The Relationship Between Loneliness And Depression Among Nursing Home Older Adults And Its Affecting Mechanism

ObjectivesTo evaluate the reliability and validity of Hospital Depression Scale(HDS)among nursing home older adults,discuss the mediation of resilience(as an internal resource)and the moderated mediation of resilience and social support(as an external resource)(family,friends and other)between loneliness and depression,which would provide a practical basis for the intervention program of health care and promoting healthy aging.MethodsUsing a stratified cluster sampling,323 nursing home older adults aged 60 and over were recruited from 6 administrative districts of Jinan,Shandong Province.Questionnaires included sociodemographic characteristics,Mini-mental State Examination(MMSE),Activities of Daily Living Scale(ADL),Connor-Davidson Resilience Scale-10 item(CD-RISC-10),12-item Multidimensional Scale of Perceived social support(MSPSS),University of California at Los Angels Loneliness Scale(UCLA Loneliness Scale)and Hospital Depression Scale(HDS).Statistical analyses were conducted using SPSS22.0 and AMOS22.0,including descriptive analyses,Wilcoxon signed-rank test and Kruskal-Wallis H test,Pearson and Spearman correlation,mediating analyses and moderated mediate analyses.Results1.There was a low factor loading about Item 4(0.19)of Hospital DepressionScale via Confirmatory factor analysis.After the deletion Item 4.the factor loadings of the construct validity HDS with 6 items were from 0.49 to 0.82.and the fit indices were ?2= 22.029,?2/df = 2.448,GFI = 0.978,AGFI = 0.948,NFI= 0.966,IFI=0.980,CFI = 0.980,RMSEA = 0.067.which indicated the construct validity was good.The Cronbach'? was 0.805.and the test-retest reliability was 0.785.The correlation coefficients of each item and the total scores were between 0.279 and 0.782(all P<0.001).2.The mean age of the nursing home older adults was 78.62± 9.25.Most elderly were female(63.5%).unmarried(83.9%).54.5%of the elderly accepted primary school education or under and 53.3%of the older adults reported a fair economical status.There was 45.5%of older adults staying in nursing home from 1 to 5 years.The mean scores of the cognitive function were 21.44 ± 6.07.Most older adults had two or more chronic diseases(56.0%).The mean scores of activity of daily life were 28.15 ± 11.26;more than half of them showed obvious dysfunction(65.6%).The mean scores of resilience and social support were 28.36± 7.16 and 58.17± 15.09;the loneliness and depression were 38.62± 10.38 and 5.60± 4.07.3.The results of Wilcoxon signed-rank test and Kruskal-Wallis H test indicated various educational status(Z = 6.1 09,P = 0.047).cognitive function(Z= 20.074,P<0.001)and activity of daily life(Z = 22.280,P<0.001)presented significantly differences on depression.3.The correlation showed that depression were positively related to loneliness(r=0.452.P<0.001).Depression were negatively related to resilience(r =-0.441,P<0.001)and social support(r =-0.172.P<0.001).Loneliness were negatively associated with resilience(r =-0.496.P<0.001)and social support(r =-0.437,P<0.001).And resilience had a positive relation to social support(r = 0.255.P<0.001).4.The mediating role of resilience between loneliness and depression showed that with the effect of sociodemographic and health-related variables being controlled,the indirect paths were loneliness-resilience(path a:-0.482;95%CI:-0.576,-0.389),and resilience-depression(path b:-0.324;95%CI:-0.432,-0.217).The indirect effect(path a × path b)was 0.157(95%CI:0.095,0.223),which indicated that the mediation of resilience was established and the mediating effect was accounted for 33.8%.5.The moderated mediation model of resilience and social support between loneliness and depression showed that family support could moderate the indirect paths of the mediation model,that was path a(loneliness*family support:0.084;95%CI:0.004,0.164)and path b(resilience*family support:0.094;95%CI:0.002,0.186);friends support just moderated the latter path of the indirect path of the mediation model,that was path b(resilience*friends support:0.138;95%CI:0.046,0.229);other support also moderated the latter path of the indirect path of the mediation model(resilience*other support:0.130;95%CI:0030,0.230).These indicated that the moderated mediation model was established.Besides,as the level of different social support increased,the indirect effect decreased.Conclusions1.There were good reliability and validity of HDS-6 among nursing home older adults.2.Depression,loneliness,resilience and social support could be significant related to each other.3.Resilience could mediate the relationship between loneliness and depression.4.Different social support(family support,friends support and other support)could moderate the indirect path of loneliness—resilience—depression.The moderated mediation models were established.