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Subject: search.filters.subject.Depression in old age

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    Group guided low intensity self-help for community dwelling older adults experiencing low mood : a dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Albany, New Zealand
    (Massey University, 2017) Martyn, James
    Depression is amongst the most common health issues affecting older adults, however, access to evidence-based psychological treatments remains low amongst this age group. This is due, in part, to numerous barriers that surround current mental health treatment and delivery, which has contributed to discrepancies between treatment needs, availability, and uptake. To address such barriers, low intensity Cognitive Behavioural Therapies (LI-CBT) and in particular guided self-help interventions have emerged as promising, brief, cost-effective, and evidence-based alternatives to traditional high intensity therapies. Recently, interventions have begun to utilise the advantages of guided LI-CBT selfhelp within a group or class setting, thus providing both a cost-effective and time-efficient form of treatment delivery. Of these group guided approaches, Living Life to the Full (LLTTF) is the only intervention that primarily targets depression and has undergone randomised effectiveness testing. While early evidence lends support for the efficacy of LLTTF, further research is needed to extend the findings to different populations and age groups, particularly older adults. The current study examined the effect of the group guided version of LLTTF on community dwelling older adults’ ratings of depression, anxiety, and quality of life. Additionally, the relationship between older adults’ engagement with LLTTF and improvements in their reported ratings on all primary outcome measures was evaluated. Twenty-four older adult participants with symptoms of depression were recruited from a New Zealand community setting. Participants completed the intervention over eight sessions and data was collected at baseline, during each session, and at 1- and 6-week follow-up. Data was analysed using Multilevel Modelling, implementing a multilevel (2 level), repeated measure (11 waves), single group design. Results indicated significant improvements in participants’ symptoms of depression, anxiety, and quality of life over time. There was no evidence of an interaction between participants’ engagement and depression or anxiety ratings. Unexpectedly, engagement did however interact with quality of life, demonstrating that higher levels of out-of-class engagement with self-help content was related to significantly lower improvements in quality of life. Finally, supplementary analyses indicated greater reductions in anxiety symptoms amongst participants who lived with others compared to those who lived alone. These results endorse LLTTF as a viable and effective low intensity treatment option for depression in older adults, with additional benefits for symptoms of anxiety and quality of life. When delivered to older adults, LLTTF could increase treatment access and choice, contribute to the reduction of secondary mental health service load, minimise treatment barriers, and importantly support older adults’ to manage symptoms of depression and anxiety while remaining in communities of their choosing.
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    Doing good and feeling well : understanding the relationship between volunteering and mental wellbeing in older adult populations through the application of a social-cognitive theory of depression : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2015) Cooper, Louise Elizabeth
    Previous research indicates that volunteering can improve positive psychological wellbeing, and protect against the onset of depressive symptoms amongst older adults. However, the mechanisms at play in the relationship remain unclear. This research project analysed two data sets in order to test the predictions of a social-cognitive theory of depression as it applies to the volunteering-psychological wellbeing relationship. A social cognitive theory of depression (as described by Oatley and Bolton (1985)) suggests that older adults are susceptible to symptoms of depression and reduced psychological wellbeing when difficult life events limit their ability to maintain social roles that have previously facilitated investment in valued facets of their self-concept. Therefore, volunteering may compensate for such role losses by enabling older adults to continue to contribute to their sense of self through their volunteering role, and subsequently protect them from the effects that such role-loss may have on their psychological functioning. Using longitudinal data from a New Zealand-based sample, this research illustrates that older adults who have relatively poorer physical health are more likely to be protected from experiences of depressive symptoms as a result of consistently volunteering than those who experience higher levels of health. Analyses of longitudinal data also provide some evidence that employment status may moderate the impact of volunteering consistency on protection against symptoms of depression. In addition, analyses of cross-sectional data demonstrate a relationship between contributions to self-concept through the enactment of social roles, and better psychological wellbeing. This research also suggests that the extent to which negative life events limit a person’s ability to invest in their sense of self is related to psychological wellbeing outcomes. Finally, it is suggested that the amount of investment in self-concept facilitated by a volunteering role is related to psychological wellbeing. However, investment in self-concept through volunteering was not shown to moderate the relationship between pertinent life stressors, and psychological wellbeing. To a large extent, these findings align with a social-cognitive theory of depression (Oatley & Bolton, 1985), but they raise questions about the way that compensatory coping through social role changes has previously been theorised.
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    Identifying mood- and age-related differences in attentional biases in dysphoria : an eye-tracking study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2013) Field, Jodi
    Previous research has indicated that individuals who experience depression selectively attend to negative information for greater periods of time than non-depressed individuals. This negative bias may reflect difficulty disengaging from negative stimuli that is not seen in non-depressed individuals. While there has been a high level of researcher interest in this arena, no studies have investigated the presence of a negative bias in older adults. Accordingly, the present study employed eye tracking techniques to investigate differences in negative biases between dysphoric (n = 27; 14 younger adults; 13 older adults) and non-dysphoric (n = 29; 14 younger adults; 15 older adults) participants by presenting competing emotionally valenced stimuli. In an additional stage of the experiment, the presence of an interpretation bias was investigated whereby participants rated the previously viewed images for perceptions of ‘mood’. Results from the eye tracking task were mixed, with partial support being found for a negative bias in dysphoric participants. Similarly, partial support was found for the hypothesis that non-dysphoric participants would attend to positive stimuli for greater periods of time than dysphoric participants. No age-related differences were found in the non-dysphoric group when attending to sad and happy images. However, when attending to sad images, younger dysphoric participants showed greater average glance durations than older dysphoric participants. Results from the rating task were also mixed. No evidence of a negative interpretation bias was found in the dysphoric group. Similarly no evidence of a positive interpretation bias was found in the nondysphoric group. Consistent with previous research, older non-dysphoric participants provided more positive ratings for happy images compared to younger non-dysphoric participants. Although overall results are not consistent with previous research, methodological issues in the present study may go some way to explain these inconsistencies. Limitations in using eye tracking techniques on older adults offer one possible explanation. Further, the sub-clinical level of dysphoria in the present sample suggests that negative biases are most evident at severe, clinical levels of depression.
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    An exploration of the relationship of social networks with depression among older adults : a prospective study : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2014) Cowpertwait, Louise Laura
    Research has highlighted social integration as a protective factor against depression among older adults. This thesis aims to clarify whether specific features of social networks are particularly important, the effect of perceived connectedness on the relationship between structural social integration and depressive symptoms, and whether social integration is a longitudinal predictor of depressive symptoms among older adults. The thesis also describes the social networks and prevalence of depression among older people in New Zealand, including older Māori, of which there is limited availability of existing research. The current study utilised data taken at three waves of measurement from 3594 community-dwelling older people living in New Zealand including 172 older Māori. The relationship between components of social network structure and depression were compared using standard statistical techniques. Consistent with previous research, contact with non-family social ties was significantly and negatively associated with depressive symptoms whereas contact with family was not significantly correlated. Unlike other studies, social network size significantly predicted depressive symptoms. A series of hierarchical multivariate linear regression models indicated that, after controlling for demographics and health variables such as age, functional ability and exercise, structural integration and perceived connectedness uniquely explained between 1 and 4% of the variability in depressive symptoms. According to a multilevel model for change, social integration did not predict different trajectories of depressive symptoms over 36-months. Perceived connectedness was found to mediate 29% of the effect of structural social integration on depressive symptoms. Results highlight the relative importance of perceived connectedness in older adults’ depression. Composite measures of structural social integration in depression research with older people are indicated with the exception of items related to family ties and marital status. Measures of social integration, especially objective measures based on social network structure, may not be reliable indicators of depression risk. These findings highlight a need for further investigation into the efficacy of social interventions, especially targeting non-family ties and perceived connectedness.