Abstract
This study investigates the role of a motivational process based on a composite of four subcomponents (self-efficacy, decision regulation, activation regulation and motivation regulation), as a mediator of the relationship between social support and depression assessed with the Geriatric Depression Scale in cognitively impaired and unimpaired individuals. Participants were 229 adults with a mean age of 74 years (range: 52–94 years). The sample comprised 64 participants diagnosed with mild cognitive impairment (MCI), 47 participants diagnosed with early-stage Alzheimer’s disease (AD), and a group of 118 participants without any cognitive impairment. In this cross-sectional study, bivariate correlations and linear regression models were used to assess the association between the predictor variables and depression. Linear regression models were controlled for age, gender, education, cognitive status, cognitive impairment and activities. In the total sample, social support (β = −0.15, p < 0.05) and motivational processes (β = −0.41, p < 0.001) were significantly associated with depression; the impact of social support was mediated by motivational processes. While motivational processes were associated with depression in all three groups (no impairment: β = −0.61, p < 0.001; MCI: β = −0.28, p < 0.05; early AD: β = −0.30, p < 0.06), social support lost significance (no impairment: β = −0.36, p < 0.001; MCI: β = 0.07, p = 0.59; early AD: β = −0.08, p = 0.62). Based on these findings, it can be argued that the impact of social support on depressive symptoms is attenuated by cerebral deterioration in cognitively impaired individuals, while motivational processes remain relevant.
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Alexopoulos GS, Meyers BS, Young RC, Mattis S, Kakuma T (1993) The course of geriatric depression with “reversible dementia”: a controlled study. Am J Psychiatry 150(11):1693–1699
Apostolova LG, Cummings JL (2008) Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dement Geriatr Cogn Disord 25(2):115–126
Atkinson R, Shiffrin R (1971) The control of short-term memory. Sci Am 225:82–90
Ballard CG, Bannister C, Oyebode F (1996) Review: depression in dementia sufferers. Int J Geriatr Psychiatry 11:507–515
Bandura A (1992) On rectifying the comparative anatomy of perceived control: comments on ‘Cognates of personal control’. Appl Prev Psychol 1:121–126
Bandura A (1997) Self-efficacy: the exercise of control. Freeman, New York
Bandura A (1982) Self-efficacy mechanism in human agency. Am Psychol 37(2):122
Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182
Beekman ATF, Deeg DJH, Geerlings SW, Schoevers RA, Smit JH, van Tilburg W (2001) Emergence and persistence of late life depression: a 3-year follow-up of the Longitudinal Aging Study Amsterdam. J Affect Disord 65(2):131–138
Benight CC, Bandura A (2004) Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy. Behav Res Therapy 42:1129–1148
Benton AL, Hamsher K (1989) Multilingual aphasia examination. University of Iowa, Iowa City
Berkman LF, Glass T, Brissette I, Seeman TE (2000) From social integration to health: Durkheim in the new millennium. Soc Sci Med 51:843–857
Bisconti TL, Bergeman CS (1999) Perceived social control as a mediator of the relationships among social support, psychological well-being, and perceived health. Gerontologist 39:94–103
Bisschop MI, Kriegsman DMW, Beekman ATF, Deeg DJH (2004) Chronic diseases and depression: the modifying role of psychosocial resources. Soc Sci Med 59(4):721–733. doi:10.1016/j.socscimed.2003.11.038
Blazer DG (2002) Self-efficacy and depression in late life: a primary prevention proposal. Aging Ment Health 6(4):315–324
Blazer DG (2003) Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58(3):M249–M265
Blazer DG, Hybels CF, Pieper CF (2001) The association of depression and mortality in elderly persons: a case for multiple, independent pathways. J Gerontol A Biol Sci Med Sci 56:M505–M509
Brodaty H, Luscombe G (1996) Depression in persons with dementia. Int Psychogeriatr 8:609–622
Brown GW, Andrews B, Harris T, Adler Z, Bridge L (1986) Social support, self-esteem and depression. Psychol Med 16:813–831
Bruce ML (2002) Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry 52(3):175–184
Brunstein JC (1999) Persönliche Ziele und subjektives Wohlbefinden bei älteren Menschen. Zeitschrift für Differentielle und Diagnostische Psychologie 20:58–71
Brunstein JC, Schultheiss OC, Grässmann R (1998) Personal goals and emotional well-being: the moderating role of motive dispositions. J Pers Soc Psychol 75:494–508
Cervilla JA, Prince MJ (1997) Cognitive impairment and social distress as different pathways to depression in the elderly: a cross-sectional study. Int J Geriatr Psychiatry 12(10):995–1000
Chou KL (2005) Everyday competence and depressive symptoms: social support and sense of control as mediators or moderators? Aging Ment Health 9(2):177–183
Cutrona CE, Troutman BR (1986) Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression. Child Dev 57(6):1507–1518
Dillon C, Allegri RF, Serrano CM, Iturry M, Salgado P, Glaser FB (2009) Late-versus early-onset geriatric depression in a memory research center. Neuropsychiatr Dis Treat 5:517
Fankhauser S, Wagner B, Krammer S, Aeschbach M, Pepe A, Maercker A (2010) The impact of social and interpersonal resources on adjustment disorder symptoms in older age. Motivational variables as mediators? GeroPsych 23:227–241
Ferraro FR, Chelminski I (1996) Preliminary normative data on the Geriatric Depression Scale-Short Form (GDS-SF) in a young adult sample. J Clin Psychol 52(4):443–447
Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Forstmeier S, Rüddel H (2007) Improving volitional competence is crucial for the efficacy of psychosomatic therapy: a controlled clinical trial. Psychother Psychosom 76:89–96
Forstmeier S, Maercker A (2008) Motivational reserve: lifetime motivational abilities influence cognitive and emotional health in old age. Psychol Aging 23:886–899
Forstmeier S, Maercker A (submitted) Motivational processes in Mild Cognitive Impairment and mild Alzheimer’s disease: the Motivational Reserve in Alzheimer’s (MoReA) Study
Friedman B, Heisel MJ, Delavan RL (2005) Psychometric properties of the 15-item geriatric depression scale in functionally impaired, cognitively intact, community-dwelling elderly primary care patients. J Am Geriatr Soc 53(9):1570–1576
Fydrich T, Sommer G, Menzel U, Höll B (1987) Fragebogen zur Sozialen Unterstützung (Kurzform; SOZU-K-22) [Social Support Questionnaire (short form)]. Zeitschrift für Klinische Psychologie 16:434–436
Fydrich T, Geyer M, Hessel A, Sommer G, Brähler E (1999) Fragebogen zur Sozialen Unterstützung (F-SozU): Normierung an einer repräsentativen Stichprobe [Social Support Questionnaire (F-SozU): Norms from a representative sample]. Diagnostica 45:212–216
Gollwitzer PM, Oettingen G (2012) Goal pursuit. In: Ryan RM (ed) Oxford handbook of motivation. Oxford University Press, New York, pp 208–231
González-Salvador T, Lyketsos CG, Baker A, Hovanec L, Roques C, Brandt J (2000) Quality of life in dementia patients in long-term care. Int J Geriatr Psychiatry 15(2):181–189
Greenglass ER (1993) The contribution of social support to coping strategies. Appl Psychol 42(4):323–340
Greenglass E, Fiksenbaum L, Eaton J (2006) The relationship between coping, social support, functional disability and depression in the elderly. Anxiety Stress Coping 19(1):15–31
Heckhausen J, Heckhausen H (2008) Motivation and action. Cambridge University Press, New York
Henderson AS, Grayson DA, Scott R, Wilson J, Rickwood D, Kay DWK (1986) Social support, dementia and depression among the elderly living in the Hobart community. Psychol Med 16:379–390
Herrmann N, Mittmann N, Silver IL, Shulman KI, Busto UA, Shear NH (1996) A validation study of The Geriatric Depression Scale short form. Int J Geriatr Psychiatry 11(5):457–460
Holahan CJ, Moos RH, Bonin L (1997a) Social support, coping, and psychological adjustment: a resource model. In: Pierce GR, Lakey B, Sarason IG, Sarason BR (eds) Sourcebook of social support and personality. Plenum Press, New York, pp 169–186
Holahan CJ, Moos RH, Holahan CK, Brennan PL (1997b) Social context, coping strategies, and depressive symptoms: an expanded model with cardiac patients. J Pers Soc Psychol 72(4):918–928
Jang Y, Haley WE, Small BJ, Mortimer JA (2002) The role of mastery and social resources in the associations between disability and depression in later life. Gerontologist 42(6):807–813
Isaacs B, Kennie A (1973) The set test as an aid to the detection of dementia in old people. Br J Psychiatry 123:467–470
Kaplan E, Goodglass H, Weintraub S (1978) The Boston naming test. Veterans Administration Medical Center, Boston
Koizumi Y, Awata S, Kuriyama S, Ohmori K, Hozawa A, Seki T (2005) Association between social support and depression status in the elderly: results from a community-based, prospective cohort study in Japan. Psychiatry Clin Neurosci 59:563–569
Kruglanski AW, Thompson EP, Higgins ET, Atash MN, Pierro A, Shah JY (2000) To “do the right thing” or to “just do it”: locomotion and assessment as distinct self-regulatory imperatives. J Pers Soc Psychol 79:793–815
Kuhl J (1981) Motivational and functional helplessness: the moderating effect of state versus action orientation. J Pers Soc Psychol 40(1):155–170
Kuhl J, Fuhrmann A (1998) Decomposing self-regulation and self-control: the Volitional Components Inventory. In: Heckhausen J, Dweck CS (eds) Motivation and self-regulation across the life span. Cambridge University Press, Cambridge, pp 15–49
Lazarus RS (1991) Emotion and adaption. Oxford University Press, London
Lesher EL, Berryhill JS (1994) Validation of the Geriatric Depression Scale-Short Form among inpatients. J Clin Psychol 50(2):256–260
Lewin K, Dembo T, Festinger L, Sears PS (1944) Level of aspiration. In: McHunt J (ed) Personality and the behaviour disorders, vol 1. Ronald, New York, pp 333–378
Luszczynska A, Gutiérrez-Doña B, Schwarzer R (2005) General self-efficacy in various domains of human functioning: evidence from five countries. Int J Psychol 40:80–89
Lyketsos CG, Olin J (2002) Depression in Alzheimer’s disease: overview and treatment. Biol Psychiatry 52(3):243–252
Lyketsos CG, Steele C, Galik E, Rosenblatt A, Steinberg M, Warren A (1999) Physical aggression in dementia patients and its relationship to depression. Am J Psychiatry 156(1):66–71
Mackinnon DP, Dwyer JH (1993) Estimating mediated effects in prevention studies. Eval Rev 17:144–158
Maercker A, Forstmeier S, Enzler A, Krüsi G, Helfenstein E, Hörler E (2008) Adjustment disorders, PTSD, and depressive disorders in old age: findings from a community survey. Compr Psychiatry 49:113–120
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 34(7):939–944
Modrego PJ, Ferrandez J (2004) Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol 61(8):1290–1293
Morris JC (1993) The clinical dementia rating (CDR): current version and scoring rules. Neurology 43(11):2412–2414
Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G (1989) The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 39:1159–1165
Morris PL, Robinson RG, Raphael B, Bishop D (1991) The relationship between the perception of social support and post-stroke depression in hospitalized patients. Psychiatry 54(3):306–316
Nelson PB (1989) Social support, self-esteem, and depression in institutionalized elderly. Issues Ment Health Nurs 10:55–68
Neundorfer MM, McClendon MJ, Smyth KA, Stuckey JC, Strauss ME, Patterson MB (2001) A longitudinal study of the relationship between levels of depression among persons with Alzheimer’s disease and levels of depression among their family caregivers. J Gerontol Ser B Psychol Sci Soc Sci 56(5):P301–P313
Nezu AM, Ronan GF (1988) Social problem solving as a moderator of stress-related depressive symptoms: a prospective analysis. J Couns Psychol 35(2):134–138
Oxman T, Berkman L, Kasl S, Freeman D, Barrett J (1992) Social support and depressive symptoms in the elderly. Am J Epidemiol 135:356–368
Penninx BWJH, van Tilburg T, Boeke AJP, Deeg DJH, Kriegsman DMW, van Eijk JTM (1998) Effects of social support and personal coping resources on depressive symptoms: different for various chronic diseases? Health Psychol 17(6):551
Reitan R (1958) Validity of the Trail Making Test as an indication of organic brain damage. Percept Motor Skills 8:271–276
Rholes WS, Michas L, Shroff J (1989) Action control as a vulnerability factor in dysphoria. Cogn Therapy Res 13:263–274
Rosen WG, Mohs RC, Davis KL (1984) A new rating scale for Alzheimer’s disease. Am J Psychiatry 141(11):1356–1364
Rotter JB (1966) Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr Gen Appl 80:1–28
Rubin EH, Veiel LL, Kinscherf DA, Morris JC, Storandt M (2001) Clinically significant depressive symptoms and very mild to mild dementia of the Alzheimer type. Int J Geriatr Psychiatry 16:694–701
Saltzman KM, Holahan CJ (2002) Social support, self-efficacy, and depressive symptoms: an integrative model. J Soc Clin Psychol 21(3):309–322
Scarmeas N, Zarahn E, Anderson KE, Habeckl CG, Hilton J, Flynn J (2003) Association of life activities with cerebral blood flow in Alzheimer disease: implications for the cognitive reserve hypothesis. Arch Neurol 60:359–365
Scholz U, Gutierrez Dona B, Sud S, Schwarzer R (2002) Is general self-efficacy a universal construct? Psychometric findings from 25 countries. Eur J Psychol Assess 18:242–251
Schwarzer R, Taubert S (2002) Tenacious goal pursuits and striving toward personal growth: proactive coping. In: Frydenberg E (ed) Beyond coping: meeting goals, vision, and challenges. Oxford University Press, London, pp 19–35
Sheikh JI, Yesavage JA (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5(1–2):165–173
Skinner EA (1996) A guide to constructs of control. J Pers Soc Psychol 71:549–570
Smith GC, Kohn SJ, Savage-Stevens SE, Finch JJ, Ingate R, Lim Y (2000) The effects of interpersonal and personal agency on perceived control and psychological well-being. Gerontologist 40:458–468
Sobel ME (1982) Asymptotic intervals for indirect effects in structural equation models. In: Leinhart S (ed) Sociological methodology. Jossey-Bass, San Francisco
Stice E, Ragan J, Randall P (2004) Prospective relations between social support and depression: differential direction of effects for parent and peer support? J Abnorm Psychol 113(1):155–159. doi:10.1037/0021-843x.113.1.155
Stroop JR (1935) Studies of interference in serial verbal reaction. J Exp Psychol 18:643–662
Thoits PA (1986) Social support as coping assistance. J Consult Clin Psychol 54(4):416–423
Thoits PA (1995) Stress, coping, and social support processes: where are we? What next? J Health Soc Behav 35:53–79
Van den Berg MD, Oldehinkel AJ, Bouhuys AL, Brilman EI, Beekman ATF, Ormel J (2001) Depression in later life: three etiologically different subgroups. J Affect Disord 65(1):19–26
Wade TD, Kendler KS (2000) The relationship between social support and major depression: cross-sectional, longitudinal, and genetic perspectives. J Nerv Ment Dis 188(5):251–258
Waite A, Bebbington P, Skelton-Robinson M, Orrell M (2004) Life events, depression and social support in dementia. Br J Clin Psychol 43(3):313–324
Wang HX, Karp A, Winblad B, Fratiglioni L (2002) Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project. Am J Epidemiol 155:1081–1087
Watkins E, Baracaia S (2002) Rumination and social problem-solving in depression. Behav Res Ther 40(10):1179–1189
Wechsler D (1987) Wechsler Memory Scale—Revised (WMS-R). The Psychologigal Corporation, San Antonio
Wechsler D (1997) Wechsler Adult Intelligence Scale. Third Edition (WAIS-III). The Psychological Corporation, San Antonio
Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Petersen RC (2004) Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256(3):240–246
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M (1983) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatry Res 17:37–49
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This project was funded by the Swiss National Science Foundation SNSF, the Velux Foundation, the Tropos Foundation, the Kurt Fries Foundation, and the Swiss Alzheimer’s Association.
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Fankhauser, S., Drobetz, R., Mortby, M. et al. Depressive symptoms in later life: differential impact of social support and motivational processes on depression in individuals with and without cognitive impairment. Eur J Ageing 11, 321–332 (2014). https://doi.org/10.1007/s10433-014-0311-2
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DOI: https://doi.org/10.1007/s10433-014-0311-2