The Mediating Effect of Spiritual Well-being on Depressive Symptoms and Health-related Quality of Life Among Elders

doi:10.1016/j.apnu.2017.12.008

Archives of Psychiatric Nursing

Volume 32, Issue 3, June 2018, Pages 418-424

https://doi.org/10.1016/j.apnu.2017.12.008 Get rights and content

Highlights

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Elderly are facing various life stressors, disease and disability.
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Fast growing older population highlights the urgency of helping elders to maintain good health and improve quality of life.
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Spiritual well-being (SWB) was positively related to HRQOL, but negatively correlated with depressive symptoms.
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Spiritual well-being significantly mediated the relationship between depressive symptoms and mental components of HRQOL.
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Psychiatric nurses could develop interventions that may increase SWB to help elders improve their health and QOL.

Abstract

The purpose of this study was to investigate the mediating effect of spiritual well-being (SWB) on depressive symptoms (DS) and health-related quality of life (HRQOL) among Taiwanese elders. A convenience sample of 150 Taiwanese elders completed self-administrated questionnaires participated in this cross-sectional study. This study revealed that SWB was positively related to HRQOL but negatively correlated with DS. Results of hieratical regression analyses suggested that SWB significantly mediated the relationship between DS and mental components of HRQOL. Findings from this study suggest that nurses and health care providers should develop strategies to enhance spiritual well-being when caring for elders to maintain good health and promote quality of life.

Section snippets

Introduction and Backgrounds

A notably growing rate of older population has been recognized worldwide (United Nations, 2013, WHO, 2016). It is estimated that the proportion of the global population aged 60 years or older will increase from 11.7% in 2013 to 21.1% in 2050 (United Nations, 2013). The rapid growth of population over age 60 is especially noticeable in developing countries (United Nations, 2013). It is estimated that China is to be the country in the world with the fastest increase of aging population during the

Purposes of the Study

As healthcare continues to focus on clients as a whole, it is imperative to consider the clients' spiritual well-being and the possible influences on health outcomes. Identifying factors and their impacts on elders' quality of life for future development of useful strategies to help elders to promote quality of life and prevent depressive symptoms is important. To add new knowledge to the gaps of existing literature, the purposes of this study were: (1) to detect the relationships between

Methods

This study was conducted as part of a cross-sectional study aimed to investigate potential factors that are significant to elders' health with the ultimate goal of enabling health care providers to develop culturally competent spiritual interventions and promote quality of life of elderly populations with diverse cultural backgrounds. This present study intended to add to our knowledge about spiritual well-being, health-related quality of life, and depressive symptoms and their

Characteristics of the Sample

The characteristics of the convenience sample of 150 elderly Taiwanese participants were shown in Table 1. About 94.7% of the participants were at the ages of 65 to 84. The majority of the participants were married (66%); and most of them were living with other people (84.6%). Most of the participants had completed at least high school (62.8%) education. About 85.5% of the participants reported having a religion, and Buddhism is the most common (56.6%) religious practice among the participants.

Discussions

Spiritual well-being and depressive symptoms are important factors in predicting older people's perceived quality of life. Congruent with the findings reported in previous studies (Ali et al., 2015, Dalmida et al., 2011, Mills et al., 2015), this study provided additional evidences in support of the existing literature about the interrelationship between spiritual well-being, depressive symptoms, and health-related quality of life. As this study hypothesized, the results showed that spiritual

Conclusions

Knowledge regarding the relationship between spiritual well-being and depressive symptoms in Chinese elders is important for enhancing health care providers' capability to deliver culturally appropriate care and interventions for promoting mental health and preventing mental problems among elders. This study has yielded valuable information about the roles of spiritual well-being in mediating the health consequences of elders. Effective programs that can improve elders' spiritual well-being may

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The mediating effect of spiritual well-being found in this study also highlights the importance of providing spiritual interventions and care to elders and especially to those who suffer from depression. Literature showed that spiritual well-being is a significant indicator of elder's positive health outcomes and could be a mediator buffers the destructive effects of depressive symptoms on health-related quality of life among elders (Bai & Lazenby, 2015; Lee & Salman, 2018). Therefore, interventions aim at increasing spiritual well-being could be vital for elders to promote better heath and successfully cope with stress in their life.
As the population is quickly ageing, strategies for helping elders to maintain and promote good health and well-being are urgently needed. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Delivering culturally competent care is necessary for taking care of elders. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Spiritual well-being has been found particularly important for older adults' overall health. This descriptive, correlational and predictive study used data that was collected from a convenience sample (N = 150) to examine the effects of spiritual well-being on the relationship between depression and self-perceived health, and to describe spiritual practices commonly used by Taiwanese elders. Findings from this study revealed that spiritual well-being was positively correlated with self-perceived health, negatively associated with depression, and significantly mediated the relationship between depression and self-perceived health. Relaxation and exercise were the most commonly used spiritual practices by Taiwanese elders. Findings from this study support the important role of spiritual well-being in elders' health and add to the body of knowledge about the spiritual practices used by Taiwanese elders. Nurses and health care providers should deliver culturally appropriate spiritual care to enhance spiritual well-being for elders to maintain good health for diverse elder population.
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Filipinos hold on to their faith and trust their lives to the Transcendent in varying scenarios, from the simple appreciation of daily blessings to the fatalistic resignation of their destiny during trials and tribulations. This high level of spirituality among Filipino older adults enable them to establish better social relations (Soriano et al., 2016), to achieve positive health outcomes (Lee & Salman, 2018), and to overcome challenges (Lagman et al., 2015). Focusing on the emerging model, it is important to highlight that both spirituality and community satisfaction had the strongest total effects to quality of life.
Although healthy ageing aims for better quality of life, the inability of older adults to adequately care for themselves and their health impair the realization of such objective. Moreover, in a collectivist community like the Philippines, the family, community, and Transcendent are inseparable in promoting quality of life. This study developed and tested a model of quality of life (QoL) among chronically-ill, community-dwelling older adults.
From August to November 2017, a cross-sectional study of 304 chronically-ill, community-dwelling older adults from selected rural communities in the Philippines was conducted. Respondents completed a five-part survey packet composed of the socio-demographic profile, modified Older People’s Quality of Life, Spirituality Assessment Scale, Hypertension Self-Care Profile, and Diabetes Self-Management Questionnaire.
Socio-demographics, community satisfaction, spirituality, and disease self-management accounted 29.00% of QoL, generating a good model (χ²/df = 1.44, RMSEA = 0.038, and PNFI = 0.64). Spirituality (β = 0.34, p < 0.01) was the strongest predictor of QoL, while community satisfaction had both direct (β = 0.26, p < 0.01) and indirect (β = 0.08, p < 0.01) effects. Disease self-management directly (β = 0.15, p = 0.016) influenced QoL. In contrast, longer chronicity and larger family size impair QoL.
Quality of life among chronically-ill, community-dwelling older adults is a multi-faceted health construct influenced by socio-demographics, disease self-management, community satisfaction, and spirituality. The presented model highlights the positive effect of disease self-management, community satisfaction, and spirituality which can be utilized in developing appropriate community-based geriatric strategies, policies, and programs. Further, forming collaborative groups with socially-active community elderly and community-based self-care programs can be ventured to address the needs of older adults.
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^☆: This study was supported by a Faculty Seed Grant of College of Nursing and Heath at Wright State University.

View full text

The Mediating Effect of Spiritual Well-being on Depressive Symptoms and Health-related Quality of Life Among Elders☆

Highlights

Abstract

Section snippets

Introduction and Backgrounds

Purposes of the Study

Methods

Characteristics of the Sample

Discussions

Conclusions

Journal of Clinical Epidemiology

Applied Nursing Research

Journal of Pain and Symptom Management

The relationship between spiritual well-being and quality of life among elderly people

Holistic Nursing Practice

A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer

Journal of Palliative Medicine

On the psychosocial impact and mechanisms of spiritual modeling

The International Journal for the Psychology of Religion

The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations

Journal of Personality and Social Psychology

HRQOL concepts

The Center for Epidemiologic Studies Depression Scale in older Chinese: Thresholds for long and short forms

International Journal of Geriatric Psychiatry

Depression in Taiwan: Epidemiological survey utilizing CES-D

Seishin Shinkeigaku Zasshi

Health-related quality of life mediates associations between multi-morbidity and depressive symptoms in Chinese primary care patients

Family Practice

Statistical power analysis for the behavioral sciences

Cognitive-behavioral therapy with older adults

British Columbia Medical Journal

The Spirituality Index of Well-Being: A new instrument for health-related quality-of-life research

Annals of Family Medicine

Spiritual well-being and health-related quality of life among African–American women with HIV/AIDS

Applied Research in Quality of Life

Spirituality, religiosity and depressive symptoms among individuals in substance-abuse treatment

Journal of Religion & Spirituality in Social Work: Social Thought

Psychosocial interventions for the promotion of mental health and the prevention of depression among older adults

Health Promotion International

Psychosocial interventions for the prevention of depression in older adults: Systematic review and meta-analysis

Journal of Aging and Health

Measuring a dimension of spirituality for health research: Validity of the spirituality index of well-being

Research on Aging

Beyond Baron and Kenny: Statistical mediation analysis in the new millennium

Communication Monographs

Foundation health measure report: Health-related quality of life and well-being

Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese?

Journal of Evaluation in Clinical Practice

Associations among patient characteristics, health-related quality of life, and spiritual well-being among Arab Muslim cancer patients

Journal of Palliative Medicine