Stanley A. Murrell

The Prevalence and Correlates of Anxiety Symptoms in Older Adults

An anxiety symptom scale was administered to a community sample of 713 males and 1338 females representative of persons aged 55 and older in Kentucky and quite similar to that of the US population in that age range. On the basis of a cutting point established previously, 17.1% of the males and 21.5% of the females were estimated to experience sufficient anxiety symptoms to place them at risk so as to require some form of intervention. In addition to gender and marital status differences, the study found a systematic but complex relationship between anxiety and age within this age range. Anxiety was inversely associated with socioeconomic status, education, and urban dwelling. Anxiety was inversely and highly correlated with physical health, and related to the presence of nine specific medical conditions and the need for and use of a number of medical services. The implications of the findings regarding the use of medical services for early diagnosis and treatment for mental health needs are discussed.

Social support, life events, and stress as modifiers of adjustment to bereavement by older adults.

As part of a larger panel study, interviews were obtained from 3 samples of older adults: 45 persons who had recently lost a spouse, 40 who had lost a parent or child, and 45 who were not bereaved. Assessments were conducted before and after the deaths. In the widowed sample, health remained quite stable, but depression increased sharply, then remained elevated. Changes were minimal in the sample who had lost a parent or child and in the nonbereaved sample. Multiple regression procedures were used to identify factors that contribute to depression and health 9 months after the spouses death. Postbereavement depression was associated with higher prebereavement depression, higher financial pressures, higher global stress, fewer new interests, and lower social support. Health was a function of prebereavement health, new interests, financial pressures, and global stress. In general, life events and resources had stronger effects in the widowed sample than in the comparison samples.

Protective function of resources related to life events, global stress, and depression in older adults.

1,402 older adults were interviewed twice with a six month interval. The direct, indirect, and interactive relationships of resources, life events, global stress, and depression were examined using multiple regression procedures to isolate the unique contributions of six hypothesized functions of resources: (1) stronger resources did not reduce undesirable events; (2) stronger resources did reduce the degree to which one experienced global stress; (3) stronger resources reduced depressive symptoms; (4) strong resource persons had less global stress than weak resource persons at low levels of events, but this advantage disappeared as level of events increased (opposite of prediction); (5) the traditional buffer hypothesis was not supported; the advantage of strong resource persons over weak resource persons held at all levels of events; (6) strong resource persons had less change in depression than weak resource persons only at the higher levels of global stress. This form followed the buffer effect previously attributed to events.

Contribution of education to health and life satisfaction in older adults mediated by negative affect.

Objectives: The authors developed a model of relationships between two enduring attributes (educational attainment and negative affect) and two indicators of successful aging (health and life satisfaction). Methods: A probability sample of 1,177 participants (age 55 and older) were interviewed four times at 6-month intervals. Structural equation models were developed based on the authors’ hypothetical model proposing a mediating effect of negative affect between health and successful aging. Results: As predicted, education and negative affect both were directly related to health and life satisfaction. Also, as predicted, negative affect mediated the relationship between education and successful aging indicators. Discussion: Education appears to confer a lifelong advantage for healthy aging. Part of this advantage is accounted for by the relationship between education and trait negative affect. Higher educational attainment is related to lower levels of trait negative affect; lower negative affect results in better health and life satisfaction.

Transitory Impact of Life-Event Stress on Psychological Symptoms in Older Adults*

A probability sample of 1,429 adults aged 55 and older was interviewed in their homes three times at six-month intervals. Measures of symptoms, social support, and education were obtained before measures of life-event stress. A LISREL analysis of three waves and two intervals of data yielded a goodness offit of .989 between the data and the model. For both intervals, increases in stress led to increases in symptoms, which supported the Dohrenwend hypothesis of a normative stress reaction. This reaction typically did not persist beyond six months unless there was high stress over both intervals. Contrary to Dohrenwends resource mediation hypothesis, social support and education did not influence either the reaction to or the recovery from stress. Symptoms were very stable over the one-year period. Overall, the results depict older adults as quite consistent and resilient. Because life events were correlated over time and were predicted by person characteristics, they should not be considered as independent of person factors. A panel of stress researchers from both the biomedical and the behavioral sciences conducted a critical assessment of the state of the sciences related to stress, health, and disease (Elliott and Eisdorfer 1982). This panel developed a conceptual framework to organize its review of findings and its recommendations. The framework included activators, reactions, consequences, and mediators. Activators are potential stressors in the environment that can prompt a reaction in the individual; the reaction may or may not lead to a more permanent condition, a consequence. Mediators act at each

Protective functions of health and self-esteem against depression in older adults facing illness or bereavement.

Four functions were examined by which health and self-esteem could ward off depression over time in older adults. Adults (N = 1,074)--55 years and older--were interviewed 5 times at 6-month intervals. Demographic and prevent depression controls were included. Neither health nor self-esteem served as an interactive buffer. Both had direct negative effects on depression, independent of events, over 2 years. Neither illnesses nor bereavements had direct effects on depression; both had indirect effects through other events; illness also had indirect effects by weakening health. Health had stronger preventive effect on illnesses but was more vulnerable to undesirable events than was self-esteem. There was little support for the specificity hypothesis that a close match between event and resource would increase resource effects.

Impact of Psychological and Physical Health, Stressful Events, and Social Support on Subsequent Mental Health Help Seeking among Older Adults.

Factors that influence mental health help seeking among adults 55+ years were examined prospectively. A discriminant analysis significantly differentiated between 120 older adults needing and seeking services and a comparison group of 120 older adults not needing services. Prior to having sought help, help seekers demonstrated poorer psychological well-being, reported more physical health problems, reported a higher level of unpleasant stressful events, and perceived greater deficits in the amount of social support available to them in time of need. The vast majority of these older help seekers sought help for their mental health problems from a medical doctor rather than from a mental health center or clinic or from a minister. Significantly more help seekers than nonseekers experienced stressful events involving bereavement, social and economic loss, and new physical illness.

Longitudinal relationships between depressive symptoms and health in normal older and middle-aged adults

Comorbidity between health and depression is salient in late life, when risk for physical illness rises. Other community studies have not distinguished between the effects of brief and long-standing depressive symptoms on excess morbidity and mortality. S. Cohen and M. S. Rodriguezs (1995) differential hypothesis of pathways between depression and health was used to examine the relationships between health and depression in a prospective probability sample of 1,479 community-resident middle-aged and older adults. Findings suggest that different durations of depressive symptoms have different relationships to health. Health had an impact on short-term increases in depressive symptoms but depressive symptoms had a weaker impact on health. The reciprocal impact was indistinguishable from the health influence on depression. In contrast, longer term depressive symptoms had a clear impact on health. The results imply that physical illness can affect depressive states; depressive traits but not states can affect illness.

Educational Attainment, Positive Psychological Mediators, and Resources for Health and Vitality in Older Adults

Objectives: To further explain the relationship of education to health by a prospective examination of positive psychological states as mediators. Furthermore, to examine the resources of desirable events, self-esteem, and social support as possible mediators between positive psychological states and subsequent health and vitality. Methods: Four in-home interviews were conducted at 6-month intervals with a probability sample of 1,277 older adults (aged 55 and older); multiple regression was used to estimate mediating effects. Results: Positive states mediated the education relationship to both symptoms and vitality, independent of negative states; the resource measures did not mediate the positive state-health relationship. Discussion: Higher education level appears to increase the likelihood of being serene and happy, and healthy and vital, in later years; positive psychological states appeared to have both a promotion function (for vitality) and protective function (against health symptoms); self-esteem showed promise as a possible mediator of the effects of psychological states on health.

Resources, life events, and changes in psychological states: A prospective framework.

Concluding CommentsAs researchers, we are intrigued by the complexities and questions involved in the study of resources and life events. As community psychologists, we hope this framework will contribute to improving the well-being of human groups. We believe that knowing those resources most likely to be effective in buffering or boosting a particular event should guide the planning of programs for groups likely to experience that event. Moreover, it is hoped that this framework will promote the idea that resources may “boost” positive experiences, thus increasing the likelihood of growth. The promotion of positive health has long been a value in community psychology but has been difficult to actualize. The boosting of desirable events may be one step in that direction.