A Structural Equation Model of the Effects of Social, Religious, and Adaptive Coping On Loneliness and Depression Among Older Women with Chronic Illness

Purpose: In the United States, nearly 80% of all older adults have one or more chronic illness. Disability and functional impairment that often accompany these conditions make social isolation, loneliness and depression a real risk for older people, especially older women, since they comprise the majority of older people living alone and living with multiple co-morbidities. A stress and coping framework informed our conceptual model for the effects of social, religious, and adaptive coping resources on mental health outcomes among older women with one or more chronic conditions. Structural Equation Modeling (SEM) was used to test the conceptual model. Coping resources included perceived social support, religious coping, and Selection, Optimization and Compensation (SOC) adaptive coping, which emphasizes specific adaptations to age-related changes. Our proximal outcome of interest was loneliness among these women and our ultimate outcome was depressive symptoms. Methods: Data were collected by mailed questionnaires. Depressive symptoms were measured by the 20-item CED-D and loneliness by the DeJong-Giervald Loneliness Scale. Our coping resource measures included social and instrumental support, positive and negative religious coping, and a ten-item measure of SOC coping. A convenience sample of 138 community-dwelling women aged 65 or older with at least one chronic illness were recruited through aging-related partner agencies in northern Ohio. Results: Sixty-eight percent of respondents were white and 32% were African American, with mean age of 72.6 years. The women reported an average of more than three chronic conditions, with the highest incidence of hypertension, arthritis, heart disease, diabetes and digestive disorders. We achieved a good-fitting SEM model (Chi-square = 37.86, df = 44, p = .731; CFI= 1.0, TLI= 1.0, RMSEA=.00). Significant pathways in the model showed that non-white race and less adequate income had direct effects on number of chronic illnesses and amount of physical impairment/disability. These health variables then had significant positive direct effects upon depressive symptoms. Unmarried women, those with less perceived social support and those using more positive religious coping were significantly more lonely. Loneliness, in turn, had a significant positive direct effect on depressive symptoms. In this sample of respondents, there was also a direct effect from non-white race to more depressive symptoms. Perceived social support had both an indirect effect (through loneliness) and a direct effect on depressive symptoms. SOC was influenced by the amount of health impairment/disability, but had no direct or indirect effects on either loneliness or depression. Conclusions and Implications: This model demonstrates two somewhat distinct pathways to depressive symptoms for older women with chronic illness: one through greater physical symptoms, impairment and disability, and another through loneliness. Both disability and loneliness are putative risk factors for late life depression but this study suggests these risks may operate somewhat independently. On the other hand, of the coping resources tested, subjective social support influenced both loneliness and depression. Older women in the community coping with chronic conditions may benefit from intervention approaches that address disability-related issues and loneliness, and assist them in identifying and marshaling sources of social support.