Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Procedure
2.2. Measures
2.3. Statistical Analysis
3. Results
3.1. Sociodemographic Differences in Psychological Resilience
3.2. Correlation Analysis, and Hierarchical Linear Regressions
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Nussbaumer-Streit, B.; Mayr, V.; Dobrescu, A.I.; Chapman, A.; Persad, E.; Klerings, I.; Wagner, G.; Siebert, U.; Christof, C.; Zachariah, C.; et al. Quarantine alone or in combination with other public health measures to control COVID-19: A rapid review. Cochrane Database Syst. Rev. 2020, 9, CD013574. [Google Scholar] [CrossRef] [PubMed]
- Mazza, C.; Ricci, E.; Biondi, S.; Colasanti, M.; Ferracuti, S.; Napoli, C.; Roma, P.A. Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int. J. Environ. Res. Public Health 2020, 17, 3165. [Google Scholar] [CrossRef] [PubMed]
- Rossi, R.; Socci, V.; Talevi, D.; Mensi, S.; Niolu, C.; Pacitti, F.; Di Marco, A.; Rossi, A.; Siracusano, A.; Di Lorenzo, G. COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy. Front. Psychiatry 2020, 11, 790. [Google Scholar] [CrossRef] [PubMed]
- García-Portilla, P.; de la Fuente Tomás, L.; Bobes-Bascarán, T.; Jiménez Treviño, L.; Zurrón Madera, P.; Suárez Álvarez, M.; Menéndez Miranda, I.; García Álvarez, L.; Sáiz Martínez, P.A.; Bobes, J. Are Older Adults Also at Higher Psychological Risk from COVID-19? Aging Ment. Health 2020, 25, 1297–1304. [Google Scholar] [CrossRef] [PubMed]
- Sardella, A.; Chiara, E.; Alibrandi, A.; Bellone, F.; Catalano, A.; Lenzo, V.; Quattropani, M.C.; Basile, G. Changes in Cognitive and Functional Status and in Quality of Life of Older Outpatients during the COVID-19 Pandemic. Gerontology 2022. published online ahead of print. [Google Scholar] [CrossRef] [PubMed]
- Zaninotto, P.; Iob, E.; Demakakos, P.; Steptoe, A. Immediate and Longer-Term Changes in the Mental Health and Well-being of Older Adults in England During the COVID-19 Pandemic. JAMA Psychiatry 2022, 79, 151–159. [Google Scholar] [CrossRef]
- Bottesi, G.; Ghisi, M.; Altoè, G.; Conforti, E.; Melli, G.; Sica, C. The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Compr. Psychiatry 2015, 60, 170–181. [Google Scholar] [CrossRef]
- Zhang, W.; Walkover, M.; Wu, Y.Y. The challenge of COVID-19 for adult men and women in the United States: Disparities of psychological distress by gender and age. Public Health 2021, 198, 218–222. [Google Scholar] [CrossRef]
- Paccagnella, O.; Pongiglione, B. Depression deterioration of older adults during the first wave of the COVID-19 outbreak in Europe. Soc. Sci. Med. 2022, 299, 114828. [Google Scholar] [CrossRef]
- Reppas-Rindlisbacher, C.; Mahar, A.; Siddhpuria, S.; Savage, R.; Hallet, J.; Rochon, P. Gender Differences in Mental Health Symptoms Among Canadian Older Adults During the COVID-19 Pandemic: A Cross-Sectional Survey. Can. Geriatr. J. 2022, 25, 49–56. [Google Scholar] [CrossRef]
- Curtis, A.F.; Schmiedeler, A.; Musich, M.; Connell, M.; Miller, M.B.; McCrae, C.S. COVID-19-Related Anxiety and Cognition in Middle-Aged and Older Adults: Examining Sex as a Moderator. Psychol. Rep. 2022, 332941211064820. [Google Scholar] [CrossRef]
- Yan, S.; Xu, R.; Stratton, T.D.; Kavcic, V.; Luo, D.; Hou, F.; Bi, F.; Jiao, R.; Song, K.; Jiang, Y. Sex differences and psychological stress: Responses to the COVID-19 pandemic in China. BMC Public Health 2021, 21, 79. [Google Scholar] [CrossRef] [PubMed]
- Russell, D.; Taylor, J. Living alone and depressive symptoms: The influence of gender, physical disability, and social support among Hispanic and non-Hispanic older adults. J. Gerontol. B Psychol. Sci. Soc. Sci. 2009, 64, 95–104. [Google Scholar] [CrossRef] [PubMed]
- Koo, J.H.; Son, N.; Yoo, K.B. Relationship between the living-alone period and depressive symptoms among the elderly. Arch. Gerontol. Geriatr. 2021, 94, 104341. [Google Scholar] [CrossRef]
- Stone, J.; Evandrou, M.; Falkingham, J. The transition to living alone and psychological distress in later life. Age Ageing 2013, 42, 366–372. [Google Scholar] [CrossRef]
- Wagnild, G.M.; Young, H.M. Development and psychometric evaluation of the Resilience Scale. J. Nurs. Meas. 1993, 1, 165–178. [Google Scholar]
- MacLeod, S.; Musich, S.; Hawkins, K.; Alsgaard, K.; Wicker, E.R. The impact of resilience among older adults. Geriatr. Nurs. 2016, 37, 266–272. [Google Scholar] [CrossRef]
- Taylor, M.G.; Carr, D. Psychological Resilience and Health Among Older Adults: A Comparison of Personal Resources. J. Gerontol. B Psychol. Sci. Soc. Sci. 2021, 76, 1241–1250. [Google Scholar] [CrossRef]
- Lee, K.; Jeong, G.C.; Yim, J. Consideration of the Psychological and Mental Health of the Elderly during COVID-19: A Theoretical Review. Int. J. Environ. Res. Public Health 2020, 17, 8098. [Google Scholar] [CrossRef] [PubMed]
- Riehm, K.E.; Brenneke, S.G.; Adams, L.B.; Gilan, D.; Lieb, K.; Kunzler, A.M.; Smail, E.J.; Holingue, C.; Stuart, E.A.; Kalb, L.G.; et al. Association between psychological resilience and changes in mental distress during the COVID-19 pandemic. J. Affect. Disord. 2021, 282, 381–385. [Google Scholar] [CrossRef]
- Chen, L.K. Older adults and COVID-19 pandemic: Resilience matters. Arch. Gerontol. Geriatr. 2020, 89, 104124. [Google Scholar] [CrossRef]
- Lenzo, V.; Quattropani, M.C.; Musetti, A.; Zenesini, C.; Freda, M.F.; Lemmo, D.; Vegni, E.; Borghi, L.; Plazzi, G.; Castelnuovo, G.; et al. Resilience Contributes to Low Emotional Impact of the COVID-19 Outbreak Among the General Population in Italy. Front. Psychol. 2020, 11, 576485. [Google Scholar] [CrossRef]
- Lovibond, P.F.; Lovibond, S.H. Manual for the Depression Anxiety Stress Scales, 2nd ed.; Psychology Foundation: Sydney, Australia, 1995. [Google Scholar] [CrossRef]
- Girtler, N.; Casari, E.F.; Brugnolo, A.; Cutolo, M.; Dessi, B.; Guasco, S.; Olmi, C.; De Carli, F. Italian validation of the Wagnild and Young Resilience Scale: A perspective to rheumatic diseases. Clin. Exp. Rheumatol. 2010, 28, 669–678. [Google Scholar]
- Whitesides, L.; Lynn, J. The Psychosocial Effects of Frailty on Women. Clin. Geriatr Med. 2021, 37, 543–552. [Google Scholar] [CrossRef]
- Palomo, I.; García, F.; Albala, C.; Wehinger, S.; Fuentes, M.; Alarcón, M.; Arauna, D.; Montecino, H.; Mendez, D.; Sepúlveda, M.; et al. Characterization by Gender of Frailty Syndrome in Elderly People according to Frail Trait Scale and Fried Frailty Phenotype. J. Pers. Med. 2022, 12, 712. [Google Scholar] [CrossRef] [PubMed]
- Hou, F.; Bi, F.; Jiao, R.; Luo, D.; Song, K. Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China: A cross-sectional study. BMC Public Health 2020, 20, 1648. [Google Scholar] [CrossRef]
- Matud, M.P.; Zueco, J.; Díaz, A.; Del Pino, M.J.; Fortes, D. Gender differences in mental distress and affect balance during the first wave of COVID-19 pandemic in Spain. Curr. Psychol. 2022, 1–15. [Google Scholar] [CrossRef]
- Veer, I.M.; Riepenhausen, A.; Zerban, M.; Wackerhagen, C.; Puhlmann, L.M.C.; Engen, H.; Köber, G.; Bögemann, S.A.; Weermeijer, J.; Uściłko, A.; et al. Psycho-social factors associated with mental resilience in the Corona lockdown. Transl. Psychiatry 2021, 11, 67. [Google Scholar] [CrossRef]
- Rodrigues, F.R.; Tavares, D.M.D.S. Resilience in elderly people: Factors associated with sociodemographic and health conditions. Rev. Bras. Enferm. 2021, 74, e20200171. [Google Scholar] [CrossRef]
- Böell, J.E.; Silva, D.M.; Hegadoren, K.M. Sociodemographic factors and health conditions associated with the resilience of people with chronic diseases: A cross sectional study. Rev. Lat. Am. Enferm. 2016, 24, e2786. [Google Scholar] [CrossRef]
- Górska, S.; Singh Roy, A.; Whitehall, L.; Irvine Fitzpatrick, L.; Duffy, N.; Forsyth, K. A systematic review and correlational meta-analysis of factors associated with resilience of normally aging, community-living older adults. Gerontologist 2021, gnab110. [Google Scholar] [CrossRef]
- Kotwal, A.A.; Cenzer, I.S.; Waite, L.J.; Covinsky, K.E.; Perissinotto, C.M.; Boscardin, W.J.; Hawkley, L.C.; Dale, W.; Smith, A.K. The epidemiology of social isolation and loneliness among older adults during the last years of life. J. Am. Geriatr Soc. 2021, 69, 3081–3091. [Google Scholar] [CrossRef]
- Cacioppo, S.; Grippo, A.J.; London, S.; Goossens, L.; Cacioppo, J.T. Loneliness: Clinical import and interventions. Perspect. Psychol. Sci. 2015, 10, 238–249. [Google Scholar] [CrossRef] [PubMed]
- Veronese, N.; Galvano, D.; D’Antiga, F.; Vecchiato, C.; Furegon, E.; Allocco, R.; Smith, L.; Gelmini, G.; Gareri, P.; Solmi, M.; et al. Interventions for reducing loneliness: An umbrella review of intervention studies. Health Soc. Care Community 2021, 29, e89–e96. [Google Scholar] [CrossRef]
- Wickens, C.M.; McDonald, A.J.; Elton-Marshall, T.; Wells, S.; Nigatu, Y.T.; Jankowicz, D.; Hamilton, H.A. Loneliness in the COVID-19 pandemic: Associations with age, gender and their interaction. J. Psychiatr. Res. 2021, 136, 103–108. [Google Scholar] [CrossRef]
- Sayin Kasar, K.; Karaman, E. Life in lockdown: Social isolation, loneliness and quality of life in the elderly during the COVID-19 pandemic: A scoping review. Geriatr. Nurs. 2021, 42, 1222–1229. [Google Scholar] [CrossRef]
- Van Tilburg, T.G.; Steinmetz, S.; Stolte, E.; Van Der Roest, H.; De Vries, D.H. Loneliness and Mental Health During the COVID-19 Pandemic: A Study Among Dutch Older Adults. J. Gerontol. B Psychol. Sci. Soc. Sci. 2021, 76, e249–e255. [Google Scholar] [CrossRef] [PubMed]
- Damásio, B.F.; Borsa, J.C.; Da Silva, J.P. 14-item resilience scale (RS-14): Psychometric properties of the Brazilian version. J. Nurs. Meas. 2011, 19, 131–145. [Google Scholar] [CrossRef]
- Surzykiewicz, J.; Konaszewski, K.; Wagnild, G. Polish Version of the Resilience Scale (RS-14): A Validity and Reliability Study in Three Samples. Front. Psychol. 2019, 9, 2762. [Google Scholar] [CrossRef]
- Quattropani, M.C.; Lenzo, V.; Mucciardi, M.; Toffle, M.E. Psychometric properties of the Italian version of the Short Form of the Metacognitions Questionnaire (MCQ-30). BPA Appl. Psychol. Bull. 2015, 269, 30–42. [Google Scholar]
- Quattropani, M.C.; Lenzo, V.; Mucciardi, M.; Toffle, M.E. Metacognition as predictor of emotional distress in cancer patients. Life Span. Disabil. 2016, 19, 221–239. [Google Scholar]
- Lenzo, V.; Gargano, M.T.; Mucciardi, M.; Lo Verso, G.; Quattropani, M.C. Clinical efficacy and therapeutic alliance in a time-limited group therapy for young adults. Res. Psychother. Psychopathol. Process. Outcome 2014, 17, 9–20. [Google Scholar] [CrossRef] [Green Version]
Sociodemographic Characteristics | All Sample (N = 108) |
---|---|
Age, years (mean ± SD) | 70.02 (±3.53) |
Gender, % (female) | 60 (55.6) |
Primary and secondary school, n (%) | 9 (8.3) |
High school; n (%) | 41 (38) |
Bachelor’s degree; n (%) | 5 (4.6) |
Master’s degree; n (%) | 39 (36.1) |
Postgraduate; n (%) | 14 (13) |
Married, n (%) | 65 (60.2) |
Unmarried, n (%) | 11 (10.2) |
Widow/er, n (%) | 11 (10.2) |
Divorced, n (%) | 12 (11.1) |
Other, n (%) | 9 (8.3) |
Subjects with children, n (%) | 91 (84.3) |
Retired, n (%) | 65 (60.2) |
Psychological Clinical Assessment | All Sample (N = 108) | |
---|---|---|
Psychological Distress | ||
DASS-21 Depression (mean ± SD) | 8.80 (±8.81) | |
DASS-21 Anxiety (mean ± SD) | 5.56 (±6.58) | |
DASS-21 Stress (mean ± SD) | 10.43 (±8.50) | |
Subjects with mild to extremely severe DASS-21 Depression, n (%) | 43 (39.8) | DASS-21 Depression (mean ± SD) = 17.40 ± 7.49 |
Subjects with mild to extremely severe DASS-21 Anxiety, n (%) | 27 (25) | DASS-21 Anxiety (mean ± SD) = 14.59 ± 7.14 |
Subjects with mild to extremely severe DASS-21 Stress, n (%) | 24 (22.2) | DASS-21 Stress (mean ± SD) = 23.17 ± 6.04 |
Psychological Resilience | ||
Resilience Scale (RS) total (mean ± SD) | 122.19 (±36.17) | |
RS Meaningfulness (mean ± SD) | 35.37 (±11.37) | |
RS Self - Reliance (mean ± SD) | 30.62 (±8.67) | |
RS Perseverance (mean ± SD) | 14.61 (±4.85) | |
RS Existential Aloneness (mean ± SD) | 16.01 (±4.95) | |
RS Equanimity (mean ± SD) | 15.03 (±5.20) |
Psychological Resilience | Female (N = 60) | Male (N = 48) | Effect Size | p |
---|---|---|---|---|
Resilience Scale (RS) total (mean ± SD) | 115.35 (±41.23) | 130.75 (±26.64) | 0.054 | 0.027 |
RS Meaningfulness (mean ± SD) | 33.45 (±12.98) | 37.77 (±8.51) | 0.024 | 0.049 |
RS Self - Reliance (mean ± SD) | 28.75 (±9.19) | 32.97 (±7.42) | 0.044 | 0.011 |
RS Perseverance (mean ± SD) | 13.73 (±5.36) | 15.70 (±3.90) | 0.026 | 0.035 |
RS Existential Aloneness (mean ± SD) | 14.98 (±5.83) | 17.31 (±3.17) | 0.020 | 0.014 |
RS Equanimity (mean ± SD) | 14.25 (±5.95) | 16.02 (±3.90) | 0.038 | 0.079 |
Psychological Resilience | In a Relation (N = 67) | Not in A Relation (N = 41) | Effect Size | p |
---|---|---|---|---|
Resilience Scale (RS) total (mean ± SD) | 130.55 (±26.82) | 108.54 (±44.76) | 0.046 | 0.026 |
RS Meaningfulness (mean ± SD) | 37.80 (±8.56) | 31.39 (±14.11) | 0.034 | 0.055 |
RS Self - Reliance (mean ± SD) | 32.32 (±7.27) | 27.85 (±10.06) | 0.042 | 0.034 |
RS Perseverance (mean ± SD) | 15.73 (±3.69) | 12.78 (±5.90) | 0.046 | 0.026 |
RS Existential Aloneness (mean ± SD) | 17.17 (±3.72) | 14.12 (±6.06) | 0.054 | 0.016 |
RS Equanimity (mean ± SD) | 16.23 (±4.17) | 13.07 (±6,10) | 0.060 | 0.011 |
Psychological Resilience | With Children (N = 91) | No Children (N = 17) | Effect Size | p |
---|---|---|---|---|
Resilience Scale (RS) total (mean ± SD) | 125.55 (±35.17) | 104.24 (±37.18) | 0.055 | 0.015 |
RS Meaningfulness (mean ± SD) | 36.39 (±11.22) | 29.88 (±10.91) | 0.062 | 0.010 |
RS Self - Reliance (mean ± SD) | 31.45 (±8.38) | 26.23 (±9.16) | 0.045 | 0.028 |
RS Perseverance (mean ± SD) | 14.96 (±4.82) | 12.70 (±4.70) | 0.036 | 0.051 |
RS Existential Aloneness (mean ± SD) | 16.41 (±4.82) | 13.88 (±5.20) | 0.055 | 0.015 |
RS Equanimity (mean ± SD) | 15.43 (±5.11) | 12.88 (±5.26) | 0.038 | 0.041 |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |
---|---|---|---|---|---|---|---|---|---|
1. DASS-21 Depression | 1 | ||||||||
2. DASS-21 Anxiety | 0.609 ** | 1 | |||||||
3. DASS-21 Stress | 0.747 ** | 0.687 ** | 1 | ||||||
4. Resilience Scale (RS) total | −0.292 ** | −0.181 * | −0.312 ** | 1 | |||||
5. RS Meaningfulness | −0.286 ** | −0.199 * | −0.315 ** | 0.955 ** | 1 | ||||
6. RS Self-Reliance | −0.226 * | −0.128 | −0.255 ** | 0.928 ** | 0.837 ** | 1 | |||
7. RS Perseverance | −0.288 ** | −0.151 | −0.313 ** | 0.904 ** | 0.865 ** | 0.815 ** | 1 | ||
8. RS Existential Aloneness | −0.167 | −0.151 | −0.218 * | 0.843 ** | 0.811 ** | 0.753 ** | 0.714 ** | 1 | |
9. RS Equanimity | −0.246 * | −0.238 * | −0.288 ** | 0.844 ** | 0.780 ** | 0.720 ** | 0.751 ** | 0.790 ** | 1 |
Dependent Variables | Independent Variables | Model | Coefficients | ||||
---|---|---|---|---|---|---|---|
R2 | F | ||||||
DASS-21 Depression | 0.248 * | 2.617 | |||||
SE(B) | β | t | p | ||||
Age | 0.240 | −0.054 | −0.555 | 0.580 | |||
Gender | 1.766 | 0.054 | 0.537 | 0.593 | |||
Education | 0.680 | 0.016 | 0.161 | 0.872 | |||
Relationship status | 1.882 | −0.098 | −0.937 | 0.351 | |||
Presence of children | 2.372 | 0.033 | 0.340 | 0.735 | |||
Retirement status | 1.892 | −0.022 | −0.213 | 0.832 | |||
RS Total score | 0.449 | −2.734 | 2.028 | 0.045 | |||
RS Meaningfulness | 0.610 | −1.707 | −2.135 | 0.035 | |||
RS Self - Reliance | 0.516 | −1.145 | −2.155 | 0.026 | |||
RS Perseverance | 0.614 | −0.733 | −2.171 | 0.032 | |||
RS Existential Aloneness | 0.581 | −0.314 | 0.962 | 0.339 | |||
RS Equanimity | 0.563 | −0.878 | −1.644 | 0.010 | |||
R2 | F | ||||||
DASS-21 Anxiety | 0.226 * | 2.314 | |||||
SE(B) | β | t | p | ||||
Age | 0.182 | −0.008 | −0.081 | 0.936 | |||
Gender | 1.338 | 0.011 | 0.112 | 0.911 | |||
Education | 0.515 | −0.005 | −0.050 | 0.960 | |||
Relationship status | 1.426 | −0.156 | −1.480 | 0.142 | |||
Presence of sons | 1.797 | −0.016 | −0.158 | 0.875 | |||
Retirement status | 1.434 | −0.021 | −0.196 | 0.845 | |||
RS Total score | 0.340 | −4.758 | 2.547 | 0.012 | |||
RS Meaningfulness | 0.469 | −2.224 | −2.741 | 0.007 | |||
RS Self - Reliance | 0.391 | −1.154 | −2.240 | 0.027 | |||
RS Perseverance | 0.465 | −0.498 | −1.454 | 0.149 | |||
RS Existential Aloneness | 0.441 | −0.019 | −0.056 | 0.955 | |||
RS Equanimity | 0.426 | −1.339 | −3.973 | <0.001 | |||
R2 | F | ||||||
DASS-21 Stress | 0.267 * | 2.881 | |||||
SE(B) | β | t | p | ||||
Age | 0.229 | −0.149 | −1.546 | 0.125 | |||
Gender | 1.683 | 0.052 | 0.529 | 0.598 | |||
Education | 0.648 | 0.012 | 0.123 | 0.902 | |||
Relationship status | 1.793 | −0.134 | −1.302 | 0.196 | |||
Presence of sons | 2.260 | −0.035 | -0.356 | 0.722 | |||
Retirement status | 1.803 | −0.006 | −0.059 | 0.953 | |||
RS Total score | 0.427 | −3.367 | 1.852 | 0.047 | |||
RS Meaningfulness | 0.590 | −1.692 | −2.143 | 0.035 | |||
RS Self - Reliance | 0.491 | −1.042 | −2.077 | 0.041 | |||
RS Perseverance | 0.585 | −0.577 | −1,730 | 0.087 | |||
RS Existential Aloneness | 0.554 | −0.351 | 1.089 | 0.279 | |||
RS Equanimity | 0.536 | −0.842 | −2.567 | 0.012 |
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Sardella, A.; Lenzo, V.; Basile, G.; Musetti, A.; Franceschini, C.; Quattropani, M.C. Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. J. Pers. Med. 2022, 12, 1414. https://doi.org/10.3390/jpm12091414
Sardella A, Lenzo V, Basile G, Musetti A, Franceschini C, Quattropani MC. Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. Journal of Personalized Medicine. 2022; 12(9):1414. https://doi.org/10.3390/jpm12091414
Chicago/Turabian StyleSardella, Alberto, Vittorio Lenzo, Giorgio Basile, Alessandro Musetti, Christian Franceschini, and Maria C. Quattropani. 2022. "Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic" Journal of Personalized Medicine 12, no. 9: 1414. https://doi.org/10.3390/jpm12091414
APA StyleSardella, A., Lenzo, V., Basile, G., Musetti, A., Franceschini, C., & Quattropani, M. C. (2022). Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. Journal of Personalized Medicine, 12(9), 1414. https://doi.org/10.3390/jpm12091414