Dissertations, Theses, and Capstone Projects

Date of Degree

9-2023

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Tracey A. Revenson

Committee Members

Jennifer Ford

Joel Erblich

Laura Reigada

Gregory Hinrichsen

Subject Categories

Clinical Psychology | Geropsychology | Health Psychology

Keywords

Aging, multimorbidity, depression

Abstract

Given the high prevalence of multimorbidity (MM) among older adults and the exponential growth of the older adult U.S. population, identifying factors that can lessen depressive symptoms and improve quality of life (QOL) in this population is timely and important. While it is well established that MM is associated with greater depressive symptoms and poorer QOL (Li et al., 2016; Makovski et al., 2019; Marengoni et al., 2011; Read et al., 2017), the mechanisms underlying these relationships remain understudied. The illness intrusiveness model (Devins et al., 1984) proposes that stressors posed by diseases (disease-related factors) and their treatments (treatment-related factors) disrupt patients’ lives by limiting participation in valued activities, roles, and interests. As a result of this disruption, the opportunities to receive and maintain positive reinforcement from the environment are reduced, resulting in depressive symptoms and poor QOL (Devins et al., 1984). In this dissertation, direct and indirect relationships between disease- and treatment-related factors and psychosocial adjustment among older adults with MM were explored. It was hypothesized that illness intrusiveness would operate as a mediator of these relationships. Further, in line with the social ecological framework (Revenson, 1990, 2003; Revenson & Pranikoff, 2005), factors related to the temporal, interpersonal and sociocultural contexts were explored as potential moderators influencing the direct and indirect relationships between disease- and treatment-related factors and psychosocial adjustment. The sample included 366 adults ≥ 62 years old (60% female; = 72, . All constructs were measured through well validated self-report scales during a one-time online survey. Data were collected about participants’ medical conditions, treatment- and disease-related factors, illness intrusiveness, depressive symptoms, QOL, and four contextual factors: social support, age, expectations regarding aging, and financial difficulties. Multiple regression analysis and structural equation modeling were used. The results provide strong support for the direct relationship between disease-related factors and psychosocial adjustment. Illness intrusiveness emerged as a significant mediator of the relationship between disease-related factors and QOL. Further, social support and expectations regarding aging moderated the relationship between disease-related factors and depressive symptoms (although not the indirect relationship between disease-related factors and psychosocial adjustment via illness intrusiveness). The findings suggest promising new targets for interventions to improve health outcomes among older adults with MM, focusing on illness intrusiveness as a target of change.

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