis was used to examine the mediating effects of perceived social support and depressive symptoms in the relationship between forgiveness and life satisfaction.

RESULTS

Forgiveness of others and oneself have positively associated with life satisfaction, and multiple mediation analyses indicated that perceived social support and depressive symptoms mediate the relationship between forgiveness of others and oneself and life satisfaction.

CONCLUSION

Forgiveness of others and self is linked with life satisfaction not only through perceived social support but also depressive symptoms. Forgiveness can enhance life satisfaction of older people. It can also enhance the effects of social support on their social relationships and reduce depressive symptoms, which lead to higher life satisfaction.

Through Him and With Him? A Longitudinal Study of How God-Mediated Control Beliefs Shape the Relationship between Divine Forgiveness and Physical Health in Later Life

Objectives: While there has been a recent surge in research on forgiveness and health, much less is known about the relationship between divine forgiveness and health. Methods: Using longitudinal data from the 2001-2004 Religion, Aging, and Health Survey from the United States, the current study assesses how changes in beliefs in God-mediated control, a perceived collaborative relationship with a divine power, affect the association between divine forgiveness and physical health among Christian older adults. Results: Older adults with consistently high beliefs in God-mediated control over the study period received stronger health benefits of divine forgiveness. Forgiveness by God also had a stronger relationship with health compared to forgiveness of self and others. Discussion: The findings underscore the importance of subjective beliefs about God. Future research directions are proposed to advance the study of religion and health in later life by conceiving of a more salient role for divine forgiveness.

Different Routes, Same Effects

Abstract. In the field of forgiveness interventions, little research has been done on the comparative effects of learning-oriented versus action-oriented routes in managing unresolved interpersonal transgressions. In this study, 73 older adults ( M = 68.8 years) were randomized to either a learning-oriented group intervention condition that emphasized learning factors by helping older adults to understand the transgression in a more adaptive way; or to an action-oriented group intervention condition that emphasized action factors by helping older adults to practice new behaviors and skills to manage the transgression. The findings indicated that both conditions resulted in decreases in revenge, transgression-related thoughts and feelings, negative affect, and psychological distress as well as increases in life satisfaction. We were able to demonstrate that both routes are equally effective in reducing negative states and producing positive states.

Forgiveness and late life functioning: the mediating role of finding ego-integrity

OBJECTIVES

This study seeks (1) to replicate previous findings on the mediating effect of integrity/despair in the relation between forgiveness and depression in an elderly population and (2) to extend these findings to other aspects of functioning, namely life satisfaction and subjective health. Both aims were studied in a sample of residential elderly.

METHODS

Residential elderly (n = 329, M = 87 years) filled out questionnaires on forgivingness, depressive symptoms, life satisfaction, subjective health and the developmental task of integrity/despair. Structural equation modeling was used to test the mediational role of integrity-despair in the relation between forgivingness and the aspects of functioning. Direct and indirect effects are tested.

RESULTS

The results confirmed earlier findings stating that forgivingness and depression are negatively associated in residential elderly and that the developmental task of finding integrity and avoiding despair is significant mediator in this relationship. A similar pattern of mediational associations was found for life satisfaction. However, for subjective health only a direct effect between forgiveness and subjective health was found, whereas the developmental task of integrity and despair did not function as an underlying mechanism.

DISCUSSION

Framed within a life span perspective, we showed that the developmental task of finding a balance between integrity and despair is an important intrapersonal mechanism through which forgivingness is related with depressed feelings and life satisfaction for residential elderly. A different mechanism might explain the direct effect between forgiveness and subjective health.

O Perdão sob a Perspectiva do Ofensor: uma Revisão da Sistemática

Resumo Neste estudo foram realizadas revisões sistemáticas sobre as atitudes para receber o perdão e para perdoar a si mesmo. Considerando a escassez de estudos e relevância dos temas, o objetivo foi conhecer a forma como essas atitudes foram investigadas nas publicações recentes. O levantamento dos artigos foi realizado no portal Periódicos Capes, sendo selecionados estudos publicados entre 2006 e 2016. Na revisão sobre receber o perdão foram utilizados os descritores: “receber o perdão” e “buscar o perdão”, em português e inglês. Após a aplicação dos critérios de inclusão e exclusão foram selecionados 12 artigos. Destacou-se a predominância do interesse na investigação da motivação para receber o perdão, sendo este um dos objetivos da maioria dos estudos revisados. Estes estudos contribuíram para o conhecimento da atitude para receber o perdão ao estabelecer os fatores, condições ou variáveis que favorecem a motivação para o pedido de desculpas ou para buscar receber o perdão. No que se refere ao autoperdão, foi utilizado o descritor “autoperdão”, em português e inglês. Foram selecionados 54 artigos após a aplicação dos critérios de inclusão e exclusão. Parte considerável dos estudos buscou delimitar e diferenciar os processos de autoperdão genuíno e de pseudo-autoperdão. Estes estudos procuraram estabelecer como é possível se perdoar genuinamente e exploraram as variáveis que tem um papel significativo nesse processo. Considera-se que as revisões realizadas poderão auxiliar estudos e atuações que busquem incentivar as atitudes para receber o perdão e para perdoar a si mesmo, possibilitando conhecimentos para que as atuações sejam mais efetivas.

Mindfulness-based forgiveness groups for older adults

Interventions that enable individuals to be more forgiving toward themselves and others are important for older adults. This article describes a group intervention for adults aged 60 or older that integrates forgiveness-related skills with a mindfulness approach. The Mindfulness-based Forgiveness Group was designed to meet for eight sessions. The skills taught included: recognizing one's own expectations and unenforceable rules, broadening one's perspectives about the context of the transgression, and discovering positive intentions through exercises as well as a variety of meditations to cultivate mindfulness, self-compassion and forgiveness. Data from five Mindfulness-Based Forgiveness Groups were collected. Based on pre- and post-test measures, analyses indicate that participants improved significantly in relation to forgiveness, mindfulness/self-compassion, and mental health. Using qualitative post-test data from participants, we identify elements of the intervention that appear to be helpful. Suggestions are provided for social workers seeking to replicate and build upon this promising intervention.

Unforgiveness: Refining theory and measurement of an understudied construct

This research presents a multidimensional conceptualization of unforgiveness and the development and validation of the unforgiveness measure (UFM). The scale was developed based on a qualitative study of people's experiences of unforgiven interpersonal offences (Study 1). Three dimensions of unforgiveness emerged (Study 2): emotional-ruminative unforgiveness, cognitive-evaluative unforgiveness, and offender reconstrual. We supported the scale's factor structure, reliability, and validity (Study 3). We also established the convergent and discriminant validity of the UFM with measures of negative affect, rumination, forgiveness, cognitive reappraisal, and emotional suppression (Study 4). Together, our results suggest that the UFM can capture variability in victims' unforgiving experiences in the aftermath of interpersonal transgressions. Implications for understanding the construct of unforgiveness and directions for future research are discussed.

Brooding Is Related to Neural Alterations during Autobiographical Memory Retrieval in Aging

Brooding rumination is considered a central aspect of depression in midlife. As older people tend to review their past, rumination tendency might be particularly crucial in late life since it might hinder older adults to adequately evaluate previous events. We scanned 22 non-depressed older adults with varying degrees of brooding tendency with functional magnetic resonance imaging (MRI) while they performed the construction and elaboration of autobiographical memories. Behavioral findings demonstrate that brooders reported lower mood states, needed more time for memory construction and rated their memories as less detailed and less positive. On the neural level, brooding tendency was related to increased amygdala activation during the search for specific memories and reduced engagement of cortical networks during elaboration. Moreover, coupling patterns of the subgenual cingulate cortex with the hippocampus (HC) and the amygdala predicted details and less positive valence of memories in brooders. Our findings support the hypothesis that ruminative thinking interferes with the search for specific memories while facilitating the uncontrolled retrieval of negatively biased self-schemes. The observed neurobehavioral dysfunctions might put older people with brooding tendency at high risk for becoming depressed when reviewing their past. Training of autobiographical memory ability might therefore be a promising approach to increase resilience against depression in late-life.

Unforgiveness, depression, and health in later life: the protective factor of forgivingness

OBJECTIVES

Feeling unforgiven by others has been linked to poor health outcomes. The current study examined whether feeling unforgiven by others is associated with depression and self-rated health among older adults in the United States. The potential moderating roles of forgiving others and self-forgiveness in the association between unforgiveness and both depression and self-rated health was also assessed along with gender differences.

METHOD

Data were drawn from a sample of 1009 adults in Wave 2 of the Religion, Aging, and Health Survey, a national sample of adults aged over 67. Depression was measured using the eight item short form from the Center for Epidemiologic Studies-Depression (CES-D) scale. Self-rated health was assessed with a one-item indicator.

RESULTS

Analyses indicated that higher levels of self-forgiveness ameliorated the relationship between unforgiveness by others and depression for men and women and higher levels of forgiving others attenuated the association between unforgiveness by others and depression for women. Self-forgiveness was protective of depression for women who reported unforgiveness by others and low levels of forgiving others. Regardless of levels of self-forgiveness, men who were most likely to forgive others experienced a significant association between unforgiveness by others and depression. Neither forgiving others nor the self were significant moderators in the association between unforgiveness and self-rated health.

CONCLUSION

Forgiving others and the self may be protective of well-being when women feel unforgiven by others. These findings have implications for forgiveness intervention programs and contribute to literature pertaining to forgiveness and health in later life.

Religion in the lives of older women serving life in prison

This exploratory qualitative study examined the roles of religiousness in the lives of 21 older women (mean age = 63) serving life sentences in one southern state. Based on survey and focus group methodology, several themes emerged as important focal points, including early religious experiences prior to incarceration, imprisonment and religious doubt, participation in formal and informal religious activities, and use of religion in coping with stressors such as interpersonal relationships, trauma, and health statuses. Irrespective of their religious upbringing, all participants agreed that religiosity/spirituality played a key role in their ability to cope with their prison experience as well as for maintaining hope and the opportunity for release.

Rumination and Loneliness Independently Predict Six-Month Later Depression Symptoms among Chinese Elderly in Nursing Homes

Background

Previous studies conducted in Western countries independently demonstrated that loneliness and rumination are remarkable risk factors of depression among the elderly in both community and nursing homes. However, knowledge on the relationship between these three constructs among the elderly in Eastern countries is scarce. The current study aims to determine the relationship between loneliness, rumination, and depression among Chinese elderly in nursing homes.

Methods

A total of 71 elderly participants with an average age of 82.49 years completed this six-month longitudinal study. Physical reports indicated that none of the participants were clinically depressed before the study. At Time 1, their loneliness and rumination were measured using UCLA-8 Loneliness Scale and Ruminative Responses Scale. Six months later, the participants completed the Center for Epidemiologic Studies Depression Scale to assess depressive symptoms (Time 2).

Results

Multiple regression analysis revealed that both loneliness and rumination at Time 1 were the predictors of depression symptoms at Time 2 among the Chinese elderly in nursing homes. However, in the mediation analysis using PROCESS, the indirect effect between loneliness at Time 1 and depression symptoms at Time 2 was insignificant.

Conclusions

Results suggest that previous loneliness and rumination thinking are predictors of future depression symptoms among the Chinese elderly in nursing homes. However, the insignificant mediation further suggests that the differences between loneliness and rumination should be explored in future studies. Findings have important implications for mental health professionals in nursing homes in China.

Prospective associations between unforgiveness and physical health and positive mediating mechanisms in a nationally representative sample of older adults

OBJECTIVE

This study examined the prospective association between unforgiveness and self-reported physical health and potential positive psychological mediators of this association.

DESIGN

Participants were a national sample of 1024 USA's adults of ages 66 years and older. Data were collected at two time points separated by three years.

MAIN OUTCOME MEASURES

Measures of trait unforgiveness, self-rated physical health, socio-demographics, health behaviours and positive psychological traits (e.g. life satisfaction, self-esteem) were included in a comprehensive survey known as the 'Religion, Aging, and Health Survey.'

RESULTS

The results indicated that unforgiveness was prospectively associated with declines in self-reported physical health three years later, and poor initial self-reported health status did not predict increases in unforgiveness across time. Furthermore, the prospective association of unforgiveness with self-reported health was mediated by a latent positive psychological traits variable.

CONCLUSION

These results confirm cross-sectional findings suggesting that unforgiveness is related to health. The present study also suggests that unforgiveness has a prospective, but not reciprocal, association with self-reported physical health. Unforgiveness may have its association with self-reported physical health through its interruption of other positive traits that typically confer health benefits.

Trajectories of change in dimensions of forgiveness among older adults and their association with religious commitment

Forgiveness is a complex construct with an important role in religious traditions worldwide, and is associated with mental and physical health outcomes. This seven-year longitudinal study examined changes within individuals during, and differences based on birth cohort, in forgiveness during late life. Growth curve analysis was used to analyze the general pattern of change across the course of older adulthood in eight dimensions related to forgiveness. Increases over time were observed in forgiveness of others, conditionality of forgiveness of others, forgiveness of self, feelings of being forgiven by God, and feelings of being forgiven by others. Decreases over time were observed in difficulty forgiving oneself, and perceptions of conditionality in God's forgiveness. Religious commitment was related to reporting more a more forgiving attitude on seven of these dimensions, but also to more perceived conditionality in God's forgiveness. Finally, differences in mean levels of forgiveness emerged between birth cohorts.

Standardization of the korean version of the posttraumatic embitterment disorder self-rating scale

OBJECTIVE

Embitterment is a persistent feeling of being let down or insulted, feeling like a "loser", or feeling revengeful but helpless. In South Korea, social injustice experienced during rapid industrial development and protracted unemployment during the Asian economic crisis may lead to strong feelings of embitterment. North Korean defectors and victims of industrial disasters may also experience humiliation and feelings of injustice. Posttraumatic Embitterment Disorder (PTED) is a recent conceptualization of a new psychiatric disorder. This study tested the reliability and validation of the Korean version of the PTED Scale.

METHODS

Subjects aged 18 years or older were recruited from a psychiatric outpatient clinic. All subjects were diagnosed with a depressive disorder. Subjects completed the Korean version of the PTED Scale, the Patient Health Questionnaire (PHQ-9) and the Patient Health Questionnaire (PHQ-15) at baseline and two weeks later.

RESULTS

Approximately 15.4% of subjects could be categorized as having PTED. The test-retest reliability of the PTED Scale was good (r=0.76) and the internal consistency was very high (Cronbach's alpha=0.962). Positive correlations were found between the PTED Scale, the PHQ-9 and the PHQ-15, indicating substantial convergent validity of the PTED Scale.

CONCLUSION

The Korean version of the PTED Scale is a reliable and valid measurement of embitterment in Korean adults as an emotional reaction to a negative life event.

Consideration of forgiveness to enhance the health status of older male prisoners confronting spiritual, social, or emotional vulnerability

Participants in this study included 261 men, aged 45 and older, residing within state-managed correctional facilities in Oklahoma. Path analysis was used to examine an integrated mediation model. Spiritual ambivalence, loneliness, and depressive affect had direct negative associations with forgiveness, controlling for age, race, education, and type of crime. Forgiveness also maintained a direct positive association with perceived health status, whereas depressive affect maintained a direct negative association with perceived health status. In addition, a significant indirect effect of depressive affect on perceived health through forgiveness emerged. Overall, the model explained 38% of the variance in forgiveness and 23% in perceived health. Greater spiritual ambivalence, loneliness, and depressive affect diminish forgiveness among older male prisoners, yet higher levels of forgiveness, are associated with greater perceived health.

Parental Religious Socialization Practices, Connectedness With Others, and Depressive Symptoms in Late Life

This purpose of this study is to examine two constructs that have been largely overlooked in the study of religious involvement among older people: parental religious socialization practices and feelings of connectedness with others. The data are from an ongoing nationwide survey of older people. Findings from a latent variable model that was designed to examine the two focal constructs provides support for the following relationships:(1) older people whose parents encouraged them to become more involved in religion are more likely to attend worship services; (2) older people whose parents promoted religious involvement and older individuals who attend church more often are more likely to report that they see a fundamental connection among all human beings; (3) older adults who feel more closely connected to others will be more likely to forgive people for the things they have done; and (4) older people who are more forgiving are likely to experience fewer symptoms of depression over time.