Ego-integrity versus ego-despair: the effect of "accepting the past" on depression in older women

The Hebrew version of the adolescent and adult time inventory-time attitudes scales (AATI-TA): a validation study

In the present study, we examined the construct validity of scores on the Hebrew version of the Adolescent and Adult Time Inventory-Time Attitudes Scale (AATI-TA). The AATI-TA was translated into Hebrew by bilingual speakers, using the back-translation method. Participants included 452 young adults (M_age = 22.47, SD_age = 1.98, 51.5% female). Several measures of psychological well-being were used to establish convergent validity, including scales assessing self-esteem, life satisfaction, and optimism, and depressive, anxiety, and somatic symptoms. Internal consistency estimates for AATI-TA scores were high and confirmatory factor analyses supported the six-factor structure. Correlational analyses indicated the expected relationships between time attitudes and measures of psychological well-being, providing convergent validity support for the AATI-TA scores. The findings of this study support the use of the Hebrew version of the AATI-TA in further studies about time attitudes.

Social withdrawal and psychological well-being in later life: does marital status matter?

Objectives: Personality researchers have found that dispositional traits are typically stabile over the life course, but shyness is one trait that has rarely been examined in later life. Shyness as a global trait has been linked negatively to multiple psychological indices of childhood well-being, including loneliness. Despite the fact that older adults may already be at risk for experiencing heightened loneliness, regret, or decreased fulfillment, research has not assessed these experiences in relation to personality in later life. In the past few decades, research on social withdrawal has moved beyond treating shyness as a global trait and started to examine the multiple motivations behind socially withdrawn behavior.Method: Employing data from 309 older participants of the Huntsman Senior Games, the current study used regression analyses to examine the potential relations between three forms of withdrawal (shyness, avoidance, and unsociability) and loneliness, regret, and fulfillment in later life.Results and Conclusion: Results indicated that shyness, avoidance, and unsociability, respectively, were significantly associated with increased loneliness and regret, and decreased fulfillment. Further, marital status (married, divorced, widowed) moderated links between withdrawal and psychological indices of well-being in later life.

Religious Coping Styles and Depressive Symptoms in Geriatric Patients: Understanding the Relationship through Experiences of Integrity and Despair

Older persons are often confronted with challenging events in their lives. Religion can offer them a way to deal with these challenges. The study of religious coping styles helps us to understand how people find support in their religion or wrestle with aspects of their religion when they are confronted with difficulties. Especially when older adults face illness and hospitalization, religious coping styles might be triggered. Despite the fact that the public role of religion, especially Christianity, is diminishing in West European societies, a large group of Belgian geriatric patients call themselves religious. Previous studies have shown that there is a link between positive/negative religious coping styles and the depressive symptoms that often occur in older adults. More recently, some scholars have emphasized that this relationship is more complex. Therefore, this paper investigates the role of one possible underlying mechanism between positive/negative religious coping styles and depressive symptoms in geriatric patients, namely the developmental process of integrity and despair as two factors within this mechanism. One hundred thirty-nine geriatric inpatients from three hospitals in Belgium who reported to feel religiously affiliated were involved in this study. Our results indicate that experiences of integrity and despair function as an explanatory pathway in the relationship between negative religious coping styles and depressive symptoms. Further, a direct link was found between both when accounting for experiences of integrity and despair. For positive religious coping styles, no direct or indirect relationship with depressive symptoms was found. In healthcare, geriatric caregivers need to be aware of the interaction between positive and negative religious coping styles, the developmental process of integrity and despair, and depressive symptoms.

The Conceptual Structure of the Management by Nurses of the Ego Integrity of Residents of Nursing Homes

BACKGROUND

The number of older people admitted to nursing homes has continued to rise with the recent expansion of the Republic of Korea's long-term care system. Maintaining ego integrity is a major task for older people approaching the end of life. As efforts to maintain ego integrity include the final stages of life, this concept is critically important for older people in nursing homes. This study was designed to assess issues related to ego integrity in the nursing home environment to determine how nurses should play a key role in managing this important life task.

PURPOSE

The management by nurses of the ego integrity of residents of nursing homes is a new phenomenon that is central to promoting long-term, quality care. This study was designed to clarify and conceptualize this management phenomenon in the context of nursing homes.

METHODS

A hybrid model of concept development was used to analyze the ways in which nurses manage the ego integrity of residents of nursing homes. In the theoretical phase, a working definition of the management by nurses of residents' ego integrity is developed using a literature review. In the fieldwork phase, in-depth interviews are conducted with eight nurses from six nursing homes in Seoul and three other provinces. Finally, in the final analytical phase, the theoretical and fieldwork findings are interpreted and compared.

RESULTS

Two components, assessment and intervention, of the approach by nurses to managing the ego integrity of residents of nursing homes were identified. Assessment incorporates 10 attributes in the following three dimensions: "identifying the extent to which residents' basic needs are being fulfilled," "determining how residents achieve friendly relationships with others," and "determining how each resident creates a harmonious view of his or her life." Intervention incorporates nine attributes in the following two dimensions: "helping residents develop a positive view of life" and "helping residents make the best use of their remaining functional abilities."

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

By managing the ego integrity of residents, nurses have a significant influence on residents' sociopsychological adaptation, especially in the challenging environment of a nursing home. This study supports that managing the ego integrity of residents of nursing homes is an important and practical component of the role played by nurses and of the aid and care they provide. Furthermore, the findings verify the effectiveness of intervention studies in examining assessment tools and developing guidelines for ego-integrity management.

The role of ego integrity and despair in older adults' well-being during the COVID-19 crisis: the mediating role of need-based experiences

The COVID-19 pandemic has affected people across the world, with important heterogeneity among older adults in how they respond to the challenges associated with this crisis. Relying on a cross-fertilization between Erikson's personality theory and self-determination theory, this study aimed to examine possible sources of resilience (i.e., ego integrity and need satisfaction) and vulnerability (i.e., despair) in older adults' (mal) adjustment, thereby additionally considering the role of multiple risk and protective factors (e.g., gender and marital status). During the second month of the lockdown period in Belgium, 693 older adults (M _age = 70.06, SD = 4.48, range: 65-89 years, 62.1% female) filled out online questionnaires concerning the study variables, while also completing assessments of several important sociodemographic factors. Structural equation modeling suggested that both ego integrity and despair related to indicators of well-being and psychological distress through experienced need satisfaction. Additionally, we found several factors to protect (e.g., higher perceived income) or diminish (e.g., being widowed) older adults' well-being during these challenging times, with little evidence for a moderating role of these factors in associations between the psychological variables. Theoretical and practical implications of these results are discussed.

Dialogical Integration of Life Experiences and Successful Aging

This article examines the hypothesis that the dialogical integration of life experiences is related to successful aging. Life story interviews with 93 older Czech adults were sorted into categories characterized by specific patterns of life experience integration: (i) without dialogical processes, (ii) with differentiated I-positions, (iii) with dialogical relationships, (iv) partially integrated, and (v) completely integrated. The results indicated that the categories were ordered, yielding low-level correlations with scales of successful aging in predicted directions. A comparison of the categories revealed that they were related to successful aging in a cumulative way, starting with the most essential indicator (lower scores of rumination) in the participants who had developed at least dialogical relationships, continuing to higher well-being linked with partial integration, and ending with an advanced indicator (optimism toward future) linked with complete integration. These relationships were summarized in a hypothetical model that is open to further examination.

Dialogical and Integrated Self in Late Adulthood: Examining Two Adaptive Ways of Growing Old

We examined two contradictory views of Erikson's concept of ego integrity: as an outcome of the tension between integrity and despair, or as a dialogical process of balancing positive and negative life experiences. One hundred sixty-seven Czech older adults participated in the study. Dialogically integrated, outcome-integrated, and outcome-despairing participants were selected based on the Ego Integrity Scale and based on methods mapping life-reviewing dialogue. The three subsamples were compared in their psychological adaptation. The results showed that the dialogically integrated participants scored similarly in well-being and meaningfulness of life as outcome-integrated participants and better than outcome-despairing participants. However, the dialogically integrated participants were also prone to experiencing negative emotions. As they were older than the other two subsamples and reported worse physical health, we concluded that the life-reviewing dialogue helps them maintain a sense of meaning in life and a certain level of well-being. Hence, the results support relevance of the dialogical-process view.

Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial

CONTEXT

Dignity therapy (DT) is a psychotherapeutic intervention with increasing evidence of acceptability and utility in palliative care settings.

OBJECTIVES

The aim of this study was to evaluate the legacy creation component of DT by comparing this intervention with life review (LR) and waitlist control (WC) groups.

METHODS

Seventy adults with advanced terminal disease were randomly allocated to DT, LR, or WC followed by DT, of which 56 completed the study protocol. LR followed an identical protocol to DT except that no legacy document was created in LR. Primary outcome measures were the Brief Generativity and Ego-Integrity Questionnaire, Patient Dignity Inventory, Functional Assessment of Cancer Therapy-General, version 4, and treatment evaluation questionnaires.

RESULTS

Unlike LR and WC groups, DT recipients demonstrated significantly increased generativity and ego-integrity scores at study completion. There were no significant changes for dignity-related distress or physical, social, emotional, and functional well-being among the three groups. There were also no significant changes in primary outcomes after the provision of DT after the waiting period in the WC group. High acceptability and satisfaction with interventions were noted for recipients of both DT and LR and family/carers of DT participants.

CONCLUSION

This study provides initial evidence that the specific process of legacy creation is able to positively affect sense of generativity, meaning, and acceptance near end of life. High acceptability and satisfaction rates for both DT and LR and positive impacts on families/carers of DT participants provide additional support for clinical utility of these interventions. Further evaluation of specific mechanisms of change post-intervention is required given DT's uncertain efficacy on other primary outcomes.

A Unitary Healing Praxis Model for Women in Despair

The evolution of a unitary healing praxis model derived from three unitary appreciative inquiries of despair is described. Explication of unitary appreciative inquiry and how it informed and contributed to the development of the model is provided. The model is based on a conceptualization of healing as appreciating the inherent wholeness of life and provides knowledge specific to the individual lives of women in despair. The process of generative theorizing that led to the creation of the model is explicated. Unitary, appreciative, and participatory responses to despair are integrated in the model, praxis modalities are delineated, key concerns and perspectives of women in despair are addressed, and potentialities for healing are illustrated.

Development of a brief measure of generativity and ego-integrity for use in palliative care settings

Objective:

Our aim was to develop and test a brief measure of generativity and ego-integrity that is suitable for use in palliative care settings.

Method:

Two measures of generativity and ego-integrity were modified and combined to create a new 11-item questionnaire, which was then administered to 143 adults. A principal-component analysis with oblique rotation was performed in order to identify underlying components that can best account for variation in the 11 questionnaire items.

Results:

The two-component solution was consistent with the items that, on conceptual grounds, were intended to comprise the two constructs assessed by the questionnaire.

Significance of Results:

Results suggest that the selected 11 items were good representatives of the larger scales from which they were selected, and they are expected to provide a useful means of measuring these concepts near the end of life.

Prevalence and correlates of depression among Australian women: a systematic literature review, January 1999- January 2010

Background

Little is known about the prevalence and correlates of depression among Australian women. This systematic review of depression among women in Australia, the largest identified to date, highlights the prevalence and correlates of depression across the life span.

Results

The report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (PRISMA). Six health related databases were selected: Medline, PsychInfo, SCOPUS, Cinhal, Informit and Cochrane Systematic Reviews. 1,888 initial articles were found, and 111 articles were considered relevant for review. Prevalence rates of depression among women ranged from 2.6% to 43.9%. Higher rates were reported for younger women, or specific population groups. Most significant correlates included, age, adverse life events, tobacco use, sole motherhood, and previous mental health problems.

Conclusions

Limitations include the scope of the investigation’s aims and inclusion criteria, and the failure to identify gender specific data in most studies. Publication bias was likely, given that only papers reported (or translated) in English were included. Despite the breadth of information available, there were noticeable gaps in the literature. Some studies reported on affective disorders, but did not specifically report on depression; it is concluded that each mental illness warrants separate investigation. It was also common for studies to report a total prevalence rate without separating gender. This report recommends that it is vital to separate male and female data. The report concludes that more research is needed among mid-age women, Indigenous women, non-heterosexual women and Culturally and Linguistically Diverse (CALD) women.

Despair: a unitary appreciative inquiry

A unitary appreciative case study method was used to explicate unitary understandings of despair embedded in the unique personal life contexts of the participants. Fourteen women engaged in dialogical, appreciative interviews that led to the creation of profiles of the life pattern or course associated with despair for each woman. Three exemplar cases are detailed including the profiles that incorporate story, metaphor, music, and imagery. The voices of the women provide morphogenic knowledge of the contexts, nature, consequences, and contributions of despair as well as practical guidance for healthcare providers.