The Impact of Sense of Loneliness on Geriatric Depression: The Mediating Role of Sense of Mattering and Psychological Adjustment

doi:10.21203/rs.3.rs-4679831/v1

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Research Article

The Impact of Sense of Loneliness on Geriatric Depression: The Mediating Role of Sense of Mattering and Psychological Adjustment

https://doi.org/10.21203/rs.3.rs-4679831/v1

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Background

Depression is a highly prevalent mental disorder in older adults, and among its highest risk factors is loneliness. Although this relationship is commonly evident, the mechanisms underlying it, such as sense of mattering and psychological adjustment, lack exploration. The current research aims to examine the relationship between loneliness and geriatric depression and explore the mediating roles of sense of mattering and psychological adjustment.

Methods

A sample of 200 older adults (63.5% females; mean age = 75.6; SD = 8.806) was recruited from 24 geriatric homes in Cairo, Egypt. Participants responded to the Arabic versions of the Mini Mental State Examination for excluding the severely demented, Geriatric Depression Scale-15, University of California, Los Angeles Loneliness Scale-version 3, General Mattering Scale, and Brief Adjustment Scale-6. The mediation analysis was conducted using multiple linear regression with Hayes’ process macro on SPSS26 and structural equation modelling on JASP0.18.1.0

Results

Sense of mattering and psychological adjustment showed a significant total effect (β = .051, 95%CI [.045, .056], z = 18.436, p < .001) separated into a significant direct effect (β = .019, 95%CI [.009, .029], z = 3.784, p < .001) and a significant indirect effect (β = .031, 95%CI [.022, .041], z = 6.478, p < .001), indicating simultaneous partial mediation by the two variables. Additionally, sense of mattering accounts for 76% of the impact of loneliness on geriatric depression, and psychological adjustment accounts for 60.1%.

Conclusion

Loneliness significantly impacts geriatric depression through sense of mattering and psychological adjustment. These findings implicate substantial insight for interventions that can be targeted at the reduction of geriatric depression through reducing loneliness feelings and enhancing sense of mattering and adjustment.

Sense of loneliness

geriatric depression

sense of mattering

psychological adjustment

mediation

One of the most globally prevalent, persistent mental disorders is depression, and among the highly impacted yet unattended growing populations is the elderly; depression affects 35.1% of the world’s elderly [1]. Geriatric depression is a mood disorder that affects people above 60 years of age and is evident by constant sadness and loss of interest, along with other common major depression symptoms, including suicidal thoughts, and somatic symptoms along with significant quality of life deterioration [2].

The elderly face paramount physical/biological, psychological, and social challenges throughout the complex process of aging, many of which are associated with depression. The interplay of genes, gender, particularly female, age-related neurological and cognitive changes, somatic disorders, stressors, subjective health perception, low socioeconomic class, dependence for daily living activities, low social engagement, isolation/loneliness, and having a history of depression or suicidal ideation, has been the most featured for geriatric depression risk factors in cross-world literature [3–5].

Among the few psychological risk factors studied previously was loneliness as a subjective feeling and/or objective experience of isolation from social surroundings; it is experienced by the majority of elderly and is highly, positively associated with geriatric depression [6, 7]. Nevertheless, loneliness as a predictor along with other controllable factors that may indirectly influence its association with elderly depression was not investigated. Moreover, geriatric depression afflicts 23.7–74.5% of the Egyptian population [8]. However, its correlates and determinants for Egyptian elderly are inconclusive. For instance, not only has subjective loneliness been correlated with geriatric depression scarcely in Egyptian literature, but also other determinants that may also correlate to geriatric depression and influence the prior relationship, such as sense of mattering and psychological adjustment, have not gained research attention.

Sense of mattering is the feeling that an individual is important, valued, and needed to others interpersonally and to the broader society [9]. Psychological adjustment is the ability to change behaviors/attitudes in response to and in an attempt to cope with changing conditions in the environment [10]. Elderlies experience constant inevitable changes, such as those in their physical and mental health, social relationships, and losses. Loneliness, sense of mattering, and psychological adjustment can be controllable predictors for geriatric depression, and if these factors and their possible direct and indirect effects are left unstudied and not implicated for, depression and loneliness will continue to be growing problems for the elderly population, cause hazardous consequences for them and their caregivers, and strain health institutes.

Besides the compelling significance of these factors, examining them in the Egyptian population is feasible through standardized tools and ethical standards; they foreshow potential interventions implicated in prevention and treatment of geriatric depression, enhancing elderly functioning and quality of life.

Hence, this research intends to examine the impact of sense of loneliness, sense of mattering, and psychological adjustment on geriatric depression as its predictors and the role of sense of mattering and psychological adjustment in mediating this relationship in a sample of Egyptian elderly recruited from geriatric homes, responding to the question of what is the mediating effect of sense of mattering and psychological adjustment on the relationship between sense of loneliness and geriatric depression?

Sense of Loneliness and Geriatric depression

The impact of loneliness, as a subjective feeling or actual isolation, on physical and mental health, such as leading to depression, can be explained by Cacioppos’ (2018) evolutionary theory of loneliness, Weiss's (1973) theory of social needs that when unmet lead to feelings of loneliness, and cognitive discrepancy theory, were adults have a desired perception of social connection that differs from the actual one [11–13].

The association between loneliness and geriatric depression has gained substantial research consideration for over a decade. Loneliness is prevalent in 20–34 percent of elderly who are bound to their homes and pose significantly high risks of depression longitudinally in men and women, whether subjective loneliness or actual low social engagement [14–18]. Moreover, loneliness exhibited strong, persistent associations with later depressive symptoms in elderly in cross-country studies; it predicts the onset independently of demographic risk factors [19, 7, 20–22].

Furthermore, loneliness appears to have physiological mechanisms that manifest in declining neurocognitive and immune systems, cardiovascular disease, mortality risk, dementia, physical inactivity and depression [23–26]. Moreover, Covid-19 pandemic elderly inpatients with mood disorders and outpatients reported high loneliness that significantly correlated with depressive symptoms, poor subjective health, and fear [27–29].

Studies carried out in Egypt showed similar results, where self-reported loneliness positively correlated with and predicted depression in elderlies of various settings [30, 31, 4, 32, 6, 33, 34].

Hence, the literature depicts a vast evidence of positive, significant correlations between subjective/objective loneliness and geriatric depression. Despite the non-abundance of Egyptian studies, the majority of studies universally utilized respective versions of the UCLA and GDS to measure them. Most of the results direct to the need for interventions to address loneliness in old adults when treating depression. Therefore, the current study hypothesizes that:

Sense of loneliness will be positively correlated with geriatric depression.

Sense of Mattering and Geriatric Depression

Rosenberg’s and McCullough’s (1981) theory of mattering explains that humans’ feelings of being valued, needed, and important to others strongly impact their thinking and behavior [9]. Furthermore, Erikson (1982) proposed that older adults may experience depressive symptoms due to feeling stagnant, or stuck, rather than generative, or useful and mattering [35].

Sense of mattering has recently commenced being examined in relation to depression in certain populations, yet scarcely specially with elderly; however, the findings are worth the current study’s further investigations. For instance, sense of mattering and depression were found to be associated and mediated by loneliness in postpartum women and longitudinally in adults [36, 37]. Moreover, it has evidence of protecting the well-being of elderly during crisis/stress, such as the pandemic, contributing to positive aging and resilience, while its absence leads to physical and mental problems, including suicide [38–41]. Mattering feeling was significantly correlated to geriatric depression due to negative perceived self-worth and social support in elderlies of different sexual identities and circumstances, whereby trials of interventions that enhance their mattering/purpose after retirement showed efficacy [42–46].

Therefore, although not thoroughly studied, sense of mattering proves essential for the physical and mental health of elderlies with an inverse relation with depression and can be further examined in relation to other predictors. Consequently, the second hypothesis of this study is that:

Sense of mattering will be negatively correlated with geriatric depression.

Psychological Adjustment and Geriatric Depression

The transdiagnostic theory of adjustment explains that stressful life changes cause emotional disequilibrium, often leading to depression, and requires cognitive, behavioral, interpersonal, and environmental resources to protect against it [47]. Older adults experience several major changes and stressors, often all at once, such as loss of loved ones, abandonment by significant others, physical, often disabling/hospitalizing disorders, and loss of financial security/certainty, which may lead to adjustment disorders, or the dysfunctional inability to adapt to stressors [48].

Older adults’ lack of psychological adjustment to retirement, physical disability, life changes, and acute cardiac problems significantly predicted geriatric depression; it can be due to lack of adaptive coping, such as acceptance and hopelessness about the future as explained by Erikson’s concept of “ego integrity versus hopelessness” [49–53].

Moreover, adjustment problems and depression were correlated in older adults with early-stage dementia, evident from clinical trials, those with strong memory functioning, assessed during the pandemic, and those living without their families [54–56]. Higher adjustment abilities show evidences of lowering cortisol levels and less depressive symptoms in older adults [57, 58].

Therefore, psychological adjustment was examined and found to correlate with geriatric depression in a few studies, yet not thoroughly studied as a predictor of depression with other factors nor in Egyptian geriatric research. Hence, the third hypothesis of this study is that:

Psychological adjustment will be negatively correlated with geriatric depression.

Sense of Loneliness and Sense of Mattering in Older Adults: Paving the Way for Mediation

Sense of mattering demonstrates a significant, negative correlation with loneliness, actual/technological social disconnection, and a positive one with life satisfaction and health status in older adults [59, 60]. Mattering can contribute to loneliness in older adults when they are abandoned, not involved in decisions, retired, or treated negatively by caregivers, impacting their physical and mental health and needing therapeutic incorporation [61–63]. This presumed yet underexamined relationship, leads to a fourth hypothesis whereby:

Sense of loneliness will be negatively correlated with sense of mattering in older adults.

Since the correlation between loneliness and geriatric depression and their temporal sequence are well established and consistent, studying factors that may mediate this relationship is worthwhile to uncover the mechanism of these controllable factors, driving further implications for interventions. However, the literature has not paid fair attention to these factors. A few studies examined loneliness-geriatric depression mediators, finding that social support, resilience, perceived health, hardiness, and perceived stress can mediate or partially mediate this relationship in older adults [64–68].

Nevertheless, although substantially evident to correlate with geriatric depression and loneliness [59, 60], sense of mattering was not investigated as a mediator in this relationship before. Therefore, the current study hypothesizes that:

Sense of mattering may mediate the relationship between sense of loneliness and geriatric depression.

Sense of Loneliness and Psychological Adjustment: Paving the Way for Mediation

Loneliness is among the myriad challenges that old adults experience, which impacts their ability to adjust, inducing feelings of “psychological loss”. In fact, strong, positive associations have been found between feeling lonely and psychological maladjustment in older adults, where maladjustment predicts loneliness and increased internet use [69–73]. Although this relationship requires further investigation, it is feasible to hypothesize that:

Sense of loneliness may be negatively correlated with psychological adjustment.

Further rational is the temporal order of feeling lonely, consequently having poor psychological adjustment, and as a result acquiring symptoms of geriatric depression. Since the literature has evidence on the loneliness-depression, loneliness-adjustment, and adjustment-depression relationships, the current study additionally hypothesizes that:

Psychological adjustment may mediate the relationship between sense of loneliness and geriatric depression.

Conceptual Model

The interplay of several modifiable factors contributing to geriatric depression signifies the need to investigate them and their mechanisms to incorporate them in interventions targeting elderly depression. Sense of loneliness, sense of mattering, and psychological adjustment are all evident to correlate with geriatric depression in the global literature. However, there is a gap of knowledge regarding the relative importance of each contributor. Moreover, since loneliness is consistently correlated with geriatric depression, information about factors mediating this relationship, such as sense of mattering and psychological adjustment, is important yet lacking.

Finally, geriatric research in Egypt has not yet investigated any of the aforementioned variables in relation to geriatric depression other than loneliness, nor any mediating variables. Therefore, the purpose of the current study is to investigate the impact of sense of loneliness, sense of mattering, and psychological adjustment on geriatric depression as predictors with different relative importance indicated statistically, and the ability of sense of mattering and psychological adjustment to mediate the relationship between loneliness and depression; hypotheses are conceptualized in Fig. 1.

Research Design

The current study utilized a quantitative, cross-sectional, descriptive, correlational research design; its selection is justified by its convenience to fulfill the purpose of the research and respond to the research question/problem. The researcher collected data from participants at a specific time point using psychometric tools and statistically analyzed the results, correlating variables and assessing mediation effects, rather than attempts of manipulation or establishing causation [74, 75].

Sample

A total of 200 old adults aging 60+, from all socioeconomic classes, were recruited from 24 geriatric homes in Cairo, Egypt through purposive sampling, since participants were recruited upon meeting the eligibility criteria indicated below. Inclusion/exclusion criteria aimed to indicate participants’ eligibility for assessment on the variables’ tools and avoid the impact of confounding variables, such as severe dementia.

Inclusion criteria:

60 + years, consent to participate, at least literate, and a fair hearing ability.

Exclusion criteria:

Severe dementia/cognitive impairment indicated by a score lower than 17 on the Arabic Mini Mental State Examination (MMSE) [76] and a history of psychiatric illness that may be contributing to current mood symptoms.

The sample size was calculated using the software G*Power3.1.9.7, utilized for calculating sample size and statistical power [77]. The calculated sample size was 182; therefore, the current study aimed at 200 older adults for acceptable statistical significance, in congruence to sizes used in reviewed studies [31, 4, 32, 6, 33].

Measures

Mini-mental State Examination (MMSE)-Arabic

In order to screen for severe dementia that may prevent participants from understanding the variables’ tools, the Arabic version of Mini-mental State Examination (MMSE), adapted for Egyptian participants, was used. It covers 30 items of cognitive functions, providing cut-off scores for cognitive impairment level; 23–30 for normal cognitive functioning, ≤ 22 for mild cognitive impairment, and ≤ 17 for severe cognitive impairment. These cutoff scores showed 95% sensitivity and 73.83% specificity in indicating cognitive impairment categories and screening for dementia; it has high test-retest reliability of r = 0.7 and criterion validity [78, 76, 79].

Demographic Data Tool

A demographic data questionnaire was designed by the researcher to ensure that the intended sample characteristics are fulfilled, such as age (60+), gender, education level, and socioeconomic status.

Geriatric Depression Scale-15 (Short Form)

Geriatric depression was measured by the Geriatric Depression Scale-15 (GDS-15), which is the short version of GDS-30, developed by Yesavage et al. (1983) [80]. GDS-15 is a yes/no self-report that screens for depression symptoms in older adults, regarding respondent’s feeling over the past week. Scores range from 0–15; scoring 0–4 indicates no depression, 5–8 mild depression, 9–11 moderate depression, and 12–15 severe depression. 5 of the items are reversed (1,5,7,11,13) [81]. GDS-15 has high criterion, discriminant, convergent, and construct validity as well as internal consistency and test-retest reliability in original and Arabic-adapted versions [82–85].

The Arabic GDS-15 was administered on the current sample and showed high internal consistency (Cronbach’s α = 0.868; McDonald's ω = 0.872) and composite/construct reliability (Coefficient ω = 0.856; Coefficient α = 0.868).

University of California, Los Angeles Loneliness Scale-Version 3 (UCLA-3)

The third, most recently revised version of the University of California, Los Angeles Loneliness Scale (UCLA) was used to assess sense of loneliness. UCLA is a 20-item self-report that is responded to by rating statements with O (often), S (sometimes), R (rarely), and N (never) feeling the way stated. It has 9 reversed items (1,5,6,9,10,15,16,19,20); scores of 20–40 indicate low loneliness, 40–60 indicate mild loneliness, and 60–80 indicate high loneliness. UCLA-3 was assessed on psychometric properties on elderly samples, resulting in high internal consistency, test-retest reliability, convergent validity, and construct validity on the original and Arabic, Egyptian versions [86–89].

UCLA-3-Arabic was administered on the current sample and had high internal consistency (Cronbach’s α = 0.946; McDonald's ω = 0.946) and composite/construct reliability (Coefficient ω = 0.931; Coefficient α = 0.946).

Brief Adjustment Scale–6 (BASE-6)

Psychological adjustment was measured by Brief Adjustment Scale–6 (BASE-6), a six-item self-report composed of 3 items for perceptions about distress and 3 items for relationships, self-esteem, and general functioning. Items are rated on a 7-point Likert scale (1 = not at all, 4 = somewhat, and 7 = extremely), where scores range from 6–42, and higher scores indicate low psychological adjustment [90]. BASE-6 was validated on older adults, demonstrating high internal consistency, test-retest reliability, as well as convergent, construct, content, and criterion validity in original and Arabic, Egyptian versions [91, 90, 92, 93].

In the present study, BASE-6-Arabic showed high internal consistency (Cronbach’s α = 0.932; McDonald's ω = 0.932) and composite/construct reliability (Coefficient ω = 0.933; Coefficient α = 0.932).

General Mattering Scale (GMS)

Sense of mattering was measured by the General Mattering Scale (GMS), conceptualized on importance, attention, and dependence as mattering dimensions [9]. GMS is a 5-item self-report that assesses the individual’s extent of feeling important to others by a 5-point Likert rating (not at all to very much); scores range from 5–20, with higher scores indicating higher sense of mattering. Unidimensional GMS previously demonstrated high internal consistency and construct, convergent, divergent, and criterion validity [94–96].

For standardization on the current sample, the GMS was translated and back translated with the assistance of English language university professors and approved for content and face validity from a committee of academic psychiatry and psychology professors. GMS has high internal consistency (Cronbach’s α = 0.92; McDonald's ω = 0.927) and composite/construct reliability (Coefficient ω = 0.926; Coefficient α = 0.92). Moreover, its single-factor has high construct validity (Chi-square Χ² (5) = 5.040; p = 0.411, Comparative Fit Index (CFI) = 1, Tucker-Lewis Index (TFI) = 1, Root mean square error of approximation (RMSEA) = 0.006), and significant item loadings (p < .001), ranging between 0.753–1.305. In addition, it has high convergent and discriminant validity, Average Variance Extracted (AVE) = 0.724, square root of AVE = 0.85.

Data Collection Procedures

Geriatric homes in Cairo, Egypt were visited and briefed about the research, then provided approval for recruiting participants from their institutes; participants then provided their oral and written informed consents to participate.

Consequently, the researcher met and administered data collection tools with participants individually in their convenient settings. Initially, the researcher introduced herself to participants, briefed the procedure, and encouraged them to ask questions, ensuring good initial rapport, evident from verbal and nonverbal participants’ cues, before test administration.

To ensure eligibility of all consented participants, information regarding some inclusion/exclusion criteria were first gathered from the responsible personnel in the geriatric homes; consequently, MMSE was implemented to ensure a study-eligible mental state, followed by the demographic data questionnaire, GDS-15, UCLA-3, BASE-6, and GMS. The tools were administered in a 20-25-minute session with breaks in between upon the participant’s request. The researcher repeated the procedure for 200 participants in 24 geriatric homes.

The research was approved by the research and ethics committee of the faculty of Arts and Humanities in the British University in Egypt. All ethical guidelines of the American Psychological Association were adhered to prior to and throughout data collection and publication. These guidelines include: an ethical board’s approval and a written informed consent for the geriatric home responsible personnel and the participants which contains the study’s purpose, procedures, participants’ rights for confidentiality, participants’ rights to withdraw, expectations and benefits from participating, and participants’ rights to acquire results.

Data Analysis

The data collected from participants were then analyzed using specific descriptive and inferential statistics on SPSS26 and JASP0.18.1.0. Descriptive statistics included mean, standard deviation, and frequencies for the sample’s demographic data and scores on the variables’ tools. Inferential statistical tests included confirmatory factor analysis for assessing construct, convergent, and discriminant validity of the tools utilized, as well as reliability analysis. In addition, multiple linear regression with Hayes’ process macro with bootstrapping and structural equation model were implemented for mediation analysis for the study’s main hypothesis and results.

Sample Description

Table 1 demonstrates that participants ages ranged from 60–100 (M = 75.6, SD = 8.806). The number of children participants ranged from 0–8 (M = 1.72 children, SD = 1.586). Their average score on MMSE was 25.74 (SD = 3.844); these scores make them all eligible to participate in the study, categorized as no to moderate cognitive impairment. For gender, 63.5% (N = 127) were females and 36.5% (N = 73) were males. For the educational level, 6% (N = 12) had no formal education yet literate, 11.5% (N = 23) had primary education, 19% (N = 38) had secondary education, 55% (N = 110) had university education, and 8.5% (N = 17) had postgraduate degrees. For the socioeconomic level, 30.5% (N = 61) were in the low level, 40.5% (N = 81) were in the middle level, and 29% (N = 58) were in the high level. For the marital status, 13% (N = 26) were single, 17% (N = 34) were married, 16.5% (N = 33) were divorced, and 53.5% (N = 107) were widowed.

Table 1

Demographic Characteristics
Sample Characteristics	n	%	Mean	Std. Deviation
Gender
Males	73	36.5
Females	127	63.5
Age			75.6	8.806
Educational level
None	12	6
Primary	23	11.5
Secondary	38	19
University	110	55
Postgraduate	17	8.5
Socioeconomic level
Low	61	30.5
Middle	81	40.5
High	58	29
Marital Status
Single	26	13
Married	34	17
Divorced	33	16.5
Widowed	107	53.5
Number of children			1.72	1.586
MMSE			25.74	3.844
Note.N = 200

Descriptive Analysis

Descriptive statistics were utilized to summarize data collected on each variable. Table 2 shows that participants GDS-15 scores ranged from 0–15, indicating no to severe depression, respectively (M = 7.04, SD = 4.236); their average score indicates that the majority had geriatric depression symptoms. In addition, their UCLA scores ranged from 20–76, pertaining to low to high sense of loneliness (M = 45.6, SD = 15.7); their average score indicates that the majority experienced at least moderate sense of loneliness. Their scores of BASE-6 ranged from 6–30, indicating good to poor psychological adjustment (M = 13.94, SD = 8.185); their average score indicate that most participants had at least moderate maladjustment. Participants’ scores on GMS ranged from 0–20, indicating no to high sense of mattering (M = 9.88, SD = 6.144); their average score indicates that most participants experienced low sense of mattering.

Correlations

The correlations matrix (Table 2) shows that all variables were significantly correlated with each other (p < .0001), and all correlations were strong, ranging from − 0.747 to -0.872. As shown, the hypotheses regarding variables relationships are supported; geriatric depression was positively correlated with loneliness and psychological maladjustment, while negatively correlated with sense of mattering. Loneliness was positively correlated with psychological maladjustment and negatively correlated with sense of mattering. Psychological maladjustment was negatively correlated with sense of mattering.

Table 2

*Variables Descriptive Statistics and Correlations*
Variable	M	SD	1	2	3	4
1. Geriatric Depression	7.045	4.236	0.868
2. Sense of Loneliness	45.595	15.700	0.793***	0.946
3. Sense of Mattering	9.880	6.144	-0.759***	-0.872***	0.92
4. Psychological Adjustment	13.940	8.185	0.814***	0.775***	-0.747***	0.932
Note. N = 200
* p < .05, p < .01, * p < .001

The diagonal line includes Cronbach’s alpha of the tests’ variables

Mediation Analysis

To analyze the mediation effects of sense of mattering and psychological adjustment on the relationship between sense of loneliness and geriatric depression, multiple linear regression with Hayes’ process macro with bootstrapping and structural equation model (SEM) were utilized after ensuring significant correlations among variables. Both analyses revealed equivalent results.

In the mediation analysis of the SEM (Table 3), sense of mattering was a partial mediator in the model with a significant total effect (β = .051, 95%CI [.045, .056], z = 18.436, p < .001), parted in a significant direct effect (β = .035, 95%CI [.024, .046], z = 6.411, p < .001), and a significant indirect effect (β = .016, 95%CI [.006, .025], z = 3.248, p = .001). Furthermore, analyzing psychological adjustment as a mediator revealed a significant total effect (β = .051, 95%CI [.045, .056], z = 18.436, p < .001) that is separated into a significant direct effect (β = .026, 95%CI [.019, .033], z = 6.99, p < .001) and a significant indirect effect (β = .025, 95%CI [.018, .031], z = 7.67, p < .001), indicating partial mediation. When analyzed simultaneously, mattering and adjustment showed a significant total effect (β = .051, 95%CI [.045, .056], z = 18.436, p < .001) separated into a significant direct effect (β = .019, 95%CI [.009, .029], z = 3.784, p < .001) and a significant indirect effect (β = .031, 95%CI [.022, .041], z = 6.478, p < .001), indicating simultaneous partial mediation by the two variables. Finally, sense of mattering accounts for 76% of the impact of loneliness on geriatric depression, and psychological adjustment accounts for 60.1%.

Table 3

*Mediation Analyses by SEM*
Model	Estimate	R²	95% CI
Model	Estimate	R²	LL	UL
Model1 (Mediation by SoM)
Total Effect	.051***	0.76	.045	.056
Direct Effect	.035***		.024	.046
Indirect Effect	.016**		.006	.025
Model2 (Mediation by PsA)
Total Effect	.051***	.601	.045	.056
Direct Effect	.026***		.019	.033
Indirect Effect	.025***		.018	.031
Model3 (Mediation by SoM and PsA)
Total Effect	.051***		.045	.056
Direct Effect	.019***		.009	.029
Indirect Effect	.031***		.022	.041
Note. N = 200
p < .01, * p < .001
SoM: Sense of mattering; PsA: Psychological Adjustment

This research examines the mediating effects of sense of mattering and psychological adjustment on the relationship between sense of loneliness and geriatric depression in elderlies in senior homes in Cairo, Egypt. The main hypothesis of this study was confirmed, since loneliness has a significant, direct effect on elderly depression and a significant, indirect effect on it through sense of mattering and psychological adjustment. The study’s main findings are discussed in relevance to reviewed literature and implications.

Sense of loneliness appears to significantly, positively correlate with and predict geriatric depression, evident by correlational and regression/SEM analyses, supporting the study’s first hypothesis. These results align with the prevalence of loneliness and its longitudinal risk for depression in older adults [20, 22] and its result in physiological diseases and consequent elderly depression [24, 30]. The results are demonstrated by the evolutionary theory of loneliness, theory of social needs, and cognitive discrepancy theory [11–13]. Hence, reducing subjective loneliness can reduce depression symptoms in older adults.

Moreover, the analyses revealed that sense of mattering and psychological adjustment are significantly, negatively correlated with and predict depression, confirming the second and third hypotheses. These findings integrate with mattering’s protective impacts and reduction risks on elderlies’ mental health [38, 46]. The mattering-depression relationship is explained by theories of mattering impacting thinking/behaving and integrity-despair life-stages [9, 35]. Moreover, the findings conform with research regarding the negative impacts of elderly’s maladjustment on physical health and depression [49, 55]; they are supported by the transdiagnostic theory of adjustment [47]. Hence, intervention targeting feelings of mattering and adjustment abilities may reduce elderly depression.

Additionally, loneliness and mattering were found to significantly, negatively correlate, supporting the fourth hypothesis; this correlation was found in studies of abandoned/retired elderlies, producing negative physical/mental health effects [59, 63]. This relationship led to the fifth hypothesis, which was supported, as sense of mattering partially mediates the relationship between loneliness and geriatric depression. Therefore, interventions targeting loneliness may reduce elderly depression through enhancing mattering.

Furthermore, loneliness and adjustment are significantly, negatively correlated, confirming the sixth hypothesis and aligning with research about loneliness-maladjustment associations in older adults [70, 71]. Moreover, psychological adjustment was found to partially mediate the loneliness-depression relationship, supporting the last hypothesis (H7). Hence, addressing loneliness may reduce geriatric depression through enhancing adjustment.

Limitations

Some of this studies limitations include inability to establish causal relationships due to the cross-sectional design. Future longitudinal research will help establish causal relationships between each variable and the outcome. Moreover, accounting for the setting where older adults reside may have had a role in the resultant relationships, such as in a comparative study of elderlies in their families’ homes versus geriatric homes. Additionally, physical health impacts were not controlled. Elderlies have a variety of chronic, disabling diseases that must be examined and controlled in relation to depression. Finally, although high generalizability was aimed, the purposive sampling technique may have restricted it; other probability sampling methods may guarantee higher generalizability.

Future Research and Practical Implications

The findings of this study highlight the need for further research in this area of geropsychology, given the scarcity of prior research on the investigated variables, while counterbalancing the aforementioned limitations. Future research may also capitalize on different types of mattering or adjustment within direct/indirect impact on depression and aim for a nationwide sample to enhance generalizability.

Additionally, given the prevalence of geriatric depression, clinical implications direct mental health professionals in clinical settings and geriatric homes to the need for regular elderlies’ screening for depression and incorporating in their depression treatment strategies for reducing their loneliness feelings, while enhancing their sense of mattering and adjustment ability. Other geriatric healthcare practitioners must consider collaborating with mental health professionals for elderly depression diagnosis and treatment. The findings also imply social practices regarding psychoeducation for elderly and their families about geriatric mental health and depression, risk factors, and management. It can also direct policy makers to constitute regulations for public and private health institutes for geriatric depression screening and suggest trainings for mental health professionals and caregivers on the treatment and management; all directions are considered within cultural differences.

To conclude, the current study explores the mediating effects of sense of mattering and psychological adjustment on the relationship between sense of loneliness and geriatric depression. In spite of its limitations, this study revealed worthwhile findings regarding the mechanism of the elderly loneliness-depression association. Loneliness can directly predict elderly depression and indirectly, through reducing the partial mediators mattering and adjustment. Hence, these results amplify the literature on geriatric mental health and constitute frameworks for mental illness prevention and therapeutic interventions.

AVE= Average Variance Extracted

BASE-6: Brief Adjustment Scale-6.

CFI: Comparative Fit Index

GDS-15: Geriatric Depression Scale-15

GMS: General Mattering Scale

MMSE: Mini Mental State Examination for excluding the severely demented

PsA: Psychological Adjustment

RMSEA= Root mean square error of approximation

SEM: Structural Equation Modeling

SoM: Sense of mattering

TFI: Tucker-Lewis Index

UCLA-3: University of California, Los Angeles Loneliness Scale-version 3

Ethics Approval and Consent to Participate

This study was approved by the research and ethics committee of the faculty of Arts and Humanities in the British University in Egypt. Participants signed an informed consent prior to participation.

Consent for Publication

Participants consented for publication of their anonymous results.

Availability of Data

Data gathered and analyzed during this study are available in an additional file submitted by the author.

Competing Interests

The author declares no competing interests.

Funding

Not Applicable

Authors’ Contributions

This research has a single author.

Acknowledgments

I sincerely thank Prof. Mohamed Saad, vice dean of the Faculty of Arts and Humanities in the British University in Egypt for supervising this research and guiding through it. I appreciate Dr. Yomna Breikaa for back translating the GMS.

Cai H, Jin Y, Liu R, et al (2023) Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys. Asian Journal of Psychiatry 80:103417. doi: 10.1016/j.ajp.2022.103417
MacQueen GM, Frey BN, Ismail Z, et al (2016) Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder. The Canadian Journal of Psychiatry 61:588–603. doi: 10.1177/0706743716659276
Fiske A, Wetherell JL, Gatz M (2009) Depression in older adults. Annual Review of Clinical Psychology 5:363–389. doi: 10.1146/annurev.clinpsy.032408.153621
Ahmed D, El Shair IH, Taher E, Zyada F (2014) Prevalence and predictors of depression and anxiety among the elderly population living in geriatric homes in Cairo, Egypt. Journal of the Egyptian Public Health Association 89:127–135. doi: 10.1097/01.epx.0000455729.66131.49
Jagadeesan S, Muthathal S, Santra A (2022) Geriatric depression and its predictors in the National Capital Territory (NCT) of India – a quantitative study. Tropical Doctor 52:74–78. doi: 10.1177/00494755211044859
Hassan S, Amein N, Mohamed N (2017) Relationship between Loneliness and Depression among Elderly in Minia City. Biomedicine and Nursing 3(4): 105–112. doi:10.7537/marsbnj030417.11
Lee SL, Pearce E, Ajnakina O, et al (2021) The association between loneliness and depressive symptoms among adults aged 50 years and older: A 12-year population-based Cohort Study. The Lancet Psychiatry 8:48–57. doi: 10.1016/s2215-0366(20)30383-7
Odejimi O, Tadros G, Sabry N (2020) A systematic review of the prevalence of mental and neurocognitive disorders amongst older adults’ populace in Egypt. Middle East Current Psychiatry. doi: 10.1186/s43045-020-00055-8
Rosenberg M, McCullough BC (1981) Mattering: Inferred Significance and Mental Health Among Adolescents. Research in Community & Mental Health. 2:163–182
American Psychological Association (2023) Psychological adjustment. In APA Dictionary of Psychology. Available at: https://dictionary.apa.org/adjustment
Cacioppo JT, Cacioppo S (2018) Loneliness in the modern age: An evolutionary theory of loneliness (ETL). Advances in Experimental Social Psychology 127–197. doi: 10.1016/bs.aesp.2018.03.003
Weiss RS (1973) Loneliness: The experience of emotional and social isolation. Cambridge, MA, US: The MIT Press 236
Perlman D, Peplau L (1982) Loneliness. Encyclopedia of Mental Health. Friedman, H.S., Ed. Academic Press, San Diego 2:571-581. Available from: https://peplau.psych.ucla.edu/wp-content/uploads/sites/141/2017/07/Perlman-Peplau-98.pdf
Hussain B, Mirza M, Baines R, et al (2023) Loneliness and social networks of older adults in rural communities: A narrative synthesis systematic review. Frontiers in Public Health. doi: 10.3389/fpubh.2023.1113864
Oliveira LM, Abrantes GG, Ribeiro G da, et al (2019) Loneliness in senescence and its relationship with depressive symptoms: An integrative review. Revista Brasileira de Geriatria e Gerontologia. doi: 10.1590/1981-22562019022.190241
Van As BA, Imbimbo E, Franceschi A, et al (2021) The Longitudinal Association between loneliness and depressive symptoms in the elderly: A systematic review. International Psychogeriatrics 34:657–669. doi: 10.1017/s1041610221000399
Gureje O, Ojagbemi A (2019) Social relationships and the Association of Loneliness with major depressive disorder in the ibadan study of aging. World Social Psychiatry 1:82. doi: 10.4103/wsp.wsp_6_19
Faísca, L et al (2019) Loneliness and depressive symptomatology in elderly people. Análise Psicológica. 37:209–222. Available at: https://doi.org/10.14417/ap.1549.
Saul H, Gursul D (2021) Loneliness is strongly linked to depression among older adults, a long term study suggests. BMJ. doi: 10.1136/bmj.n2524
Zhang Y, Kuang J, Xin Z, et al (2023) Loneliness, social isolation, depression and anxiety among the elderly in Shanghai: Findings from a longitudinal study. Archives of Gerontology and Geriatrics 110:104980. doi: 10.1016/j.archger.2023.104980
Noguchi T, Saito M, Aida J, et al (2021) Association between social isolation and depression onset among older adults: A cross-national longitudinal study in England and Japan. BMJ Open. doi: 10.1136/bmjopen-2020-045834
Banerjee A, Duflo E, Grela E, et al (2023) Depression and loneliness among the elderly in low- and middle-income countries. Journal of Economic Perspectives 37:179–202. doi: 10.1257/jep.37.2.179
Cacioppo JT, Cacioppo S, Capitanio JP, Cole SW (2015) The neuroendocrinology of social isolation. Annual Review of Psychology 66:733–767. doi: 10.1146/annurev-psych-010814-015240
Holwerda TJ, Rhebergen D, Comijs HC, et al (2020) 306 - loneliness and mortality in older adults and the role of depression. International Psychogeriatrics 32:64–64. doi: 10.1017/s1041610220002069
Mazzola P (2020) Depression and social isolation are associated with loneliness among seniors with mild-to-moderate dementia—findings from the Ideal Cohort Study. Evidence Based Nursing 25:17–17. doi: 10.1136/ebnurs-2020-103387
Luo Y, Hawkley LC, Waite LJ, Cacioppo JT (2012) Loneliness, health, and mortality in old age: A National Longitudinal Study. Social Science & Medicine 74:907–914. doi: 10.1016/j.socscimed.2011.11.028
Just SA, Seethaler M, Sarpeah R, et al (2022) Loneliness in elderly inpatients. Psychiatric Quarterly 93:1017–1030. doi: 10.1007/s11126-022-10006-7
Moustakopoulou L, Adamakidou T, Plakas S, et al (2023) Exploring loneliness, fear and depression among older adults during the COVID-19 ERA: A cross-sectional study in Greek provincial towns. Healthcare 11:1234. doi: 10.3390/healthcare11091234
Bayram S, Özsarı E, Kökpınar H, et al (2023) Loneliness and depression among Turkish community-dwelling older adults during the COVID-19 pandemic. European Journal of Geriatrics and Gerontology 5:150–159. doi: 10.4274/ejgg.galenos.2023.2022-12-1
Ibrahim SH, Abdel-Khalek AH, Ali HH, Abdalla SE (2021) Relationship between depressive symptoms and loneliness feeling among elderly at Zagazig City. Annals of the Romanian Society for Cell Biology 5116–5127. Retrieved from http://annalsofrscb.ro/index.php/journal/article/view/2015
El Kady HM, Ibrahim HK (2013) Depression among a group of elders in Alexandria, Egypt. Eastern Mediterranean Health Journal 19:167–174. doi: 10.26719/2013.19.2.167
El-Sayed EB (2019) Relationship between social support, loneliness, and depression among elderly people. International Journal of Nursing Didactics 09:39–47. doi: 10.15520/ijnd.v9i01.2412
Barakat M et al (2019) Depression, anxiety and loneliness among elderly living in geriatric. American Journal of Nursing Research 7(4):400-411
El-mowafy RD et al (2020) Loneliness among elderly resident and nonresidents at the elderly care homes in Port Said City: Comparative Study. The Medical Journal of Cairo University 88: 969-981. doi: 10.21608/mjcu.2020.105132
Erikson EH. (1982) The Life Cycle Completed. New York:W.W. Norton& Company
Caetano B, Branquinho M, Canavarro MC, Fonseca A (2022) Mattering and depressive symptoms in Portuguese postpartum women: The indirect effect of loneliness. International Journal of Environmental Research and Public Health 19:11671. doi: 10.3390/ijerph191811671
Etherson ME, Smith MM, Hill AP, Flett GL (2021) Feelings of not mattering and depressive symptoms from a temporal perspective: A comparison of the cross-lagged panel model and random-intercept cross-lagged panel model. Journal of Psychoeducational Assessment 40:60–76. doi: 10.1177/07342829211049686
Flett GL, Heisel MJ (2021) Aging and feeling valued versus expendable during the COVID-19 pandemic and beyond: A review and commentary of why Mattering is fundamental to the health and well-being of older adults. International Journal of Mental Health and Addiction 19:2443–2469. doi: 10.1007/s11469-020-00339-4
Killen A, Macaskill A (2020) Positive ageing: To what extent can current models of wellbeing categorise the life events perceived as positive by older adults? International Journal of Applied Positive Psychology 5:99–119. doi: 10.1007/s41042-020-00028-6
Jenkins C, Germaine C (2019) Living well in older age: What can we learn from the Japanese experience? Nursing Older People 31:30–35. doi: 10.7748/nop.2019.e1107
Wand AP, Zhong B-L, Chiu HF, et al (2020) Covid-19: The implications for suicide in older adults. International Psychogeriatrics 32:1225–1230. doi: 10.1017/s1041610220000770
Chippendale T (2013) Factors associated with depressive symptoms among elders in senior residences: The importance of feeling valued by others. Clinical Gerontologist 36:162–169. doi: 10.1080/07317115.2012.749321
Wight RG, LeBlanc AJ, Meyer IH, Harig FA (2015) Internalized gay ageism, mattering, and depressive symptoms among midlife and older gay-identified men. Social Science & Medicine 147:200–208. doi: 10.1016/j.socscimed.2015.10.066
Redmond RA, Barrett AE (2015) The link between functional limitations and depressive symptoms. Society and Mental Health 5:33–48. doi: 10.1177/2156869314568200
Van Orden KA, Stone DM, Rowe J, et al (2013) The senior connection: Design and rationale of a randomized trial of peer companionship to reduce suicide risk in later life. Contemporary Clinical Trials 35:117–126. doi: 10.1016/j.cct.2013.03.003
Heisel MJ, Moore SL, Flett GL, et al (2020) Meaning-centered men’s groups: Initial findings of an intervention to enhance resiliency and reduce suicide risk in men facing retirement. Clinical Gerontologist 43:76–94. doi: 10.1080/07317115.2019.1666443
Carroll S, Moon Z, Hudson J, et al (2022) An evidence-based theory of psychological adjustment to long-term physical health conditions: Applications in clinical practice. Psychosomatic Medicine 84:547–559. doi: 10.1097/psy.0000000000001076
Fankhauser S, Wagner B, Krammer S, et al (2010) The impact of social and interpersonal resources on adjustment disorder symptoms in older age. GeroPsych 23:227–241. doi: 10.1024/1662-9647/a000022
Mugambi AG, Mburugu BM, Mwithalii JK (2020) Depression and adjustment to retirement among retiree teachers in Meru County, Kenya. Research on Humanities and Social Sciences 10(16):12
Murphy BM, Higgins RO, Jackson AC (2016) Anxiety, depression, and psychological adjustment after an acute cardiac event. Handbook of Psychocardiology 511–531. doi: 10.1007/978-981-287-206-7_57
McGiffin JN (2020) Psychological adjustment to disability: Heterogeneous trajectories of resilience and depression following physical impairment or amputation. Columbia University. Available from: https://doi.org/10.7916/d8-24by-d053
Bjørkløf GH, Engedal K, Selbæk G, et al (2013) Coping and depression in old age: A literature review. Dementia and Geriatric Cognitive Disorders 35:121–154. doi: 10.1159/000346633
Cetinkol G, Bastug G, Ozel Kizil ET (2020) Poor acceptance of the past is related to depressive symptoms in older adults. GeroPsych 33:246–251. doi: 10.1024/1662-9647/a000227
Regan B, Varanelli L (2013) Adjustment, depression, and anxiety in mild cognitive impairment and early dementia: A systematic review of Psychological Intervention Studies. International Psychogeriatrics 25:1963–1984. doi: 10.1017/s104161021300152x
Brinkhof LP, Ridderinkhof KR, van de Vijver I, et al (2022) Psychological coping and behavioral adjustment among older adults in times of COVID-19: Exploring the protective role of working memory and habit propensity. Journal of Adult Development 29:240–254. doi: 10.1007/s10804-022-09404-9
Parshad N, Tufail A (2014) Depression, anxiety, coping and quality of life among elderly living in old age homes and in family setup 5(1). Available from: https://pjpprp.pu.edu.pk/jour/pjpprp/article/view/93.
Wrosch C (2011) Self-regulation of unattainable goals and pathways to quality of life. The Oxford Handbook of Stress, Health, and Coping 319–33
Brennan PL, Holland JM, Schutte KK, Moos RH (2012) Coping trajectories in later life: A 20-year predictive study. Aging and Mental Health 16:305–316. doi: 10.1080/13607863.2011.628975
Kadylak T (2020) An investigation of perceived family phubbing expectancy violations and well-being among U.S. older adults. Mobile Media and Communication 8:247–267. doi: 10.1177/2050157919872238
Francis GM (1976) Loneliness: measuring the abstract. International Journal of Nursing Studies 13(3):153–60
Roos V, Malan L (2012) The role of context and the interpersonal experience of loneliness among older people in a residential care facility. Global Health Action 5:18861. doi: 10.3402/gha.v5i0.18861
Fetherstonhaugh D, Tarzia L, Nay R (2013) Being central to decision making means I am still here!: The essence of decision making for people with dementia. Journal of Aging Studies 27:143–150. doi: 10.1016/j.jaging.2012.12.007
Wilberforce M, Batten E, Challis D, et al (2018) The patient experience in community mental health services for older people: A concept mapping approach to support the development of a new quality measure. BMC Health Services Research. doi: 10.1186/s12913-018-3231-6
Yunus WM, Normah CD, Ahmad M, Ibrahim N, Said Z, et al (2013) Loneliness and depression among the elderly in an agricultural settlement: Mediating effects of social support. Asia-Pacific Psychiatry 17(5):134–139
Liu L, Gou Z, Zuo J (2016) Social support mediates loneliness and depression in elderly people. J Health Psychol 21(5):750–758
Lim YM, Baek J, Lee S, Kim JS (2022) Association between loneliness and depression among community-dwelling older women living alone in South Korea: The mediating effects of subjective physical health, resilience, and Social Support. International Journal of Environmental Research and Public Health 19(15):9246. doi: 10.3390/ijerph19159246
Ng SM, Lee TM (2020) The mediating role of hardiness in the relationship between perceived loneliness and depressive symptoms among older. Aging and Mental Health 24:805–810. doi: 10.1080/13607863.2018.1550629
Wang H, Hou Y, Zhang L, et al (2022) Chinese elderly migrants’ loneliness, anxiety and depressive symptoms: The mediation effect of perceived stress and resilience. Frontiers in Public Health 10:998532. doi: 10.3389/fpubh.2022.998532
Fang Y, Chau AKC, Fung HH, Woo J (2019) Loneliness shapes the relationship between information and communications technology use and psychological adjustment among older adults. Gerontology 65(2):198–206
Sarkar SM, Dhar BK, Crowley SS, Ayittey FK, Gazi MA (2023) Psychological adjustment and guidance for ageing urban women. Ageing International 48(1):222–230
Senese VP, Nasti C, Mottola F, Sergi I, Massaro R, Gnisci A (2021) The relationship between loneliness and psychological adjustment: Validation of the Italian version of the interpersonal acceptance-rejection loneliness scale. Frontiers in Psychology 12:655410. doi: 10.3389/fpsyg.2021.655410
Shafiq SM, Bano Z (2020) Impact of social support and adjustment problems on perceived loneliness in elderly. Pakistan Armed Forces Medical Journal 70(2): 474-79
Schwaba T, Bleidorn W (2020) Log on and Prosper? Little evidence for co-development between psychological adjustment and technology use in older adulthood. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 76(1):67–77
Setia MS (2016) Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology 61(3): 261–264. Available from: https://doi.org/10.4103/0019-5154.182410
Heath W. (2018) Psychology Research Methods. Cambridge University Press 134-156
Elkholy N, Tawfik HM, Ebeid S, Hamza SA, Madkor OR (2019) Defining cut-off scores for MMSE in an educated and illiterate Arabic speaking Egyptian elderly population. The Egyptian Journal of Geriatrics and Gerontology 6(1):1–3
Kang H (2021) Sample size determination and power analysis using the G*Power Software. Journal of Educational Evaluation for Health Professions 18,17. Available from: https://doi.org/10.3352/jeehp.2021.18.17.
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12(3):189–198.
ElKholy N, Tawfik HM, Ebeid S, et al (2020) A model of cognitive evaluation battery for diagnosis of mild cognitive impairment and dementia in educated and illiterate Egyptian elderly people. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. doi: 10.1186/s41983-020-00223-x
Yesavage JA, Brink TL, Rose TL, et al (1983) Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research 17:37–49. doi: 10.1016/0022-3956(82)90033-4
Yesavage JA, Sheikh JI (1986) Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version. Clinical Gerontologist 5(1–2):165–73
Parmelee PA, Lawton MP, Katz IR (1989) Psychometric properties of the geriatric depression scale among the institutionalized aged. Psychological Assessment: A Journal of Consulting and Clinical Psychology 1:331–338. doi: 10.1037/1040-3590.1.4.331
Pedraza O, Dotson VM, Willis FB, et al (2009) Internal consistency and test-retest stability of the Geriatric Depression Scale-short form in African American older adults. Journal of Psychopathology and Behavioral Assessment 31:412–416. doi: 10.1007/s10862-008-9123-z
Norris JT, Gallagher D, Wilson A, Winograd CH (1987) Assessment of depression in geriatric medical outpatients: The validity of two screening measures. Journal of the American Geriatrics Society 35:989–995. doi: 10.1111/j.1532-5415.1987.tb04001.x
Chaaya M, Sibai A-M, Roueiheb ZE, et al (2008) Validation of the Arabic version of the short Geriatric Depression Scale (GDS-15). International Psychogeriatrics. doi: 10.1017/s1041610208006741
Russell DW (1996) UCLA Loneliness Scale (version 3): Reliability, validity, and factor structure. Journal of Personality Assessment 66:20–40. doi: 10.1207/s15327752jpa6601_2
Abdel-Salam S (1996) Comparative study between elderly live in community and those who live in residential homes: Unpublished master thesis. Institute of Educational Studies and Researches, Cairo University
El-Desoky MM (1996) Loneliness scale. The Anglo Egyptian Bookshop
Ebraheem N, Shehata H, Thabet R (2012) Feeling of depression and loneliness among elderly people attending geriatric clubs at Assiut City. Life Science Journal 9:140–145
Peterson AP (2015) Psychometric Evaluation of the Brief Adjustment Scale-6 (BASE-6): A New Measure of General Psychological Adjustment [Thesis]. Available from: https://digital.lib.washington.edu:443/researchworks/handle/1773/34153.
Lambert MJ, Burlingame GM, Umphress V, Hansen NB, Vermeersch DA, Clouse GC, et al (1996) The Reliability and Validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy 3(4):249–58
Cruz RA, Peterson AP, Fagan C, et al (2020) Evaluation of the brief adjustment scale–6 (Base-6): A measure of general psychological adjustment for measurement-based care. Psychological Services 17:332–342. doi: 10.1037/ser0000366
El-Azzab S, Ali M, Ahmed A (2023) Efficiency of nursing intervention on psychological adjustment, perfectionism and symptoms among patients with obsessive compulsive disorder. International Egyptian Journal of Nursing Sciences and Research 3(2), 796–815. https://doi.org/10.21608/ejnsr.2023.283290
Taylor J, Turner RJ (2001) A longitudinal study of the role and significance of mattering to others for depressive symptoms. Journal of Health and Social Behavior 42(3):310-325. doi: 10.2307/3090217
Rayle AD (2005) Adolescent gender differences in mattering and Wellness. Journal of Adolescence 28:753–763. doi: 10.1016/j.adolescence.2004.10.009
Davis SM, Lepore SJ, Dumenci L (2019) Psychometric properties and correlates of a brief scale measuring the psychological construct mattering to others in a sample of women recovering from breast cancer. Quality of Life Research 28:1605–1614. doi: 10.1007/s11136-019-02118-8

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The Impact of Sense of Loneliness on Geriatric Depression: The Mediating Role of Sense of Mattering and Psychological Adjustment

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Abstract

Background

Methods

Results

Conclusion

Figures

Introduction

Sense of Loneliness and Geriatric depression

Sense of Mattering and Geriatric Depression

Psychological Adjustment and Geriatric Depression

Sense of Loneliness and Sense of Mattering in Older Adults: Paving the Way for Mediation

Sense of Loneliness and Psychological Adjustment: Paving the Way for Mediation

Conceptual Model

Research Methodology

Research Design

Sample

Inclusion criteria:

Exclusion criteria:

Measures

Mini-mental State Examination (MMSE)-Arabic

Demographic Data Tool

Geriatric Depression Scale-15 (Short Form)

University of California, Los Angeles Loneliness Scale-Version 3 (UCLA-3)

Brief Adjustment Scale–6 (BASE-6)

General Mattering Scale (GMS)

Data Collection Procedures

Data Analysis

Results

Sample Description

Correlations

Mediation Analysis

Discussion

Limitations

Future Research and Practical Implications

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1