Hostname: page-component-7b7567c8c-tnzcf Total loading time: 0 Render date: 2026-11-12T22:41:03.940Z Has data issue: false hasContentIssue false
  • English
  • Français

Comorbid Depressive and Anxiety Symptomatology in Older Adults: The Role of Aging Self-Stereotypes, Loneliness, and Feelings of Guilt Associated with Self-Perception as a Burden

Published online by Cambridge University Press:  29 September 2023

María del Sequeros Pedroso-ChaparroOpen the ORCID record for María del Sequeros Pedroso-Chaparro[Opens in a new window],
Isabel CabreraOpen the ORCID record for Isabel Cabrera[Opens in a new window],
María Márquez-GonzálezOpen the ORCID record for María Márquez-González[Opens in a new window],
Óscar RibeiroOpen the ORCID record for Óscar Ribeiro[Opens in a new window] and
Andrés Losada-BaltarOpen the ORCID record for Andrés Losada-Baltar[Opens in a new window]
María del Sequeros Pedroso-Chaparro*
Affiliation:
Universidad Autónoma de Madrid (Spain)
Isabel Cabrera
Affiliation:
Universidad Autónoma de Madrid (Spain)
María Márquez-González
Affiliation:
Universidad Autónoma de Madrid (Spain)
Óscar Ribeiro
Affiliation:
Universidade de Aveiro (Portugal)
Andrés Losada-Baltar
Affiliation:
Universidad Rey Juan Carlos (Spain)
*
Corresponding author: Correspondence concerning this article should be addressed to María del Sequeros Pedroso-Chaparro. Universidad Autónoma de Madrid. Facultad de Psicología. Departamento de Psicología Biológica y de la Salud. Calle Iván Pavlov, 6, Campus de Cantoblanco. 28049 Madrid (Spain). E-mail: maria.pedroso@uam.es
Rights & Permissions [Opens in a new window]

Abstract

The main objective of this study was to analyze the differences between older adults’ symptom profiles (subclinical, anxiety, depressive, and comorbid) in negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden. Participants were 310 community-dwelling people aged 60 years and over. The sample was grouped into four symptom profiles of older adults: anxiety, depressive, comorbid anxiety-depression, and subclinical symptoms. We carried out multinomial logistic regression analyses to analyze the role of assessed variables in the explanation of the four symptom profiles. Older adults who reported a comorbid symptomatology presented higher negative aging self-stereotypes and feelings of loneliness than the other three profiles. Compared with the subclinical profile, older adults who reported clinical symptomatology (anxiety, depressive, and comorbid profile) presented higher feelings of guilt associated with self-perception as a burden. The findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.

Keywords

comorbid anxiety-depressive symptomsguilt associated with self-perception as a burdenlonelinessnegative self-perceptions of aging

Information

Type
Research Article
Information
The Spanish Journal of Psychology , Volume 26 , 2023, e26
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Universidad Complutense de Madrid and Colegio Oficial de la Psicología de Madrid

Anxiety and depression problems tend to appear together in older adults (Beekman et al., Reference Beekman, de Beurs, van Balkom, Deeg, van Dyck and van Tilburg2000; Dong et al., Reference Dong, Freedman and Mendes de Leon2020; King-Kallimanis et al., Reference King-Kallimanis, Gum and Kohn2009; Porensky et al., Reference Porensky, Dew, Karp, Skidmore, Rollman, Shear and Lenze2009; Saade et al., Reference Saade, Nicol, Lenze, Miller, Yingling, Wetherell, Reynolds and Mulsant2019, Wolitzky-Taylor et al., Reference Wolitzky-Taylor, Castriotta, Lenze, Stanley and Craske2010; Zhao et al., Reference Zhao, Zhang, Liu, Yue, Hou, Xia, Zuo, Liu, Jia, Dong and Ge2020). For example, in a sample of older adults who reported no limitations in self-care and mobility activities, Dong et al. (Reference Dong, Freedman and Mendes de Leon2020) found that 28.1% of the older adults with depression met screening criteria for anxiety, and 34.1% of those with anxiety met screening criteria for depression. Comorbid anxiety and depressive symptomatology among older adults have been associated with disability (Dong et al., Reference Dong, Freedman and Mendes de Leon2020; Prina et al., Reference Prina, Ferri, Guerra, Brayne and Prince2011), more persistent symptoms than anxiety and depression alone (Almeida et al., Reference Almeida, Draper, Pirkis, Snowdon, Lautenschlager, Byrne, Sim, Stocks, Kerse, Flicker and Pfaff2012), memory impairment (DeLuca et al., Reference DeLuca, Lenze, Mulsant, Butters, Karp, Dew, Pollock, Shear, Houck and Reynolds2005; Kvaal et al., Reference Kvaal, McDougall, Brayne, Matthews, Dewey and MRC2008), or suicidal ideation and behavior (Jeste et al., Reference Jeste, Hays and Steffens2006; Lenze et al., Reference Lenze, Mulsant, Shear, Schulberg, Dew, Begley, Pollock and Reynolds2000; Saade et al., Reference Saade, Nicol, Lenze, Miller, Yingling, Wetherell, Reynolds and Mulsant2019). The concurrent presentation of anxiety and depressive symptoms has also been associated with a moderate efficacy of interventions (Wuthrich et al., Reference Wuthrich, Meuldijk, Jagiello, González Robles, Jones and Cuijpers2021).

The above-mentioned issues highlight the clinical relevance of analyzing comorbid anxious-depressive symptoms and their associations with sociodemographic and psychological variables. Although some sociodemographic and health-related factors associated with comorbid anxiety and depression in older adults, such as living alone (Hek et al., Reference Hek, Tiemeier, Newson, Luijendijk, Hofman and Mulder2011), socioeconomic stressors (Almeida et al., Reference Almeida, Draper, Pirkis, Snowdon, Lautenschlager, Byrne, Sim, Stocks, Kerse, Flicker and Pfaff2012) and more limitations in activities of daily living (Cairney et al., Reference Cairney, Corna, Veldhuizen, Herrmann and Streiner2008), have already been identified, research is still needed to further advance the study of psychological factors potentially related with comorbid anxiety and depression in older adults.

A psychological variable that has shown important associations with older adults´ mental health is negative self-perceptions of aging. Following the theory of stereotype embodiment (Levy, Reference Levy2009; Levy et al., Reference Levy, Slade, Murphy and Gill2012), negative self-perceptions of aging arise as a result of the internalization and activation of negative stereotypical beliefs about old age (e.g., old age is a time of inevitable cognitive decline, disability, and dependence on others; Bryant et al., Reference Bryant, Bei, Gilson, Komiti, Jackson and Judd2012), and have been widely associated with psychological distress in the literature, including anxiety (Bryant et al., Reference Bryant, Bei, Gilson, Komiti, Jackson and Judd2012; Freeman et al., Reference Freeman, Santini, Tyrovolas, Rummel-Kluge, Haro and Koyanagi2016; Levy et al., Reference Levy, Pilver and Pietrzak2014; Levy et al., Reference Levy, Chung, Slade, van Ness and Pietrzak2019) and depressive symptoms (e.g., Bryant et al., Reference Bryant, Bei, Gilson, Komiti, Jackson and Judd2012; Freeman et al., Reference Freeman, Santini, Tyrovolas, Rummel-Kluge, Haro and Koyanagi2016; Gendron et al., Reference Gendron, Inker, Andricosky and Zanjani2020; Levy et al., Reference Levy, Chung, Slade, van Ness and Pietrzak2019; O’Shea et al., Reference O’Shea, Dotson and Fieo2017; Sindi et al., Reference Sindi, Juster, Wan, Nair, Ying Kin and Lupien2012). Also, Losada-Baltar et al. (Reference Losada-Baltar, Márquez-González, Jiménez-Gonzalo, Pedroso-Chaparro, Gallego-Alberto and Fernandes-Pires2021) explored the relationship between negative self-perceptions of aging and level of psychological symptoms as a function of age group in Spanish adults aged 18 to 88 years who were assessed online during the COVID-19 lockdown. The results showed that individuals with low scores on both anxiety and sadness reported the lowest scores on negative self-perceptions of aging, and older people with comorbid symptomatology of anxiety and sadness reported the highest scores in negative self-perception of aging (Losada-Baltar et al., Reference Losada-Baltar, Márquez-González, Jiménez-Gonzalo, Pedroso-Chaparro, Gallego-Alberto and Fernandes-Pires2021).

Likewise, loneliness, defined as a “debilitating psychological condition characterized by a deep sense of emptiness, worthlessness, lack of control, and personal threat” (Cacioppo et al., Reference Cacioppo, Hawkley and Thisted2010; p. 2), has been associated with emotional distress, including symptoms of anxiety and depression in older adults (e.g., Domènech-Abella et al., Reference Domènech-Abella, Mundó, Haro and Rubio-Valera2019; Lee & Bierman, Reference Lee and Bierman2019). Previous literature has reported a consistent association between loneliness and the comorbid presence of anxiety and depressive symptoms. For example, Palgi et al. (Reference Palgi, Shrira, Ring, Bodner, Avidor, Bergman, Cohen-Fridel, Keisari and Hoffman2020), in a large sample of adults aged between 18 and 100 years old, found that loneliness was the main risk-factor for depression, anxiety and, especially, their comorbid presentation. Similar findings were reported by Igbokwe et al. (Reference Igbokwe, Ejeh, Agbaje, Umoke, Iweama and Ozoemena2020) in a sample of older adults.

Finally, being a burden to others is such a common concern for older adults (Miller et al., Reference Miller, Sinding, Griffith, Shannon and Raina2016; Peek et al., Reference Peek, Luijkx, Rijnaard, Nieboer, van der Voort, Aarts, van Hoof, Vrijhoef and Wouters2016) that it has been linked to feelings of guilt (e.g., Bigger & Vo, Reference Bigger and Vo2022). Also, previous studies found that feeling of guilt associated with self-perception as a burden, defined as the distress related to “the perception of being responsible for other relatives’ difficulties associated with an anticipated experience of care” (Pedroso-Chaparro et al., Reference Pedroso-Chaparro, Cabrera, Márquez-González, Olmos, Romero-Moreno, Vara-García, Gallego-Alberto, Barrera-Caballero and Losada-Baltar2021; p. 192), were associated with distress in older adults (Pedroso-Chaparro et al., Reference Pedroso-Chaparro, Cabrera, Márquez-González, Olmos, Romero-Moreno, Vara-García, Gallego-Alberto, Barrera-Caballero and Losada-Baltar2021). However, to our knowledge, no studies have examined the role of feelings of guilt associated with self-perception as a burden in depressive and anxiety comorbidity.

The aim of this study was to analyze the role of negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden in the explanation of older adults’ symptom profiles: (a) Subclinical (low levels of depressive and anxiety symptoms), (b) anxiety (low depressive symptoms and high anxiety symptoms), (c) depressive (high depressive symptoms and low anxiety symptoms), and (d) comorbid (high levels of both depressive and anxiety symptomatology). We hypothesize that negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden will predict a higher probability of showing a comorbid anxiety and depression symptoms profile.

Method

Participants

Participants were 310 older adults living in the community. Assessments were conducted between January 2018 and December 2019. Inclusion criteria were: (a) Being 60 years of age or older; (b) not showing explicit cognitive or functional limitations that prevent activities of daily life; and (c) not using care services such as day care centers, home care, or nursing homes. Participants were contacted through centers in the community of Madrid (Spain) that offered activities for older adults (such as painting or sewing workshops). All participants provided written informed consent to being studied and answer the assessment protocol at their centers of reference. The sample used in this study is partially shared with the study carried out by Pedroso-Chaparro et al. (Reference Pedroso-Chaparro, Cabrera, Márquez-González, Olmos, Romero-Moreno, Vara-García, Gallego-Alberto, Barrera-Caballero and Losada-Baltar2021). The Ethics Committee of the Rey Juan Carlos University approved the study protocol.

Measures

Socio-demographic variables (age, gender, marital status, and level of education) and the following variables were measured:

Self-perceptions of aging were measured using the Subjective Perception of Aging scale (de Gracia Blanco et al., Reference de Gracia Blanco, Garre Olmo, Marcó Arbonès and Monreal Bosch2004), made up of 12 items (e.g., ‘I think that for my age I am very fit’) that reflect four underlying dimensions of self-concept: Cognitive self-concept, subjective time perception, subjective perception of social relations, and physical self-concept. The answers range from 1 (‘totally agree’) to 7 (‘totally disagree’). A higher score on the Likert-type scale indicates a negative perception of aging. The internal consistency index (Cronbach) obtained in the present study was .75.

Loneliness was assessed through the Spanish version of the Three-Item Loneliness scale (Hughes et al., Reference Hughes, Waite, Hawkley and Cacioppo2004; Pedroso-Chaparro et al., Reference Pedroso-Chaparro, Márquez-González, Fernandes-Pires, Gallego-Alberto, Jiménez-Gonzalo, Nuevo and Losada2022). The scale has three items (e.g., ‘How often do you feel isolated from others?’). Response options on the three-point Likert-type scale ranged from 1 (‘hardly ever’) to 3 (‘often’). The internal consistency Cronbach (α) of the scale in the present study was .77.

Guilt associated with Self-Perception as a Burden was measured through the Guilt associated with Self-Perception as a Burden Scale (G-SPBS; Pedroso-Chaparro et al., Reference Pedroso-Chaparro, Cabrera, Márquez-González, Olmos, Romero-Moreno, Vara-García, Gallego-Alberto, Barrera-Caballero and Losada-Baltar2021). The scale has 16 items (e.g., ‘I feel guilty because my family has to stop doing other things in order to help me’), with options on the five-point Likert-type scale ranging from 1 (‘never or almost never’) to 5 (‘almost always’). The internal consistency index obtained in the present study according to the Cronbach’s alpha coefficient was .97.

Anxiety symptomatology was measured through the Spanish version of the Geriatric Anxiety Inventory (GAI; Márquez-González et al., Reference Márquez-González, Losada, Fernández-Fernández and Pachana2012; Pachana et al., Reference Pachana, Byrne, Siddle, Koloski, Harley and Arnold2007), a 20-item scale (e.g., ‘I often feel nervous’) with a dichotomous response option 0 ‘no’ and 1 ‘yes’. The cut-off score established for clinical screening is 11 or more (Pachana et al., Reference Pachana, Byrne, Siddle, Koloski, Harley and Arnold2007). The internal consistency Cronbach (α) of the scale in the present study was .93.

Depressive symptomatology was assessed through the Spanish version of the Center for Epidemiological Studies Depression Scale (CES-D; Losada et al., Reference Losada, Márquez-González, García-Ortiz, Gómez-Marcos, Fernández-Fernández and Rodríguez-Sánchez2012; Radloff, Reference Radloff1977). The scale is a 20-item scale (e.g., ‘I felt depressed’) which measures depressive symptoms during the previous week. Response options on the four-point Likert-type scale ranged from 0 (‘rarely or none of the time’) to 3 (‘most or all of the time’). The cut-off score established for clinical screening is 16 or more (Radloff, Reference Radloff1977). The internal consistency Cronbach (α) of the scale in the present study was .87.

Data Analysis

Firstly, descriptive analyses (mean, standard deviation, and range) were performed. Secondly, t-tests were conducted to compare women and men. Then, to analyze the relationship between variables, correlation analyses were performed. Finally, the sample was grouped into four symptom profiles of older adults according to the cut-off point of the CES-D (≥ 16) (Radloff, Reference Radloff1977) and the GAI (≥ 11) (Pachana et al., Reference Pachana, Byrne, Siddle, Koloski, Harley and Arnold2007) scales. The following groups or symptoms profiles were created: (a) Subclinical profile: Low levels of depressive and anxiety symptoms; (b) Anxiety profile: Low depressive symptoms and high anxiety symptoms; (c) Depressive profile: High depressive symptoms and low anxiety symptoms; and (d) Comorbid profile: High levels of both depressive and anxiety symptomatology.

Multinomial logistic regression analyses were carried out to identify predictors of emotional distress profiles in the four groups. Older adults’ gender and age, negative self-perceptions of aging, loneliness, and guilt associated with self-perception as a burden were included in the regressions as predictor variables. The profiles were fixed as the reference category in the nominal dependent variable so that all the profiles could be compared with each other. A significance level of 5% was used throughout all analyses. The IBM SPSS Statistics program (version 22.0) was used for all analyses.

Results

Participant Characteristics

Participants had a mean age of 72.01 years (SD = 6.18; range = 60-92) and consisted primarily of women (71%). Most of the participants were married (67.4%), followed by widowed (25.8%), separated or divorced (4.2%) and single (1.3%) (for the marital status, there was a reduction in the sample size to 306 participants due to missing data). Regarding years of formal education, 9.9% reported no formal education (0 years), 35.6% primary education (6 years), 26.7% lower secondary education (9 years), 21.2% higher secondary education (13 years), 4.1% a 3-year university degree (16 years), 1.4% a 5-year university degree (18 years), and 1% a Ph.D. degree (19 years or more) (for years of formal education, there was a reduction in the sample size to 292 participants due to missing data). Most of the participants reported levels of symptomatology over the suggested cut-off scores for the CES-D and the GAI. Most of them reported comorbid depressive and anxiety symptomatology (comorbid profile; n = 96, 31.0%), followed by those who reported depressive symptomatology (depressive profile; n = 76, 24.5%) and anxiety symptomatology (anxiety profile; n = 31; 10%). The remaining participants were grouped into the subclinical profile group (n = 107; 34.5%).

Gender Differences

Women reported worse self-perceived health (t = 2.22, p = .028) and higher levels of anxiety (t = -5.01, p < .01) and depressive symptoms (t= -2.71, p < .05). No additional gender differences were found.

Correlations

Associations between the assessed variables are shown in Table 1. Being older was positively associated with loneliness (r = .13, p < .05) and depressive symptoms (r = .11, p < .05). Negative self-perceptions of aging were positively associated with loneliness (r = .40, p < .01), guilt associated with self-perception as a burden (r = .21, p < .01), anxiety (r = .39, p < .01), and depressive (r = .53, p < .01) symptoms. Loneliness was positively associated with guilt associated with self-perception as a burden (r = .30, p < .01), anxiety (r = .46, p < .01) and depressive (r = .56, p < .01) symptoms. In addition, guilt associated with self-perception as a burden was positively associated with anxiety (r = .25, p < .01) and depressive (r = .35, p < .01) symptoms. Anxiety and depressive symptoms were themselves highly positively correlated (r = .59, p < .01).

Table 1.

Descriptive Data and Correlation Matrix

Note.

* p < .05;

** p < .01.

Determinants of Symptom Profile

Table 2 shows the coefficients (adjusted odds ratio) and their 95% confidence intervals predicting the anxiety, depressive, and comorbid profiles versus the reference subclinical profile; the table also shows the 95% confidence intervals predicting differences between clinical profiles. The examined predictors were gender and age, negative self-perceptions of aging, loneliness, and guilt associated with self-perception as a burden. Significant results were found for older adults’ gender, LR(3) = 31.064; p < .001. No significant results were found for age, LR(3) = 7.039; p = .071. Also, negative self-perceptions of aging had a significant relationship with the symptom profile, LR(3) = 47.17; p < .001. Finally, loneliness and guilt associated with self-perception as a burden also made a significant contribution, LR(3) = 22.43; p < .001; and LR(3) = 13.96; p = .003; respectively.

Table 2.

Multinomial Logistic Regression Analyses of Symptom Profile

Note.

* p < .05;

** p < .01.

Firstly, differences between the clinical symptomatology profiles (anxiety, depressive, and comorbid profile) and the subclinical profile are presented. Women were more likely than men to be included in the anxiety profile, depressive profile, and comorbid profile relative to the subclinical profile, OR = 2.26; 95% CI [2.612, 35.029]; OR = 1.00; 95% CI [1.309, 5.643]; and OR = 1.98; 95% CI [3.024, 17.496], respectively. In addition, negative self-perception of aging was a risk factor for being in the depressive profile and comorbid profile relative to the subclinical profile, OR = 0.08; 95% CI [1.042, 1.115]; OR = 0.11; 95% CI [1.078, 1.160], respectively. Loneliness was a risk factor for being in the comorbid profile relative to the subclinical profile, OR = 0.56; 95% CI [1.306, 2.321]. Finally, guilt associated with self-perception as a burden was a risk factor for being in the anxiety profile, depressive profile, and comorbid profile relative to the subclinical profile, OR = 0.08; 95% CI [1.018, 1.143]; OR = 0.08; 95% CI [1.024, 1.138]; and OR = 0.08; 95% CI [1.024, 1.140], respectively.

Second, the differences between the three clinical symptomatology profiles (anxiety, depressive, and comorbid profile) are presented. Women were more likely than men to be included in the comorbid profile relative to the depressive profile, OR = 0.99; 95% CI [1.179, 6.077]. In addition, negative self-perception of aging was a risk factor for being in the comorbid profile relative to the anxiety and depressive profiles, OR = 0.08; 95% CI [1.029, 1.130]; OR = 0.4; 95% CI [1.005, 1.071], respectively. Finally, loneliness was a risk factor for being in the comorbid profile relative to the anxiety profile and depressive profile, OR = 0.56; 95% CI [1.185, 2.573]; OR = 0.34; 95% CI [1.128, 1.765], respectively.

Discussion

The aim of this study was to analyze the role of negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden in the explanation of older adults’ symptom profiles: Subclinical, anxiety, depressive, and comorbid. As expected, the results of the present study replicate previous findings showing an association between negative aging self-stereotypes (e.g., Levy et al., Reference Levy, Chung, Slade, van Ness and Pietrzak2019), loneliness (e.g., Lee & Bierman, Reference Lee and Bierman2019), and guilt associated with self-perception as a burden (e.g., Pedroso-Chaparro et al., Reference Pedroso-Chaparro, Cabrera, Márquez-González, Olmos, Romero-Moreno, Vara-García, Gallego-Alberto, Barrera-Caballero and Losada-Baltar2021) and psychological distress, with significant associations obtained with anxiety and depressive symptoms. Likewise, consistent with the results of the previous studies, our data showed that women reported more anxiety and depressive symptoms than men (e.g., Ciuffreda et al., Reference Ciuffreda, Cabanillas-Barea, Carrasco-Uribarren, Albarova-Corral, Argüello-Espinosa and Marcén-Román2021). Finally, our results also showed an association between being older and depressive symptoms (e.g., Tan et al., Reference Tan, Ma, Zhu, Wang, Zou, Li, Li, He and Wu2023; Zenebe et al., Reference Zenebe, Akele, W/Selassie and Necho2021).

Regarding regression analyses, consistent with previous research, our results suggest that negative aging self-stereotypes (e.g., Losada-Baltar, et al., Reference Losada-Baltar, Márquez-González, Jiménez-Gonzalo, Pedroso-Chaparro, Gallego-Alberto and Fernandes-Pires2021) and loneliness (e.g., Igbokwe et al., Reference Igbokwe, Ejeh, Agbaje, Umoke, Iweama and Ozoemena2020) are key variables in the comorbid presence of significant anxiety and depression symptoms. However, our results provide evidence for the first time of the association between guilt linked to self-perception as a burden and comorbid depressive and anxiety symptoms, with the findings suggesting that feelings of guilt associated with self-perception as a burden are related to all three clinical symptomatology profiles (anxiety, depressive, and comorbid profile). Specifically, our results suggest that this variable allowed the anxiety, depressive, and comorbid profiles to be differentiated from the subclinical profile but did not contribute to differentiating between the anxiety and depressive symptom profiles and the comorbid profile. These results indicate that experiencing significant symptoms of distress (anxiety, depression, or both) would be equally associated with the presence of this type of guilt. Following Joyner’s (Reference Joyner1998) suggestion, one of the sources for older adults experiencing anxiety and depression symptoms could be their consideration that their symptoms may cause emotional pain in relevant people in their lives, generating in them guilt associated with self-perception as a burden. In relation to sociodemographic factors, and consistent with the results found in previous studies, our results showed that being female was significantly associated with a higher report of anxiety, depression, and comorbid symptoms (Dong et al., Reference Dong, Freedman and Mendes de Leon2020; Santini et al., Reference Santini, Fiori, Feeney, Tyrovolas, Haro and Koyanagi2016). However, no age differences were found. This result is consistent with findings in previous studies suggesting that instead of chronological age, self-perceptions of ageing are associated with distress profiles (Losada-Baltar et al., Reference Losada-Baltar, Márquez-González, Jiménez-Gonzalo, Pedroso-Chaparro, Gallego-Alberto and Fernandes-Pires2021).

Among the results worth highlighting in this study is the observed high prevalence of clinical anxiety (10%), depressive (24.5%), and comorbid anxiety and depressive (31.0%) screening criteria symptoms, with 34.5% of the participants showing no clinically significant levels of depressive and/or anxiety symptoms. Previous studies have also found high percentages of depressive and anxiety screening criteria symptoms. For example, in a sample of retired adults over 60 years of age, Igbokwe et al. (Reference Igbokwe, Ejeh, Agbaje, Umoke, Iweama and Ozoemena2020) found that 7.2% presented anxiety symptoms, 31.5% presented depressive symptoms, and 20.5% presented both types of screening criteria symptoms. The high comorbidity of significant anxiety and depressive symptoms in the older adults found in the present study is also consistent with the high co-occurrence of anxiety and depressive symptoms and disorders found in previous studies (e.g., Beekman et al., Reference Beekman, de Beurs, van Balkom, Deeg, van Dyck and van Tilburg2000; Dong et al., Reference Dong, Freedman and Mendes de Leon2020; Zhao et al., Reference Zhao, Zhang, Liu, Yue, Hou, Xia, Zuo, Liu, Jia, Dong and Ge2020). Considering the negative outcomes (e.g., longer duration of symptoms and lower efficacy of interventions) associated with comorbid presentations of anxiety and depressive symptoms, these findings also suggest that targeting negative self-perceptions of aging, loneliness, and guilt associated with self-perception as a burden might be especially important when developing interventions for older adults with emotional comorbid presentations. Specifically, our results suggest some practical implications. Programs to encourage more realistic views of ageing and strategies to reduce feelings of loneliness appear to be key for reducing anxious-depressive comorbidity in older adults. Also, normalizing the idea of accepting help may reduce feelings of guilt associated with self-perceived burden in older adults, decreasing the likelihood of experiencing anxiety, depression, or anxious-depressive comorbid symptoms.

Several limitations of the study should be mentioned. First, the cross-sectional design of the study prevents causal inferences. Future experimental and longitudinal studies are needed to confirm the findings. Second, the convenience sampling limits the extrapolation of the results to the general population of older adults. Third, even though the scale used to assess loneliness has shown appropriate psychometric properties, it is composed of only three items. Future studies may consider using more exhaustive measures of this same construct (for example, University of California, Los Angeles Loneliness Revised Scale; R-UCLA; Russell et al., Reference Russell, Peplau and Cutrona1980). In addition, this study was carried out considering established cut-off points in anxiety and depression scales to determine the symptoms profiles; these cut-off points therefore influence the number of older adults being classified with significant anxious and depressive symptoms. Finally, the present study was carried out with a sample composed of Spanish older adults, and cultural issues may be influencing the results. For example, higher levels of loneliness have been found in collectivistic societies, such as Spain, compared with individualistic societies (Lykes & Kemmelmeier, Reference Lykes and Kemmelmeier2014).

Despite these limitations, this study is a first and preliminary approach to the analysis of the role of negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden in the explanation of older adults’ symptom profiles (subclinical, anxiety, depressive, and comorbid). The obtained results stress that older adult who reported a comorbid symptomatology presented higher feelings of guilt associated with self-perception as a burden, as well as higher symptoms of loneliness and more negative self-perceptions of aging. Considering that comorbid anxiety and depressive symptoms have been associated with negative consequences such as suicidal ideation and behavior (Jeste et al., Reference Jeste, Hays and Steffens2006; Lenze et al., Reference Lenze, Mulsant, Shear, Schulberg, Dew, Begley, Pollock and Reynolds2000; Saade et al., Reference Saade, Nicol, Lenze, Miller, Yingling, Wetherell, Reynolds and Mulsant2019), a relevant issue in the older adult population (World Health Organization, 2017), the findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.

Acknowledgements

The authors thank all the participants in the study. We thank the Ayuntamiento de Getafe (Madrid, Spain) the Centro de Mayores “Ferrer i Guardia” (Madrid, Spain), and Centro de Mayores Ramón Rubial (Madrid, Spain) for their support in the recruitment of the sample.

Funding statement

María del Sequeros Pedroso-Chaparro was supported by a pre-doctoral grant from the Universidad Autónoma de Madrid. Additionally, María del Sequeros Pedroso-Chaparro was supported by the Erasmus+ Traineeship Programme.

Competing interest

None.

Data sharing

The study materials, analytic methods, and data are available from the corresponding author on reasonable request.

Authorship credit

María del Sequeros Pedroso-Chaparro conceived, designed, and supervised the study, collected, analyzed, and interpreted the data and drafted the manuscript. Isabel Cabrera conceived, designed, and supervised the study and revised the manuscript. María Márquez-González conceived, designed, and supervised the study and revised the manuscript. Oscar Ribeiro interpreted the data and revised the manuscript. Andrés Losada Baltar conceived, designed, and supervised the study and revised the manuscript.

References

Almeida, O. P., Draper, B., Pirkis, J., Snowdon, J., Lautenschlager, N. T., Byrne, G., Sim, M., Stocks, N., Kerse, N., Flicker, L., & Pfaff, J. J. (2012). Anxiety, depression, and comorbid anxiety and depression: Risk factors and outcome over two years. International Psychogeriatrics, 24(10), 1622–1632. https://doi.org/10.1017/S104161021200107XCrossRefGoogle ScholarPubMed
Beekman, A. T., de Beurs, E., van Balkom, A. J., Deeg, D. J., van Dyck, R., & van Tilburg, W. (2000). Anxiety and depression in later life: Co-occurrence and communality of risk factors. American Journal of Psychiatry, 157(1), 89–95. http://doi.org/10.1176/ajp.157.1.89CrossRefGoogle ScholarPubMed
Bigger, S. E., & Vo, T. (2022). Self-perceived burden: A critical evolutionary concept analysis. Journal of Hospice and Palliative Nursing, 24(1), 40–49. https://doi.org/10.1097/NJH.0000000000000805CrossRefGoogle Scholar
Bryant, C., Bei, B., Gilson, K., Komiti, A., Jackson, H., & Judd, F. (2012). The relationship between attitudes to aging and physical and mental health in older adults. International Psychogeriatrics, 24(10), 1674–1683. https://doi.org/10.1017/S1041610212000774CrossRefGoogle ScholarPubMed
Cacioppo, J. T., Hawkley, L. C., & Thisted, R. A. (2010). Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging, 25(2), 453–463. https://doi.org/10.1037/a0017216CrossRefGoogle ScholarPubMed
Cairney, J., Corna, L. M., Veldhuizen, S., Herrmann, N., & Streiner, D. L. (2008). Comorbid depression and anxiety in later life: Patterns of association, subjective well-being, and impairment. The American Journal of Geriatric Psychiatry, 16(3), 201–208. https://doi.org/10.1097/JGP.0b013e3181602a4aCrossRefGoogle ScholarPubMed
Ciuffreda, G., Cabanillas-Barea, S., Carrasco-Uribarren, A., Albarova-Corral, M. I., Argüello-Espinosa, M. I., & Marcén-Román, Y. (2021). Factors associated with depression and anxiety in adults ≥ 60 years old during the COVID–19 pandemic: A systematic review. International Journal of Environmental Research and Public Health, 18(22), Article 11859. https://doi.org/10.3390/ijerph182211859CrossRefGoogle ScholarPubMed
de Gracia Blanco, M., Garre Olmo, J., Marcó Arbonès, M., & Monreal Bosch, P. (2004). Analysis of self-concept in older adults in different contexts. European Journal of Psychological Assessment, 20(4), 262–274. https://doi.org/10.1027/1015-5759.20.4.262CrossRefGoogle Scholar
DeLuca, A. K., Lenze, E. J., Mulsant, B. H., Butters, M. A., Karp, J. F., Dew, M. A., Pollock, B. G., Shear, M. K., Houck, P. R., & Reynolds, C. F. III. (2005). Comorbid anxiety disorder in late life depression: Association with memory decline over four years. International Journal of Geriatric Psychiatry, 20(9), 848–854. https://doi.org/10.1002/gps.1366CrossRefGoogle ScholarPubMed
Domènech-Abella, J., Mundó, J., Haro, J. M., & Rubio-Valera, M. (2019). Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA). Journal of Affective Disorders, 246, 82–88. https://doi.org/10.1016/j.jad.2018.12.043CrossRefGoogle ScholarPubMed
Dong, L., Freedman, V. A., & Mendes de Leon, C. F. (2020). The association of comorbid depression and anxiety symptoms with disability onset in older adults. Psychosomatic Medicine, 82(2), 158–164. https://doi.org/10.1097/PSY.0000000000000763CrossRefGoogle ScholarPubMed
Freeman, A. T., Santini, Z. I., Tyrovolas, S., Rummel-Kluge, C., Haro, J. M., & Koyanagi, A. (2016). Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA). Journal of Affective Disorders, 199, 132–138. https://doi.org/10.1016/j.jad.2016.03.042CrossRefGoogle ScholarPubMed
Gendron, T., Inker, J. K., Andricosky, R., & Zanjani, F. (2020). Development of the Relational Ageism Scale: Confirmatory test on survey data. The International Journal of Aging and Human Development, 90(3), 281–296. https://doi.org/10.1177/0091415019836956CrossRefGoogle ScholarPubMed
Hek, K., Tiemeier, H., Newson, R. S., Luijendijk, H. J., Hofman, A., & Mulder, C. L. (2011). Anxiety disorders and comorbid depression in community dwelling older adults. International Journal of Methods in Psychiatric Research, 20(3), 157–168. https://doi.org/10.1002/mpr.344CrossRefGoogle ScholarPubMed
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys. Research on Aging, 26(6), 655–672. https://doi.org/10.1177/0164027504268574CrossRefGoogle Scholar
Igbokwe, C. C., Ejeh, V. J., Agbaje, O. S., Umoke, P. I. C., Iweama, C. N., & Ozoemena, E. L. (2020). Prevalence of loneliness and association with depressive and anxiety symptoms among retirees in Northcentral Nigeria: A cross-sectional study. BMC Geriatrics, 20(1), Article 153. https://doi.org/10.1186/s12877-020-01561-4CrossRefGoogle ScholarPubMed
Jeste, N. D., Hays, J. C., & Steffens, D. C. (2006). Clinical correlates of anxious depression among elderly patients with depression. Journal of Affective Disorders, 90(1), 37–41. https://doi.org/10.1016/j.jad.2005.10.007CrossRefGoogle ScholarPubMed
Joyner, J. D. (1998). A phenomenological exploration of suffering within chronic depressive illness. The Catholic University of America.Google Scholar
King-Kallimanis, B., Gum, A. M., & Kohn, R. (2009). Comorbidity of depressive and anxiety disorders for older Americans in the national comorbidity survey replication. The American Journal of Geriatric Psychiatry, 17(9), 782–792. https://doi.org/10.1097/JGP.0b013e3181ad4d17CrossRefGoogle ScholarPubMed
Kvaal, K., McDougall, F. A., Brayne, C., Matthews, F. E., Dewey, M. E., & MRC, CFAS. (2008). Co-occurrence of anxiety and depressive disorders in a community sample of older people: Results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). International Journal of Geriatric Psychiatry, 23(3), 229–237. https://doi.org/10.1002/gps.1867CrossRefGoogle Scholar
Lee, Y., & Bierman, A. (2019). Loneliness as a mediator of perceived discrimination and depression: Examining education contingencies. The International Journal of Aging and Human Development, 89(2), 206–227. https://doi.org/10.1177/0091415018763402CrossRefGoogle ScholarPubMed
Lenze, E. J., Mulsant, B. H., Shear, M. K., Schulberg, H. C., Dew, M. A., Begley, A. E., Pollock, B. G., & Reynolds, C. F. (2000). Comorbid anxiety disorders in depressed elderly patients. The American Journal of Psychiatry, 157(5), 722–728. http://doi.org/10.1176/appi.ajp.157.5.722CrossRefGoogle ScholarPubMed
Levy, B. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6), 332–336. http://doi.org/10.1111/j.1467-8721.2009.01662.xCrossRefGoogle ScholarPubMed
Levy, B. R., Chung, P. H., Slade, M. D., van Ness, P. H., & Pietrzak, R. H. (2019). Active coping shields against negative aging self-stereotypes contributing to psychiatric conditions. Social Science & Medicine, 228, 25–29. https://doi.org/10.1016/j.socscimed.2019.02.035CrossRefGoogle ScholarPubMed
Levy, B. R., Pilver, C. E., & Pietrzak, R. H. (2014). Lower prevalence of psychiatric conditions when negative age stereotypes are resisted. Social Science & Medicine, 119, 170–174. https://doi.org/10.1016/j.socscimed.2014.06.046CrossRefGoogle ScholarPubMed
Levy, B. R., Slade, M. D., Murphy, T. E., & Gill, T. M. (2012). Association between positive age stereotypes and recovery from disability in older persons. JAMA, 308(19), 1972–1973. https://doi.org/10.1001/jama.2012.14541CrossRefGoogle ScholarPubMed
Losada, A., Márquez-González, M., García-Ortiz, L., Gómez-Marcos, M. A., Fernández-Fernández, V., & Rodríguez-Sánchez, E. (2012). Loneliness and mental health in a representative sample of community-dwelling Spanish older adults. The Journal of Psychology, 146(3), 277–292. https://doi.org/10.1080/00223980.2011.582523CrossRefGoogle Scholar
Losada-Baltar, A., Márquez-González, M., Jiménez-Gonzalo, L., Pedroso-Chaparro, M. d. S., Gallego-Alberto, L., & Fernandes-Pires, J. (2021). Diferencias en función de la edad y la autopercepción del envejecimiento en ansiedad, tristeza, soledad y sintomatología comórbida ansioso-depresiva durante el confinamiento por la COVID–19 [Differences in anxiety, sadness, loneliness and comorbid anxiety and sadness as a function of age and self-perceptions of aging during the lock-out period due to COVID–19]. Revista Española de Geriatría y Gerontología, 55(5), 272–278. https://doi.org/10.1016/j.regg.2020.05.005CrossRefGoogle Scholar
Lykes, V. A., & Kemmelmeier, M. (2014). What predicts loneliness? Cultural difference between individualistic and collectivistic societies in Europe. Journal of Cross-Cultural Psychology, 45(3), 468–490. https://doi.org/10.1177/0022022113509881CrossRefGoogle Scholar
Márquez-González, M., Losada, A., Fernández-Fernández, V., & Pachana, N. A. (2012). Psychometric properties of the Spanish version of the Geriatric Anxiety Inventory. International Psychogeriatrics, 24, 137–144. https://doi.org/10.1017/S1041610211001505CrossRefGoogle ScholarPubMed
Miller, P. A., Sinding, C., Griffith, L. E., Shannon, H. S., & Raina, P. (2016). Seniors’ narratives of asking (and not asking) for help after a fall: Implications for identity. Ageing & Society, 36(2), 240–258. https://doi.org/10.1017/S0144686X14001123CrossRefGoogle Scholar
O’Shea, D. M., Dotson, V. M., & Fieo, R. A. (2017). Aging perceptions and self-efficacy mediate the association between personality traits and depressive symptoms in older adults. International Journal of Geriatric Psychiatry, 32(12), 1217–1225. https://doi.org/10.1002/gps.4584CrossRefGoogle ScholarPubMed
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E., & Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19, 103–114. https://doi.org/10.1017/S1041610206003504CrossRefGoogle ScholarPubMed
Palgi, Y., Shrira, A., Ring, L., Bodner, E., Avidor, S., Bergman, Y., Cohen-Fridel, S., Keisari, S., & Hoffman, Y. (2020). The loneliness pandemic: Loneliness and other concomitants of depression, anxiety and their comorbidity during the COVID–19 outbreak. Journal of Affective Disorders, 275, 109–111. https://doi.org/10.1016/j.jad.2020.06.036CrossRefGoogle ScholarPubMed
Pedroso-Chaparro, M. S., Cabrera, I., Márquez-González, M., Olmos, R., Romero-Moreno, R., Vara-García, C., Gallego-Alberto, L., Barrera-Caballero, S., & Losada-Baltar, A. (2021). Validation of the Guilt associated with Self-Perception as a Burden Scale (G-SPBS). Behavioural and Cognitive Psychotherapy, 49(2), 185–196. https://doi.org/10.1017/S1352465820000557CrossRefGoogle ScholarPubMed
Pedroso-Chaparro, M. d. S., Márquez-González, M., Fernandes-Pires, J.-A., Gallego-Alberto, L., Jiménez-Gonzalo, L., Nuevo, R., & Losada, A. (2022). Validación de la versión española de la Escala de Soledad de Tres Ítems [Validation of the Spanish version of the Three-Item Loneliness Scale]. Studies in Psychology, 43(2), 311–331. https://doi.org/10.1080/02109395.2021.1989889CrossRefGoogle Scholar
Peek, S. T. M, Luijkx, K. G., Rijnaard, M. D., Nieboer, M. E., van der Voort, C. S., Aarts, S., van Hoof, J., Vrijhoef, H. J. M., & Wouters, E. J. M. (2016). Older adults’ reasons for using technology while aging in place. Gerontology, 62(2), 226–237. https://doi.org/10.1159/000430949CrossRefGoogle ScholarPubMed
Porensky, E. K., Dew, M. A., Karp, J. F., Skidmore, E., Rollman, B. L., Shear, M. K., & Lenze, E. J. (2009). The burden of late-life generalized anxiety disorder: Effects on disability, health-related quality of life, and healthcare utilization. The American Journal of Geriatric Psychiatry, 17(6), 473–482. http://doi.org/10.1097/JGP.0b013e31819b87b2CrossRefGoogle ScholarPubMed
Prina, A. M., Ferri, C. P., Guerra, M., Brayne, C., & Prince, M. (2011). Co-occurrence of anxiety and depression amongst older adults in low- and middle-income countries: Findings from the 10/66 study. Psychological Medicine, 41(10), 2047–2056. https://doi.org/10.1017/S0033291711000444CrossRefGoogle ScholarPubMed
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. https://doi.org/10.1177/014662167700100306CrossRefGoogle Scholar
Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. https://doi.org/10.1037/0022-3514.39.3.472CrossRefGoogle ScholarPubMed
Saade, Y. M., Nicol, G., Lenze, E. J., Miller, J. P., Yingling, M., Wetherell, J. L., Reynolds, C. F. III & Mulsant, B. H. (2019 ). Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment. Depression & Anxiety, 36(12), 1125–1134. https://doi.org/10.1002/da.22964CrossRefGoogle ScholarPubMed
Santini, Z. I., Fiori, K. L., Feeney, J., Tyrovolas, S., Haro, J. M., & Koyanagi, A. (2016). Social relationships, loneliness, and mental health among older men and women in Ireland: A prospective community-based study. Journal of affective disorders, 204, 59–69. https://doi.org/10.1016/j.jad.2016.06.032CrossRefGoogle Scholar
Sindi, S., Juster, R.-P., Wan, N., Nair, N. P. V., Ying Kin, N., & Lupien, S. J. (2012). Depressive symptoms, cortisol, and cognition during human aging: The role of negative aging perceptions. Stress, 15(2), 130–137. https://doi.org/10.3109/10253890.2011.599047CrossRefGoogle ScholarPubMed
Tan, J., Ma, C., Zhu, C., Wang, Y., Zou, X., Li, H., Li, J., He, Y., & Wu, C. (2023). Prediction models for depression risk among older adults: Systematic review and critical appraisal. Ageing Research Reviews, 83, Article 101803. https://doi.org/10.1016/j.arr.2022.101803CrossRefGoogle ScholarPubMed
Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A., & Craske, M. G. (2010). Anxiety disorders in older adults: A comprehensive review. Depression & Anxiety, 27(2), 190–211. https://doi.org/10.1002/da.20653CrossRefGoogle ScholarPubMed
World Health Organization. (2017, December 12). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adultsGoogle Scholar
Wuthrich, V. M., Meuldijk, D., Jagiello, T., González Robles, A., Jones, M. P., & Cuijpers, P. (2021). Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. International Journal of Geriatric Psychiatry, 36(6), 858–872. https://doi.org/10.1002/gps.5486CrossRefGoogle ScholarPubMed
Zenebe, Y., Akele, B., W/Selassie, M., & Necho, M. (2021). Prevalence and determinants of depression among old age: A systematic review and meta-analysis. Annals of General Psychiatry, 20(1), Article 55. https://doi.org/10.1186/s12991-021-00375-xCrossRefGoogle ScholarPubMed
Zhao, W., Zhang, Y., Liu, X., Yue, J., Hou, L., Xia, X., Zuo, Z., Liu, Y., Jia, S., Dong, B., & Ge, N. (2020). Comorbid depressive and anxiety symptoms and frailty among older adults: Findings from the West China health and aging trend study. Journal of Affective Disorders, 277, 970–976. https://doi.org/10.1016/j.jad.2020.08.070CrossRefGoogle ScholarPubMed
Figure 0

Table 1.Descriptive Data and Correlation Matrix

Figure 1

Table 2.Multinomial Logistic Regression Analyses of Symptom Profile