Socioeconomic resources predict trajectories of depression and resilience following disability.

Abstract

Adjustment to chronic disability is a topic of considerable focus in the rehabilitation sciences and constitutes an important public health problem given the adverse outcomes associated with maladjustment. While existing literature has established an association between disability onset and elevated rates of depression, resilience and alternative patterns of adjustment have received substantially less empirical inquiry. The current study sought to model heterogeneity in mental health responding to disability onset in later life while exploring the impact of socioeconomic resources on these latent patterns of adaptation. Method: Latent growth mixture modeling was utilized to identify trajectories of depressive symptoms surrounding physical disability onset in a population sample of older adults. Individuals with verified disability onset (n ϭ 3,204) were followed across four measurement points representing a 6-year period. Results: Four trajectories of depressive symptoms were identified: resilience (56.5%), emerging depression (17.2%), remitting depression (13.4%), and chronic depression (12.9%). Socioeconomic resources were then analyzed as predictors of trajectory membership. Prior education and financial assets at the time of disability onset robustly predicted class membership in the resilient class compared to all other classes. Conclusion: The course of adjustment in response to disability onset is heterogeneous. Our results confirm the presence of multiple pathways of adjustment surrounding late-life disability, with the most common outcome being near-zero depressive symptoms for the duration of the study. Socioeconomic resources strongly predicted membership in the resilient class compared with all other classes, indicating that such resources may play a protective role during the stress of physical disability onset. Impact and ImplicationsThe current analysis helps to establish that the course of adjustment to disability onset in later life is heterogeneous, with the most common trajectory being resilience, followed by alternative patterns of adjustment that indicate more significant depressive burden. Socioeconomic variables strongly predicted membership in the resilient class compared to other classes, suggesting that such resources may buffer against the psychological stress of functional decline. Current findings suggest that older adults with lower socioeconomic status are most at risk for elevated depressive symptoms following disability onset. Socioeconomic factors may thus be important predictors of adjustment difficulty, which has important policy implications for the guidance and targeted distribution of treatment resources.

The Frequent Stressor and Mental Health Monitoring-Paradigm: A Proposal for the Operationalization and Measurement of Resilience and the Identification of Resilience Processes in Longitudinal Observational Studies

“…This would obviously be a trivial explanation that does not necessitate to presuppose any kind of protective, or resilience, processes. An example of a trauma-resilience study where this is a probable explanation is a recent report that individuals' wealth predicts the absence of mental health problems following the onset of physical disability (McGiffin et al, 2019 ). Wealth prevents or reduces exposure to additional stressors, such as the financial consequences of disability-related medical bills or a diminished household income and, thus, can be used to ease many of the pains and discomforts associated with the disability.…”

Stressor Appraisal as an Explanation for the Influence of Extra-Individual Factors on Psychological Resilience

“…The scenario is more than a hypothetical one. For instance, several studies have provided evidence that financial assets predict maintenance of mental health despite onset of physical disability (McGiffin, Galatzer-Levy, & Bonanno, 2019). In line with psychosocial resource models of mental health and resilience (Hobfoll, 2002), these data can be interpreted to show that wealth and related socioeconomic variables are resilience factors.…”

The reciprocal relationship between depression and disability in low‐income homebound older adults following tele‐depression treatment

“…, 22 , 23 For low‐income homebound older adults, financial strain is also an added depression risk factor 18 . A study found that younger age, less education, and lower financial assets at the onset of chronic disability also predicted chronic depression across six years, suggesting the important role of socioeconomic resources in determining depression outcomes among disabled older adults 24 …”

“…18 A study found that younger age, less education, and lower financial assets at the onset of chronic disability also predicted chronic depression across six years, suggesting the important role of socioeconomic resources in determining depression outcomes among disabled older adults. 24 Given the limited effectiveness of pharmacotherapy for late-life depression in general and for socioeconomically disadvantaged older adults and persistent depression in particular, [25][26][27] skills-based psychotherapy is recommended. 28,29 However, because of their homebound state, depressed low-income homebound older adults have difficulty accessing psychotherapy through existing mental health systems.…”