Positive attributes in elderly people with different degrees of depression: a study based on network analysis

Abstract

Introduction: Depression in aging may lead to loss of autonomy and worsening of comorbidities. Understanding how positive attributes contribute to healthier and happier aging has been one of the purposes of Positive Psychology. However, the literature still lacks studies that evaluate how depression in the elderly is related to constructs considered positive.

Objective: The present study aimed comparing scores of constructs of spiritual well-being, social support, self-esteem, life satisfaction, affection, optimism, and hope in the elderly with minimal, mild, moderate, and severe depression and healthy controls in order to investigate possible indirect and mediated relationships between positive constructs and depression.

Methods: A cross-sectional study was conducted with elderly, 62 of whom were diagnosed with different severity of Major Depression (DSM-V) (minimum, mild, moderate, and severe according to the Beck Depression Inventory - BDI) and 66 healthy controls matched by age, sex and schooling. The instruments used were adapted and validated versions of the Spirituality Self-Rating Scale, the Rosenberg Self-Esteem Scale, the Medical Outcomes Social Scale of Support, the Life Satisfaction Scale, the Positive and Negative Affect Schedule, the Revised Life Orientation Test, and the Adult Dispositional Hope Scale. After comparing the means of scores between groups, an analysis of normalized partial association networks was performed to investigate the direct and mediated relationships between depression and other evaluated constructs.

Results: Scores of spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affects, and hope differed significantly between the control group and the degrees of depression (p < 0.001). The analysis of normalized partial association networks has shown that the relations of depression with the constructs of life satisfaction, self-esteem, and social support are mediated, while the constructs of dispositional hope, positive affect, spiritual well-being, and optimism are indirectly related to depression. The social class was also positively related to depression.

Conclusion: Depression in different degrees is associated with a reduction in the scores of instruments that evaluate positive attributes. The constructs directly associated with depression are spiritual well-being, optimism, positive affect, and dispositional hope. The others had mediated relationship. These results may contribute to the planning of future interventions for the prevention of depression among the elderly.

Keywords: Aging; Depression; Network analysis; Positive Psychology; Well-being.

Fig. 1

Regularized partial network — Glasso method between Positive Psychology constructs and indicators of depression. CS, social class; Bcateg, depression scores; PPBES, spiritual well-being; PPEAS, social support; PPAE, self-esteem; PPSV, life satisfaction; AP, positive affects; PPOT, optimism; PPED, dispositional hope. The blue color assumed to be positive vs. red color negative relationship and the width of the lines (assumed to correspond to strength of the relationship)

Fig. 2

Measures of centrality between the constructs of Positive Psychology and the indicators of depression. Legend: Measures of values standardized with zero mean, “closeness” represents the variables with the highest number of weighted connections, and “expected influence” represents the variables with the greatest positive influence over the others