Guilt associated with self-perception as a burden in older adults. Cross-sectional, experimental, and longitudinal analysis

Resumen

During old age, concerns about health and disability increase (Fergus et al., 2017), being one of the main health-related concerns of older adults becoming dependent and, consequently, being a burden to others (e.g., Gudat et al., 2019; Jahn & Curkrowicz, 2011), an experience frequently associated with negative feelings, especially, feelings of guilt (e.g., Bigger & Vo, 2022). However, feelings of guilt associated with self-perception as a burden have been scarcely studied. The main aim of this Doctoral Thesis is to analyze in healthy older adults, through cross-sectional, experimental, and longitudinal methods, the variable feelings of guilt associated with self-perception as a burden. In addition, this Doctoral Thesis aimed to explore potential factors involved in the onset of these feelings and the possible relationships of these feelings of guilt with older adults mental health indicators. The first chapter presents the theoretical framework common to the seven studies carried out. The second chapter describes the general objective of this Doctoral Thesis and presents the specific objectives and hypothesis. The third chapter provides an overview of the main methodological aspects of the seven studies. Subsequently, in the fourth chapter, the studies are presented with their own sections: Introduction, Method, Results, Discussion, and References. The fifth chapter presents a general discussion of the findings of the studies along with their limitations. Finally, a summary of the most important conclusions and contributions of the Doctoral Thesis is presented. The main objective of the first study was to develop an instrument for the assessment of feelings of guilt for perceiving oneself as a burden for the family: the Guilt for Perceiving oneself as a Burden Scale (G-SPBS). Specifically, the psychometric properties of this new instrument were analyzed in a sample of 298 people aged 60 years or more who did not show explicit cognitive or functional impairment that prevents the development of basic activities of daily living, nor did they use care services such as day centers, home care, or nursing homes . The results showed a unifactorial solution and good psychometric properties for the scale. The results also showed that a higher score on the scale was associated with higher scores in anxiety and depression symptoms. These findings suggest that the Guilt for Perceiving oneself as a Burden Scale shows good psychometric properties which endorse its use with healthy community older adults, and therefore can contribute to improving our understanding of psychological distress in older adults. The second study aimed to analyze the role of self-perceptions of aging, perceived control, self-perceived burden, and depressive symptoms in explaining feelings of guilt associated with self-perception as a burden in older people. Participants were 317 older adults. The results suggest that reporting more negative self-perceptions of aging is associated with lower perceived control in older adults. In addition, lower perceived control was associated with a greater perception of being a burden and greater depressive symptoms. Likewise, a higher perception of being a burden was associated with more depressive symptoms and greater guilt associated with self-perception as a burden. Finally, greater depressive symptoms were associated with greater feelings of guilt associated with self-perception as a burden. The model showed good fit to the data, explaining 41% of the depressive symptoms and 45% of the guilt associated with self-perception as a burden. This study shows evidence of potential correlates of psychological distress in older adults with no explicit physical or cognitive problems, suggesting paths through which feelings of guilt for perceiving oneself as a burden may develop in this population. The main purpose of the third study was to analyze the relationship between negative self-perceptions of aging, perceived control, and anxiety and depressive symptoms, and guilt associated with self-perception as a burden in older adults through two models. Participants in this study were 351 older adults. The results suggest that negative self-perceptions of aging are associated with lower perceived control in older adults. In addition, lower perceived control was associated with greater anxiety symptoms (model 1) and greater depressive symptoms (model 2). Finally, both lower perceived control and greater anxiety (model 1) and depressive (model 2) symptoms were associated with more guilt associated with self-perception as a burden. The models explained 26.37% of anxiety symptoms (model 1), 48.51% of depressive symptoms (model 2), and 13.73% (model 1) and 14.44% (model 2) of guilt for perceiving oneself as a burden. This study provides additional support to the previously mentioned potential correlates with feelings of guilt associated with self-perception as a burden in older adults, adding the relevance of anxiety symptoms. For the fourth study participants were classified into four groups or profiles according to their scores in depressive and anxiety symptomatology (subclinical, anxious, depressive, and comorbid anxious-depressive). The main objective of this study was to analyze the differences between symptomatic profiles in older adults in the variables self-perception of aging, loneliness, and feelings of guilt associated with self-perception as a burden. The results suggest, first, that older adults who reported comorbid anxiety and depressive symptoms also reported higher scores in negative self-perceptions of aging and more loneliness than the other three profiles. Second, the three symptomatic profiles (anxious, depressive, and anxious-depressive comorbid) reported higher levels of guilt associated with self-perception as a burden than the subclinical profile. The findings of this study show evidence regarding potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults. The fifth study was designed to analyze the relationship between physical limitations, guilt associated with self-perception as a burden, and loneliness in community-dwelling older adults who did not show explicit difficulties in performing basic activities of daily living, but who may report some limitation in their physical functioning (e.g., climbing several flights of stairs). Participants were 190 older adults. The results suggest that the association between physical limitations and loneliness is greater in those older adults who report greater guilt associated with self-perception as a burden. The findings of this study suggest that guilt feelings associated with perceiving oneself as a burden may contribute to understanding, preventing, and treating loneliness in older adults. The main objective of the sixth study, that was done with a sample of 106 older adults, was to analyze the associations of self-perceptions of aging and implicit age identity with psychological distress, including anxiety and depressive symptoms and guilt associated with self-perception as a burden in older adults living in the community. The results are consistent with previous studies, showing an association between greater self-perceptions of aging and greater emotional distress, including more anxiety and depressive symptoms (e.g., Levy et al., 2019), and, indirectly, greater feelings of guilt associated with self-perception as a burden. In addition, the results of study six suggest the existence of an association between older implicit age identity and greater emotional distress. Specifically, older implicit age identity was associated with greater anxiety symptoms, and these anxiety symptoms were linked, in turn, to greater depressive symptoms, and finally to guilt associated with self-perception as a burden. Therefore, an indirect association was found between implicit age identity and depressive symptoms and feelings of guilt associated with self-perception as a burden. The findings of this study suggest the relevance of implicit age identity for understanding psychological distress, including feelings of guilt associated with self-perception as a burden, in community-dwelling older adults. The last study of this Doctoral Thesis had a longitudinal design and was aimed to analyze the associations of the change in self-perceptions of aging, depressive symptoms, and feelings of guilt associated with self-perception as a burden at two time points with one year of follow-up. Participants were 60 older adults living in the community. The results are consistent with previous literature, showing an association between increases in negative self-perception of aging and increases in emotional distress. Specifically, the results of the correlations analysis found an association between increases in negative self-perception of aging and increases in depressive symptoms and feelings of guilt associated with self-perception as a burden. However, contrary to our expectations, when all the assessed variables were considered together in a regression analysis, the increase in the negative self-perceptions of aging was not a significant predictor of the increase in feelings of guilt associated with self-perception as a burden. Though, the results suggest that change in depressive symptoms is a significant predictor of change in feelings of guilt associated with self-perception as a burden. This study provides support of the importance of cognitions about aging and mental health for understanding discomfort linked to the perception of being a burden in older adults. Finally, taking into account all the results of the seven studies, it is worth highlighting that this Doctoral Thesis has made it possible to develop a new assessment instrument to assess feelings of guilt associated with self-perceptions as a burden in older adults. Likewise, the findings suggest that feelings of guilt associated with self-perception as a burden are reported by people aged 60 years or more even though they did not show explicit cognitive or functional impairment that prevents the development of basic activities of daily living, nor did they use care services such as day centers, home care or nursing homes. The studies that compose this Doctoral Thesis suggest that negative self-perceptions of aging, older implicit age identity, lower perceived control, and anxiety and depressive symptoms, and their comorbid presence, are associated with reporting feelings of guilt associated with self-perception as a burden. To conclude, feelings of guilt associated with self-perception as a burden are related to psychological distress in healthy older adults, including symptoms of depression, anxiety, and loneliness.