CHAPTER 5: RESULTS
5.3 PSYCHOSOCIAL STATUS
Psychosocial status of the residents was measured using three constructs, namely:
wellbeing as measured by the WHO (five) Wellbeing Index (WHO-5); psychosocial distress (depression and anxiety) measured by the Kessler-6 (K6); and emotional and social loneliness using the 6 item de Jong Gierveldt Loneliness scale (referred to as the Loneliness Scale). All scales, showed moderate to good internal consistency
with Cronbach α’s of .827, .862, .574, .545 and .644 for the WHO-5, the K6, the overall Loneliness scale and the Emotional and Social Loneliness subscales respectively.
5.3.1 Mental wellbeing
The average score for mental wellbeing was 17.5 (sd 5.9) out of a possible 25, with scores ranging from 2 to 25. Using the categorisation of poor sense of wellbeing (<13) and sense of wellbeing (>13), 62 (82.7%) of the respondents reported a relative sense of wellbeing and 13 (17.3%) a poor sense of wellbeing. There were no significant differences between the younger old (60 – 75 years) and the older old (75+ years), gender, marital status, race or education level for mental well-being.
However, when considering the recommendation by the Psychiatric Research Unit in Hillerod, a WHO Collaborating Centre for Mental Health to classify any negative response, a response of “at no time” (0) or “some of the time” (1), nearly half of the respondents (37, 49.3%) reported a poor sense of wellbeing (http://www.cure4you.dk).
Examining the frequencies of the individual statements of mental wellbeing, the most positive statement was that in the two weeks prior to data collection, 63 (84.0%) of the respondents “felt calm and relaxed”. The lowest frequency was for the statement
“felt active and vigorous” with 50 (66.7%) agreeing with this statement, which is congruent with the ageing process and may not be an indication of mental wellbeing.
Removing this last item from the analysis reveals that 45 (60%) are mentally well.
Seven (9%) of the respondents who did not feel active and vigorous were in the younger old group and 15 (20%) in the older old age group. (See Table 11: WHO-5 measured over the last 2 weeks).
Table 11: WHO-5 measured over last 2 weeks.
WHO-5 Item “More than half of the time to all of the time”
Frequency (%)
“Some of the time to at no time”
Frequency (%)
Felt calm and relaxed 63(84.0%) 12(16.0%)
Felt cheerful and in good spirits 61(81.3%) 13(17.3%)
Daily life filled with interest 58(74.7%) 17(22.7%)
Woke up feeling fresh & rested 56(74.7%) 14(18.7%)
Felt active & vigorous 50(66.7%) 22(29.3%)
5.3.2 Psychosocial distress
The average score for psychosocial distress was 10.0 (sd 4.9) out of a possible 30, with scores ranging from 6 to 28. There were significant differences between males and females (U=2.5, p=.014), with average scores being 11.9 (sd 5.8) for males and 9.4 (sd 4.5) for females. There were no significant differences between the younger old and the older, race, and level of education or marital status for psychosocial distress.
Of the 75 residents, 56 (74.7%) of the respondents reported no psychosocial distress (scores between 6 and 11), while 14 (18.7%) reported mild to moderate psychosocial distress (indicative of a mild to moderate mental health disorder), and five respondents reported experiencing severe psychosocial distress (indicative of a severe mental disorder).
The most common psychosocial distress reported by the respondents were “being restless and fidgety” and “feeling so sad that nothing could cheer them up”, with 21 (28.0%) reported feeling this “some to all of the time”. The least common feeling was that of hopelessness with only 9 (12%) who experienced this feeling (See Table 12:
Psychosocial distress measured over the last 4 week).
Table 12: Psychosocial distress measured over the last 4 week
Item “Some to all of the time”
Frequency n(%)
“A little to none of the time”
Frequency n(%)
Restless or fidgety 21(28.0%) 54(72.0%)
So sad nothing could cheer you up 21(28.0%) 54(72.0%)
That everything was an effort 16(21.3%) 59(78.7%)
Nervous 14(18.7%) 61(81.3%)
Feeling worthless 11(14.7%) 64(85.3%)
Feeling hopeless 9(12.0%) 66(88.0%)
There was consistency between the K6 and the WHO-5 with a medium negative bivariate correlation between WHO-5 and K6 (r =-.488, p=<.001), with 27.6% of the variation in wellbeing score being explained by lack of psychosocial distress and indicating that with an increase in psychological distress there is a medium decrease in mental wellbeing.
5.3.3 Loneliness
Overall loneliness as well as emotional and social loneliness was measured. The average score for loneliness was 7.7 (sd 1.5) out of a total score of 12. The respondents reported no significant differences in social loneliness than emotional loneliness with scores of 3.8 (sd 0.9) and 3.9 (sd 1.0) out of a total score of 6 respectively. There were no significant differences in these scores between, the younger and older old, gender, marital status or education level.
Classifying the responses, only 21 (28.0%) respondents were not lonely, with 53 (70.7%) lonely and one respondent intensely lonely. Looking at the individual items measuring loneliness, only a few respondents reported “experiencing a sense of emptiness” (16, 21.3%) or “feeling rejected” (19, 25.3%), but respondents did report that they “miss having people around” (34, 45.3%). (Table 13: Loneliness scale items).
Table 13: Loneliness scale items
Emotional or Social Loneliness Subscale
Item Frequency
n(%)
Emotional I experience a general sense of emptiness 16(21.3%)
Emotional I often feel rejected 19(25.3%)
Emotional I miss having people around me 34(45.3%)
Social There are NOT many people I can trust completely 31(41.3%) Social There are NOT plenty people can rely on when problem 17(22.7%)
Social There are NOT enough people I feel close to 9(12.0%)
Of the 75 respondents, 39 (52.0%) respondents were not socially lonely, 33 (44.0%) were socially lonely and 3 (4.0%) were intensely socially lonely. Of the 36 (48%) who met criteria for socially lonely, 31 (41.3%), indicated they had lower levels of trust.in comparison to the not-lonely (17.2 sd 4.1 vs 19.3 sd 2.8). In terms of emotional loneliness, again a similar number (34, 45.3%) were not emotionally lonely and 32 (42.7%) were lonely and 9 (12.0%) were intensely lonely. The 9 residents who were intensely emotionally lonely were all single.
There were significant differences in emotional loneliness scores between the respondents experiencing different levels of psychosocial distress. The 19 residents that may possibly have a mental disorder such as depression on the K6, had significantly higher emotional loneliness scores compared to respondents not reporting any significant level of psychosocial distress shows high statistical significance (4.7 vs 3.6, U=3.7 p<.001). Similarly, another factor affecting emotional loneliness was the time staying in the residence with those residing for less than a year experiencing the greatest levels of emotional loneliness (4.4 sd 1.2) compared to those staying in the facility for five years or more (3.6 sd 0.9) (K=6.5, p=.038).
There were significant differences in scores for race for emotional loneliness with those identified as Indian reporting higher emotional lonely scores (4.4 sd 0.8) compared to the White respondents (3.8 sd 1.1) (K= 2.7, p=.007).
There were significant difference in overall loneliness levels of those respondents who had a poor sense of mental wellbeing, as measured by reporting any negative symptom (8.7 sd 1.8) and those who did not (7.5 sd 1.3) (U =2.3, p=.020). This was
largely driven by the emotional loneliness with scores of 4.7 (sd 1.3) and 3.8 (sd 0.9) respectively (U=2.3, p=.021). The same pattern was seen in emotional and overall loneliness with significant differences across respondents with no mental disorder as per the K6 (3.6 sd 0.8 and 7.4 sd 1.3) and those respondents with some disorder (4.4 sd 1.1 and 8.5 sd 1.6) (K=16.2, p<.001).
There was also a medium positive correlation between K6 and loneliness (r=- .492, p=<.001), with medium levels of increased loneliness associated with medium levels of increased psychological distress, and 24.2% of the variation in psychological distress score being explained by the presence of loneliness. This correlation again was driven by a positive correlation between K6 and emotional loneliness (r=- .533, p=<.001), with high levels of increased emotional loneliness associated with high increases of psychological distress and 28.4% of the variation in psychological distress score being explained by the presence of loneliness.