Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey.

Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.

Chronic and Transient Loneliness in Western Countries: Risk Factors and Association With Depression. A 2-Year Follow-Up Study.

INTRODUCTION: Our aim was to test risk factors for chronic and transient loneliness as well as cross-sectional and longitudinal associations of courses of loneliness with depression. METHODS: Responses from participants in Wave 5 (T1, 2013) and Wave 6 (T2, 2015) of The Survey of Health, Ageing and Retirement in Europe (SHARE) (N = 45,490) were analyzed. The existence of clinically significant symptoms of depression was defined as reporting a value greater than or equal to 4 on the Euro-D scale. Loneliness was measured through the 3-item UCLA loneliness scale and a single question. Both measures were tested in separate regression models to identify risk factors for transient (loneliness at T1) and chronic (loneliness at T1 and T2) loneliness as well as their associations with depression. RESULTS: Chronic loneliness was observed in 47%-40% of the cases of loneliness, according to the UCLA scale and the single question, respectively. Risk factors for chronic loneliness in both models were being female, not being married, having a low educational level, having poor mental and physical health, being limited in activities, having a poor social network, and living in a culturally individualistic country. Risk factors for transient loneliness were less robust and no significant effects were found for variables such as sex and physical health in both models, education level in the UCLA measure model, and social network size in the single question model. Chronic loneliness also showed a strong association with depression in the cross-sectional model and a marked one in the longitudinal model. CONCLUSION: The courses of loneliness are relevant in the study of its risk factors and association with depression.

Loneliness during the last phase of the COVID-19 pandemic in Spain: A longitudinal study of group-based trajectories, risk factors, and consequences in mental health.

INTRODUCTION: The present study aims to investigate the courses of loneliness following a national state of emergency including a curfew due to a rise in COVID-19 cases, associated risk factors, and the effect of loneliness on symptoms of depression and anxiety. METHODS: Data of 2,000 adults in Spain which were interviewed by telephone at the first follow-up of the MINDCOVID project (February-March 2021) and of whom 953 were interviewed nine months later (November-December 2021) were analyzed. Group-based trajectories and mixed models were constructed. RESULTS: Three courses of loneliness were detected: (1) invariant low loneliness (42.6%), (2) decreasing medium loneliness (51.5%), and (3) fairly invariant high loneliness (5.9%). Loneliness courses were associated with the severity and variability of symptoms of depression and anxiety. In contrast to the majority of pre-pandemic studies, younger adults more frequently reported loneliness compared to middle-aged and, particularly, older individuals. Other risk factors for loneliness were being female, being unmarried, and, notably, having pre-pandemic mental disorders. CONCLUSIONS: Future studies should validate whether the newly observed loneliness patterns across age groups persist and assess the evolution of loneliness courses and their impact on mental health, with particular attention given to young adults and individuals with pre-existing mental disorders.

Social inequalities in mental and physical health derived from the COVID-19 pandemic in Spain beyond SARS-CoV-2 infection.

BACKGROUND: Understanding the impact of the COVID-19 crisis on health involves conducting longitudinal studies to evaluate the inequalities that may have been exacerbated by the pandemic. The purpose of this study was to estimate differences in physical and mental health derived from the COVID-19 pandemic, beyond SARS-CoV-2 infection, in the Spanish general population according to the participants' level of education; and to assess the evolution of these differences from June 2020 (just after the lockdown) to nine months later (February-March 2021). METHODS: This is a longitudinal prospective study of a representative sample of non-institutionalized Spanish adults, through computer-assisted telephone interviews. Mobility, self-care, usual activities, pain/discomfort and anxiety/depression problems were measured with EQ-5D-5L. Prevalence ratio (PR) between high and low education levels and adjusted PR were estimated by Poisson regression models. Analyses were stratified by gender. RESULTS: A total of 2,000 participants answered both surveys. Individuals with low level of education reported more health problems in both genders, and absolute inequalities remained quite constant (mobility and self-care problems) or decreased (pain/discomfort and anxiety/depression problems). The greatest relative inequalities were observed just after the lockdown, with age-adjusted PR ranging from 1.31 (95%CI 1.08-1.59) for women and 1.34 (95%CI 1.05-1.69) for men in pain/discomfort to 2.59 (95%CI 0.98-6.81) for women and 4.03 (95%CI 1.52-10.70) for men in self-care; aPR decreased after nine months for most dimensions. CONCLUSIONS: Prevalence of health problems increased during the COVID-19 pandemic in all education groups, but the increase was higher in women and men with a high level of education, suggesting that its impact appeared later in this group. Further analysis on the role of governmental economic aid given to vulnerable people might shed light on this evolution.

Variations in sociodemographic and health-related factors are linked to distinct clusters of individuals with depression based on the PHQ-9 instrument: NHANES 2007-2018.

BACKGROUND: Depression is a heterogeneous disease. Identification of latent depression subgroups and differential associations across these putative groups and sociodemographic and health-related factors might pave the way toward targeted treatment of individuals. METHODS: We used model-based clustering to identify relevant subgroups of 2900 individuals with moderate to severe depression (defined as scores ≥10 on the PHQ-9 instrument) from the NHANES cross-sectional survey. We used ANOVA and chi-squared tests to assess associations between cluster membership and sociodemographics, health-related variables, and prescription medication use. RESULTS: We identified six latent clusters of individuals, three based on depression severity and three differentially loaded by somatic and mental components of the PHQ-9. The Severe mental depression cluster had the most individuals with low education and income (P < 0.05). We observed differences in the prevalence of numerous health conditions, with the Severe mental depression cluster showing the worst overall physical health. We observed marked differences between the clusters regarding prescription medication use: the Severe mental depression cluster had the highest use of cardiovascular and metabolic agents, while the Uniform severe depression cluster showed the highest use of central nervous system and psychotherapeutic agents. LIMITATIONS: Due to the cross-sectional design we cannot make conclusions about causal relationships. We used self-reported data. We did not have access to a replication cohort. CONCLUSIONS: We show that socioeconomic factors, somatic diseases, and prescription medication use are differentially associated with distinct and clinically relevant clusters of individuals with moderate to severe depression.

The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis.

BACKGROUND: Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations. AIMS: The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020-2022) in the general population. METHOD: The method entailed a systematic review and random-effects meta-analysis of quantitative studies. RESULTS: Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency index, and by methodological moderators, such as sample size, collection date, methodological quality, and the measurement scales. CONCLUSIONS: Social support had a weak association with mental disorder symptoms during the COVID-19 pandemic while the association with loneliness was moderate. Strategies to address loneliness could be highly effective in reducing the impact of the pandemic on social relationships and mental health.

What factors explain the changes in major depressive disorder symptoms by age group during the COVID-19 pandemic? A longitudinal study.

BACKGROUND: Data collected during the COVID-19 pandemic suggest an increase in major depressive disorder (MDD) among younger adults. The current study aims to assess the association of age groups and MDD risk before and during the COVID-19 pandemic and quantify the effect of potential mediating variables such as loneliness, social support, resilience, and socioeconomic factors. METHODS: A representative sample of Spanish adults was interviewed before (2019, N = 1880) and during (2020, N = 1103) the COVID-19 pandemic. MDD was assessed using the CIDI, loneliness through the UCLA scale, social support through the OSSS-3, resilience with the 6-BRS, and worsened economic circumstances and unemployment through a single question. Mixed-models were used to study changes in MDD by age group. Regression models were constructed to quantify the association between age and potential mediators, as well as their mediating effect on the association between age group and MDD. RESULTS: Among the younger age cohorts (18-29 and 30-44 years) the probability of having MDD during the pandemic increased from 0.04 (95 % CI: 0.002-0.09) to 0.25 (0.12-0.39) and from 0.02 (-0.001-0.03) to 0.11 (0.04-0.17), respectively. Some 36.6 % of the association between age and risk of MDD during the pandemic was explained by loneliness (12.0 %), low resilience (10.7 %), and worsened economic situation (13.9 %). LIMITATIONS: Reliance on self-report data and generalizability of the findings limited to the Spanish population. CONCLUSIONS: Strategies to decrease the impact of a pandemic on depressive symptoms among young adults should address loneliness, provide tools to improve resilience, and enjoy improved financial support.

The role of social support, detachment, and depressive and anxiety symptoms in suicidal thoughts and behaviours during the Covid-19 lockdown: Potential pathways.

During the COVID-19 pandemic, anxiety and depressive symptoms, as well as problems related to social relationships, such as available social support and feelings of detachment from others, have worsened. These factors are strongly associated with suicidal thoughts and behaviours (STB). The effects of feelings of detachment on mental health and on STB have been scarcely studied, together with the relation that it may have with available social support. Therefore, the aim of the present study was to assess potential pathways connecting these conditions. A nationally representative sample of Spanish adults (N = 3305) was interviewed during the COVID-19 pandemic (June 2020). STB, social support, and depressive and anxiety symptoms were measured with the C-SSRS (modified version), OSSS-3, PHQ-8, and GAD-7 scales, respectively. Multivariable logistic regression models and mediation analyses were performed. Social support and some of its components (i.e., social network size and relations of reciprocity) were associated with lower odds of STB. Detachment significantly mediated (22% to 25%) these associations. Symptoms of emotional disorders significantly mediated the association between social support components (29% to 38%) - but not neighbourhood support - with STB, as well as the association between detachment and higher odds of STB (47% to 57%). In both cases, depressive symptoms were slightly stronger mediating factors when compared to anxiety symptoms. Our findings suggest that interventions aimed at lowering depressive and anxiety symptoms, and STB should provide social support and help tackle the feeling of detachment in a complementary way.

The Association Between Substance Use Disorder and Depression During the COVID-19 Lockdown in Spain and the Moderating Role of Social Support: a Cross-Sectional Study.

Substance use disorder is on the rise; it has increased massively during the COVID-19 lockdown and has been found as a risk factor for depressive symptoms and major depressive disorder. Less is known about the hypothetical moderating effect of social support in that association. Three thousand five hundred Spanish adults were interviewed by phone during the COVID-19 lockdown (May-June 2020). The 8-item Patient Health Questionnaire Depression Scale (PHQ-8) was used to measure the symptoms of depression. The CAGE Adapted to Include Drugs (CAGE-AID) questionnaire was used to assess substance use disorder during the previous month. Social support was measured through the Oslo Social Support Scale (OSSS-3). Regression models were constructed to assess factors related to depressive symptoms. People with substance use disorder (alcohol and drugs) showed considerable high levels of depressive symptoms, particularly among those with low levels of social support, which reported levels above major depressive disorder cut-off.

The Association of Age With Depression, Anxiety, and Posttraumatic Stress Symptoms During the COVID-19 Pandemic in Spain: The Role of Loneliness and Prepandemic Mental Disorder.

OBJECTIVE: Older adults may be at lower risk of common mental disorders than younger adults during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has shown shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of prepandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and prepandemic mental disorders on the association between age and mental disorder symptoms. METHODS: Cross-sectional data of 2000 adults in Spain interviewed by telephone during the COVID-19 pandemic (February-March 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the eight-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder Scale, and the four-item checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), respectively. Loneliness was measured with the three-item University of California at Los Angeles Loneliness Scale. Several regression models were constructed to assess factors related to loneliness and mental disorders. RESULTS: According to cutoff points used, 12.4% of participants revealed depression, 11.9% revealed anxiety, and 11.6% revealed posttraumatic stress. Age was negatively related to mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without prepandemic mental disorders and in older adults with them. The association between age and loneliness was stronger in those with prepandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms. CONCLUSIONS: Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.

Mental health symptoms 1 year after the COVID-19 outbreak in Spain: The role of pre-existing mental disorders and their type.

BACKGROUND: The type of pre-existing disorder might determine changes in mental health symptoms (i.e., anxiety, depression) during the COVID-19 pandemic and influence the effect of psychological factors (e.g., social support, resilience, stress) on such symptoms. METHODS: Longitudinal data from two assessments (June-2020 and February/March-2021) collected through telephone interviews (Spanish general population) were analysed. Outcome variables included anxiety (GAD-7) and depressive symptoms (PHQ-8). Psychological factors included COVID-perceived stress (adapted COVID-perceived risk scale), social support (OSSS-3), and resilience (CD-RISC). Pre-existing mental conditions (3 groups: mood, anxiety, and comorbid depression+anxiety) were assessed using the CIDI checklist. Changes in anxiety and depressive symptoms between baseline and follow-up were assessed with the paired samples Wilcoxon test. Tobit regression and interaction models were conducted to test associations between psychological factors and these symptoms in follow-up. RESULTS: Final sample included 1942 participants (mean age 49.6 yrs., ±16.7; 51.7 % females). Anxiety symptoms increased in all groups except for those with pre-existing mood conditions. Depressive symptoms only increased in those without pre-existing mental disorders and in those with pre-existing anxiety. Higher baseline resilience, increases in social support, and decreases in COVID-perceived stress were associated with lower anxiety and depressive symptoms. The type of pre-existing mental disorder did not modify these associations. LIMITATIONS: Lack of pre-pandemic data and the limited number of pre-existing mental conditions. CONCLUSIONS: Having pre-pandemic mental disorders is associated with different patterns of anxiety and depressive symptoms during the pandemic. COVID-related stress, social support, and resilience are key factors in improving mental health regardless of the mental diagnosis.

[Pre-post evaluation of an intergenerational program to improve wellbeing in older adults and age stereotypes in primary and secondary students: CRENCO project]. / Evaluación pre-post de un programa intergeneracional para mejorar el bienestar en personas mayores y los estereotipos edadistas en alumnos de primaria y secundaria: proyecto CRENCO.

OBJECTIVE: The present study aims to evaluate the effectiveness of the CRENCO project which was carried out during the COVID-19 pandemic including intergenerational activities shared by students from primary and secondary education and users of two centers for older adults and a day hospital in Catalonia. The effectiveness was assessed in terms of well-being in older adults and on negative stereotypes about the elderly in primary and secondary students. METHODS: Three interventions were carried out in which 32 older persons (9 users of centers for older adults and 23 of a day hospital), 99 primary students and 56 secondary students participated. Participants answered a questionnaire before and after the interventions. Through multilevel linear models for repeated measures, changes in feelings of loneliness, social support, anxiety and depressive symptoms, self-reported health and health-related quality of life were evaluated in older people. In primary and secondary students, changes in age stereotypes were evaluated. RESULTS: Health-related quality of life and self-reported health improved statistically after the interventions in older persons. Users of the day hospital also reported an improvement in social support. Primary school students improved their age stereotypes; no statistically significant changes were detected in secondary students. CONCLUSION: The results of the present study contribute to underlining the importance of intergenerational programs such as the one proposed by CRENCO, capable of improving well-being and providing a more realistic vision of the older adults. Our results suggest that these programs should be implemented during childhood in order to prevent the proliferation of ageist stereotypes in later life stages.

Evaluación pre-post de un programa intergeneracional para mejorar el bienestar en personas mayores y los estereotipos edadistas en alumnos de primaria y secundaria: proyecto CRENCO / Pre-post evaluation of an intergenerational program to improve wellbeing in older adults and age stereotypes in primary and secondary students: CRENCO project

Objetivo: El presente estudio tiene como objetivo evaluar la efectividad del proyecto CRENCO, que se desarrolló durante la pandemia por COVID-19, incluyendo actividades intergeneracionales compartidas por alumnos de primaria y secundaria y personas mayores en Cataluña. Se evalúa su efecto en el bienestar de las personas mayores y en los estereotipos negativos sobre las personas mayores de los alumnos.Métodos: Se llevaron a cabo tres intervenciones en las que participaron 32 personas mayores (9 usuarios de centros para mayores y 23 de un hospital de día), 99 alumnos de primaria y 56 alumnos de secundaria. Los participantes fueron entrevistados antes y después de las intervenciones. A través de modelos lineales multinivel de efectos aleatorios para medidas repetidas, se evaluaron, en personas mayores, cambios en sentimientos de soledad, soporte social, sintomatología ansiosa y depresiva, salud autopercibida y calidad de vida relacionada con la salud. En alumnos de primaria y secundaria se evaluaron cambios en estereotipos edadistas.Resultados: Las personas mayores reportaron una mejor calidad de vida relacionada con la salud y una mejor salud autopercibida al finalizar las intervenciones. Los usuarios del hospital de día reportaron también una mejora en el soporte social. Los alumnos de primaria mejoraron sus estereotipos edadistas, lo cual no sucedió en estudiantes de secundaria.Conclusiones: Los resultados del presente estudio contribuyen a subrayar la importancia de programas intergeneracionales como el que plantea CRENCO, capaces de mejorar el bienestar y aportar una visión más realista de las personas mayores. Nuestros resultados sugieren que estos proyectos deben ser implantados durante la infancia con el objetivo de impedir la proliferación de los estereotipos edadistas en las posteriores etapas vitales. (AU)

Objective: The present study aims to evaluate the effectiveness of the CRENCO project which was carried out during the COVID-19 pandemic including intergenerational activities shared by students from primary and secondary education and users of two centers for older adults and a day hospital in Catalonia. The effectiveness was assessed in terms of well-being in older adults and on negative stereotypes about the elderly in primary and secondary students.Methods: Three interventions were carried out in which 32 older persons (9 users of centers for older adults and 23 of a day hospital), 99 primary students and 56 secondary students participated. Participants answered a questionnaire before and after the interventions. Through multilevel linear models for repeated measures, changes in feelings of loneliness, social support, anxiety and depressive symptoms, self-reported health and health-related quality of life were evaluated in older people. In primary and secondary students, changes in age stereotypes were evaluated.Results: Health-related quality of life and self-reported health improved statistically after the interventions in older persons. Users of the day hospital also reported an improvement in social support. Primary school students improved their age stereotypes; no statistically significant changes were detected in secondary students.Conclusion: The results of the present study contribute to underlining the importance of intergenerational programs such as the one proposed by CRENCO, capable of improving well-being and providing a more realistic vision of the older adults. Our results suggest that these programs should be implemented during childhood in order to prevent the proliferation of ageist stereotypes in later life stages. (AU)

The Mental Health of Employees with Job Loss and Income Loss during the COVID-19 Pandemic: The Mediating Role of Perceived Financial Stress.

The COVID-19 outbreak, which was followed by home confinement, is expected to have had profound negative impact on the mental health of people. Associated factors, such as losing jobs and income, can be expected to lead to an increased risk of suffering from psychopathological problems. Therefore, this study was aimed at researching the associations of job and income loss with mental health, as well as the possible mediating role of perceived financial stress during the COVID-19 outbreak. The sample included 2381 Spanish workers who were interviewed right after the first COVID-19 lockdown. Measures were taken for generalized anxiety disorder, panic attacks, depression, post-traumatic stress disorder, substance abuse, suicidal thoughts and behaviors, working conditions, sociodemographic variables, and perceived financial stress. Logistic regression models were calculated with psychological variables as outcomes, and with job loss and income loss as predictors. Mediation analyses were performed by adding the financial threat as a mediator. Nineteen point six percent and 33.9% of participants reported having lost their jobs and incomes due to the pandemic, respectively. Only income loss was related to a higher risk of suffering from depression and panic attacks. When adding financial stress as a mediator, the indirect effects of job and income loss on the mental health measures were found to be significant, therefore indicating mediation. These findings pinpoint the vulnerability of this population, and highlight the need for interventional and preventive programs targeting mental health in economic crisis scenarios, such as the current one. They also highlight the importance of implementing social and income policies during the COVID-19 pandemic to prevent mental health problems.

The impact of COVID-related perceived stress and social support on generalized anxiety and major depressive disorders: moderating effects of pre-pandemic mental disorders.

BACKGROUND: We assessed the moderating effect of pre-pandemic mental disorders on the association of COVID-related perceived stress and social support with mental health. METHODS: A nationally representative sample of 3500 Spanish adults was interviewed in June 2020 (mean age 49.25 years, ± 15.64; 51.50% females). Mental health included Generalized Anxiety Disorders (GAD; GAD-7, cut-off point of ≥ 10), Major Depressive Disorders (MDD; PHQ-8, cut-off point of ≥ 10) and the comorbid form (those screening positive for GAD and MDD). COVID-related stress was assessed using an adapted version of the Peri Life Events Scale, and social support using the Oslo Social Support Scale. Logistic regression models were used to assess if COVID-related stress and social support were related to mental health outcomes and interactions were conducted to examine whether these relationships differed according to the presence of pre-pandemic mental disorders. RESULTS: Higher COVID-related stress was associated with a higher risk of lower mental health. The association between COVID-related stress with GAD and MDD was significantly moderated by pre-pandemic mental disorders, except for comorbid GAD + MDD. Higher levels of social support were linked to better mental health. Only the association between social support and GAD was significantly moderated by pre-pandemic mental disorders. That is, for those without pre-pandemic mental disorders, higher levels of social support decreased the odds of GAD, while minor decreases were observed in those with pre-pandemic mental disorders. CONCLUSIONS: The impact of COVID-related stress and social support on specific indicators of mental health may vary depending on the existence of a previous mental disorder.

The effect of loneliness and social support on the course of major depressive disorder among adults aged 50 years and older: A longitudinal study.

BACKGROUND: Previous research indicates that social support, loneliness, and major depressive disorder (MDD) are interrelated. Little is known about the potential pathways among these factors, in particular in the case of adults aged 50 years and older and suffering from MDD. The objective was to investigate whether loneliness mediates the association between low social support and recurrent episodes of MDD. METHODS: We used data from a cohort of the Spanish general population interviewed at three time-points over a 7-year period. We included 404 individuals aged 50+ suffering from MDD in the baseline assessment. A 12-month major depressive episode was assessed with the Composite International Diagnostic Interview (CIDI) at each interview. The University of California, Los Angeles Loneliness Scale was used to measure loneliness, whereas social support was assessed through the Oslo Social Support Scale. We tested cross-lagged and autoregressive longitudinal associations using structural equation modeling. RESULTS: We identified two significant longitudinal mediation patterns: lower social support predicted higher subsequent levels of loneliness (Coef. = -0.16; p < .05), which in turn predicted an increase in MDD recurrence (Coef. = 0.05; p < .05). CONCLUSIONS: Interventions focused on promoting social support among older adults suffering from MDD may decrease feelings of loneliness and prevent recurrent episodes of MDD.

The association of detachment with affective disorder symptoms during the COVID-19 lockdown: The role of living situation and social support.

INTRODUCTION: There is growing concern about the effect of lockdown and social distancing on mental health. Subjective feelings related to social relationships such as detachment have shown a strong effect on mental health, whereas objective factors might have a moderating role in that association. OBJECTIVE: To investigate whether social support and living situation have a moderating effect on the association between detachment and affective disorder symptoms during the COVID-19 lockdown. METHODS: 3,305 Spanish adults were interviewed by phone at the end of the COVID-19 lockdown (May-June 2020). Detachment during confinement was assessed with a single-item frequency question. Anxiety symptoms were measured through GAD-7, depressive symptoms through PHQ-9, and social support through the Oslo Social Support Scale (OSSS). Associations with anxiety and depressive symptoms were tested through Tobit regression models. Interactions of detachment with living situation and social support were tested as independent variables. RESULTS: People living alone showed significantly lower levels of anxiety whereas people living with another (but not as a couple) showed higher levels of depression. Detachment was strongly associated with both affective disorders. Social support had a statistically significant moderating effect on that association. Those with a low level of social support and a high level of detachment reported means of depression and anxiety above major depression (10.5 CI 95% 9.6, 11.4 at OSSS=10) and generalized anxiety disorders (10.1 CI 95% 9.2, 11.0 at OSSS=9) cut offs CONCLUSION: Interventions centered on improving social support could alleviate feelings of detachment and prevent affective disorders during lockdowns.

Social network size, loneliness, physical functioning and depressive symptoms among older adults: Examining reciprocal associations in four waves of the Longitudinal Aging Study Amsterdam (LASA).

INTRODUCTION: Previous research indicates that social isolation, loneliness, physical dysfunction and depressive symptoms are interrelated factors, little is known about the potential pathways among them. The aim of the study is to analyse simultaneously reciprocal relationships that could exist between the four factors to clarify potential mediation effects. METHODS: Within a large representative sample of older people in the Longitudinal Aging Study Amsterdam (LASA), participants aged 75 and over were followed up over a period of 11 years (four waves). We tested cross-lagged and autoregressive longitudinal associations of social network size, loneliness, physical functioning and depressive symptoms using structural equation modelling (SEM). RESULTS: Several statistically significant cross-lagged associations were found: decreasing physical functioning (Coef. = -0.03; p < 0.05), as well as social network size (Coef. = -0.02; p < 0.05), predicted higher levels of loneliness, which predicted an increase in depressive symptoms (Coef. = 0.17; p < 0.05) and further reduction of social network (Coef. = -0.20; p < 0.05). Decreasing physical functioning also predicted an increase in depressive symptoms (Coef. = -0.08; p < 0.05). All autoregressive associations were statistically significant. CONCLUSION: Interventions focused on promoting social activities among older adults after negative life events, such as loss of social contacts or declining physical function, may alleviate feelings of loneliness and act as mental health protector.

Negative old-age life events and well-being in later life: the moderating and mediating role of loneliness.

OBJECTIVES: Although older adults often experience negative life events or loss experiences, they rarely experience large decreases in their quality of life or well-being. Emotionally satisfying relationships in older adults may serve as a protective factor that reduces the impact of negative events in decreasing well-being. The availability of these close social contacts is essential, and their potential for alleviating feelings of loneliness after negative events could have an important role in promoting well-being. The aim of this study was to test the hypothetical moderation and mediation effects of social and emotional loneliness on the occurrence of negative old-age life events and well-being in later life. DESIGN: This was a cross-sectional survey conducted as part of the Detection, Support and Care for older people - Prevention and Empowerment research project (2015-2018). SETTING: Participants were community-dwelling older adults in Flanders (Belgium). PARTICIPANTS: The sample composed of 770 participants aged 60 years and over. MEASUREMENTS: Participant demographics, social and emotional loneliness, and subjective well-being were measured. Moderation and mediation analyses were performed using the regression-based approach as conducted by Hayes and Rockwood (2017). RESULTS: Results indicated that a low degree of (social) loneliness is a protective, moderating factor and (emotional) loneliness is a mediating factor on the effects of negative life events on well-being in later life. CONCLUSIONS: Findings highlight the importance of emotionally and socially satisfying social contacts in order to maintain positive subjective well-being in later life when negative life events may occur.