Depression‐linked beliefs in older adults with depression

Abstract

Aims and objectives To clarify beliefs linked with depression among older adults with depression in Japan. Background As a result of global population ageing, caring for older adults with depression has become an important issue worldwide. In this paper, the concept of “beliefs” pertains to phenomena that lead to distress about disease and can be alleviated through talk therapy. While previous studies focused on illness beliefs in people with mental illness and depression, no studies have yet focused on such beliefs among older adults with depression. Design Qualitative, narrative‐research‐based method. Methods Observation and 1–5 narrative interviews lasting 60–90 min were conducted with each of 19 older adults with depression in a Japanese psychiatric ward. The resulting narratives were thematically analysed to derive relevant themes and subthemes. Reporting of this research adheres to COREQ guidelines. Results Four themes and twelve subthemes were revealed. Depression‐linked beliefs among older adults with depression were (1) “guilt and regret,” (2) “pessimism,” (3) “futility of treatment” and (4) “desire to be needed by loved ones and society.” Conclusion Depression‐linked beliefs among older adults with depression constituted spiritual pain reflecting character tendencies, including experiences of loss and developmental challenges related to ageing as well as subjects' natural diligence and consideration for others. Relevance to clinical practice (1) Helping nurses better understand distress experienced by older adults with depression, who are prone to feel guilt and regret when reflecting on the past and to alleviate distress through dialogue and providing positive affirmation for patients. (2) To understand and assuage distress over experiences of loss in old age. (3) To help older adults with depression form a more relaxed attitude towards life, so that even if they have experienced loss as a result of old age, they can maintain their self‐esteem and existential sense of self‐worth.

‘I wanted to talk about it, but I couldn’t’, an H70 focus group study about experiencing depression in early late life

“…Although sometimes incapable of meeting the needs of others during depression, it was important to still feel needed in their roles as friends, parents or grandparents. This is in line with the results of others [6,21], who also pointed out the need to feel needed by society [21]. Older adults with depression have expressed that not feeling needed generated thoughts that no one would care if they died [21].…”

“…This is in line with the results of others [6,21], who also pointed out the need to feel needed by society [21]. Older adults with depression have expressed that not feeling needed generated thoughts that no one would care if they died [21]. Despite the relatively young age of the participants, there was a need to have an existential dialogue about aging and death during their depression.…”

“…This was related to fear of being a burden; they wanted to avoid that their offspring would need to step into the role as 'the adult'. Another reason for being reluctant to share experiences was expressed by older adults hospitalized for depression; they believed that the pains of aging and depression cannot be understood by those who have not experienced them personally [21].…”

“…Hence, our participants did not consider depression to be a normal part of aging. Instead, they were grieving the loss of their old normal selves, described by others as having spiritual pain [21] which reflects losses and challenges in relation to aging. Previous studies have reported that lower mood was anticipated by younger-old adults in their late 60s [15], frail older adults in their late 70s [23], and older-old adults in their late 80s from the general population [25].…”

“…These studies showed cultural-specific manifestations and coping strategies for depression among older adults, emphasizing the need for cultural-appropriate interventions. Among studies that have focused specifically on help-seeking behaviors, symptom recognition, and recovery in relation to ageing, we note that two explore depression experiences among older adults aged 65-85 in Japan [20,21], three from the United Kingdom involving persons aged 58-84 [22], 75+ [23], and 65+ [24], and one study set in Sweden in which all participants were age 87-88 [25]. In addition, experiences of depression in relation to masculinity and ageing were examined in two Canadian studies involving men age 55-80+ [26,27].…”