Understanding loneliness in late life.

Loneliness in late adulthood is a public health issue. Thus, understanding the etiology of loneliness is of critical importance. Here, we conceptualize the development of loneliness in late life as dynamic interactions between individual and contextual processes. Specifically, we suggest that loneliness arises if the existing social relationships are unable to meet a set of social expectations. These expectations are fulfilled by three different layers of the social structure: 1) close confidants; 2) broader social networks; and 3) involvement in the community. Although older adults experience losses in their broader network and engage less in the community, they may avoid loneliness by focusing on close confidants. However, these adaptations may make it more difficult for older adults to overcome loneliness.

Rethinking Social Relationships in Adulthood: The Differential Investment of Resources Model.

Empirical evidence about the development of social relationships across adulthood into late life continues to accumulate, but theoretical development has lagged behind. The Differential Investment of Resources (DIRe) model integrates these empirical advances. The model defines the investment of time and energy into social ties varying in terms of emotional closeness and kinship as the core mechanism explaining the formation and maintenance of social networks. Individual characteristics, acting as capacities, motivations, and skills, determine the amount, direction, and efficacy of the investment. The context (e.g., the living situation) affects the social opportunity structure, the amount of time and energy available, and individual characteristics. Finally, the model describes two feedback loops: (a) social capital affecting the individual's living situation and (b) different types of ties impacting individual characteristics via social exchanges, social influences, and social evaluations. The proposed model will provide a theoretical basis for future research and hypothesis testing.

You Aren't as Close to my Family as You Think: Discordant Perceptions about In-laws and Risk of Divorce.

In-law relationships can act as sources of both support and stress for couples. Independent of the nature of the actual relationships with in-laws, it may be that couple similarity in perceptions of these ties determines if they undermine or facilitate marital stability. The current study sought to examine how spousal connections to in-laws and concordance about these relationships early in marriage predicted marital stability in a sample of 355 Black and White married couples followed over 16 years. Husbands and wives reported on time spent with families, whose family they turn to for support, and closeness with families during their first year of marriage. Analyses revealed that discordance on these issues early in marriage was common. We found that even after controlling for husband and wife reports of connections with in-laws, discordance on closeness with the wife's family predicted divorce. Thus, when conceptualizing the costs and benefits of connections with in-laws, it is important to consider not only the nature of spouses' ties to each other's families, but the extent to which their views of these ties are concordant.

Patient crying during psychotherapy intake sessions: Relationship to patient characteristics and early treatment process.

The aim of the present study is to further the understanding of who cries at the beginning of psychotherapy and patients' experience of crying in that process. Intake sessions for 53 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics were also collected at intake. Results indicate that crying during intake sessions was related to lower global functioning and higher severity of childhood sexual abuse. Furthermore, patients who cried at intake were over four times more likely to also cry at feedback, and those who cried at feedback were almost 12 times more likely to have cried at intake. Finally, crying in the intake session did not appear to be related to patient- or therapist-rated working alliance. Overall, the present study provides valuable information about characteristics of patients who cry at the outset of the therapy process and patients' experience of crying over time in therapy. Findings suggest the need for further research on patient characteristics and aspects of the therapy process that may predict patient crying over the course of treatment, as well as how these early crying experiences may be related to eventual patient outcomes.

Aging veterans' mental health and well-being in the context of COVID-19: The importance of social ties during physical distancing.

Prior wartime trauma likely acts as a double-edged sword that promotes both aging veterans' vulnerability and resilience in the context of the current COVID-19 pandemic. During this stressful time, aging veterans may benefit from having an array of socially supportive network ties. We therefore suggest that clinicians working with veterans encourage veterans to (a) create or sustain positive social connections while maintaining physical distance and (b) call upon coping strategies that helped them manage past difficulties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Strength of Weaker Ties: An Underexplored Resource for Maintaining Emotional Well-Being in Later Life.

OBJECTIVES: The purpose of this study was to examine dynamic links between changes in social ties and changes in emotional well-being. METHOD: Trivariate dual-change score models were used to test whether a large number of close ties would be more strongly associated with low levels of depressed affect than a large number of weaker ties, and a large number of weaker ties would be more strongly associated with high levels of positive affect compared to a large number of close ties, across three waves of a large, regionally representative sample of U.S. adults aged 40 and older (N = 802). RESULTS: We found that a greater number of weaker ties was associated with having more close ties over time, and that the number of weaker ties was more strongly predictive of positive age-related changes in both aspects of well-being (i.e., more positive affect and less depressed affect) than the number of close ties. DISCUSSION: Contrary to popular theoretical orientations in gerontology, weaker ties may offer older adults a more effective avenue for promoting emotional well-being over time than close ties, and may have the additional benefit of compensating for losses in the number of close ties.

Psychological Adjustment of Aging Vietnam Veterans: The Role of Social Network Ties in Reengaging with Wartime Memories.

It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in -helping - or hindering - aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts.

The Increasing Importance of Friendship in Late Life: Understanding the Role of Sociohistorical Context in Social Development.

Historically, family ties have been understood as the primary source of support for aging adults, and past empirical and theoretical work has highlighted the tendency of older adults to focus on close family. However, in line with demographic changes and historical increases in the diversity of social structures, friendships are increasing in importance in recent generations of older adults. Given the powerful role of context in shaping these changes, this paper offers a conceptual analysis linking individual agency to sociohistorical context as a way to understand this increasing diversity of social ties. More specifically, we propose that the individual invests time and energy to form and maintain social ties, and that each individual has a specific social opportunity structure (all potential ties that are available to invest in, as well as the costs of those investments). Furthermore, this investment of time and energy is determined in part by individual differences in capacities and motivations. We argue that sociohistorical context influences this process in three important ways: (1) in its effect on the social opportunity structure; (2) in its direct effect on time and energy; and (3) in its effect on individuals' capacities and motivations. We believe that these mechanisms can account for the increasing diversity of social ties across adulthood, as well as the potential for future historical changes.

Marital Quality, Loneliness, and Depressive Symptoms Later in Life: The Moderating Role of Own and Spousal Functional Limitations.

Loneliness is a mechanism through which marital quality relates to older adults' mental health. Links between marital quality, loneliness, and depressive symptoms, however, are often examined independent of older adults' functional health. The current study therefore examines whether associations between marital quality, loneliness, and depressive symptoms are contextually dependent on individuals' own (or their spouse's) functional limitations, as well as on gender. Data came from couples (N = 1084) who participated in the Health and Retirement Study (HRS), a nationally representative dataset of older adults (age 50+). We utilized data from the 2014 leave-behind psychosocial questionnaire to measure spousal support/strain and loneliness, and interview data from 2014 to measure baseline depressive symptoms and demographic covariates (e.g., race and education). Depressive symptoms in 2016 served as the focal outcome variable. Findings from a series of path models estimated in MPLUS indicated that loneliness is a mechanism through which spousal support predicts older adults' depressive symptoms. Such linkages, however, were dependent on individuals' own functional limitations and gender. For functionally limited males in particular, spousal support was shown to reduce depressive symptoms insofar as it was associated with lower levels of loneliness; otherwise, it was associated with higher levels of depressive symptoms. Such findings reinforce the importance of taking a contextualized approach when examining associations between support and emotional well-being later in life.

Do Demographic Changes Jeopardize Social Integration among Aging Adults Living in Rural Regions?

OBJECTIVES: Contextual influences of the living environment on the social integration of adults have been primarily studied cross-sectionally. Here, we argue that context (i.e., urban vs rural environment) as well as changes in context (i.e., population decline) are potentially important for the development of social integration across middle adulthood and late life. METHOD: We used a large-scale longitudinal data set representative of the late middle-aged and older German population (N = 4,790; aged 40 to 85 years) that assessed participants every 6 years across 3 waves. To examine our assumptions, we implemented multilevel latent growth curve models. RESULTS: We found that declines in network size were more pronounced in rural than in urban areas. Moreover, age-related declines in network size, social engagement, and social support were particularly pronounced in rural districts that demonstrated above average population decline. DISCUSSION: Our results imply that ongoing demographic changes, particularly in rural areas, may introduce additional barriers for maintaining social integration into late life.

The impact of psychotherapist training and experience on posttermination contact.

This study sought to enhance our understanding of posttermination contact, with a particular focus on the role of training and experience in shaping attitudes and behaviors with respect to the posttermination period. We collected anonymous online survey data related to attitudes, policies, and experience of posttermination contact from 144 licensed clinicians. Our sample was composed of an experienced group of clinicians, with 20.7 years in practice on average. Clinicians had a range of clinical orientations and ∼25% of respondents were from outside of the United States. Over 90% of the participants (130) endorsed having had some form of posttermination contact, and 25% (36) reported initiating posttermination contact with a past patient. Only 62 participants (43.4%) reported receiving graduate training related to posttermination contact, and those with graduate training were more likely to have an established posttermination policy that they reviewed with patients. In addition, recent graduates were more likely to report having had training on this topic than older graduates. In terms of attitudes, therapists were more likely to anticipate positive rather than negative consequences of posttermination contact for both patients and themselves, and the longer a therapist had been in practice the less likely they were to anticipate negative consequences of posttermination contact. Additionally, a clinician's contact with their own therapist made them more likely to anticipate positive consequences for both themselves and their patients. Given the ubiquity of posttermination contact, the posttermination period should be given more attention in training programs and research. (PsycINFO Database Record

Social relationships, loneliness, and mental health among older men and women in Ireland: A prospective community-based study.

BACKGROUND: Data is lacking on the association of interpersonal stressors and social isolation with mental disorders and the mediating role of loneliness. Thus, we examined this association prospectively using community-based data. METHODS: Data on 6105 adults aged ≥50 years from the Irish Longitudinal Study on Ageing (TILDA) was analyzed. Mental health outcomes were assessed 2 years after baseline. Depressive and anxiety symptoms were evaluated with validated scales. Multivariable linear regression and mediation analyses were conducted. RESULTS: Higher levels of spousal support, less strain from spouse and better social network integration were protective against depressive symptoms in men. Social support from friends and children was protective against depressive symptoms in both genders. Higher levels of social strain from children were positively associated with depressive symptoms in women. Loneliness was a significant mediator in the majority of these associations. CONCLUSION: Interventions aimed at increasing relationship quality and strengthening existing social network structures, with a specific focus on reducing feelings of loneliness, may be beneficial in the prevention of depressive symptoms among older adults.

Relationship Between Patient SWAP-200 Personality Characteristics and Therapist-Rated Therapeutic Alliance Early in Treatment.

In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223-233; Psychother Res 9:405-423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333-353, Am J Psychiatry 161:1350-1365, 1743-1754; Am J Psychiatry 156:258-272, 273-285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists' views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction.

Structural and functional social network attributes moderate the association of self-rated health with mental health in midlife and older adults.

BACKGROUND: Social relationships are multifaceted, and different social network components can operate via different processes to influence well-being. This study examined associations of social network structure and relationship quality (positive and negative social exchanges) with mental health in midlife and older adults. The focus was on both direct associations of network structure and relationship quality with mental health, and whether these social network attributes moderated the association of self-rated health (SRH) with mental health. METHODS: Analyses were based on survey data provided by 2001 (Mean age = 65, SD = 8.07) midlife and older adults. We used Latent Class Analysis (LCA) to classify participants into network types based on network structure (partner status, network size, contact frequency, and activity engagement), and used continuous measures of positive and negative social exchanges to operationalize relationship quality. Regression analysis was used to test moderation. RESULTS: LCA revealed network types generally consistent with those reported in previous studies. Participants in more diverse networks reported better mental health than those categorized into a restricted network type after adjustment for age, sex, education, and employment status. Analysis of moderation indicated that those with poorer SRH were less likely to report poorer mental health if they were classified into more diverse networks. A similar moderation effect was also evident for positive exchanges. CONCLUSIONS: The findings suggest that both quantity and quality of social relationships can play a role in buffering against the negative implications of physical health decline for mental health.

Social network typologies and mortality risk among older people in China, India, and Latin America: A 10/66 Dementia Research Group population-based cohort study.

BACKGROUND: Restricted social networks have been associated with higher mortality in several developed countries but there are no studies on this topic from developing countries. This gap exists despite potentially greater dependence on social networks for support and survival due to various barriers to health care and social protection schemes in this setting. Thus, this study aims to examine how social network type at baseline predicts all-cause mortality among older adults in six Latin American countries, China, and India. METHODS: Population-based surveys were conducted of all individuals aged 65+ years in eight countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, China, and India). Data on mortality were obtained at follow-up (mean 3.8 years after cohort inception). Follow-up data for 13,891 individuals were analysed. Social network types were assessed using Wenger's Practitioner Assessment of Network Type (PANT). Cox proportional hazard models were constructed to estimate the impact of social network type on mortality risk in each country, adjusting for socio-demographics, receipt of pension, disability, medical conditions, and depression. Meta-analysis was performed to obtain pooled estimates. RESULTS: The prevalence of private network type was 64.4% in urban China and 1.6% in rural China, while the prevalence of locally integrated type was 6.6% in urban China and 86.8% in rural China. The adjusted pooled estimates across (a) all countries and (b) Latin America showed that, compared to the locally integrated social network type, the locally self-contained [(b) HR = 1.24, 95% CI 1.01-1.51], family dependent [(a) HR = 1.13, 95% CI 1.01-1.26; (b) HR = 1.13, 95% CI 1.001-1.28], and private [(a) HR = 1.36, 95% CI 1.06-1.73; (b) HR = 1.45, 95% CI 1.20-1.75] social network types were significantly associated with higher mortality risk. CONCLUSION: Survival time is significantly reduced in individuals embedded in restricted social networks (i.e. locally self-contained, family dependent, and private network types). Social care interventions may be enhanced by addressing the needs of those most at risk of neglect and deteriorating health. Health policy makers in developing countries may use this information to plan efficient use of limited resources by targeting those embedded in restricted social networks.

Patient Crying in Psychotherapy: Who Cries and Why?

AIM: The aim of the present study is to further the understanding of who cries in therapy and the relation of technique with crying behaviour in therapy. METHOD: Psychological assessment feedback sessions, prior to the initiation of formal therapy for 52 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics and the process of the session were collected at the time of the session. Therapist's interventions were recorded verbatim and independently rated. RESULTS: The number of times a patient cried during their session correlated negatively with global assessment of functioning scores and positively with measures of borderline personality disorder pathology as well as a measure of severity of childhood sexual abuse. Patients' crying behaviour demonstrated significant negative correlations with the overall experience of the session (bad/good), smoothness and positivity. Group differences between criers and non-criers reflected these trends as well. No significant correlations or group differences were found with regard to patient-rated or therapist-rated alliance as it relates to crying behaviour. Analysis indicates that therapist intervention prior to patient crying most often encouraged the exploration and expression of difficult affect, new perspectives on key issues or the patient's fantasies and wishes. DISCUSSION: Our study addresses a significant gap in the clinical literature on crying. Crying behaviour seems to be related to certain clinical variables and has a negative impact on patient experience of the session in which they cry, although the alliance remained unaffected. LIMITATIONS: Small sample, outpatients with mild/moderate psychopathology and graduate trainees provided therapy. KEY PRACTITIONER MESSAGE: Patients with greater problems in emotional dysregulation, borderline personality disorder symptoms and greater severity of childhood sexual abuse are more likely to display greater affective intensity during the beginning of treatment. Results suggest that the alliance may remain strong despite patients experiencing a session in which they cried as difficult. Therapeutic interventions that focus on affect, new understanding of old patterns and patient fantasies with outpatient clinical populations appeared to be associated with crying in session.

Development of the Crying Proneness Scale: associations among crying proneness, empathy, attachment, and age.

Crying is a unique form of human emotional expression that is associated with both positive and negative evocative antecedents. This article investigates the psychometric properties of a newly developed Crying Proneness Scale by examining the factor structure, test-retest reliability, and theoretically hypothesized relationships with empathy, attachment, age, and gender. Based on an analysis of data provided by a Dutch panel (Time 1: N = 4,916, Time 2: N = 4,874), exploratory and confirmatory factor analyses suggest that crying proneness is a multidimensional construct best characterized by four factors called attachment tears, societal tears, sentimental/moral tears, and compassionate tears. Test-retest reliability of the scale was adequate and associations with age, gender, empathy, and attachment demonstrated expected relations. Results suggest that this scale can be used to measure crying proneness, and that it will be useful in future studies that aim to gain a better understanding of normal and pathological socioemotional development.

Relationship between SWAP-200 patient personality characteristics and patient-rated alliance early in treatment.

Research on the therapeutic alliance suggests patient personality characteristics to be plausible correlates of alliance formation. To date, research has largely focused on the relationship between the alliance and facets of patient personality measured via patient self-report, versus personality syndromes.In the present study, we assess patient personality using a clinician-rated measure-the Shedler-Westen Assessment Procedure-200 (SWAP-200; Shedler and Westen [Assessment 5:335-355, 1998; Am J Psychiatry 161:1350-1365, 2004; Am J Psychiatry 161:1743-1754, 2004]; Westen and Shedler [Am J Psychiatry 156:258-272, 1999; Am J Psychiatry 156:273-285, 1999])-and investigate the extent to which empirically derived personality configurations correlate with patient-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic.The SWAP-200 Dependent Clinical Prototype and Dysphoric: Dependent-Masochistic Q-Factors were found to significantly correlate with early alliance. Also identified were specific SWAP-200 items that independently correlated with early alliance scores.The results of the present study demonstrate a relation between patient personality characteristics and therapeutic alliance that may serve to further a conceptual understanding of the alliance.