Mediating role of spirituality on the relationship between stress and depression among older adults in assisted living

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Lee, Kyoung Hag
Jun, Jung Sim
Bolin, Brien L.
Yoon, Dong Pil
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Purpose: To meet the growing need of older adults for assisted living, the number of Assisted Living Facilities (ALFs) in the United States has increased 15 to 20 percent annually. Older adults living in ALFs have often experienced stressful life events such as losing a loved one, losing social status, relocation from their homes, health problems, and social isolation, which may lead to depressive symptoms. Numerous studies on depressive symptoms, the impact of stress on depression, and the role of spiritual factors and religion on the depression among older adults have been written (Gruber-Baldini, Zimmerman, Boustani, Watson, Williams, & Reed, 2005; Lustyk, Beam, Miller, & Olson, 2006; Koenig, George, & Siegler, 1988). However, little is known about the association between stress and depression, as well as the mediating role of spirituality in the relationship between stress and depression among older men and women in ALFs. Thus, the purpose of this study is to examine these topics related to ALFs.


This cross-sectional study recruited 316 older residents (male n=92 and female n=224 in ALFs by using a purposive sampling method. From 2009 through 2010, face-to-face interviews lasting 60 to 90 minutes were conducted. To measure the depression levels of older adults in ALFs, this study used the Geriatric Depression Scale-Short Form (Sheikh & Yesavage, 1986). To measure the levels of stress, this study used the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). To measure spiritual factors (spiritual experience, spiritual coping, and forgiveness), this study used three subscales of the Brief Multidimensional Measures of Religiousness/Spirituality (Fetzer Institute & National Institute on Aging Working Group, 2003). This study employed four methods of data analysis: Chi-square, t-test, a hierarchical regression, and a Sobel test for testing the three hypotheses.


Chi-square reveals significant differences (p≤.05) between older adult men and women for marital status, education, driving capability, losing spouse, and losing friend. Also t-test reveals that older adult women are significantly more likely to have spiritual experience, spiritual coping, and forgiveness than older adult men. Hierarchical regression indicates that older adults with a high level of stress is significantly more likely to experience a high level of depression than other (β = .19, p≤.001). For older adult men residents, Sobel’s -values of two models (mediating variables: spiritual coping and forgiveness) are significant. The relationship between stress and depression is decreased when spiritual coping or forgiveness are mediated. For older adult women residents, Sobel’s -value of only one model (mediating variable: forgiveness) is significant. However, the relationship between stress and depression is not decreased when forgiveness is mediated.


Two implications are suggested based on the findings of this study. First, this study suggests ALFs should regularly screen residents who may be experiencing stressful situation or those who have depressive symptoms. To assess the stressful situations and depressive symptoms, ALFs need to hire professionally trained social workers. Second, this study suggests ALFs provide appropriate spiritual support programs to minimize psychological distress.

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Lee, K.H., Jun, J.S., Bolin, B.L., & Yoon, D.P. (2013). Mediating role of spirituality on the relationship between stress and depression among older adults in assisted living. Presented at The Society for Social Work and Research 2013 Annual Conference, January 16-20.
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