A psychological pathway from insomnia to depression among older adults
- Authors: Sadler, Paul , McLaren, Suzanne , Jenkins, Megan
- Date: 2013
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 25, no. 8 (2013), p. 1375-1383
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- Description: Background: Higher levels of insomnia predict greater depression severity among older adults; however. The psychological mechanisms underlying this relationship are unclear. This study tested a path model that explored whether dysfunctional beliefs about sleep and hopelessness mediate. The relationship from insomnia to depression. It was hypothesized that insomnia would predict depression, both directly and indirectly, via dysfunctional beliefs about sleep and hopelessness. Methods: A community sample of 218 independent-living Australian older adults aged from 65 to 96 years completed a self-report questionnaire package. From the initial 218 participants, 171 completed a measure of depression three months later. Results: Path analysis demonstrated that maladaptive sleep beliefs and hopelessness partly explained how insomnia influenced depression, irrespective of the presence of obstructive sleep apnea and/or restless legs syndrome. Conclusions: An older adult's beliefs about sleep and sense of hopelessness were important psychological factors that helped explain how insomnia related to depression. © 2013 International Psychogeriatric Association.
- Description: 2003011128
Cognitive behavior therapy for older adults with insomnia and depression : A randomized controlled trial in community mental health services
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Harvey, Jack , Jenkins, Megan
- Date: 2018
- Type: Text , Journal article
- Relation: Sleep Vol. 41, no. 8 (2018), p. 1-12
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- Description: Study Objectives: To investigate whether cognitive behavior therapy was effective for older adults with comorbid insomnia and depression in a community mental health setting, and explore whether an advanced form of cognitive behavior therapy for insomnia produced better outcomes compared to a standard form of cognitive behavior therapy for insomnia. Methods: An 8-week randomized controlled clinical trial was conducted within community mental health services, Victoria, Australia. Seventy-two older adults (56% female, M age 75 ± 7 years) with diagnosed comorbid insomnia and depression participated. Three conditions were tested using a group therapy format: cognitive behavior therapy for insomnia (CBT-I, standard), cognitive behavior therapy for insomnia plus positive mood strategies (CBT-I+, advanced), psychoeducation control group (PCG, control). The primary outcomes were insomnia severity (Insomnia Severity Index) and depression severity (Geriatric Depression Scale). Primary and secondary measures were collected at pre (week 0), post (week 8), and follow-up (week 20). Results: CBT-I and CBT-I+ both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post (p < .001), which were maintained at follow-up. Although the differences between outcomes of the two treatment conditions were not statistically significant, the study was not sufficiently powered to detect either superiority of one treatment or equivalence of the two treatment conditions. Conclusion: CBT-I and CBT-I+ were both effective at reducing insomnia and depression severity for older adults. Mental health services that deliver treatment for comorbid insomnia with cognitive behavior therapy may improve recovery outcomes for older adults with depression. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR); URL: https://www.anzctr.org.au; Trial ID: ACTRN12615000067572; Date Registered: December 12, 2014.
Cognitive behaviour therapy for insomnia and depression : qualitative reflections from older adults who participated in a randomised controlled trial
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan
- Date: 2020
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 24, no. 6 (2020), p. 932-938
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- Description: Objectives: To explore the experiences of older adults who participated in a randomised controlled trial (RCT) that tested cognitive behaviour therapy for insomnia and depression. Methods: Focus groups were conducted post treatment for older adults (M age = 75 years; 61% female) who participated in a RCT that tested two experiential interventions targeting comorbid insomnia and depression (cognitive behaviour therapy for insomnia, CBT-I; cognitive behaviour therapy for insomnia plus positive mood strategies, CBT-I+). Six semi-structured focus group interviews (N = 31) were analysed using a qualitative thematic analysis. Results: Interview data were transcribed into 424 sentences and 60 codes were extracted. Thirty-four initial themes emerged, which were transformed into 3 themes and 10 subthemes. The three primary themes were (1) positive experiences, (2) negative experiences, and (3) suggested modifications. The positive subthemes were (1a) therapists, (1b) togetherness, (1c) use of strategies reduced symptoms, and (1d) acceptance. The negative subthemes were (2a) persistent symptoms, (2b) program too condensed, and (2c) attendance obstacles. The suggested modifications were (3a) lengthen program, (3b) multi-dimensional learning, and (3c) multi-modal delivery options. Conclusion: The experiences and suggestions identified in this study strengthen the foundation to advance therapeutic program development for older adults with comorbid insomnia and depression. Future CBT-I programs for older adults may be improved by increasing the length of therapy (e.g. 8 sessions to 12 sessions), adding multi-dimensional learning opportunities (e.g. visual/audio/mentorship), and offering various modes of treatment delivery (e.g. group, individual, internet, telephone). © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
- Description: Federation University Australia and the Australian Government Research Training Program Scholarship
Housing type and depressive symptoms among older adults: a test of sense of belonging as a mediating and moderating variable
- Authors: McLaren, Suzanne , Turner, Jayne , Gomez, Rapson , McLachlan, Angus , Gibbs, Petah
- Date: 2013
- Type: Text , Journal article
- Relation: Aging & Mental Health Vol. 17, no. 8 (November 2013), p. 1023-1029
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- Description: Objectives: Higher levels of depression have been documented among older adults who reside in an assisted living facility, compared with those who remain in their own homes. The aims of the current study were to test whether the relationship between housing type and depressive symptoms was mediated by a sense of belonging and whether housing type and sense of belonging interact to influence the depressive symptoms among older adults (moderation model).Method: A sample of 257 older adults who lived in their own homes and 166 older adults who lived in an assisted living facility completed the psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale.Results: Results showed that a sense of belonging partially mediated the relationship between housing type and depressive symptoms, such that living in a nursing home was associated with lower levels of belonging, and lower levels of belonging were, in turn, associated with higher levels of depressive symptoms. Residing in an assisted living facility was associated with depressive symptoms at low and average levels of belonging.Conclusion: Results highlight the need for more research on the role of sense of belonging as an influencing factor on depressive symptoms among institutionalised older adults for both theoretical and treatment goals.
- Description: C1
Marital status and suicidal ideation among Australian older adults: the mediating role of sense of belonging
- Authors: McLaren, Suzanne , Gomez, Rapson , Gill, Peter , Chester, Jessica
- Date: 2014
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 27, no. 1 (2014), p. 145-154
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- Description: Marriage has been identified as a protective factor in relation to suicide among older adults. The current study aimed to investigate whether sense of belonging mediated the marital status-suicidal ideation relationship, and whether gender moderated the mediation model. It was hypothesized that the relationship between being widowed and lower levels of sense of belonging, and between lower levels of belonging and higher levels of suicidal ideation, would be stronger for older men than older women. A community sample of Australian men (n = 286) and women (n = 383) aged from 65 to 98 years completed the psychological subscale of the Sense of Belonging Instrument and the suicide subscale of the General Health Questionnaire. The results supported the moderated mediation model, with gender influencing the marital status-sense of belonging relation. For men, widowhood was associated with lower levels of belongingness, whereas for women, marital status was unrelated to sense of belonging. It would appear crucial to develop and implement interventions which assist older men to find new ways to feel important and valued after the death of their spouse.
Resiliency among older adults : Dispositional hope as a protective factor in the insomnia–depressive symptoms relation
- Authors: Trezise, Alexandra , McLaren, Suzanne , Gomez, Rapson , Bice, Bridget , Hodgetts, Jessica
- Date: 2018
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 22, no. 8 (2018), p. 1088-1096
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- Description: Objectives: Depression is a significant mental health issue among older Australian adults. Research has indicated that insomnia is a key risk factor for the development of depressive symptoms in older adults, and that dispositional hope may be protective against the development of depressive symptoms in this population. This study examined whether dispositional hope and its dimensions, agency and pathways, moderated the relationship between insomnia symptoms and depressive symptoms among older Australian adults. Method: A community sample of 88 men (Mage = 71.11, SDage = 5.54) and 111 women (Mage = 70.25, SDage = 4.64), aged 65–94 years, completed the Insomnia Severity Index, Adult Dispositional Hope Scale, and Centre of Epidemiologic Studies Depression Scale. Results: After controlling for gender, age, relationship status, education level, method of participation, and perceived physical health, results supported the moderation models. The insomnia–depressive symptoms relation was significant for older adults with low and average (but not high) levels of dispositional hope, agency, and pathways. The Johnson–Neyman analyses indicated that the insomnia–depressive symptoms relation was significant for older adults who scored below 27.10 on dispositional hope, below 13.73 on agency, and below 13.49 and above 15.64 on pathways. Conclusion: The results of this study imply that interventions aimed at increasing dispositional hope, agency, and pathways among older adults who experience symptoms of insomnia may reduce their depressive symptoms. A cautionary note, however, is that very high scores on pathways among older adults who experience insomnia symptoms may be detrimental to their mental health.
The relationship between living alone and depressive symptoms among older gay men : the moderating role of sense of belonging with gay friends
- Authors: McLaren, Suzanne
- Date: 2016
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 28, no. 11 (2016), p. 1895-1901
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- Description: Background: Living alone is a risk factor for depressive symptoms among older adults, although it is unclear if it is a risk factor for older gay men. A sense of belonging to the gay community is protective and might compensate for living alone. This research investigated whether a sense of belonging with gay friends weakened the relationship between living alone and depressive symptoms among older gay men. Methods: A community sample of 160 Australian gay men aged 65-92 years completed the Center for Epidemiologic Studies Depression Scale and two visual analogue scales assessing a sense of belonging with gay friends. Results: Results supported the moderation model, with increasing levels of belonging with gay friends weakening the relationship between living alone and depressive symptoms. Conclusion: Results imply that enhancing a sense of belonging with gay friends among older gay men who live alone is likely to be a protective factor in relation to depressive symptoms.
The relationship between living alone, sense of belonging, and depressive symptoms among older men: the moderating role of sexual orientation
- Authors: McLaren, Suzanne
- Date: 2020
- Type: Text , Journal article
- Relation: Aging & Mental Health Vol. 24, no. 1 (Jan 2020), p. 103-109
- Full Text: false
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- Description: Objectives: Living alone is a risk factor for depressive symptoms among older men, and is likely to occur due to belongingness needs being unmet. It is proposed the living alone-sense of belonging and living alone-depressive symptoms relations are stronger for gay men than heterosexual men, due to different family circumstances. This research tested a moderated mediation model, specifically whether the relationship between living alone and depressive symptoms is mediated by sense of belonging, and whether the living alone-sense of belonging and living alone-depressive symptoms relationships are moderated by sexual orientation. Method: A community sample of 169 Australian gay men aged 65 to 93 years and 187 Australian heterosexual men aged 65 to 94 years completed the Psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale. Results: Results supported the simple mediation model, with living alone being associated directly and indirectly with depressive symptoms via sense of belonging. The conditional indirect effect of living alone on depressive symptoms via sense of belonging was not significant, and therefore the moderated mediation model was not supported. Conclusion: Results imply that older men who live alone are at increased risk of depressive symptoms directly and indirectly via lower levels of sense of belonging.
The relationships between self-compassion, rumination, and depressive symptoms among older adults : the moderating role of gender
- Authors: Hodgetts, Jessica , McLaren, Suzanne , Bice, Bridget , Trezise, Alexandra
- Date: 2021
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 25, no. 12 (2021), p. 2337-2346
- Full Text: false
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- Description: Objectives: Depression is a significant mental health issue for older adults. Rumination is a key risk factor for depressive symptoms, and self-compassion is a protective factor. The aim of the current study was to test the processes by which self-compassion might act as a protective factor among older adults by investigating a mediation model, and whether the model is conditional on gender. It was hypothesised that self-compassion and its six components (self-kindness, common humanity, mindfulness, self-judgement, isolation, and over-identification) would be indirectly associated with depressive symptoms via rumination. Method: A sample of 135 older Australian women and 106 older Australian men aged between 65 and 89 years completed the Centre for Epidemiologic Studies Depression Scale, the Ruminative Thought Style Questionnaire, and the Self-Compassion Scale. Results: Results supported the mediation models for self-compassion for both men and women, however, support for the models involving the individual components of self-compassion varied according to gender. The mediation effects were stronger for women than men. Conclusion: Interventions aimed at increasing self-compassion might have benefits for older adults. Future research investigating whether tailoring interventions according to gender of participants is efficacious is needed. © 2020 Informa UK Limited, trading as Taylor & Francis Group.