Does Engagement in Pleasant Events Mediate the Relation Between Physical Disability and Affective Outcomes in Older Adults?

The current study examined potential mediators of the association between physical disability and depressive symptoms, along with positive mental health variables, including meaning in life and positive affect, within the framework of an empirically supported model of depression---the behavioral model of depression (Lewinsohn, 1985). The behavioral model of depression posits that reduced contact with positive reinforcement in the environment (i.e., engagement in pleasant events) precipitates and maintains depressive symptoms (Lewinsohn et al., 1985). Treatment studies have demonstrated the efficacy of interventions based on the behavioral model of depression in older adults (Cuijpers et al., 2007; Dimidjian et al., 2006; Hopko et al., 2003). The application of the behavioral model of depression to understanding the link between physical disability and depressive symptoms fits well with previous conceptualizations specifying the ways in which disability may affect mood (Bruce, 2001). First, consistent with role of life events in the behavioral model of depression (Lewinsohn et al., 1985), onset of disability can function as a discrete life event with the potential to create initial dysregulation in mood and disruption in schedules of reinforcement (Bruce, 2001; Dunne et al., 2011; Heckhausen et al., 2010), conditions that serve as catalysts for reduction in positive reinforcement over time (Lewinsohn, 1985). Second, physical disability is often chronic in nature and requires goal-adjustment and various forms of coping for successful adaption over time (Boerner, 2004; Hall et al., 2010). Failure to successfully adjust goals and coping strategies in response to physical disability may lead to reduced positive reinforcement if older adults do not replace lost activities with new ones, thereby increasing risk for depression over time (Duke et al., 2002). The current study was designed to examine whether the frequency of pleasant events, as well as frequency by pleasantness of events product (i.e., frequency of pleasant events and frequency x pleasantness of events), mediated the association between physical disability and affective outcomes (depressive symptoms, positive affect, meaning in life), after controlling potential confounds (age, gender, education, cognitive functioning, and perceived social support; Blazer, 2003). Participants were (N = 82) adults 65 years and older recruited from Morgantown, WV and surrounding towns/cities, Mage = 77.6 (SD = 8.0), 64.6% female, 97.6% White. Questionnaires measured physical disability (ADLS/IADLS), affective outcomes (GDS, GSIS-MIL, PANAS-PA), pleasant events (OPPES), and covariates (MoCA, DSSI, demographics). Simple mediation analyses with each proposed mediator (frequency of pleasant events and frequency x pleasantness of events) predicting affective outcomes were conducted using Preacher and Hayes\u27 (2008) bootstrapping macro in SPSS. Consistent with predictions, frequency of pleasant events mediated the association between physical disability and affective outcomes, including depressive symptoms (unstandardized coefficient = 0.16, 95% bias-corrected CI [0.03, 0.41]), meaning in life (unstandardized coefficient = -1.58, 95% bias-corrected CI [-3.19, -0.47]), and positive affect (unstandardized coefficient = -2.65, 95% bias-corrected CI -5.38, -0.88]). The frequency by pleasantness of events product mediated the association between physical disability and affective outcomes (depressive symptoms: unstandardized coefficient = 0.11, 95% bias-corrected CI [0.01, 0.35]; meaning in life: unstandardized coefficient = -1.10, 95% bias-corrected CI [-2.59, -0.13]; positive affect: unstandardized coefficient = -1.89, 95% bias-corrected CI -4.38, -0.26). Mediation effects remained after controlling for covariates. Post hoc analyses revealed that after controlling for frequency of pleasant events, there was no longer significant indirect effect of pleasantness ratings, suggesting that frequency of pleasant events is most impactful in accounting for the association between physical disability and affective outcomes. Results are consistent with the behavioral mode of depression and generate ideas for future research, including prospective study designs, inclusion of daily diaries to capture real-time activity and mood, and inclusion of variables that may account for additional variance in the association between physical disability and affective outcomes in multiple mediation models, such the role of avoidance. Major depressive disorder (MDD) is a mental health condition characterized by the presence of depressed mood and/or anhedonia most of the day, nearly every day for two weeks, along with a minimum of five of nine additional symptoms (e.g., loss of energy, feelings of worthlessness or guilt; American Psychiatric Association, 2013). By the year 2020, MDD is expected to be the second leading cause of disease burden worldwide surpassing the disease burden attributed to road-traffic accidents and cardiovascular disease (Murray & Lopez, 1997). MDD is associated with increased all-cause and disease-related mortality (Kohler et al., 2013; Meijer et al., 2011; Park, Katon, & Wolf, 2013; Pinquart & Duberstein, 2010; Zheng et al., 1997). In addition, MDD is one of the strongest predictors of suicide across the life span (Brown, Beck, Steer, & Grisham, 2000; Conwell, Duberstein, & Caine, 2002). The economic consequences of MDD in the U.S. are staggering. In 2000, the cost of MDD, including direct treatment costs, morbidity, and mortality, was {dollar}81.1 billion (Greenberg et al., 2000). Reducing prevalence rates of MDD through interventions is a public health imperative that first begins with identifying the groups that are vulnerable to depressive symptoms

The Influence of Self-Reported Family Functioning on Depression Symptom Severity and Psychological Well-Being in Treatment-Seeking Older Adults

Among treatment-seeking older adults, positive social ties are related to depression outcomes prospectively. Less is known regarding the role of negative social ties in relation to depression and well-being outcomes among patients in treatment. The current study adds to this literature through the cross-sectional and prospective examination of patients\u27 appraisal of family members perceived criticism in relation to self-reported depressive symptom severity and psychological well-being In addition, potential moderators of these relations were examined, including personality variables (Neuroticism and Conscientiousness), cognitive functioning, and living status. adults 60 years of age and older newly (\u3c 1 month after intake session) receiving treatment for depressive or anxious symptomatology at a university-affiliated outpatient clinic as part of an on-going study that assessed depression and decision-making in late life. Results demonstrated that individuals with increased perceived criticism also had greater depressive symptom severity, at least measured at one point in time. Perceived criticism failed to predict change in depression symptom severity in the prospective analyses. Similarly, perceived criticism was associated with lower psychological well-being in the cross-sectional analyses; however, perceived criticism failed to predict change in psychological well-being in prospective analyses. No significant interactions were found with perceived criticism, suggesting at least in the current study, personality variables, cognitive functioning, and living status did not qualify the relation between perceived criticism and depression symptom severity or change in depression symptom severity over time. EI was not significantly associated with depression symptom severity and psychological well-being cross-sectionally and prospectively, after controlling for perceived criticism and perceived social support from family. Implications, limitations, and future directions are discussed

Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?

OBJECTIVES: Sleep continuity (i.e., ability to initiate and/or maintain sleep) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, a large archival dataset was used to examine age differences in sleep continuity, problem endorsement, and sleep related daytime dysfunction. METHOD: Participants were categorized as: Young Adults (18-29 years); Adults (30-44 years); Middle Aged Adults (45-64 years); and Older Adults (65-89 years). Young Adults, Adults, and Middle Aged Adults were 1:1 matched with Older Adults (n = 233) on the basis of gender, race, ethnicity, and BMI. MANOVA, ANOVAs, and chi-square analysis were performed to assess for age-related differences. RESULTS: In a sample of 932 adults with self-reported sleep continuity disturbance (i.e., insomnia), sleep continuity was significantly worse in older age groups. This effect was limited to middle and late insomnia with middle aged and older adults waking up with greater frequency and for longer durations of time during the night and in the early morning than younger cohorts. Problem endorsement largely increased across age groups (except for sleep latency) but reports of overall sleep-related daytime dysfunction showed no difference by age. CONCLUSION: When evaluating sleep continuity disturbance, assessing whether the patient identifies their sleep continuity disturbance as a problem and whether it affects their daytime function can be informative, particularly in older adults. It may serve to reveal (case-by-case) when there are discordances between incidence/severity of illness and problem endorsement/daytime dysfunction. Such information may better inform if treatment should be initiated

“I Didn’t Know What Was Wrong:” How People With Undiagnosed Depression Recognize, Name and Explain Their Distress

BACKGROUND: Diagnostic and treatment delay in depression are due to physician and patient factors. Patients vary in awareness of their depressive symp-toms and ability to bring depression-related concerns to medical attention. OBJECTIVE: To inform interventions to improve recog-nition and management of depression in primary care by understanding patients ’ inner experiences prior to and during the process of seeking treatment. DESIGN: Focus groups, analyzed qualitatively. PARTICIPANTS: One hundred and sixteen adults (79% response) with personal or vicarious history of depres