دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 21 The Comparison of the Effectiveness of Morning and Evening Exercise on Cognitive Performance and Depression in Older Adults with Type 2 Diabetes مقایسۀ تأثیر زمان تمرین صبح و عصر بر عملکرد شناختی و افسردگی سالمندان مبتلا به دیابت نوع 2 19 1 3605 10.22126/jap.2025.10909.1792 FA عذرا محمدپناه اردکان گروه روان‌شناسی، دانشکده علوم انسانی و اجتماعی، دانشگاه اردکان، یزد، ایران 0000-0003-0259-5733 زهرا همتی فارسانی گروه علوم ورزشی، دانشکده علوم انسانی و اجتماعی، دانشگاه اردکان، یزد، ایران 0000-0001-8499-795X زهرا حیدری گروه سلامت سالمندی، دانشکده بهداشت، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران 0009-0005-6862-7533 شهرزاد حبیبی قهفرخی گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران 0000-0003-0817-5844 Journal Article 2024 07 27 Depression in old age is considered the second leading cause of disability after physical illnesses. Depression in older adults is often associated with cognitive impairment. It is therefore important to consider the physical, emotional, and cognitive changes that occur during this stage of life. Physical activity may also exert a protective effect against cognitive decline in older adults. Therefore, this study aimed to determine the effects of morning and evening aerobic exercise on cognitive performance and depression in older adults with type 2 diabetes. This was a quasi-experimental study using a pretest-posttest design with a control group. The statistical population consisted of all older women with medical records at the Shahrekord Diabetes Association. The sample included 45 older women aged 55 to 65 years selected through convenience sampling method and based on the inclusion and exclusion criteria. They were randomly assigned to morning exercise, evening exercise and control groups. The intervention consisted of a 12-week aerobic exercise program with an intensity of 60-70% of maximum heart rate reserve. The tools used in this research include the Beck Depression questionnaire, and Montreal Cognitive Assessment (MoCA). Data were analyzed using ANCOVA in SPSS-22. The results indicated that both morning and evening aerobic exercise significantly affected blood glucose levels, cognitive function, and depression in older adults, with greater benefits observed in the evening exercise group. Maintaining physical health, such as controlling diabetes through regular physical activity, may help improve social relationships and reduce the risk of depression. Moreover, increased blood flow to the brain, higher levels of brain hormones, reduced inflammation and stress, and enhanced social interaction may contribute to improved cognitive performance in older adults. EXTENDED ABSTRACT Introduction The rapid advancement of technology, improvements in medical science, and enhanced healthcare conditions have led to a decline in mortality rates, an increase in life expectancy, and ultimately a growing trend of aging populations in the coming years. This demographic shift has accelerated the global transition toward an aging population. During the later stages of life, individuals often face various physical and psychological health challenges, including diabetes, cognitive decline, and increased depression, which contribute to reduced life satisfaction and greater dependency. Consequently, maintaining mental health in modern society is a critical issue that yields lasting benefits for individuals, families, and communities. Physical exercise plays a fundamental role in preserving health and enhancing the quality of life. Engaging in physical activity at any time is beneficial, although certain periods may be more effective than others. Considering the significance of mental health and the existing gap in research on interventions for cognitive and emotional disorders in this stage of life, this study seeks to examine two hypotheses: (1) Aerobic exercise can influence psychological indicators such as depression and cognitive function; and (2) the timing of exercise (morning vs. evening) may produce different effects on cognitive performance and depression. Method This study employed a quasi-experimental design with a pre-test and post-test approach, including a control group. The study population consisted of all women with medical records at the Diabetes Association of Shahrekord. Sampling was conducted through a public call for participation among women diagnosed with type 2 diabetes who met the eligibility criteria, using a convenience sampling method. Inclusion criteria were: (1) a diagnosis of type 2 diabetes for more than five years, and (2) an age range of 55–65 years. Exclusion criteria included: (1) musculoskeletal injury, (2) inability to perform the exercise program, and (3) presence of a specific medical condition that contraindicated exercise. A total of 45 women aged 55–65 years (mean age: 60.07 ± 5.07 years) were randomly assigned to three groups: morning exercise (15 participants), evening exercise (15 participants), and control (15 participants). Before and after the exercise period, all participants completed the Beck Depression Inventory and the Montreal Cognitive Assessment. The 12-week training program consisted of three sessions per week, each lasting 30 minutes, involving moderate-intensity walking and running (at 60–70% of maximum heart rate reserve), including warm-up and cool-down phases. Finally, the collected data from the questionnaires were analyzed using descriptive statistics (mean, standard deviation, etc.) and inferential statistics (ANCOVA) in SPSS version 26. Results Prior to data analysis, it was determined that the distribution of scores for all variables was normal, and the assumption of homogeneity of variances was confirmed. Additionally, the assumption of homogeneity of regression coefficients was examined, with results indicating that the F values were not significant at the .05 level for any variable. After verifying the assumptions of covariance analysis, the research hypotheses were evaluated using both multivariate and univariate analyses of covariance. To examine the impact of morning and evening aerobic exercise on cognitive performance and depression, Multivariate Analysis of Covariance (MANCOVA) was employed. The results of the Box’s M test were assessed to ensure no violation of the assumption of equality of covariance matrices, confirming that this assumption was met. As shown in the following table, the p values for all tests indicated a significant difference in cognitive performance (Montreal Cognitive Assessment) and depression scores (Beck Depression Inventory) between the pretest and posttest across the three groups: morning exercise, evening exercise, and control. Thus, physical exercise was effective in influencing cognitive performance and depression, supporting the primary hypothesis that aerobic exercise significantly affects these psychological variables.The results of the Bonferroni test indicate that, for the variables of depression and cognitive performance (as measured by the Montreal Cognitive Assessment), there is a significant difference between both experimental groups (morning and evening exercise) and the control group (p < .001). However, the difference between the morning and evening exercise groups was not statistically significant (p > .05). This means that both intervention methods, compared to the control group, had a significant effect in reducing depression and improving cognitive performance. Additionally, evening aerobic exercise appeared to have a greater impact on both variables. Conclusion The later stages of life are characterized by various physical, social, and psychological changes. One of these changes is the transition away from previous occupational roles, leading to a reduction in job-related responsibilities and, consequently, a decline in social interactions. Another significant characteristic is the experience of loneliness, particularly in cases where an individual has experienced the loss of friends, peers, or long-time acquaintances, increasing feelings of depression over time. Some individuals gradually withdraw from social life, while society may also marginalize them, reinforcing a sense of meaninglessness and deepening depression. Physical changes also occur, such as the gradual deterioration of cortical cells in the brain. Furthermore, the overall physical health of an individual plays a crucial role in their ability to participate in social activities, as health status becomes a fundamental determinant of social engagement at this stage of life. Findings from the present study indicate that aerobic exercise can enhance cognitive performance and reduce depression. The timing of physical activity may depend on specific objectives, while individual conditions and preferences may also influence the choice of exercise time. If individuals face time constraints or have particular preferences, it is essential to tailor exercise routines accordingly to ensure alignment with their needs and lifestyles. Overall, the results demonstrate that aerobic exercise program, regardless of time of day, had a positive effect on depression and cognitive performance in women with type 2 diabetes. Ethical Consideration Ethical Code This study was approved by the Ethics Committee of Yazd University (IR.YAZD.REC.1402.044) and registered in the Iranian Registry of Clinical Trials (IRCT) under the identifier IRCT20181212041935N1. Financial Support This research was financially supported by the Iranian National Science Foundation (INSF) under approval code 4013082. Authors’ Contributions A.M.A: Conceptualization, Methodology, Project administration, Data Curation, Writing - Review & Editing; Z.H.F: Conceptualization, validation, Writing - Review & Editing; Z.H: Data Curation, Visualization; Sh.H.GH: Validation, Formal analysis, data Curation. Conflict of Interest The authors declare no conflicts of interest Acknowledgments We sincerely appreciate the financial support provided by INSF, and extend our deepest gratitude to all participants for their valuable contributions to this study. References Abbasi, M., Mirdrikvand, F., Adavi, H., & Hojjati, M. (2017). The relationship between personality traits (psychoticism and extraversion) and self-efficacy with depression in the elderly. Salamand: Iranian Journal of Aging. 4(12), 458-466. [Persian] Alowaydhah, S., Weerasekara, I., Walmsley, S., & Marquez, J. (2024). The Effects of various types of physical exercise on health outcomes in older adults with depression: A Systematic review and meta‐analysis of controlled trials. Depression and Anxiety, 2024(1), https://doi.org/10.1155/2024/9363464 Azizan, Z., Zali, H., Mirmotalebisohi, S.A., Bazrgar, M., Ahmadiani, A. (2024). Deciphering molecular bridges: Unveiling the interplay between metabolic syndrome and Alzheimer’s disease through a systems biology approach and drug repurposing. PloS ONE. 19(5), e0304410. https://doi.org/10.1371/journal.pone.0304410 Boucard, G.K., Albinet, C.T., Bugaiska, A., Bouquet, C.A., Clarys, D., Audiffren, M. (2012). Impact of physical activity on executive functions in aging: a selective effect on inhibition among old adults. J Sport Exerc Psychol. 34(6), 808-27. https://doi.org/10.1123/jsep.34.6.808 Boustani, M., Peterson, B., Hanson, L., Harris, R., Lohr, K.N. (2003). U.S. Preventive Services Task Force. Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 138(11), 927-37. https://doi.org/10.7326/0003-4819-138-11-200306030-00015 Bednarczyk, M. R., Aumont, A., Décary, S., Bergeron, R., & Fernandes, K. J. (2009). Prolonged voluntary wheel-running stimulates neural precursors in the hippocampus and forebrain of adult CD1 mice. Hippocampus, 19(10), 913–927. https://doi.org/10.1002/hipo.20621 Buchwald, S. C. L., Gitelman, D., Smits, D., Rodriguez de la Vega, P. E., & Barengo, N. C. (2024). The Impact of physical activity on memory loss and concentration in adults aged 18 or older in the U.S. in 2020. International journal of environmental research and public health, 21(9), 1193. https://doi.org/10.3390/ijerph21091193 Cardoso Cassilhas, R., Sousa, R., Caxa, L., Viana, V., Meeusen, R., Gonçalves, F., Magalhães, C., Tufik, S., Dias Peixoto, M., Monteiro-Junior, R., & Mello, M. (2022). Indoor aerobic exercise reduces exposure to pollution, improves cognitive function, and enhances BDNF levels in the elderly. Air Quality, Atmosphere & Health, 15. https://doi.org/10.1007/s11869-021-01083-x Carta MG, Cossu G, Pintus E, Zaccheddu R, Callia O, Conti G, Pintus M, Aviles Gonzalez CI, Massidda MV, Mura G, Sardu C, Contu P, Minerba L, Demontis R, Pau M, Finco G, Cocco E, Penna MP, Orr G, etr. (2021). Moderate exercise improves cognitive function in healthy elderly people: Results of a randomized controlled trial. Clin Pract Epidemiol Ment Health.17, 75-80. https://doi.org/10.2174/1745017902117010075 Dong, Y., Zhang, X., Zhao, R., Cao, L., Kuang, X., & Yao, J. (2024). The effects of mind-body exercise on anxiety and depression in older adults: a systematic review and network meta-analysis. Front. Psychiatry. 15,1305295. https://doi.org/10.3389/fpsyt.2024.1305295 Docherty-Skippen, S. M., Hansen, A., & Engel, J. (2019). Teaching and assessment strategies for nursing self-care competencies in Ontario's nursing education programs. Nurse education in practice, 36, 108–113. https://doi.org/10.1016/j.nepr.2019.03.011 Emsaki, G., Molavi, H., Chitsaz, A., Movahed Abtahi, M., & Asgari, K. (2011). Introduction and investigation of psychometric properties of Montreal Cognitive Assessment Scale in patients with Parkinson's disease. Journal of Isfahan Medical School. 29(158), 1606-1615. [Persian] Esmaeili, M. H., & rozbahani, Z. (2018). The Effect of different doses of metformin on spatial learning and memory in diabetic rats. Journal of Ardabil University of Medical Sciences. 18(3), 298-309. [Persian] Ghasemi Pirbaluti, M., Shariat, A., & Ghazanfari, A. (2019). Meta-analytic review of exercise therapy on reducing depression in the elderly in Iran. Health Psychology. 8(30), 69-80. [Persian] Ghasemi Ardakani, A., Mohammadpanah Ardakan, A., Safi, M., and Kargar Shourki, M. (2022). The mediating role of cognitive impairments in the relationship between personality traits and meta-emotion in the elderly. Khazar Journal of Health and Aging. 8(1), 77-90. [Persian] Ganji Arjanaki, A. (2022). Exercise for diabetes control. https://civilica.com/note/2015/ Mirshahi, F. (2019). A study of common psychological interventions of Iranian psychotherapists in the treatment of mental disorders in the elderly: with an emphasis on the last three years. Rooyesh Ravashenashi. 7(8), 97-106. [Persian] Hamidi, R., Fekrizadeh, Z., Azadbakht, M., Garmaroudi, G., Taheri Tanjani, P., Fathizadeh, Sh., & Ghaiswandi, A. (2015). A study of the validity and reliability of the second version of the Beck Depression Inventory (BDI-II) in Iranian elderly. Journal of Sabzevar University of Medical Sciences, 22(1), 189-198. [Persian] Imanzadeh, A., & Hamrahzadeh, M. (2017). Identifying factors facilitating and inhibiting quality of life in elderly women and men (phenomenological research). Salamand: Iranian Journal of Aging, 12(4), 430-445. [Persian] Isik, K., Başoğul, C., & Yildirim, H. (2021). The relationship between perceived loneliness and depression in the elderly and influencing factors. Perspectives in psychiatric care, 57(1), 351–357. https://doi.org/10.1111/ppc.12572 Jonsson, T., Stefansson, H., Steinberg, S., Jonsdottir, I., Jonsson, P. V., Snaedal, J., Bjornsson, S., Huttenlocher, J., Levey, A. I., Lah, J. J., Rujescu, D., Hampel, H., Giegling, I., Andreassen, O. A., Engedal, K., Ulstein, I., Djurovic, S., Ibrahim-Verbaas, C., Hofman, A., Ikram, M. A., … Stefansson, K. (2013). Variant of TREM2 associated with the risk of Alzheimer's disease. The New England journal of medicine, 368(2), 107–116. https://doi.org/10.1056/NEJMoa1211103 Kashi, A., rezaei, S., & rafiee, S. (2017). The effect of aerobic, aerobic in water and exercises in water on working memory in elderly women with Alzheimer's disease. Journal of Geriatric Nursing. 3(3),57-67. [Persian] Khodadadi, S., Pourhadi, S., Hosseini, S., Sam, Sh., Khairkhah, F., & Mohammadi, Z. (2022). Studying the relationship between social support, cognitive status and depression with daily life activities of the elderly in Amirkola city. Salamand: Iranian Journal of Aging. 17(1),2-15. [Persian] Kim, Y. S., Song, B. K., Oh, J. S., & Woo, S. S. (2014). Aerobic exercise improves gastrointestinal motility in psychiatric inpatients. World journal of gastroenterology, 20(30), 10577–10584. https://doi.org/10.3748/wjg.v20.i30.10577 Li, H., Su, W., Dang, H., Han, K., Lu, H., Yue, S., & Zhang, H. (2022). Exercise training for mild cognitive impairment adults older than 60: A Systematic review and meta-analysis. Journal of Alzheimer's disease: JAD, 88(4), 1263–1278. https://doi.org/10.3233/JAD-220243 Mancilla, R., Brouwers, B., Schrauwen-Hinderling, V. B., Hesselink, M. K. C., Hoeks, J., & Schrauwen, P. (2021). Exercise training elicits superior metabolic effects when performed in the afternoon compared to morning in metabolically compromised humans. Physiological reports, 8(24), e14669. https://doi.org/10.14814/phy2.14669 Morimoto, S. S., Kanellopoulos, D., & Alexopoulos, G. S. (2014). Cognitive impairment in depressed older adults: implications for prognosis and treatment. Psychiatric annals, 44(3), 138–142. https://doi.org/10.3928/00485713-20140306-05 Moriya, M., Aoki, C., & Sakatani, K. (2016). Effects of physical exercise on working memory and prefrontal cortex function in post-stroke patients. Advances in experimental medicine and biology, 923, 203–208. https://doi.org/10.1007/978-3-319-38810-6_27 National Institutes of Heal. (2022). National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20892. https://www.nih.gov. Ochi, R., & Midorikawa, A. (2021). Decline in emotional face recognition among elderly people may reflect mild cognitive impairment. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.664367 Oraki, M., Mehdizadeh, A., & Dortaj, A. (2019). The effectiveness of self-care empowerment training on life expectancy, happiness and quality of life of the elderly in Iranian elderly care centers in Dubai. Journal of the Elderly, 14(3), 331-320. [Persian] Parham, M., Rezvan, S., amirkanian, F., barati, A., & nikkhah, M. H. (2020). Comparative study of diagnostic value of Montreal cognitive assessment (MoCA) and Mini–Mental state examination (MMSE) tests for assessment and cognitive impairments screening in patients with metabolic syndrome. Journal of Sabzevar University of Medical Sciences, 27(4), 570-576. Radmehr, A., & Shahbazi, Sh. (2018). The effect of public sports on cognitive performance of elderly people with Alzheimer's disease, 7th International Conference on Modern Research in Sport Sciences and Physical Education: Hamedan. [Persian] Sims-Robinson, C., Kim, B., Rosko, A., & Feldman, E. L. (2010). How does diabetes accelerate Alzheimer disease pathology? Nature reviews. Neurology, 6(10), 551–559. https://doi.org/10.1038/nrneurol.2010.130 Sato, S., Basse, A. L., Schönke, M., Chen, S., Samad, M., Altıntaş, A., Laker, R. C., Dalbram, E., Barrès, R., Baldi, P., Treebak, J. T., Zierath, J. R., & Sassone-Corsi, P. (2019). Time of Exercise Specifies the Impact on Muscle Metabolic Pathways and Systemic Energy Homeostasis. Cell metabolism, 30(1), 92–110.e4. https://doi.org/10.1016/j.cmet.2019.03.013 Saeedi, N., Lotfi, M., Akbarian, M., Saeedi, A., & Salehi, A. (2021). Emotional regulation: a comparative study in the elderly and adults. Salamand: Iranian Journal of Aging. 16(3), 412-425. [Persian] Shokoohifar, S., & Bakhshipour, A. (2021). The mediating role of meaning in life in relation to mental health and psychological well-being in the elderly. Khazar Journal of Health and Aging. 6(2), 57-70. [Persian] Saberi, A., Goodarzi, S., & Abbasi, S. (2019). The effect of physical activity on depression in the elderly with emphasis on the mediating role of social capital. Journal of Social Capital Management. 7(1), 1-23. [Persian] Savikj, M., Gabriel, B. M., Alm, P. S., Smith, J., Caidahl, K., Björnholm, M., Fritz, T., Krook, A., Zierath, J. R., & Wallberg-Henriksson, H. (2019). Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial. Diabetologia, 62(2), 233–237. https://doi.org/10.1007/s00125-018-4767-z Tseng, H. L., Yang, S. C., Yang, S. H., & Shieh, K. R. (2015). Hepatic circadian-clock system altered by insulin resistance, diabetes and insulin sensitizer in mice. PloS one, 10(3), e0120380. https://doi.org/10.1371/journal.pone.0120380 Westerhof, G. J., Nehrkorn-Bailey, A. M., Tseng, H. Y., Brothers, A., Siebert, J. S., Wurm, S., Wahl, H. W., & Diehl, M. (2023). Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis. Psychology and aging, 38(3), 147–166. https://doi.org/10.1037/pag0000737 Wang, X., Yang, J., Lu, T., Zhan, Z., Wei, W., Lyu, X., Jiang, Y., & Xue, X. (2020). The effect of swimming exercise and diet on the hypothalamic inflammation of ApoE-/- mice based on SIRT1-NF-κB-GnRH expression. Aging, 12(11), 11085–11099. https://doi.org/10.18632/aging.103323 افسردگی در دوران سالمندی، پس از بیماری‌های جسمی، به‌عنوان دومین علت ناتوانی شناخته می‌شود. افسردگی در سالمندان اغلب با اختلالات شناختی همراه است. بنابراین، توجه به تغییرات جسمی، هیجانی و شناختی در این دوره از زندگی ضروری است. فعالیت بدنی می‌تواند نقش محافظتی در برابر افت عملکرد شناختی در سالمندان ایفا کند. از این ‌رو، این مطالعه با هدف بررسی تأثیر تمرینات هوازی صبحگاهی و عصرگاهی بر عملکرد شناختی و افسردگی در سالمندان مبتلا به دیابت نوع ۲ انجام شد. این پژوهش به‌صورت نیمه‌آزمایشی با طرح پیش‌آزمون-پس‌آزمون همراه با گروه کنترل انجام گرفت. جامعه آماری شامل کلیه زنان سالمند دارای پرونده پزشکی در انجمن دیابت شهرکرد بود. نمونه مورد مطالعه‌ شامل ۴۵ زن سالمند در بازه سنی ۵۵ تا ۶۵ سال بود که به روش نمونه‌گیری در دسترس و بر اساس معیارهای ورود و خروج انتخاب شدند و به‌صورت تصادفی در سه گروه ورزش صبحگاهی، ورزش عصرگاهی و کنترل تقسیم شدند. مداخله شامل یک برنامه تمرین هوازی ۱۲ هفته‌ای با شدت 60 تا 70 درصد از ضربان قلب ذخیره بود. ابزارهای پژوهش شامل پرسشنامه افسردگی بک و آزمون عملکرد شناختی مونترال بودند. داده‌ها با استفاده از تحلیل کوواریانس (ANCOVA) در نرم‌افزار SPSS نسخه ۲۲ تحلیل شدند. نتایج نشان داد که تمرینات هوازی صبحگاهی و عصرگاهی تأثیر معناداری بر سطوح قند خون، عملکرد شناختی و افسردگی در سالمندان داشتند، به‌طوری‌که اثرات تمرین در گروه ورزش عصرگاهی بیشتر بود. حفظ سلامت جسمی، مانند کنترل دیابت از طریق فعالیت بدنی منظم، می‌تواند به بهبود روابط اجتماعی و کاهش خطر افسردگی کمک کند. همچنین، افزایش جریان خون مغزی، ترشح بیشتر هورمون‌های مغز، کاهش التهاب، استرس و افسردگی و افزایش تعاملات اجتماعی می‌توانند در بهبود عملکرد شناختی سالمندان نقش مؤثری داشته باشند.

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دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 21 The Comparison of the Effectiveness of Emotional Cognitive Regulation Training and Transcranial Direct Current Stimulation on Resilience, Cognitive Flexibility, and Rumination in Older Women with Major Depressive Disorder مقایسه اثربخشی آموزش تنظیم شناختی هیجانی و تحریک الکتریکی مستقیم فراجمجمه‌ای در تاب‌آوری، انعطاف‌پذیری شناختی و نشخوار فکری زنان سالمند با اختلال افسردگی اساسی 42 21 3661 10.22126/jap.2025.11478.1821 FA محمدرضا نوروزی همایون گروه مشاوره، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0000-0003-3242-7650 علی نصیری گروه روان‌شناسی، دانشکده علوم‌تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0009-0000-5953-3643 اسماعیل صدری دمیرچی گروه مشاوره، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0000-0003-0568-052X محمد نریمانی گروه روان‌شناسی، دانشکده علوم‌تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0000-0002-9710-4046 Journal Article 2024 12 07 The present study aimed to compare the effectiveness of Emotion Regulation Training (ERT) and Transcranial Direct Current Stimulation (tDCS) in enhancing resilience and cognitive flexibility, as well as in reducing rumination, among women diagnosed with Major Depressive Disorder (MDD) in later stages of life. This quasi-experimental study employed a pretest-posttest design with a control group. The study population consisted of women formally diagnosed with MDD and residing in assisted nursing homes that collaborated with the research. A total of 45 eligible participants were selected through convenience sampling based on inclusion criteria of the study. They were then randomly assigned to one of three groups, namely ERT, tDCS, and control, using simple random allocation. Each intervention group received eight weekly 50-minute individual sessions. Data were collected using the Connor-Davidson Resilience Scale, the Cognitive Flexibility Questionnaire, and the Ruminative Responses Scale. The data were analyzed using univariate analysis of covariance (ANCOVA) and Tukey’s post hoc test, with a significance level set at .05, using SPSS-27 software. The ANCOVA results revealed significant differences among the three groups regarding the dependent variables. Tukey’s post hoc analysis showed that only the ERT group demonstrated significant improvements in resilience and cognitive flexibility, as well as reductions in rumination, compared to the control group. These findings underscore the effectiveness of ERT as a cognitive-based intervention in promoting mental health among older adults with MDD. EXTENDED ABSTRACT Introduction Major depression disorder (MDD) in older adults is one of the most prevalent psychological disorders, exerting profound negative effects on quality of life, cognitive functioning, and mental health within this age group. This condition leads to reduced resilience, diminished cognitive flexibility, and increased rumination. Resilience, as a crucial coping factor, plays a significant role in reducing the severity of depressive symptoms, whereas cognitive flexibility refers to an individual’s ability to shift perspectives and adapt to new circumstances. Additionally, rumination, recognized as a maladaptive cognitive style, contributes to the persistence and reinforcement of MDD. Cognitive-behavioral interventions, along with innovative psychological and neuropsychological techniques, can effectively improve these dimensions. Emotion regulation training (ERT) is a promising intervention that focuses on enhancing adaptive strategies while reducing maladaptive responses. Furthermore, transcranial direct current stimulation (tDCS), a non-invasive method for modulating brain activity, has garnered considerable attention, particularly in the treatment of psychological disorders. However, limited research has compared the effectiveness of these interventions in individuals with MDD at later stages of life. This research gap highlights the necessity of examining novel interventions, such as ERT and tDCS, to enhance resilience and cognitive flexibility, and to reduce rumination in this population. Method The present was a quasi-experimental with a pretest-posttest design and a control group. The study population consisted of 45 women (ages 61 to 82) diagnosed with MDD, who were randomly assigned to three groups with 15 participants (two experimental groups and one control group). Inclusion criteria included (1) a diagnosis of MDD made by a psychiatrist or psychologist at the care facility, based on DSM-5-TR, (2) an age range between 60 and 85 years, (3) informed consent obtained from both the participant and their legal guardian, and (4) a minimum level of literacy, defined as at least six years of formal education. Exclusion criteria included (1) comorbid psychotic features, (2) the presence of metallic implants in the body or head, or intracranial devices, (3) a history of traumatic brain injury or symptoms indicative of any form of dementia, (4) receipt of medical or psychological interventions aimed at treating depression within the month preceding the study, and (5) a history of epilepsy or traumatic brain injury. The first experimental group received ERT in an individual format over eight weekly 50-minute sessions. This protocol, adapted from James Gross’s Handbook of Emotion Regulation (2015), included skills such as cognitive reappraisal, acceptance, mindfulness, identifying negative thoughts, and increasing pleasurable activities. The second experimental group underwent tDCS using the NEUROSTIM-2 device, with a 2-milliampere intensity applied for 30 minutes per session across eight weekly sessions. The anodal electrode was placed over F3 (left prefrontal cortex), while the cathodal electrode was positioned at Fp2 (right prefrontal cortex). The stimulation aimed to enhance cognitive flexibility and reduce rumination in the first four sessions and improve resilience in the subsequent four sessions. Data were collected before and after the interventions while ensuring ethical confidentiality, using resilience, cognitive flexibility, and rumination questionnaires, and analyzed with SPSS version 27. Participants were excluded if they missed more than two sessions or withdrew from the study. The control group received no intervention. Results Descriptive analysis indicated that the mean scores for resilience and cognitive flexibility increased in the experimental groups during the post-test phase, while mean rumination scores decreased. To conduct a more precise analysis and control for the effects of the pre-test, univariate analysis of covariance (ANCOVA) was employed. Prior to performing this analysis, all necessary assumptions were examined. These included normal data distribution (Shapiro-Wilk test), homogeneity of variances (Levene’s test), and homogeneity of regression slopes, all of which were confirmed. Additionally, a significant correlation was observed between pre-test and post-test scores across all variables. The results of ANCOVA (Table 1) indicated that, after controlling for the pre-test effect across all three variables, the overall impact of the interventions on the dependent variables in the post-test phase was statistically significant. Follow-up analyses revealed that the ERT intervention significantly enhanced resilience and cognitive flexibility while reducing rumination. In contrast, the tDCS did not show a significant effect on any of the dependent variables. Based on these findings, it can be concluded that ERT is an effective intervention for improving psychological indicators in older individuals with MDD. Conclusion The primary objective of this study was to compare the effectiveness of two non-pharmacological interventions, ERT and tDCS, in improving resilience and cognitive flexibility, and in reducing rumination in older women diagnosed with MDD. The first hypothesis proposed that ERT significantly enhances resilience and cognitive flexibility while reducing rumination in women with MDD. The second hypothesis suggested that tDCS has a significant impact on improving resilience and cognitive flexibility, and on reducing rumination. The results supported the first hypothesis, confirming that ERT was effective in improving resilience and cognitive flexibility, and in reducing rumination. This outcome suggests that ERT, as a psychological intervention based on modifying cognitive and emotional patterns, directly contributes to the enhancement of psychological resilience. A fundamental assumption in this area is that individuals with MDD tend to engage in negative and maladaptive thought patterns, which can lead to increased rumination and decreased resilience. ERT helps individuals reframe their perspective on stressful situations through techniques such as cognitive reappraisal, problem reinterpretation, and emotion acceptance, ultimately strengthening their psychological coping abilities. In contrast, the second hypothesis, regarding the effectiveness of tDCS in improving resilience and cognitive flexibility, and reducing rumination was not supported by the results. This finding suggests that, while tDCS is recognized as a novel intervention for cognitive and psychological disorders, various factors may have impeded its expected impact on individuals with MDD in older adults. Ethical Consideration Ethical Code This study was conducted in accordance with ethical principles for scientific research and the standards set by institutional ethics committees. Financial Support This study did not receive any financial support. Authors’ Contributions M.N.H: Conceptualization, writing - review & editing, methodology, project administration; A.N: Conceptualization, writing - review & editing, software, formal analysis, data curation; E.S.D: Supervision; M.N: Supervision Conflict of Interest The author had no conflicts of interest. Acknowledgments The authors express their gratitude to all individuals who contributed to the execution of this research. References Adamczyk, A. K., Koch, S. B., Wyczesany, M., Roelofs, K., & van Peer, J. M. (2024). Emotion regulation flexibility: EEG/EMG predictors and consequences of switching between reappraisal and distraction strategies. Psychophysiology, 61(11), e14646. https://doi.org/10.1111/psyp.14646 Akhouri, D., & Bashir, T. (2024). Elderly: Risk Factors, Challenges, Burden, and Effective Management Plan. In Difficulties and Challenges in Geriatric Health Management (pp. 27-44). IGI Global. Aksu, S., Indahlastari, A., O’Shea, A., Marsiske, M., Cohen, R., Alexander, G. E., ... & Woods, A. J. (2024). Effect of transcranial direct current stimulation with cognitive training on executive functions in healthy older adults: a secondary analysis from the ACT trial. GeroScience, 1-20. https://doi.org/10.1007/s11357-024-01455- Almasi, M., Noroozi Homayoon, M. and Rezaei sharif, A. (2021). The Effectiveness of Neurofeedback Therapy and Transcranial Direct Current Stimulation in Cognitive Dominance of Children with Attention Deficit/ Hyperactivity Disorder. Neuropsychology, 7(25), 111-130. Angevaare, M. J. (2023). Resilience in Older Adults: More Than Meets the Eye: A conceptual & empirical exploration of resilience in older adults. Burwell, R. A., & Shirk, S. R. (2007). Subtypes of rumination in adolescence: Associations between brooding, reflection, and depression. Journal of Clinical Child & Adolescent Psychology, 36(1), 56-65.https://doi.org/10.1023/A:102391031556 Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20(6), 1019-1028. https://doi.org/10.1002/jts.20271 Cole, M. W. (2024). Cognitive flexibility as the shifting of brain network flows by flexible neural representations. Current Opinion in Behavioral Sciences, 57, Article 101384. https://doi.org/10.1016/j.cobeha.2024.101384 Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76-82. https://doi.org/10.1002/da.10113 Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34(3), 241–253. https://doi.org/10.1007/s10608-009-9276-4 Eisma, M. C., Janshen, A., Huber, L. F., & Schroevers, M. J. (2023). Cognitive reappraisal, emotional expression and mindfulness in adaptation to bereavement: a longitudinal study. Anxiety, Stress, & Coping, 36(5), 577-589. https://doi.org/10.1080/10615806.2023.2165647 Eskandari, H., Pajouhinia, S., & Abavisan, Y. (2016). Explanation of psychological problems based on cognitive flexibility and self-differentiation. Shefaye Khatam, 4(3), 18-27. http://shefayekhatam.ir/article-1-970-fa.html [Persian] Noroozi Homayoon, M., Almasi, M., Sadri Damirchi, E. and Hatami Nejad, M. (2023). Comparing the Effectiveness of Transcranial Direct Current Stimulation and Repeated Transcranial Magnetic Stimulation Treatment on Working Memory, Impulsivity and Self-Harm Behaviors in People with Borderline Personality. Neuropsychology, 8(31), 1-19. https://doi.org/10.30473/clpsy.2023.65222.1678 [Persian] Gross, J. J. (2015). Handbook Of Emotion Regulation. (2nd ed.). The Guilford Press. Hakimirad, E. (2024). The effect of transcranial direct current stimulation (tDCS) on cognitive flexibility in children with specific learning disorders. https://doi.org/10.21203/rs.3.rs-4029317/v1 Hatami Nejad, M., Noroozi Homayoon, M., Sadeghi, M., & Sadri Damirchi, E. (2024). Development of a student social anxiety model based on uncompromising perfectionism and experiential avoidance with a mediating role of difficulty in emotion regulation. Journal of Applied Psychological Research. https://doi.org/10.22059/japr.2024.375061.644904 [Persian] Hatami Nejad, M., Sadeghi, M., Sadri Damirchi, E., & Noroozi Homayoon, M. (2025). Examining the influence of alexithymia, gender, and age on drug use among iranian students: the mediating role of emotion regulation difficulties. Scientific Reports, 15(1), 3650. https://doi.org/10.1038/s41598-025-87394-w Hauptman, M., Liu, Y. F., & Bedny, M. (2024). Built to Adapt: Mechanisms of Cognitive Flexibility in the Human Brain. Annual Review of Developmental Psychology, 6. https://doi.org/10.1146/annurev-devpsych-120621-042108 Hoebeke, Y., Vanderhasselt, M. A., Carême, M., Maurage, P., & Heeren, A. (2024). No impact of tDCS on stress-induced state rumination and no influence of executive control and trait rumination: A double-blind sham-controlled within-subjects study. Clinical Neuropsychiatry, 21(1), 99. https://doi.org/10.36131/cnfioritieditore20240107 Horczak, P., Wang, C., De Witte, S., De Smet, S., Remue, J., De Raedt, R., ... & Baeken, C. (2023). Combining transcranial direct current stimulation with group cognitive behavioral therapy developed to treat rumination: a clinical pilot study. Frontiers in Neurology, 14, Article 1167029. https://doi.org/10.3389/fneur.2023.1167029 Hu, R., Li, J., Lu, Y., Luo, H., Zhang, Y., Wang, X., ... & Luo, Q. (2024). The effect of transcranial direct current stimulation (tDCS) on cognitive function recovery in patients with depression following electroconvulsive therapy (ECT): protocol for a randomized controlled trial. BMC Psychiatry, 24(1), 130. https://doi.org/10.1186/s12888-024-05567-9 Jentsch, V. L., & Wolf, O. T. (2024). The bidirectional interplay between stress and cognitive emotion regulation. Psychoneuroendocrinology, 160, Article 106719. https://doi.org/10.1016/j.psyneuen.2023.106719 Jog, M. A., Anderson, C., Kubicki, A., Boucher, M., Leaver, A., Hellemann, G., ... & Narr, K. (2023). Transcranial direct current stimulation (tDCS) in depression induces structural plasticity. Scientific Reports, 13(1), 2841. https://doi.org/10.1038/s41598-023-29792-6 Kaptan, M., Konstantopoulos, C. G., Mackey, S. C., & You, D. S. (2024). Which types of rumination will predict longitudinal physical and psychological status in patients with chronic pain? The Journal of Pain, 25(4), 65. https://doi.org/10.1016/j.jpain.2024.01.299 Kazemi, N., Arjmandnia, A. A., Moradi, R., Mohammadi, S., & Sadeghi Fard, M. (2020). The effectiveness of self-compassion training program on psychological well-being and rumination of the mothers of children with special learning disabilities. Rooyesh, 9(1), 27-36. http://frooyesh.ir/article-1-1480-fa.html [Persian] Keyhani, M., Taghvaei, D., Rajabi, A., & Amirpour, B. (2015). Internal consistency and confirmatory factor analysis of the Connor-Davidson Resilience Scale (CD-RISC) among nursing female students. Iranian Journal of Medical Education, 14(10), 857-865. http://ijme.mui.ac.ir/article-1-3254-fa.html [Persian] Kochaksaraei, M. R., Mafakheri, A., & Jajarmi, M. (2024). Comparing the effect of transcranial direct current stimulation (tdcs) and cognitive-behavioral therapy on substance craving control and rumination in methamphetamine-dependent patients. Journal of Adolescent and Youth Psychological Studies (JAYPS), 5(2), 75-83. https://doi.org/10.61838/kman.jayps.5.2.9 Kong, S., Chen, Y., Huang, H., Yang, W., Lyu, D., Wang, F., ... & Hong, W. (2024). Efficacy of transcranial direct current stimulation for treating anhedonia in patients with depression: A randomized, double-blind, sham-controlled clinical trial. Journal of Affective Disorders, 350, 264-273. https://doi.org/10.1016/j.jad.2024.01.041 Kosonogov, V. V., Ntoumanis, I., Hajiyeva, G., & Jaaskelainen, I. (2023). Emotion regulation: A study of electroencephalographic correlates. Genes & Cells, 18(4), 618-621. https://doi.org/10.17816/gc623335 Kurtoğlu, M. B., Yücel, D., Coşkun, E., & Katar, K. S. (2024). The relationship between adverse childhood experiences and social anxiety disorder symptoms: the mediating role of rumination. Current Psychology, 1-8. https://doi.org/10.1007/s12144-024-06021-5 Li, S., Tang, Y., Zhou, Y., & Ni, Y. (2024). Effects of transcranial direct current stimulation on cognitive function in older adults with and without mild cognitive impairment: A systematic review and meta-analysis of randomized controlled trials. Gerontology, 70(5), 544-560. https://doi.org/10.1159/000537848 Mehta, A., & Gupta, G. (2024). Resilience in Adolescents: The role of parental and adolescent emotion regulation. Mind and Society, 13(01), 47-57. https://doi.org/10.56011/mind-mri-131-20246 Mouatsou, C., & Koutra, K. (2023). Emotion regulation in relation with resilience in emerging adults: The mediating role of self-esteem. Current Psychology, 42(1), 734-747. https://doi.org/10.1007/s12144-021-01427-x Nejad, M. H., Damirchi, E. S., Sadeghi, M., & Homayoon, M. N. (2025). Developing a Model of Experiential Avoidance Based on Childhood Trauma and Victimization, Mediated by Insecure Attachment Styles. European Journal of Trauma & Dissociation, Article 100513. https://doi.org/10.1016/j.ejtd.2025.100513 Nejati, V., Salehinejad, M. A., Nitsche, M. A., Najian, A., & Javadi, A. H. (2020). Transcranial direct current stimulation improves executive dysfunctions in ADHD: implications for inhibitory control, interference control, working memory, and cognitive flexibility. Journal Of Attention Disorders, 24(13), 1928-1943. https://doi.org/10.1177/1087054717730611 Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115-121. https://doi.org/10.1037/0022-3514.61.1.115 Noroozi Homayoon, M., Hatami Nejad, M., Sadri Damirchi, E. and sadeghi, M. (2024). Comparing the effectiveness of emotion regulation training and transcranial direct current stimulation on improving executive functions and impulsivity in male students with attention deficit hyperactivity disorder. Neuropsychology, 10(37), -. doi:10.30473/clpsy.2024.71022.1742 [Persian] Noroozi Homayoon, M., Sadri Damirchi, E., Sadeghi, M. and Hatami Nejad, M. (2025). Comparing the effectiveness of cognitive-emotional regulation training and transcranial direct current stimulation on difficulty in regulating emotions, rumination and quality of life in divorced women. Women’s Health Bulletin, 12(1), 21-29. doi:10.30476/whb.2024.103315.1300 Noroozi Homayoon, M., Akhavi Samarein, Z., Sadeghi, M., Hatami Nejad, M., & Jafari Moradlo, M. (2024). Comparing the efficacy of emotion-focused therapy and transcranial direct current stimulation on impulsivity, emotional regulation, and suicidal ideation in young people with borderline personality disorder. Journal of Research in Psychopathology.https://doi.org/10.22098/jrp.2024.14488.1221 Noroozi Homayoon, M., Sadeghi, M., Sadri Damirchi, E., & Hatami Nejad, M. (2025). The relationship between sense of coherence and perceived social support with resilience: The mediating role of adaptive cognitive-emotional regulation strategies in older adults. Aging Psychology. Advance online publication. https://doi.org/10.22126/jap.2025.11026.1801 [Persian] Oriyama, K., Mukai, K., Harada, K., & Masumoto, K. (2025). Relationship between habitual use and degree of emotion regulation: Age differences in cognitive reappraisal and expressive suppression. Experimental Aging Research, 51(1), 59-72. https://doi.org/10.1080/0361073x.2024.2315917 Park, S., Kim, J. R., & Lee, C. D. (2023). Association of resilience with successful ageing and the mediating role of community participation. Alzheimer's & Dementia, 19, Article e074099. https://doi.org/10.1002/alz.074099 Ravelo, Y., Gonzalez-Mendez, R., Alegre de la Rosa, O. M., & Marrero, H. (2024). Boosting resilience attentional bias in previously bullied university students with low post-traumatic growth: a transcranial direct current stimulation study. Brain Sciences, 14(11), 1069. https://doi.org/10.3390/brainsci1411106 Rezaei, M., Shariat Bagheri, M. M., Khazaei, S., & Garavand, H. (2023). Tdcs efficacy and utility of anhedonia and rumination as clinical predictors of response to tDCS in major depressive disorder (MDD). Journal Of Affective Disorders, 339, 756–762. https://doi.org/10.1016/j.jad.2023.07.065 Rickerby, N., Krug, I., Fuller-Tyszkiewicz, M., Forte, E., Davenport, R., Chayadi, E., & Kiropoulos, L. (2024). Rumination across depression, anxiety, and eating disorders in adults: A meta-analytic review. Clinical Psychology: Science And Practice, 31(2), 251. https://psycnet.apa.org/doi/10.1037/cps0000110 Rodríguez-Nieto, G., Alvarez-Anacona, D. F., Mantini, D., Edden, R. A., Oeltzschner, G., Sunaert, S., & Swinnen, S. P. (2024). Association between Inhibitory–Excitatory Balance and Brain Activity Response during Cognitive Flexibility in Young and Older Individuals. Journal of Neuroscience, 44(36). https://doi.org/10.1523/JNEUROSCI.0355-24.2024 Roheger, M., Mäder, A., Riemann, S., Niemann, F., Kessler, K., Martin, A. K., & Meinzer, M. (2025). Intact embodiment during perspective-taking in older adults is not affected by focal tDCS. GeroScience, 1-15. https://doi.org/10.1007/s11357-025-01554- Rompilla, D. B., Nook, E. C., Stephens, J. E., Hittner, E. F., Mittal, V. A., & Haase, C. M. (2025). emotion regulation and executive functioning in late life. Affective Science, 1-12. https://doi.org/10.1007/s42761-024-00283- Rosenbaum, D., Int-Veen, I., Rubel, J., Laicher, H., Kroczek, A., Lawyer, G., ... & Ehlis, A. C. (2022). Associations of different emotion regulation strategies with coping-efficacy, rumination and stress. Cognitive Therapy and Research, 46(5), 889-901. https://doi.org/10.1007/s10608-022-10307- Rubinskiy, A. V., Chalisova, N. I., Ryzhak, G. A., Kozina, L. S., Antipov, N. O., & Marchenko, V. N. (2023). Diagnosis of fragility and age resilience from a dynamical systems perspective. Advances in Gerontology= Uspekhi Gerontologii, 36(5), 672-682. Santacruz, C. P. P., Sánchez-Valencia, G., León, T., Sánchez, H. M., Valencia, M. C. P., Muñoz-Alvarez, E. N., & Trejos, J. S. S. (2023). Resilience and quality of life in a group of older adults displaced by violence in Colombia. International Journal of Medical and Surgical Sciences, 10(4), 1-25. https://doi.org/10.32457/ijmss.v10i4.2349 Soldini, A., Vogelmann, U., Aust, S., Goerigk, S., Plewnia, C., Fallgatter, A., ... & Burkhardt, G. (2024). Neurocognitive function as outcome and predictor for prefrontal transcranial direct current stimulation in major depressive disorder: an analysis from the DepressionDC trial. European Archives of Psychiatry and Clinical Neuroscience, 1-10. https://doi.org/10.1007/s00406-024-01759- Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247-259. https://doi.org/10.1023/A:1023910315561 Upasen, R., Saengpanya, W., Awae, W., & Prasitvej, P. (2024). The influence of resilience and social support on mental health of older adults living in community: A cross-sectional study. BMC Psychology, 12(1), 397. Ursu, A., & Măirean, C. (2022). Cognitive emotion regulation strategies as mediators between resilience and stress during COVID-19 pandemic. International Journal of Environmental Research and Public Health, 19(19), 12631. Vasile, M., Aartsen, M., Precupetu, I., Tufă, L., Dumitrescu, D. A., & Radogna, R. M. (2024). Association between social isolation and mental well-being in later life. what is the role of loneliness? Applied Research in Quality of Life, 19(1), 245-267. Wang, Y., Qiu, Y., Ren, L., Jiang, H., Chen, M., & Dong, C. (2024). Social support, family resilience and psychological resilience among maintenance hemodialysis patients: A longitudinal study. BMC Psychiatry, 24(1), 76. https://doi.org/10.1186/s12888-024-05526- Wolfe, T., Gassel, A., Calvert, M., Isaac, L., James, G. A., Koscik, T. R., & Kilts, C. D. (2024). Population-level age effects on the white matter structure subserving cognitive flexibility in the human brain. BIORXIV, 2024- Wu, P., Cao, K., Feng, W., & Lv, S. (2024). Cross-lagged analysis of rumination and social anxiety among Chinese college students. BMC Psychology, 12(1), 28. https://doi.org/10.1186/s40359-023-01515- Xue, M., Cong, B., & Ye, Y. (2023). Cognitive emotion regulation for improved mental health: A chain mediation study of Chinese high school students. Frontiers in Psychology, 13, Article 1041969. https://doi.org/10.3389/fpsyg.2022.104196 Yang, C., Jung, B., & Lee, S. H. (2024). Transcranial electrical stimulation: clinical implication and practice for treatment of psychiatric illness. Clinical Psychopharmacology and Neuroscience: The Official Scientific Journal of The Korean College of Neuropsychopharmacology, 22(3), 391–404. Yong, S., Hung, M. W., Yuan, C. W., Chiu, C. C., Huang, M. C., & You, C. W. (2023). Mind and body: The complex role of social resources in understanding and managing depression in older adults. Proceedings of the ACM on Human-Computer Interaction, 7(CSCW1), 1-25. https://doi.org/10.1145/3579507 Zadhasan, Z. (2023). Evaluating the Emotion Regulation Program on Enhancing Family Resilience. KMAN Counseling & Psychology Nexus, 1(2), 51-57. https://doi.org/10.61838/kman.psychnexus.1.2.9 پژوهش حاضر با هدف مقایسه اثربخشی آموزش تنظیم هیجان و تحریک الکتریکی مستقیم فراجمجمه‌ای در ارتقای تاب‌آوری و انعطاف‌پذیری شناختی و همچنین کاهش نشخوار فکری در زنان سالمند مبتلا به اختلال افسردگی اساسی انجام شد. این مطالعه نیمه‌آزمایشی با طرح پیش‌آزمون-پس‌آزمون و گروه کنترل انجام گرفت. جامعه آماری شامل زنانی بود که تشخیص رسمی اختلال افسردگی اساسی دریافت کرده و در مراکز نگهداری سالمندانی سکونت داشتند که در این پژوهش همکاری داشتند. ۴۵ شرکت‌کننده‌ واجد شرایط از طریق روش نمونه‌گیری در دسترس و بر اساس معیارهای ورود به مطالعه انتخاب شدند. سپس آن‌ها با استفاده از گمارش تصادفی ساده به‌طور تصادفی در یکی از سه گروه آموزش تنظیم هیجان، تحریک الکتریکی مستقیم فراجمجمه‌ای، و گروه کنترل قرار گرفتند. هر گروه مداخله‌ای، هشت جلسه انفرادی هفتگی ۵۰ دقیقه‌ای دریافت کرد. برای جمع‌آوری داده‌ها از مقیاس تاب‌آوری کانر و دیویدسون، پرسش‌نامه انعطاف‌پذیری شناختی و مقیاس پاسخ‌های نشخواری استفاده شد. داده‌ها با استفاده از روش تحلیل کوواریانس تک‌متغیره و آزمون تعقیبی توکی در سطح معناداری ۰۵/۰ و با بهره‌گیری از نرم‌افزار آماری نسخه ۲۷ تحلیل شدند. نتایج تحلیل کوواریانس نشان داد که بین سه گروه در متغیرهای وابسته تفاوت معناداری وجود دارد. تحلیل تعقیبی توکی نشان داد که در مقایسه با گروه کنترل، تنها گروه آموزش تنظیم هیجان بهبود معناداری در تاب‌آوری، انعطاف‌پذیری شناختی و کاهش نشخوار فکری نشان داد. این یافته‌ها اثربخشی مداخله‌ی آموزش تنظیم هیجان را در ارتقای سلامت روان زنان سالمند مبتلا به افسردگی اساسی تأیید می‌کنند و بر نقش کلیدی مداخلات شناختی در این حوزه تأکید دارند.

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دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 21 The Comparison of Risky Decision-Making and Empathy Abilities in Older Adults With and Without Alzheimer’s Disease مقایسه تصمیم‌گیری پرخطر و توانایی همدلی در سالمندان مبتلا و غیر مبتلا به آلزایمر 59 43 3718 10.22126/jap.2025.11391.1817 FA پروین کاشف گروه روان‌شناسی، دانشکده ادبیات و علوم انسانی، دانشگاه گیلان، رشت ایران 0009-0008-3551-1771 عباس ابوالقاسمی گروه روان‌شناسی، دانشکده ادبیات و علوم انسانی، دانشگاه گیلان، رشت ایران 0000-0002-7378-9730 مهناز خسروجاوید گروه روان‌شناسی، دانشکده ادبیات و علوم انسانی، دانشگاه گیلان، رشت، ایران 0000-0002-4079-9094 Journal Article 2024 11 14 Abstract Aging is often accompanied by an increased prevalence of diseases and chronic disorders, posing significant challenges for older adults. Alzheimer’s disease is a progressive neurological disorder that profoundly affects memory, cognitive abilities, and emotional functioning. This study aimed to compare risky decision-making and empathy abilities among individuals with mild Alzheimer’s disease (mAD), those with moderate Alzheimer’s disease (moAD), and cognitively healthy individuals. In this causal-comparative study, the population included cognitively healthy individuals and those diagnosed with mAD and moAD (aged 65 and above) residing in Rasht during 2023-2024. The research sample consisted of 37 cognitively healthy individuals, 31 individuals with mAD, and 37 individuals with moAD, selected through convenience sampling and based on specialist diagnoses and Folstein and McHugh’s Mini-Mental State Examination (MMSE). Datan were collected using the Iowa Gambling Task and Baron-Cohen and Wheelwright’s Empathy Quotient questionnaire. The data were analyzed using ANOVA and MANOVA in SPSS-27. The results indicated a significant difference in risky decision-making among the three groups (P<.05). However, among empathy components, a significant difference was found only in cognitive empathy (P<.05). Post hoc analysis using Tukey’s HSD test revealed that individuals with moAD exhibited significantly higher levels of risky decision-making compared to the other two groups, between which no significant difference was observed. Furthermore, individuals with moAD showed better cognitive empathy than those with mAD. These findings underscore the importance of addressing the specific needs of individuals with Alzheimer’s disease and developing appropriate interventions to enhance their quality of life and social interactions. EXTENDED ABSTRACT Introduction Alzheimer's disease (AD) is a progressive neurological disorder closely associated with aging. This condition leads to inefficiencies in both cognitive and emotional functions. The executive dysfunction resulting from cognitive impairments in AD can significantly hinder an individual’s ability to make decisions. Furthermore, empathy is also influenced by complex cognitive and emotional processes, which may become disrupted in AD. Previous findings indicate that individuals with AD tend to make fewer safe and advantageous choices in risky decision-making situations. Given the diversity of assessment methods and the limited number of studies conducted, this area requires further investigation. Additionally, prior research suggests that AD can impact various dimensions of empathy in different ways. Considering the conflicting results obtained and the scarcity of studies conducted both within and outside Iran, further research is needed to clarify remaining uncertainties. In this regard, the present study aims to compare risky decision-making and empathy ability in individuals with mild AD (mAD), those with moderate AD (moAD) and cognitively healthy individuals. Method This study follows a causal-comparative design. The statistical population consisted of cognitively healthy individuals and those diagnosed with mAD and moAD (aged 65 and above) residing in older adult care centers in Rasht during the years 2023-2024. The research sample included 105 individuals (44 men and 61 women) living in Rasht, selected using convenience sampling from older adult care centers based on specialist medical diagnosis, patient records, and the Mini-Mental State Examination (MMSE). The sample comprised 37 cognitively healthy individuals, 31 individuals with mAD, and 37 individuals with moAD. The inclusion criteria were: (1) age (65 years and older), (2) educational background (from secondary school to bachelor's degree), and (3) voluntary consent. Exclusion criteria included: (1) chronic physical or psychological illnesses, and (2) undergoing psychological treatments or training. After explaining the study’s objectives and methodology for the participants, they were asked to complete the MMSE. Upon identifying individuals with AD and determining the severity of the disease, participants were categorized into three groups. Each group then completed the Iowa Gambling Task and the Empathy Quotient questionnaire developed by Baron-Cohen. All assessments were conducted individually. Finally, the data obtained from 105 participants were analyzed using univariate and multivariate analysis of variance in SPSS version 27. Results The results of the chi-square test indicate no significant difference in gender distribution among individuals with mAD and moAD, and cognitively healthy participants (X²=2.57, df=2, P=.27). However, there is a significant difference in educational level (X²=25.48, df =6, P=.001) and marital status (X²=12.66, df=2, P= .002) among these groups. Prior to data analysis, all variables were confirmed to follow a normal distribution. The assumption of homogeneity of variances was met for both variables across groups. Additionally, the equality of covariance matrices and the adequacy of correlations was upheld. Given these considerations, multivariate analysis of variance (MANOVA) was employed for further analysis. The results of Wilks' Lambda test revealed a significant difference in risky decision-making components among the groups (F= 3.33, P=.01, Eta²=.062), indicating that 6.2% of the variance in risky decision-making can be attributed to differences between the groups (P<.05). Post hoc analysis using Tukey’s HSD test revealed that individuals with moAD exhibited significantly higher levels of risky decision-making compared to the other two groups, between which no significant difference was observed. Furthermore, individuals with moAD showed better cognitive empathy than those with mAD. Conclusion Individuals with AD, particularly in moAD, face significant challenges in risky decision-making. This impairment in decision-making ability may stem from brain damage, leading to deficits in executive functions, working memory, and probability processing. Additionally, due to cognitive impairments, individuals with AD may struggle to accurately predict the consequences of their decisions and might remain unaware of their circumstances and related difficulties. Empathy ability (except for cognitive empathy) did not show a significant difference among the three groups. This suggests that certain aspects of emotional intelligence, such as the ability to understand others’ emotions, may remain relatively intact in individuals with AD. Emotional empathy is an innate and automatic process that emerges early in development and is associated with lower-order neural regions. Therefore, it does not rely on complex cognitive functions and may persist despite cognitive impairments caused by AD. Therefore, changes in empathy in AD may be attributed to overall cognitive decline rather than specific deficits in empathy itself. However, given that empathy was assessed using a self-report questionnaire, a method that may pose challenges for individuals with cognitive impairments, it would be beneficial for future studies to employ alternative assessment tools that require less reliance on high-level cognitive functioning. Ethical Consideration Ethical Code Ethical approval for conducting the present study was obtained from the Ethics Committee of the University of Guilan (IR.GUILAN.REC.1402.08). Financial Support This study did not receive financial support. Authors’ Contributions P.K: Conceptualization, software, formal analysis, data curation, writing - original draft, visualization; A.A: Conceptualization, methodology, software, writing - review & editing, project administration; M.J: Conceptualization, methodology, writing - review & editing Conflict of Interest The authors declare no conflicts of interest. Acknowledgments We extend our sincere gratitude to all individuals who contributed to the execution of this research. References Azimi Abrghoee, K. (2020). The relationship between social capital and psychological capital with the empathy of education staff in Yazd (Master's thesis, Human Resource Training Group, Payame Noor University, Mahyar Unit). [Persian] Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of autism and developmental disorders, 34, 163-175. https://doi.org/10.1023/B:JADD.0000022607.19833.00 Bartochowski, Z., Gatla, S., Khoury, R., Al-Dahhak, R., & Grossberg, G. T. (2018). Empathy changes in neurocognitive disorders: a review. Annals of Clinical Psychiatry, 30(3), 220-232. https://www.researchgate.net/publication/326743394 Bailey, P. E., Henry, J. D., & Von Hippel, W. (2008). Empathy and social functioning in late adulthood. Aging and Mental Health, 12(4), 499-503. https://doi.org/10.1080/13607860802224243 Bayrami, M., Hashemi, T., Poursharifi, H., & Andalib Kourayem, M. (2018). Fitting structural-causal relationships of delinquency with the mediation of self-control and parental coercion. Journal of Modern Psychological Research, 13(51), 23-47. [Persian] Beadle, J. N., & de la Vega, C. E. (2019). Impact of aging on empathy: Review of psychological and neural mechanisms. Frontiers in psychiatry, 10, 1-13. https://oi.org/10.3389/fpsyt.2019.00331 Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50(1-3), 7-15. https://doi.org/10.1016/0010-0277(94)90018-3 Bechara, A., Tranel, D., & Damasio, H. (2000). Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions. Brain, 123(11), 2189-2202. https://doi.org/10.1093/brain/123.11.2189 Behdarvandi, M. (2012). Mini-mental state examination. Tehran: Sina Institute for Cognitive Behavioral Sciences Research. [Persian] Blair, R. J. R. (2005). Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations. Consciousness and cognition, 14(4), 698-718. https://doi.org/10.1016/j.concog.2005.06.004 Brand, M., Recknor, E. C., Grabenhorst, F., & Bechara, A. (2007). Decisions under ambiguity and decisions under risk: Correlations with executive functions and comparisons of two different gambling tasks with implicit and explicit rules. Journal of clinical and experimental neuropsychology, 29(1), 86-99. https://doi.org/10.1080/13803390500507196 Chalise, H. N. (2019). Aging: basic concept. Am J Biomed Sci & Res, 1(1), 8-10. Coplan, A. (2011). Will the real empathy please stand up? A case for a narrow conceptualization. The southern journal of philosophy, 49, 40-65. https://doi.org/10.1111/j.2041-6962.2011.00056.x Defoe, I. N., Dubas, J. S., Figner, B., & Van Aken, M. A. (2015). A meta-analysis on age differences in risky decision making: adolescents versus children and adults. Psychological bulletin, 141(1), 48. https://doi.org/10.1037/a0038088 Delazer, M., Sinz, H., Zamarian, L., & Benke, T. (2007). Decision-making with explicit and stable rules in mild Alzheimer's disease. Neuropsychologia, 45(8), 1632-1641. https://doi.org/10.1016/j.neuropsychologia.2007.01.006 Demichelis, O. P., Coundouris, S. P., Grainger, S. A., & Henry, J. D. (2020). Empathy and theory of mind in Alzheimer’s disease: A meta-analysis. Journal of the International Neuropsychological Society, 26(10), 963-977. https://doi.org/10.1017/S1355617720000478 Dermody, N., Wong, S., Ahmed, R., Piguet, O., Hodges, J. R., & Irish, M. (2016). Uncovering the neural bases of cognitive and affective empathy deficits in Alzheimer’s disease and the behavioral-variant of frontotemporal dementia. Journal of Alzheimer's Disease, 53(3), 801-816. https://doi.org/10.3233/JAD-160175 De Siqueira, A. S. S., Yokomizo, J. E., Jacob-Filho, W., Yassuda, M. S., & Aprahamian, I. (2017). Review of decision-making in game tasks in elderly participants with Alzheimer disease and mild cognitive impairment. Dementia and geriatric cognitive disorders, 43(1-2), 81-88. https://doi.org/10.1159/000455120 De Souza, N. A., de Oliveira, F., de Carvalho, R. L., & Dourado, M. C. (2022). The relationship between decision-making capacity and the domains of awareness in Alzheimer disease. Alzheimer Disease & Associated Disorders, 36(1), 58-63. https://doi.org/10.1097/WAD.0000000000000484 Dondi, M., Simion, F., & Caltran, G. (1999). Can newborns discriminate between their own cry and the cry of another newborn infant? Developmental Psychology, 35(2), 418. https://doi.org/10.1037/0012-1649.35.2.418 El Haj, M., Allain, P., Boutoleau Bretonni re, C., Chapelet, G., Antoine, P., & Gallouj, K. (2022). Empathy of individuals with Alzheimer’s disease (AD) toward other AD patients. Journal of Clinical and Experimental Neuropsychology, 44(4), 293-301. https://doi.org/10.1080/13803395.2022.2110573 Ekhtiari, H., & Behzadi, A. (2002). Riskfull decision making in a group of students in Iran: Evidence of a cross-cultural difference. Advances in Cognitive Science, 3(4), 36-48. [Persian] Farlow, M. R. (2005). Moderate to severe Alzheimer disease: definition and clinical relevance. Neurology, 65(6-3), 1-4. https://doi.org/10.1212/WNL.65.6_suppl_3.S1 Fernandez Rios, M., Redolat, R., Serra, E., & Gonzalez-Alcaide, G. (2021). A systematic review of facial emotion recognition in Alzheimer's disease: A developmental and gender perspective. annals of psychology, 37(3), 478-492 https://doi.org/10.6018/analesps.439141 Fernandez-Duque, D., Hodges, S. D., Baird, J. A., & Black, S. E. (2010). Empathy in frontotemporal dementia and Alzheimer's disease. Journal of clinical and experimental neuropsychology, 32(3), 289-298. https://doi.org/10.1080/13803390903002191 Fisher, A., Landeira-Fernandez, J., Sollero de Campos, F., & Mograbi, D. C. (2019). Empathy in Alzheimer’s disease: review of findings and proposed model. Journal of Alzheimer's Disease, 69(4), 921-933. https://doi.org/10.3233/JAD-180730 Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198. Gaubert, F., Borg, C., Roux, J. C., & Chainay, H. (2024). Decision-making and ageing: everyday life situations under risk and under ambiguity. Quarterly Journal of Experimental Psychology, 77(4), 747-766. https://doi.org/10.1177/17470218231182403 Gaubert, F., & Chainay, H. (2021). Decision-making competence in patients with Alzheimer’s disease: A review of the literature. Neuropsychology Review, 31(2), 267-287. https://doi.org/10.1007/s11065-020-09472-2 Giacomucci, G., Moschini, V., Piazzesi, D., Padiglioni, S., Caruso, C., Nuti, C., ... & Bessi, V. (2024). Disentangling empathy impairment along Alzheimer's disease continuum: From subjective cognitive decline to Alzheimer's dementia. Cortex, 172, 125-140. https://doi.org/10.1016/j.cortex.2023.12.009 Grabher, B. J. (2018). Effects of Alzheimer disease on patients and their family. Journal of nuclear medicine technology, 46(4), 335-340. https://doi.org/10.2967/jnmt.118.218057 Guarino, A., Favieri, F., Boncompagni, I., Agostini, F., Cantone, M., & Casagrande, M. (2019). Executive functions in Alzheimer disease: A systematic review. Frontiers in aging neuroscience, 10, 437. https://doi.org/10.3389/fnagi.2018.00437 Gustavsson, A., Norton, N., Fast, T., Frölich, L., Georges, J., Holzapfel, D., ... & van der Flier, W. M. (2023). Global estimates on the number of persons across the Alzheimer's disease continuum. Alzheimer's & Dementia, 19(2), 658-670. https://doi.org/10.1002/alz.12694 Huo, M., Fuentecilla, J. L., Birditt, K. S., & Fingerman, K. L. (2019). Older adults’ empathy and daily support exchanges. Journal of social and personal relationships, 36(11-12), 3814-3834. https://doi.org/10.1177/0265407519837372 Jacus, J. P., Bayard, S., Raffard, S., Bonnoron, S., & Gély-Nargeot, M. C. (2012). Decision-making in normal and pathological aging. Geriatric et Psychology Neuropsychiatry du Vieillissement, 10(4), 437-444. https://hal.science/hal-04375760 Martinez-Castillo, E., Arrazola, J., Fernandez, A., Maestu, F., & Ortiz, T. (2001). Atrophy of the amygdala complex and neuropsychiatric expression of Alzheimer s disease. Revista de Neurologia, 33(5), 477-482. McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack Jr, C. R., Kawas, C. H., ... & Phelps, C. H. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & dementia, 7(3), 263-269. https://doi.org/10.1016/j.jalz.2011.03.005 Mehri, N., Messkoub, M., & Kunkel, S. (2020). Trends, determinants and the implications of population aging in Iran. Ageing International, 45(4), 327-343. https://doi.org/10.1007/s12126-020-09364-z Roalf, D. R., Mitchell, S. H., Harbaugh, W. T., & Janowsky, J. S. (2012). Risk, reward, and economic decision making in aging. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 67(3), 289-298. https://doi.org/10.1093/geronb/gbr099 Romero, A. P., & Garrido, S. G. (2018). The importance of behavioural and pyschological symptoms in Alzheimer disease. Neurología (English Edition), 33(6), 378-384. https://doi.org/10.1016/j.nrleng.2016.02.026 Seyedian, M., Falah, M., Nourouzian, M., Nejat, S., Delavar, A., & Ghasemzadeh, H. A. (2008). Validity of the Farsi version of Mini-Mental State Examination. Journal of Medical Council of I.R.I., 25(4), 408-414. [Persian] Singer, T. (2006). The neuronal basis and ontogeny of empathy and mind reading: review of literature and implications for future research. Neuroscience & Biobehavioral Reviews, 30(6), 855-863. https://doi.org/10.1016/j.neubiorev.2006.06.011 Smolen, T., Fryt, J., Czernecka, K., & Szczygieł, M. (2023). In search of the functional base of risk-taking: inexperience and safety. The Journal of General Psychology, 150(4), 423-452. https://doi.org/10.1080/00221309.2022.2097164 Smith, A. (2006). Cognitive empathy and emotional empathy in human behavior and evolution. The Psychological Record, 56(1), 3-21. https://doi.org/10.1007/BF03395534 Sun, T., Xie, T., Wang, J., Zhang, L., Tian, Y., Wang, K., ... & Wang, H. (2020). Decision-making under ambiguity or risk in individuals with Alzheimer’s disease and mild cognitive impairment. Frontiers in psychiatry, 11, 218. https://doi.org/10.3389/fpsyt.2020.00218 Tannou, T., Magnin, E., Comte, A., Aubry, R., & Joubert, S. (2021). Neural activation in risky decision-making tasks in healthy older adults: a meta-analysis of fMRI data. Brain sciences, 11(8), 1043. https://doi.org/10.3390/brainsci11081043 Vardy, E. R., Ford, A. H., Gallagher, P., Watson, R., McKeith, I. G., Blamire, A., & O’Brien, J. T. (2013). Distinct cognitive phenotypes in Alzheimer's disease in older people. International psychogeriatrics, 25(10), 1659-1666. https://doi.org/10.1017/S1041610213000914 Yang, Y., Tang, Y., Peng, W., Lü, X., Hu, L., & Chen, J. (2017). Empathy: the genetics-environment-endocrine-brain mechanism. Chinese Science Bulletin, 62(32), 3729-3742. بالارفتن سن معمولاً با افزایش شیوع بیماری‌ها و اختلالات مزمن همراه است، که چالشهایی را برای سالمندان به همراه دارد. بیماری آلزایمر یکی از اختلالات عصبی پیش‌رونده است که تأثیرات عمیقی بر حافظه، و توانایی‌های شناختی و هیجانی فرد دارد. این مطالعه باهدف مقایسه تصمیمگیری پرخطر و توانایی همدلی در سالمندان مبتلا به آلزایمر خفیف، متوسط و سالم انجام شد. طرح پژوهش حاضر از نوع علّی-مقایسه‌ای بود. جامعه آماری این پژوهش را سالمندان سالم و مبتلا به آلزایمر (65 سال به بالا) ساکن مراکز نگهداری سالمندان شهرستان رشت در سال 1402-1403 تشکیل دادند. نمونه پژوهش 37 سالمند سالم، 31 سالمند مبتلا به آلزایمر خفیف، و 37 سالمند مبتلا به آلزایمر متوسط بودند که به روش نمونهگیری در دسترس و بر اساس تشخیص متخصص و پرسش‌نامه کوتاه وضعیت ذهنی فولستین و مک هیو انتخاب شدند. جهت جمعآوری دادهها، از آزمون قمار آیوا و پرسش‌نامه بهره همدلی بارون-کوهن و ویل‌رایت استفاده شد. دادهها با استفاده از تحلیل واریانس تک و چندمتغیری در نرم‌افزار SPSS نسخه 27 تجزیه و تحلیل شد. نتایج نشان داد که بین سه گروه از نظر تصمیمگیری پرخطر تفاوت معناداری وجود دارد (05/0>P)، اما در مؤلفه‌های توانایی همدلی، تنها در همدلی شناختی بین سه گروه تفاوت معناداری یافت شد (05/0>P). نتایج آزمون تعقیبی توکی نشان داد که افراد با آلزایمر متوسط در مقایسه با دو گروه دیگر تصمیم‌گیری‌های پرخطر بیشتری دارند و دو گروه دیگر تفاوت معناداری در این شاخص ندارند. همچنین مشخص شد افراد با آلزایمر متوسط همدلی شناختی بهتری در مقایسه با افراد با آلزایمر خفیف در شاخص همدلی شناختی دارند. این پژوهش، ضرورت توجه به نیازهای خاص بیماران آلزایمری و توسعه روش‌های مناسب برای بهبود کیفیت زندگی و تعاملات اجتماعی آن‌ها را مورد تأکید قرار می‌دهد.

https://jap.razi.ac.ir/article_3718_647af63e85a4122c2ac34f717e824559.pdf

دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 21 The Effectiveness of Dialectical Behavior Therapy on Cognitive Distortions and Suicidal Thoughts in Older Adults اثربخشی رفتار درمانی دیالکتیکی بر تحریف‌های شناختی و افکار خودکشی سالمندان 75 61 3733 10.22126/jap.2025.11573.1826 FA خدیجه طاروتی گروه روان‌شناسی، واحد دزفول، دانشگاه آزاد اسلامی، دزفول، ایران 0000-0004-4802-7119 همایون هارون رشیدی گروه روان‌شناسی، واحد دزفول، دانشگاه آزاد اسلامی، دزفول، ایران 0000-0002-7912-3382 اسحاق ارجمند سیاپوش گروه روان‎شناسی، واحد اندیمشک، دانشگاه آزاد اسلامی، اندیمشک، ایران 0000-0003-4802-7117 Journal Article 2025 01 03 Nowadays suicide among older adults has become a significant public health concern in many countries. Additionally, cognitive distortions are among the psychological challenges of aging, leading individuals to misinterpret situations in an illogical and inaccurate manner. Therefore, this study aimed to determine the effectiveness of Dialectical Behavior Therapy (DBT) in reducing cognitive distortions and suicidal thoughts among older adults in Ahvaz, Iran. This was a quasi-experimental study using a pretest-posttest design with a control group. The study population comprised all older adults in Ahvaz in 2024. The sample included 30 individuals (aged 65 to 75), selected using convenience sampling, and based on eligibility criteria of the study. Participants were randomly assigned to either the experimental or control group. The experimental group received Lineman’s DBT protocol in eight 90-minute weekly sessions. The study utilized Hamamci and Buyuk Ozturk’s Cognitive Distortion Scale, as well as Beck’s Suicide Thoughts Scale. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS version 22. The results demonstrated a significant difference between the experimental and control groups in post-test in terms of mean score of cognitive distortions and suicidal thoughts, controlling for pre-test effects (P<.001). Based on these findings, DBT effectively reduces cognitive distortions and suicidal thoughts in older adults, highlighting new opportunities for clinical interventions. This study suggests DBT as a viable therapeutic approach for improving cognitive distortions and mitigating suicidal ideation in older adults. EXTENDED ABSTRACT Introduction A ging is a significant global health concern, making the mental and physical well-being of older adults a priority. Addressing psychological issues such as reducing cognitive distortions and suicidal thoughts has gained special importance in geriatric care. One of the therapeutic approaches that has recently garnered attention from clinicians for assisting older adults with psychological difficulties is Dialectical Behavior Therapy (DBT). Developed by Marsha Linehan, DBT integrates the principles of cognitive-behavioral therapy with acceptance-based strategies and is initially designed for treating borderline personality disorder. Given the lack of sufficient research on cognitive distortions and suicidal thoughts in older adults both domestically and internationally, and considering the importance of psychological factors in this population, this study seeks to bridge the existing research gap. Additionally, the researcher's experience as a psychologist in older care facilities underscores the significance of understanding the aforementioned variables in older adults. The findings of this study could be instrumental for policymakers, healthcare providers, older care institutions, and families in implementing effective treatment and preventive interventions. Thus, the aim of this study is to examine the effectiveness of DBT in reducing cognitive distortions and suicidal thoughts in older adults. Method This study was an applied study in terms of its purpose and a quasi-experimental one in terms of its method, using a pretest-posttest design with a control group. The statistical population included all older people between 65 and 75 years in Ahvaz during the second half of 2024. A total of 30 people who met the eligibility criteria of the study were selected through convenience sampling. Participants were randomly and equally assigned to an experimental group and a control group. The inclusion criteria for the study were (1) obtaining a score higher than the average on the cognitive distortions and suicidal thoughts scales, and (2) being over 65 years of age. The exclusion criteria included (1) participation in concurrent therapeutic interventions and (2) suffering from acute cognitive disorders. The Hamamchi and Buyukozturk’s cognitive distortions scale, and Beck's suicidal thoughts scale were used to collect data. The content of the therapy sessions was adapted from the teachings presented in the book titled Dialectical Behavior Therapy Techniques by McKay et al. (2007) and was held by the researcher for the experimental group in eight 90-minute weekly sessions. Each session included an introduction to its goals and topics, followed by practical exercises. Ethical considerations for this study included obtaining written consent to participate in the study, and maintaining the confidentiality of participants’ personal information. Univariate analysis of covariance (ANCOVA) was used to analyze the data in SPSS-22. Results Given the research methodology, ANCOVA was used to analyze the results. Levene’s test for the research variables was statistically non-significant, confirming the assumption of homogeneity of variances. Additionally, a crucial assumption of ANCOVA, homogeneity of regression coefficients, was tested by examining the interaction effect between the independent variable and the pre-test scores of each dependent variable to predict their respective post-test scores. The results indicated that the F-value was non-significant (P>.05), suggesting that this assumption was met. Furthermore, to verify the normal distribution of dependent variables, the Shapiro-Wilk test was performed. The test results confirmed the normality of the variables, as the the W statistic was not statistically significant (P>.05), showing that the data distribution met normality assumptions. As shown in Table 1, there is a significant difference between the experimental and control groups in terms of cognitive distortions. In other words, DBT has led to a meaningful reduction in the mean score of cognitive distortions in the experimental group compared to the control group. The effect size is 0.732, indicating that 73% of the individual differences in cognitive distortion scores can be attributed to DBT. Similarly, Table 1 illustrates a significant difference between the experimental and control groups in terms of suicidal thoughts. Specifically, DBT has resulted in a significant reduction in the mean score of suicidal thoughts in the experimental group compared to the control group. The effect size is 0.494, meaning that 49% of the individual differences in suicidal thought scores are due to the effectiveness of DBT. Therefore, the research hypotheses were confirmed, demonstrating the positive impact of DBT in reducing cognitive distortions and suicidal thoughts in older adults. Conclusion The results indicated that DBT effectively reduces cognitive distortions and suicidal thoughts in older adults. Despite the limited research on the effectiveness of DBT in addressing these issues among older adults, this study provides valuable insights. One possible explanation for these findings is that skill training in DBT helps individuals develop acceptance, fostering greater present-moment awareness. By maintaining mindful awareness of their experiences, individuals can focus their attention on the here and now rather than engaging in judgmental and reactive future, which ultimately facilitates a reduction in cognitive distortions and suicidal thoughts. The findings suggest that professionals can incorporate DBT into therapeutic practices to effectively reduce cognitive distortions and suicidal ideation in older adults. Additionally, encouraging middle-aged individuals to seek counseling services and openly discuss psychological challenges may help prevent cognitive distortions and suicidal thoughts from escalating in later life. However, this study has certain limitations, including the limited geographic scope, as participants were only from Ahvaz, reliance on self-report measures for data collection, and the lack of follow-up assessments. Future studies should explore the long-term impact of DBT across various cities, comparing its efficacy with other psychological approaches in addressing similar cognitive and emotional issues among older adults. Ethical Considerations Ethical Code This article is based on the master's thesis of the first author in Personality Psychology at Islamic Azad University, Dezful Branch. Financial Support This research received no financial support from any funding agency. Authors’ Contributions Kh.T: Conceptualization, Methodology, Software, Validation, Formal analyses, Data Curation, Visualization; H.H.R: Conceptualization, Methodology, Formal analyses, Writing - Review & Editing; E. A. S: Conceptualization, Methodology, Writing - Review & Editing, Visualization. Conflict of Interest The authors declare no conflicts of interest. Acknowledgments The authors express their sincere gratitude to all participants in this study. References Abbasinia, M., Kakabaraee, K., & Ahmadi, V. (2024). Effectiveness of dialectical behavior therapy on social problem-solving, difficulty in emotion regulation, impulsiveness, and resilience in suicide attempts in Ilam province, Iran. Journal of Ilam University of Medical Sciences, 32 (4), 122-132. [Persian] Ahmadian, A., Momeni, K., & Karami, J. (2024). The Effectiveness of dialectical behavior therapy on reducing irritability and aggression in adolescents with disruptive mood dysregulation disorder. Journal of Modern Psychological Researches, 19(73), 96-106. https://doi.org/ 10.22034/jmpr.2023.58914.5898. [Persian] Anisi, J., Fathi Ashtiani, A., Salimi, S., & Ahmadi Noudeh, K. (2005). Validity and reliability of Beck suicide scale ideation among soldiers. Journal of Military Medicine, 7(1), 33-37. [Persian] Beck, A.T., & Steer, R.A. (1991). Relationships between the Beck Anxiety Inventory and the Hamilton Rating Scale with anxious outpatients. Journal of Anxiety Disorders, 5, 213–223. https://doi.org/10.1016/0887-6185(91)90002-B Beck, A.T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for suicide ideation. J Consult Clin Psychol, 47(2), 343-352. https://doi.org/10.1037//0022-006x. 47.2.343. Bromand, N., Naziryy, G., Davoodi, A., & Fath, N. (2022). Effectiveness of dialectical behavior therapy on cognitive reactivity, suicidal thoughts and social health in repeat suicide attempters. Rooyesh. 11(9), 69-78. [Persian] Cohen, J. M., Norona, J. C., Yadavia, J. E., & Borsari, B. (2021). Affirmative dialectical behavior therapy skills training with sexual minority veterans. Cognitive and Behavioral Practice, 28(1), 77–91. https://doi.org/10.1016/j.cbpra.2020.05.008 EsmaeelPoor, K., Bakhshi Poor Rodsari, A., & Mohammadzadegan, R. (2015). Determining factor structure, validity and reliability of interpersonal cognitive distortions scale among students of Tabriz University. Biquarterly Journal of Cognitive Strategies in Learning, 2(3), 53-72. [Persian] Fehling, K., & Weiner, E. (2023). Self-directed DBT skills: A 3-Month DBT workbook to regulate intense emotions and zreate lasting change with dialectical behavior therapy. United Kingdom: Zeitgeist Hamamci, Z., & Buyukozturk, S. (2004) The Interpersonal cognitive distortions scale: Development and psychometric characteristics. Psychological Reports, 95(1), 291-303. https://doi.org/10.2466/pr0.95.1.291-303 Haroon Rashidi, H., & Zakizadeh, H. (2022). The Effectiveness of mindfulness-based cognitive therapy on the social adjustment and cognitive distortion in the elderly men. Aging Psychology, 8(2), 117-105. https://doi.org/10.22126/jap.2022.7624.1613 [Persian] Hooman, H.A. (2020). Understanding the scientific method in behavioral sciences. Tehran: Samt publications. [Persian] Kashaninia, Z., Sharifi, G., Seyedfatemi, N., & Haqqani, S. (2023). Interpersonal cognitive distortions among the Community-dwelling elderly in Tehran, Iran. The Iran Journal of Nursing, 35 (139), 490-503. URL: http://ijn.iums.ac.ir/article-1-3604-fa.html[Persian] Kiosses, D.N., Szanto, K., & Alexopoulos, G.S. (2014). Suicide in older adults: The Role of emotions and cognition. Current psychiatry reports, 16(11), 495. https://doi.org/10.1007/s11920-014-0495-3. Malekzadeh, A. (2024). The Relationship between social comparisons and suicidal ideation in older adults: The Mediating role of decision-making styles. Aging Psychology, 9(4), 325-341. https://doi.org/10.22126/jap.2024.9502.1725 [Persian] McKay, M., Wood, J., & Bertelli, J. (2007). Dialectical Behavior Therapy Techniques. Translated by Hamidpour et al. (2012). Tehran, Arjomand Publications. [Persian] Mortazavi, M., Rakebi, N., Akbarinejad Mousavi, M., & Soleymanirudbali, Z. (2022). The Effectiveness of dialectic behavioral therapy on family functioning and communication patterns of mothers of children with attention-deficit hyperactivity disorder. Journal of Disability Studies, 12, 124-129. [Persian] Naghipoor, M., Kazemianmoghadam, K., & Haroonrashidi, H. (2021). The Effectiveness of positivism training on suicide ideation and death anxiety in the elderly. Aging Psychology, 6(4), 357-367. https://doi.org/10.22126/jap.2020.5833.1478 [Persian] Sadeghi, F., Kabusi, M., Seraj, Z., Sanagoo, A., Jouybari, L., & Nikbakht, R. (2024). frequency of suicidal ideations in the Elderly living in Golestan province in 2022: A Descriptive study. Journal of Gerontology, 9 (1): 20-30. [Persian] Sadri Damirchi, E., Honarmand Ghojebegloo, P., & Amir, S. M. B. (2020). Suicidal ideation in elderly without a Spouse: The Role of interpersonal ccognitive distortions, positive and negative affect, perceived social support and meaning in life. Aging Psychology, 5(4), 347-359. https://doi.org/10.22126/jap.2020.4894.1389. [Persian] Salimi, S., & Gheirati, S. (2023). The Effectiveness of dialectical behavior therapy on self-control and anxiety tolerance in adolescents with disordered mood disorders. Journal of School Psychology, 12(4), 93-108. https://doi.org/10.22098/jsp.2024.10767.5273 [Persian] Siefy, Z., & Haroon Rashidi, H. (2024). The Effectiveness of compassion therapy on cognitive fusion and self-criticism in older adults with post-traumatic stress disorder. Aging Psychology, 9(4), 361-375. https://doi.org/10.22126/jap.2024.9623.1733 [Persian] Sheykholeslami, A., & Samadifard, H. (2017). Death anxiety in the Elderly: The Role of cognitive failures, flexibility and distortion. Journal of Geriatric Nursing, 4 (1), 48-58. [Persian] Vahia, I.V., Blazer, D.G., Smith, G.S., Karp, J.F., Steffens, D.C., Forester, B. P., Tampi, R., Agronin, M., Jeste, D.V., & Reynolds, C.F., (2020), COVID-19, Mental health and aging: A Need for new knowledge to bridge science and service. American Journal of Geriatric Psychiatry, 28(7), 695-697. https://doi.org/10.1016/j.jagp.2020.03.007 Vakili, M., Bagherzadeh Golmakani, Z., & Bolghan-Abadi, M. (2024). The Effectiveness of dialectical behavior therapy on self-blame and mental rumination in binge-eating patients. Journal of Psychological Science. 23(140), 199-217. https://doi.org/10.52547/JPS.23. 140.1973 [Persian] Yarian, S., & Ameri, N.F. (2020). The Prediction of suicidal ideation based on coping strategies and meaning in life in the Elderly. Journal of Gerontology, 5 (1), 1-10. URL: http://joge.ir/article-1-368-fa.html [Persian] امروزه در بسیاری از کشورها خودکشی افراد سالمند به‌ عنوان یک مسأله مهم بهداشت عمومی مطرح است. همچنین تحریف شناختی از جمله مشکلات روان‌شناختی سالمندی است که باعث می‌شود فرد درک درست و منطقی از مسائل نداشته باشد. بنابراین این مطالعه با هدف تعیین اثربخشی رفتار درمانی دیالکتیکی بر تحریف‌های شناختی و افکار خودکشی سالمندان شهر اهواز انجام شد. روش پژوهش نیمه‌آزمایشی با طرح پیش‌آزمون-پس‌آزمون با گروه گواه بود. جامعه آماری پژوهش تمامی سالمندان شهر اهواز در سال 1403 بودند. حجم نمونه پژوهش شامل 30 نفر سالمند (65 تا 75 ساله) بود که با روش نمونه‌گیری در دسترس و بر اساس معیارهای ورود به مطالعه انتخاب و به‌طور تصادفی در دو گروه آزمایش و گواه گمارش شدند. گروه آزمایش رفتاردرمانی دیالکتیکی لینهان را در هشت جلسه 90 دقیقه‌ای هفتگی دریافت نمودند. مقیاس‎های مورد استفاده در این پژوهش شامل مقیاس تحریف‌های شناختی حمامچی و بویوک اوزتورک و افکار خودکشی بک بود. داده‌ها با تحلیل کوواریانس تک‌متغیره، با استفاده از نرم‌افزارSPSS نسخه 22 مورد تجزیه و تحلیل قرار گرفتند. نتایج نشان داد که با کنترل اثر پیش‌آزمون در مرحله پس‌آزمون بین دو گروه گواه و آزمایش در متغیرهای تحریف‌های شناختی و افکار خودکشی تفاوت معناداری وجود دارد (001/0>P). بر اساس یافته‌های این مطالعه، رفتار درمانی دیالکتیکی سبب کاهش تحریف‌های شناختی و افکار خودکشی سالمندان می‌شود و نمایانگر افق‌های تازه‌ای در مداخلات بالینی است و می‌توان از آن به‌عنوان یک روش مداخله‌ای مؤثر در بهبود تحریف‌های شناختی و افکار خودکشی سالمندان استفاده کرد.

https://jap.razi.ac.ir/article_3733_4056a6deca90c304bc055acfc3b68f35.pdf

دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 06 The Effectiveness of Narrative Therapy on Death Anxiety and Sense of Coherence in Older Women اثربخشی روایت‌درمانی بر اضطراب مرگ و حس انسجام زنان سالمند 92 77 3657 10.22126/jap.2025.11537.1823 FA فاطمه زارع گل چشمه گروه روان‌شناسی، دانشکده علوم انسانی، واحد گرگان، دانشگاه آزاد اسلامی، گرگان، ایران 0000-0002-0763-1601 افسانه خواجوند خوشلی گروه روان‌شناسی، دانشکده علوم انسانی، واحد گرگان، دانشگاه آزاد اسلامی، گرگان، ایران 0000-0001-5310-424X ارسطو میرانی گروه روان‌شناسی، دانشکده علوم انسانی، واحد گرگان، دانشگاه آزاد اسلامی، گرگان، ایران 0000-0001-5336-3305 لیلاسادات عزیزی ضیابری گروه پرستاری، دانشکده علوم پزشکی، واحد گرگان، دانشگاه آزاد اسلامی، گرگان، ایران 0000-0003-4576-6141 Journal Article 2024 12 23 Aging is one of the most sensitive stages of human development, characterized by unique conditions and challenges. Among the most prevalent psychological health concerns in older adults are death anxiety (DA) and sense of coherence (SOC). Therefore, the present study aimed to investigate the effectiveness of narrative therapy in reducing DA and enhancing SOC in older women. This research employed a quasi-experimental method using a pretest-posttest design with a control group and a follow-up phase. The statistical population consisted of all older women (with an age range of 70 to 80 years) residing in nursing homes in Gorgan, Iran in 2024. A total of 30 participants were selected through convenience sampling and based on inclusion and exclusion criteria. Participants were randomly assigned to either the experimental group (n=15) or the control group (n=15). Data were collected using Antonovsky’s SOC Questionnaire and Templer’s DA Scale. The experimental group received Payne’s narrative therapy across eight 90-minute sessions, while the control group received no intervention during this period. Data were analyzed using ANCOVA in SPSS version 26. The results indicated that narrative therapy had a statistically significant effect on reducing DA and increasing SOC in older women. Furthermore, the positive effects of the intervention were maintained during the two-month follow-up phase. The findings suggest that narrative therapy can be considered as an effective therapeutic approach for enhancing well-being in aging populations. EXTENDED ABSTRACT Introduction Aging is a natural process, a universal phenomenon, and a distinct phase in human development and growth. Numerous influential factors play critical roles during old age, among which the sense of coherence holds particular importance. This construct is closely associated with functional status, psychological well-being, and overall health. A stronger sense of coherence in older adults correlates with higher levels of psychological well-being and serves as a key predictor of their quality of life. However, studies indicate that as individuals age, their sense of coherence tends to decline. Moreover, in later life, death is perceived more prominently as the endpoint of existence, often accompanied by heightened tension. Death anxiety encompasses a range of thoughts, fears, and emotions about the end of life and is recognized as a multidimensional concept. Research findings suggest that death anxiety is one of the common psychological challenges among older adults. Despite the breadth of research on aging, few studies have explored the potential role of narrative therapy in addressing such concerns. Therefore, this study aimed to examine the effectiveness of narrative therapy in reducing death anxiety and enhancing the sense of coherence among older women. Method This study employed a quasi-experimental method using a pretest–posttest design with a control group and a two-month follow-up. The statistical population included older women residing in nursing homes in Gorgan, Iran, in 2024. A total of 30 eligible participants were selected through convenience sampling and randomly assigned to experimental and control groups (15 participants each). Inclusion criteria were as follows: (1) willingness to participate and provision of informed consent, (2) residency in a nursing home in Gorgan, (3) minimum education level of fifth grade, (4) a score higher than 7.5 on the Death Anxiety Scale, (5) a score below 52 on the Sense of Coherence Questionnaire, (6) age range between 70 and 80 years. Exclusion criteria included: (1) presence of physical, motor, or cognitive disabilities or Alzheimer’s disease; and (2) concurrent participation in any other educational program. Data were collected using Antonovsky’s Sense of Coherence Questionnaire (1993) and Templer’s Death Anxiety Scale (1970). The intervention consisted of Payne’s narrative therapy package (2006). Although 106 older women were initially screened and met the inclusion criteria, only 30 remained after further assessments and completed the intervention. Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics, including Shapiro–Wilk test, Levene’s F-test, and ANCOVA in SPSS version 26. Results Prior to data analysis, the necessary assumptions, ncluding Levene’s test, homogeneity of regression slopes, and the Shapiro-Wilk test. Given that the assumptions for univariate analysis of covariance (ANCOVA) were met, this justified the use of ANCOVA. Descriptive findings indicated that the experimental group’s post-test scores for sense of coherence increased compared to their pre-test scores. In contrast, their post-test scores for death anxiety decreased relative to the pre-test scores. Meanwhile, the control group showed no significant difference between pre-test and post-test scores. These changes were maintained at the two-month follow-up. According to the results presented in Table 1, the F-value for sense of coherence at the post-test was 41.33, and for death anxiety, it was 66.73, both statistically significant (P<.01). These findings support the research hypothesis, indicating that narrative therapy leads to improvements in sense of coherence and a reduction in death anxiety among older adults. Furthermore, at the follow-up stage, the F-value for sense of coherence was 66.85, and for death anxiety, 56.51, both of which remained significant (P<.01). This consistency further supports the effectiveness of narrative therapy in enhancing psychological well-being in the older population. Conclusion The findings demonstrated that narrative therapy had a significant impact on reducing death anxiety and enhancing the sense of coherence among older women. This effect remained stable during the follow-up phase. Therefore, narrative therapy can be considered an effective intervention for improving sense of coherence and decreasing death anxiety in older women. In narrative therapy, human problems are viewed as emerging from painful life stories that influence individuals’ experiences. The therapeutic process involves exploring how individuals interpret and narrate their life stories, emphasizing the creation of new meanings. Clients are guided to reconsider and revise their internalized narratives, which in turn empowers older individuals to feel more capable of predicting and managing their lives. Moreover, narrative therapy teaches clients to accept responsibility for their behaviors, thereby enhancing motivation for action and effort. It helps them recognize that control and responsibility for their lives rest in their own hands, and that death anxiety does not need to dominate them. By promoting self-awareness and introspection, narrative therapy encourages positive transformation, which can enhance resilience and alleviate distress related to death. Based on the findings, the following practical recommendations are suggested: (1) Future studies should account for potential confounding variables such as intolerance of ambiguity, psychological resilience, and depression; (2) Given the significance of aging-related issues and the need to enrich the research literature, organizations such as the Welfare Organization is advised to prioritize such studies; (3) Similar research should be conducted with older women in other cities to broaden the applicability of the findings. Ethical Consideration Ethical Code This study was approved by the Ethics Committee under the code IR.IAU.CHALUS.REC.1403.072. Financial Support No financial support was received for this study Authors’ Contributions F.Z.G: Data Curation, Conceptualization, Visualization; A.Kh.Kh: Formal analysis, Writing - Review & Editing; A.M: Writing - Review & Editing, Supervision; L.A.Z: Project administration, Writing - Review & Editing Conflict of Interest The authors declare no conflict of interest Acknowledgments The authors extend their heartfelt gratitude to the Research Deputy of Islamic Azad University, Gorgan Branch, for their administrative supports and collaboration in conducting this research. The authors also sincerely thank all older participants for their patience and enthusiasm throughout the study. References Alimohamad, F., Stodehasl, N.A., & Karami, A. (2020). Developing a quality-of-life model based on metacognitive beliefs mediated by perceived stress in the elderly. Journal of Aging Psychology, 4(6), 341-355. [Persian] Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social science & medicine, 36(6), 725-733. https://doi.org/10.1016/0277-9536(93)90033-Z Ardelt, M., Gerlach, K.R. & Vaillant, G.E. (2018). Early and midlife predictors of wisdom and subjective well-being in old age. Journal of National Library of Medicine, 73, 1514–1525. https://doi.org/10.1093/geronb/gby017 Asgari, SH., & Shafei, H. (2017). Predicting the quality of life of the elderly based on internal coherence, mindfulness, and spiritual intelligence. Journal of Positive Psychology, 3(3), 61-74. [Persian] Baradari, A., Sheykhalslami, A., Sadri, A., & Ghamari, H. (2024). The Effectiveness of narrative therapy on family cohesion and marital intimacy in conflicted couples. Journal of Psychology Development, 13(7), 41-50. [Persian] Chang, A.Y., Skirbekk, V.F., Tyrovolas, S., Kassebaum, N.J., & Dieleman, J.L. (2019). Measuring population ageing: An Analysis of the global burden of disease study. Lancet Public Health, 4, 159-167. https://doi.org/10.1016/S2468-2667(19)30019-2 Delavar, A. (2022). Research Methods in Psychology and Educational Sciences. Tehran: Editorial Publications. [Persian] El-Ashry, A., El-Fatah, N, K., & Abdelhamim, E.A. (2024). Harmony found: Serenity's crucial role in alleviating death anxiety through attachment styles among community-dwelling older adults. Geriatric Nursing, 58, 247-254. https://doi.org/10.1016/j.gerinurse.2024.05.035 Fazeli, N., Soleymani, S., Farmani, F., Vakili, Y., & Ilanloo, H. (2022). The Effectiveness of narrative therapy on psychological capital and sense of coherence in people recovering from addiction. Journal of Addiction Studies, 16(64), 197-218. [Persian] Foong, H.F., Hamid, T.A., Ibrahim, R., Haron, S.A., & Shahar, S. (2018). Predicting cognitive function of the Malaysian elderly: A Structural equation modelling approach. Aging & Mental Health, 22(1), 109-120. https://doi.org/10.1080/13607863.2016.1231172 Firouzi. A., Lotfi, F., & Vaziri, SH. (2022). Effectiveness of narrative therapy and good enough sex model on sexual attitude and sexual satisfaction in married infertile men and women. Journal of the Iranian Institute for Health Sciences Research, 21(4), 385-398. [Persian] Hajihasani, M., & Naderi, N. (1400). Death anxiety in the elderly: The Role of spiritual health and perceived social support. Journal of Aging Psychology, 6(4), 319-309. [Persian] Han, A., Kim, Ju., & Kim, J. (2021). A Study of leisure walking intensity levels on mental health and health perception of older adults. Gerontology & Geriatric Medicine, 7, 1-8. https://doi.org/10.1177/2333721421999316 Hirsikangas, S., Kanste, O., Korpelainen, J., Bloigu, R., & Kyngäs, H. (2018). The Effects of intervention on the quality of life, sense of coherence and daily activities of frequent attenders. Journal of Nursing Education and Practice, 8, 63-71. https://doi.org/10.5430/jnep.v8n2p63 Hourzad, A., Pouladi, S., Ostovar, A., & Ravanipour, M. (2018). The Effects of an empowering self-management model on self-efficacy and sense of coherence among retired elderly with chronic diseases: a randomized controlled trial. Journal of Clinical Interventions in Aging, 13, 2215-2224. https://doi.org/10.2147/CIA.S183276 Jiang, D., Tang, V.F.Y., Kahlon, M., Chow, E.O.W., Yeung, D.Y.L., Aubrey, R., & Chou, K.L. (2025). Effects of wisdom-enhancementn narrative-therapy and empathy-focused interventions on loneliness over 4 weeks among older adults: A Randomized Controlled Trial. The American Journal of Geriatric Psychiatry, 33(1), 18-30. https://doi.org/10.1016/j.jagp.2024.07.003 Khalvati, M., Babakhanian, M., Khalvati, M., Nafei, A., Khalvati, M., & Gafouri, R. (2021). Death anxiety in Iranian elderly: A systematic review and meta-analysis. Journal of the Elderly, 16(2), 152-171. [Persian] Kakabaraei, K., & Maazinezhad, M. (2016). The Relationship between age and finding meaning in life with death anxiety in elderly men and women. Journal of Aging Psychology, 2(1), 37-48. [Persian] Karris, M.A., & Arger, M.A., (2019). Religious couples re-storying after infidelity: Using narrative therapy interventions with a focus on attachment. Counseling and Family Therapy Scholarship Review, 2, 1-16. https://doi.org/10.53309/JCDM6423 Lim, S.Y., & Chang, S.O. (2020). Ego-integrity management of residents in nursing homes: a concept analysis based on the method by Walker and Avant. Journal of Korean Gerontological Nursing, 20(2), 97-108. DOI:10.17079/jkgn.2018.20.2.97 Mahmoudpour, A., & Haggi, A. (2024). Predicting self-coherence in the elderly based on emotion regulation, self-compassion, and attitudes toward death. Journal of Psychology Development, 1(94), 254-243. [Persian] Mohamadzade, A. (2011). Investigating the psychometric properties of the 13-question Antonovsky Sense of Coherence Test. Master's thesis in psychology, Payam Noor University, Tehran. [Persian] Momeni, K., & Radmehr, F. (2019). The effect of mindfulness-based stress reduction therapy on marital adjustment, sense of coherence, and psychological resilience of veterans' spouses. Journal of Military Medicine, 21(1), 21-12. [Persian] Muruthi, B., McCoy, M., Chou, J., & Farnham, A. (2018). Sexual scripts and narrative therapy with older couples. The American Journal of Family Therapy, 46, 81-95. https://doi.org/10.1080/01926187.2018.1428129 Naghipour, M., Kazemiyan Moghadam, K., & Horounrashidi, H. (2020). The Effectiveness of positive psychology on suicidal ideation and death anxiety in the elderly. Journal of Aging Psychology, 4(6), 357-367. [Persian] Payne, M. (2006). Narrative therapy: An Introduction for counsellors. 2th ed. New York: SAGE Publications Ltd. 2006; 116. DOI:10.4135/9781446213322 Ramazani, F., Leylabadi, L., & Emamipour, S. (2023). Comparing the effectiveness of mindfulness-based stress reduction therapy and narrative therapy on death anxiety in the elderly. Journal of Health Promotion Management, 12(4), 28-39. [Persian] Razavinezhad, M., Ziyaie, M., & Tarkashvand, R. (2023). The Effect of group narrative therapy on psychological cohesion in patients with traumatic spinal cord injury. Journal of Psychiatric Nursing, 11(3), 23-14. [Persian] Srivastava, M., & Ghosh, A. (2024). Societal impact of death anxiety and mental health among nurses in India. Societal Impacts, 4, 100095. https://doi.org/10.1016/j.socimp.2024.100095 Taghipour, R., Siyahpoush, S., Kazemi, F., Sadeghi, P., & Farjad, T. (2020). Comparing the effectiveness of cognitive-behavioral therapy and narrative therapy on improving death-related distress and psychological resilience in female patients with breast cancer. Journal of Mashhad Medical School, 63(4), 2501-1694. [Persian] Templer, D. I. (1970). The construction and validation of a death anxiety scale. The Journal of general psychology, 82(2), 165-177. https://doi.org/10.1080/00221309.1970.9920634 Wu, J., Fu, D., Zhang, L., Xie, X., Wang, X., Shen, X., Liu, S., Xu, X., Cheng, H., Ma, X., & Lin, D. (2024). The Relationship between psychological vulnerability, aging attitudes and life meaning in elderly patients with comorbidities. Health Promotion, 26(11), 894-904. https://doi.org/10.32604/ijmhp.2024.056223 سالمندی یکی از مراحل حساس رشد انسان است که ویژگی‌ها و شرایط خاص خود را دارد، در این میان اضطراب مرگ و حس انسجام از شایع‌ترین موضوعات سلامت روان سالمندان است. بنابراین پژوهش حاضر با هدف تعیین اثربخشی روایت‌درمانی بر اضطراب مرگ و حس انسجام زنان سالمند انجام شد. روش پژوهش نیمه آزمایشی با طرح پیش‌آزمون-پس آزمون با گروه کنترل و دوره پیگیری بود. جامعه آماری پژوهش شامل تمامی زنان سالمند (با دامنه سنی 70 تا 80 سال) مراکز نگهداری سالمندان شهر گرگان در سال 1403 بود که از بین آنها نمونه ای به تعداد 30 نفر به روش نمونه گیری در دسترس بر اساس معیارهای ورود و خروج مطالعه انتخاب شدند. افراد به صورت تصادفی در گروه مداخله (15 نفر) و کنترل (15 نفر) گمارش شدند. برای جمع آوری داده ها از پرسش‌نامه های حس انسجام آنتونوسکی و اضطراب مرگ تمپلر استفاده شد. گروه مداخله هشت جلسه 90 دقیقه‌ای تحت مداخله روایت‌درمانی پاین قرار گرفت، در حالیکه در این مدت گروه کنترل هیچگونه مداخله‌ای دریافت نکرد. داده ها با استفاده از روش تحلیل کوواریانس تک‌متغیره در نرم‌افزار SPSS نسخه 26 تجزیه و تحلیل شد. نتایج نشان داد روایت‌درمانی بر کاهش اضطراب مرگ و افزایش حس انسجام در زنان سالمند به طور معنی‌داری اثرگذار است. این تأثیر در مرحله پیگیری دو ماهه نیز پایدار ماند. بنابراین می‌توان روایت درمانی را به‌عنوان یک روش کارآمد در جهت افزایش بهزیستی در زنان سالمند مورد استفاده قرار داد.

https://jap.razi.ac.ir/article_3657_128c7808df529fb388e7bb7e519c3ef4.pdf

دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 06 The Relationship Between Cognitive Flexibility, Quality of Life, and Meaning in Life with Life Satisfaction Among Older Adults: The Mediating Role of Basic Psychological Needs رابطه انعطاف‌پذیری شناختی، کیفیت زندگی و معنا در زندگی با رضایت از زندگی در سالمندان: نقش میانجی نیازهای بنیادین روان‌شناختی 115 93 3770 10.22126/jap.2025.10912.1793 FA عبداله شیخیانی خواه گروه روان‌شناسی، واحد بهبهان، دانشگاه آزاد اسلامی، بهبهان، ایران 0009-0008-3652-235X لیلا بخشی سورشجانی گروه روان‌شناسی، واحد بهبهان، دانشگاه آزاد اسلامی، بهبهان، ایران 0000-0001-6702-5921 Journal Article 2024 08 04 Due to the growing proportion of older adults in recent years, addressing the psychological well-being of this population has become increasingly important. Accordingly, the present study aimed to investigate the relationship between cognitive flexibility, quality of life (QOL), and meaning in life (MIL) with life satisfaction through the mediating role of basic psychological needs (BPNs) among older adults. This was a descriptive-correlational study using structural equation modeling (SEM). The statistical population consisted of all individuals over the age of 60 living in Bushehr during the 2023–2024 academic year. A total of 200 participants were selected using convenience sampling. Participants completed Dennis & Vander Wal’s cognitive flexibility scale, the WHO QOL questionnaire, Steger’s MIL questionnaire, Neugarten et al.’s life satisfaction scale for older adults, and Deci & Ryan’s BPNs Scale. The data were analyzed using SEM in AMOS 24. The results indicated that cognitive flexibility, QOL, and MIL were significantly associated with life satisfaction both directly and indirectly (through BPNs). Specifically, cognitive flexibility, QOL, and the presence of meaning had significant positive relationships with BPNs, whereas the search for meaning had significant negative relationship with BPNs which, in turn, had a significant positive association with life satisfaction. Therefore, it can be concluded that promoting cognitive flexibility, enhancing QOL and MIL, and satisfying BPNs may increase life satisfaction among older adults. EXTENDED ABSTRACT Introduction Given the increasing number of older adults and the challenges associated with aging, examining the psychological well-being of this demographic has become increasingly important. Numerous studies have explored cognitive flexibility, quality of life, and meaning in life across various age groups, highlighting their positive effects on life satisfaction. Nevertheless, cognitive flexibility, compared to the other variables, has received relatively less scholarly attention in older adult populations. In contrast, quality of life and meaning in life have been more extensively studied and are recognized as influential factors in life satisfaction. Further research into cognitive flexibility may lead to a deeper understanding of how this capacity contributes to quality of life in later adulthood. Moreover, the mediating role of basic psychological needs, namely autonomy, competence, and relatedness, has not been comprehensively addressed in this context, despite their known impact on both psychological well-being and quality of life. This study aims to enhance understanding of how these variables are related to life satisfaction and contribute to improvements in the lived experiences of aging individuals. Accordingly, the present research investigates the relationship between cognitive flexibility, quality of life, and meaning in life with life satisfaction, through the mediating role of basic psychological needs. Method This study was an applied one in terms of its objective and employed a descriptive-correlational design using structural equation modeling. The statistical population included individuals over the age of 60 residing in Bushehr during the 2023–2024 academic year. Among this population, 200 participants (84 women and 114 men) were selected through convenience sampling method. Inclusion criteria were: (1) being over 60 years of age, and (2) having basic literacy skills (reading and writing). Exclusion criteria were: (1) not residing in institutional care settings, and (2) current use of psychiatric medication. Data were collected using Dennis & Vander Wal’s cognitive flexibility scale, the WHO quality of life questionnaire, Steger’s meaning in life questionnaire, Neugarten et al.’s life satisfaction scale for older adults, and Deci & Ryan’s basic psychological needs Scale. Questionnaires were distributed in person at urban centers and recreational spaces to individuals who met the eligibility criteria. To assess the reliability and internal consistency of the instruments, Cronbach’s alpha coefficients were calculated. Finally, the collected data were analyzed using Pearson’s correlation coefficients and structural equation modeling in SPSS version 26 and AMOS version 24. Results To assess the assumption of normal distribution for the research variables, skewness and kurtosis tests were conducted. The obtained values indicated that all variables were within acceptable limits, supporting the univariate normality assumption. To examine potential multicollinearity, tolerance values and the variance inflation factor (VIF) were reviewed, revealing no issues with collinearity. The independence of residuals was confirmed through the Durbin-Watson test. To evaluate the research hypotheses, model fit was analyzed using structural equation modeling. Pearson’s correlation coefficient indicated significant associations between cognitive flexibility, quality of life, meaning in life, search for meaning, and basic psychological needs with life satisfaction (p< .05). Additionally, a strong negative correlation was observed between the presence of meaning and the search for meaning (p< .01). Fit indices for the proposed model were as follows: χ²/df = 0.12, GFI = 0.98, AGFI = 0.96, CFI = 0.98, and RMSEA = 0.06, all indicating a good model fit. Structural equation modeling results showed that all direct paths in the hypothesized model were statistically significant: cognitive flexibility (p<.01, β=.35), quality of life (p<.01, β=.51), presence of meaning (p<.01, β=.24), and search for meaning (p<.01,β=–.34) were significant predictors of life satisfaction. Moreover, bootstrap results confirmed the mediating role of basic psychological needs in the relationships of quality of life (p<.01, β=.22), cognitive flexibility (p<.01, β=.28), presence of meaning (p<.01, β=.19), and search for meaning (p<.01, β =.17) with life satisfaction. Conclusion Life satisfaction is one of the most important indicators of psychological well-being in later adulthood and is influenced by various factors. The results of this study revealed that basic psychological needs serve as meaningful mediators in the relationship between cognitive flexibility, quality of life, and meaning in life (both presence and search for meaning) with life satisfaction. Cognitive flexibility, as a key construct, may influence life satisfaction through the fulfillment of basic psychological needs. Individuals with higher cognitive flexibility are better equipped to adapt to life’s challenges and transitions, which, in turn, fosters greater satisfaction with life. In later adulthood, increased age, the emergence of physical and psychological difficulties, and the limitation of social and family relationships, due to the departure of children or the loss of close friends and loved ones, can adversely affect quality of life and reduce overall life satisfaction. Among influencing variables, meaning in life plays a significant role. The negative relationship found between the presence of meaning and the search for meaning supports Steger et al.’s model of presence-to-search, suggesting that individuals who already perceive a strong sense of meaning are less inclined to seek it further. Overall, the findings of this study emphasize the need to focus on these psychological and existential factors to improve quality of life and enhance life satisfaction in older populations. Accordingly, health and social planning efforts should prioritize strengthening cognitive flexibility, promoting quality of life, and fostering a sense of meaning in life as a means to support psychological and social well-being in this demographic. Ethical Consideration Ethical Code This study was approved by the Research Ethics Committee of Islamic Azad University, Behbahan Branch, under the code IR.IAU.BEHBAHAN.REC.1403.097. Financial Support This research received no financial support. Authors’ Contributions Sh.KH: Software, Validation, Formal analysis, Data curation, Writing - Original Draft; L.B.S: Conceptualization, Methodology, Writing - Review & Editing, Project administration, Supervision, Visualization Conflict of Interest The author had no conflicts of interest. Acknowledgments The authors wish to express their gratitude to the Research Affairs Department of Islamic Azad University, Behbahan Branch, for their collaboration in the implementation of this study. Special thanks are also extended to the esteemed reviewers for their insightful structural and scientific feedback. The authors are sincerely grateful to the participants in later adulthood whose contributions were vital to this research. References Abbasi, M., Adavi, H., & Hojjati, M. (2017). The relationship between religious beliefs and mental health through the mediation of purpose in life and perception of aging in retired teachers. Journal of Aging Psychology, 2(3), 195-204. [Persian] Amiri, Z., & Nabiei, M. (2023). Explaining the mediating role of self-compassion in the relationship between the satisfaction of basic psychological needs and cognitive flexibility in adolescents. In Proceedings of the 10th International Conference on New Research in Psychology, Social Sciences, Educational Sciences and Training. https://civilica.com/doc/1762002 [Persian] Ang, S. Y., Uthaman, T., Ayre, T. C., Mordiffi, S. Z., Ang, E., & Lopez, V. (2018). Association between demographics and resilience–a cross‐sectional study among nurses in Singapore. International Nursing Review, 65(3), 459-466.‏ https://doi.org/10.1111/inr.12441 Asadi Bijayee, J., Amiri Majd, M., Ghamari, M., & Fathi Aghdam, Q. (2021). The effectiveness of self-compassion training on life satisfaction and resilience in elderly women. Journal of Aging Psychology, 7(1), 55-67. https://doi.org/10.22126/jap.2021.6210.1509 [Persian] Asgari, Sh., & Shafiei, H. (2018). Predicting the quality of life in the elderly based on inner coherence, mindfulness, and spiritual intelligence. Journal of Positive Psychology Research, 3(3), 61-74. [Persian] Basharat, M., & Ranjbar Kalagari, A. (2013). The basic psychological needs satisfaction scale: Reliability, validity, and factor analysis. Educational Measurement Quarterly, 14(4), 148-168. [Persian] Campbell, R., Vansteenkiste, M., Delesie, L., Soenens, B., Tobback, E., Vogelaers, D., & Mariman, A. (2019). The Role of basic psychological need satisfaction, sleep, and mindfulness in the health-related quality of life of people living with HIV. Journal of health psychology, 24(4), 535-545. https://doi.org/10.1177/1359105316678305 Changizi, F., & Panah Ali, A. (2016). The effectiveness of group narrative therapy on life expectancy and happiness in the elderly of Tabriz. Education and Evaluation (Educational Sciences), 9(34), 63-76. https://sid.ir/paper/183647/fa [Persian] Deb, S., Thomas, S., Bose, A., & Aswathi, T. (2020). Happiness, meaning, and satisfaction in life as perceived by Indian university students and their association with spirituality. Journal of Religion and Health, 59(5), 2469-2485. https://doi.org/10.1007/s10943-020-01066-0 Deci, E. L., & Ryan, R. M. (2000). Commentaries on "The 'What' and 'Why' of goal pursuits: Human needs and the self-determination of behavior". Psychological Inquiry, 11(4), 269-318. https://doi.org/10.1207/S15327965PLI1104_01 Deci, E. L., & Ryan, R. M. (2008). Facilitating optimal motivation and psychological well-being across life's domains. Canadian psychology/Psychologie canadienne, 49(1), 14.‏ Deci, E. L., & Ryan, R. M. (2011). Levels of analysis, regnant causes of behavior and well-being: The role of psychological needs. Psychological inquiry, 22(1), 17-22. https://doi.org/10.1080/1047840X.2011.545978 Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research, 34(3), 241 -253. https://doi.org/10.1007/s10608-009-9276-4 Dickstein, D. P., Nelson, E. E., McCLURE, E. B., Grimley, M. E., Knopf, L., Brotman, M. A., Rich, B. A., Pine, D. S., & Leibenluft, E. (2007). Cognitive flexibility in phenotypes of pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(3 341-355.‏ https://doi.org/10.1097/chi.0b013e31802d0b3d Durand-Sanchez, E., Ruiz-Alvarado, C., Contreras-Valderrama, R., Morales-García, W. C., Mamani-Benito, O., Huancahuire-Vega, S., Saintila, J., Morales-García, M. & Ruiz Mamani, P. G. (2023). Sociodemographic Aspects and Healthy Behaviors Associated with Perceived Life Satisfaction in Health Professionals. Journal of Primary Care & Community Health.13, 1–10. Durkheim, Emile (1961). [1951]. The Elementary Forms of the Religious Life. New York: Collier Books. Fan, Y., Fang, S., & Yang, Z. (2018). Living arrangements of the elderly: A new perspective from choice constraints in China. China Economic Review, 50, 101-116. https://doi.org/10.1016/j.chieco.2018.04.001 Farahani, M., Mohammadi Khani, Sh., & Jokar, F. (2009). The relationship between life satisfaction, quality of life, and mental well-being in teachers of Tehran. Research in Psychological Health, 3(1), 0-5. http://rph.khu.ac.ir/article-1-97-fa.html [Persian] Forster, P., & Morris, M. (2012). Successful transition to retirement in Australia. Social Sciences Directory, 1(1), 4-12. https://doi.org/10.7563/SSD_01_01_01. Frankl, V. E. (1963). Man's search for meaning. Beacon Press. Gholami, R., Amiri Majd, M., & Bazazian, S. (2017). Basic psychological needs, meaning in life, and life satisfaction in students. Contemporary Psychology, 12(3), 1247-1251. [Persian] Hajazi, A., Saleh Najafi, A., & Amani, J. (2014). The mediating role of intrinsic motivation in the relationship between basic psychological needs and life satisfaction. Contemporary Psychology, 9(2), 77-88. https://sid.ir/paper/120129/fa [Persian] Hashemzadeh, A., & Amiri Majd, M. (2015). Comparison of quality of life, life satisfaction, and psychological well-being of mothers of children with slow development, autism, and normal development. Journal of Empowerment of Exceptional Children, 6(3), 37-51. [Persian] Heidari, F., & Motaghi, R. (2023). The effectiveness of life skills training on cognitive flexibility and quality of life in elderly patients with type 2 diabetes: A semi-experimental study. Rafsanjan University of Medical Sciences Journal, 22, 367-384. https://doi.org/10.61186/jrums.22.4.367 [Persian] Karataş, Z., Uzun, K., & Tagay, Ö. (2021). Relationships between life satisfaction, meaning in life, hope, and COVID-19 fear for Turkish adults during the COVID-19 outbreak. Frontiers in Psychology, 12, 633384. https://doi.org/10.3389/fpsyg.2021.6333 Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041-1056. https://doi.org/10.1016/j.cpr.2011.04.006 Kim, B. R., & Hwang, H. H. (2022). Analysis of Major Factors Affecting the Quality of Life of the Elderly in Korea in Preparation for a Super-Aged Society. International Journal of Environmental Research and Public Health, 19 (15), 9618. https://doi.org/10.3390/ijerph19159618 Klinger, E. (1998). Goal commitment and the psychology of motivation. In J. Y. Shah & W. L. Gardner (Eds.), Handbook of motivation science (pp. 227-248). Guilford Press. Khavarzamini, P., & Habibi Kalibar, R. (2022). Predicting academic persistence based on cognitive flexibility and academic self-concept in female high school students. Ravish Psychology, 11(4), 157-168. http://frooyesh.ir/article-1-3518-fa.html [Persian] Kudlacek, M. & Sigmundova, D. (2016). Active Lifestyle as a Determinant of Life Satisfaction among University Students. Anthropologist, 24 (1), 179-185. https://doi.org/10.1080/09720073.2016.11892004 Laverack, G., & Pratley, P. (2018). What quantitative and qualitative methods have been developed to measure community empowerment at a national level? World Health Organization. Regional Office for Europe. Luszczynska, A., Pawlowska, I., Cieslak, R., Knoll, N., & Scholz, U. (2013). Social support and quality of life among lung cancer patients: A systematic review. Psycho‐oncology, 22(10), 2160-2168. https://doi.org/10.1002/pon.3218 Masuda, A., & Tully, E.C. (2012). The Role of Mindfulness and Psychological Flexibility in Somatization, Depression, Anxiety, and General Psychological Distress in a Nonclinical College Sample. Journal of Evidence-Based Complementary & Alternative Medicine. 17 (1), 66-71. https://doi.org/10.1177/2156587211423400 Mahmoudi, M., & Dasht Bozorgi, Z. (2022). The mediating role of quality of life in the relationship between meaning in life and sense of coherence with death anxiety in elderly individuals in Ahvaz. Journal of Psychology and Educational Sciences, 7(2), 45-56. [Persian] Mohammadi Pour, F., Aflaksir, A., Mohammadi, N., & Hadianfar, H. (2021). Analysis of Meaning Components in the Lives of the Elderly. Positive Psychology Research Journal, 7(1), 1-18. https://doi.org/10.22108/PPLS.2021.122082.1901. [Persian] McCracken, L. M., & Morley, S. (2014). The Psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. Journal of Pain, 15, 221–234. https://doi.org/10.1016/j.jpain.2013.10.014 Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Satisfaction with life and associated factors among elderly people living in two cities in northwest Ethiopia: a community-based cross-sectional study. BMJ open. 2022, 12(9): Article e061931. Mombini, A., & Barikhi Barikhi, H. (2022). Life satisfaction in the elderly: The role of mental health and feelings of loneliness. Journal of Aging Psychology, 8(3), 287-298. https://doi.org/10.22126/JAP.2022.8287.1656 [Persian] Momeni, K., Amani, R., Janjani, P., Majzoobi, M. R., Forstmeier, S., & Nosrati, P. (2022). Attachment styles and happiness in the elderly: The Mediating role of reminiscence styles. BMC Geriatrics, 22, Article 349. https://doi.org/10.1186/s12877-022-03053-z[Persian] Momeni, K., Amani, R., Janjani, P., Majzoobi, M. R., & Hadian Hamdani, K. (2021). The relationship between attachment styles and positive and negative emotions in the elderly: The mediating role of reminiscence styles. Journal of Aging Psychology, 7(4), 407-422. [Persian] Najaat, S., Montazeri, A., Halakouei Naeini, K., Mohammad, K., & Majdzadeh, R. (2006). Standardization of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF): Translation and psychometric evaluation of the Iranian version. Journal of School of Public Health and Institute of Health Research, 4(4), 1-12. http://sjsph.tums.ac.ir/article-1-187-fa.html [Persian] Namani, E., Fatehi Moghaddam, A., & Mohammadi Hoseini, A. (2024). The effect of basic psychological needs on life satisfaction according to the mediating role of emotional empathy and resilience in elderly women. Journal of Aging Studies, 9(1), 62. https://doi.org/10.22034/JOGE.9.1.61 [Persian] Neugarten, B. L., Havighurst, R. J., & Tobin, S. S. (1961). The Measurement of life satisfaction. Journal of gerontology, 16, 134-143. https://doi.org/10.1093/geronj/16.2.134 Niknamy, M., Namjoo, A., Baghayi, M., & Atrekarooshan, Z. (2010). The relationship between health behaviors and life satisfaction in elderly individuals visiting active retirement centers. Journal of Gilan University of Medical Sciences, 19(73), 46-54. http://journal.gums.ac.ir/article-1-210-fa.html [Persian] Odacı, H., & Cikrikci, Ö. (2019). Cognitive flexibility mediates the relationship between big five personality traits and life satisfaction. Applied Research in Quality of Life, 14(5), 1229-1246. https://doi.org/10.1007/s11482-018-9651-y Omidy, M., & Khakpour, R. (2023). The effect of acceptance and commitment therapy (ACT) on resilience, cognitive flexibility, and life satisfaction in married women. New Advances in Psychology, Educational Sciences and Training, 63, 127-140. https://civilica.com/doc/1813032 [Persian] Olčar, D., Rijavec, M., & Ljubin Golub, T. (2019). Primary school teachers’ life satisfaction: The role of life goals, basic psychological needs and flow at work. Current Psychology, 38, 320-329. https://doi.org/10.1007/s12144-017-9611-y Pourhossein, R., Ehsani, S., Nabizadeh, R., & Ensani Mehr, N. (2019). Examining the relationship between meaning in life and life satisfaction with the mediating role of psychological capital. Ravish Psychology, 8(4), 225-232. [Persian] Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9(1), 1-28. Shahbazi Chahartaq, A., Yousefi Afrashteh, M., & Morovati, Z. (2024). Relationship between spiritual health and life satisfaction in Iranian elderly people: The mediating role of forgiveness. Salmand: Iranian Journal of Ageing, 19(1), 116-129. https://doi.org/10.32598/sija.2023.2076.5 [Persian] Shareh, H., & Eshaqi Sani, M. (2018). The predictive role of morning-evening personality, cognitive flexibility, and emotional regulation in marital satisfaction of middle-aged women. Iranian Journal of Psychiatry and Clinical Psychology (Thought and Behavior), 24(4), 384-399. [Persian] Shin, E., Kim, M., Kim, S., & Sok, S. (2023). Effects of reminiscence therapy on quality of life and life satisfaction of the elderly in the community: a systematic review. BMC geriatrics, 23(1), 1-9. https://doi.org/10.1186/s12877-023-04001-1 Snyder, C. R. (2000). Hypothesis: The role of hope in the development of a positive self-concept. In C. R. Snyder (Ed.), Handbook of hope: Theory, measures, and applications (pp. 1-20). Academic Press. Soltani Tabriz Shahabadini, M., Jahangir, P., & Niknam, M. (2023). Explaining the structural relationships between basic psychological needs and quality of life with the mediating role of emotional intelligence in orphaned and neglected adolescents. Disability Studies, 11(4), 43-54. http://jdisabilstud.org/article-1-2093-fa.html. [Persian] Steger, M. F. (2010). MLQ description scoring and feedback packet. Personal correspondence. Steger, M. F., Kashdan, T. B., Sullivan, B. A., & Lorentz, D. (2008). Understanding the search for meaning in life: Personality, cognitive style, and well-being. Journal of Happiness Studies, 9(2), 181-196. Steger, M. F., Kashdan, T. B., Sullivan, B. A., & Lorentz, D. (2006). Understanding the search for meaning in life: Personality, cognitive style, and well-being. Journal of Happiness Studies, 7(2), 197-217. Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: assessing the presence of and search for meaning in life. Journal of counseling psychology, 53(1), 80. https://doi.org/10.1037/0022-0167.53.1.80 Tan, S. Y. (2022). A Christian Approach to Counseling and Psychotherapy: Christ-centered, Biblically-based, and Spirit-filled. Wipf and Stock Publishers. Tian HM, Wang P. The role of perceived social support and depressive symptoms in the relationship between forgiveness and life satisfaction among older people. Aging & Mental Health.2021; 25(6):1042-8. https://doi.org/10.1080/13607863.2020.1746738. Vahidi Koujanq, H., Afshari, A., Rezaei Malajagh, R., Eghbali, A., & Tayari, M. (2020). Predicting life satisfaction in the elderly based on health-promoting lifestyle. Journal of Aging Psychology, 6(3), 285-297. [Persian] WHOQoL Group. (1996). WHOQOL-BREF: Introduction, administration, scoring and generic version of the assessment. Geneva: World Health Organization, 18. World Health Organization. (2015). World report on ageing and health. World Health Organization. https://www.who.int/publications/i/item/9789241565042 Yousefi Afrashteh, M., & Rezaei Shamsi, R. (2021). Spirituality and quality of life in the elderly: The mediating role of self-compassion and sense of coherence. Journal of Aging Psychology, 7(2), 137-151. [Persian] Yalçın, İ., & Malkoç, A. (2015). The relationship between meaning in life and subjective well-being: Forgiveness and hope as mediators. Journal of Happiness Studies, 16(4), 915-929. https://doi.org/10.1007/s10902-014-9530-0 Zanjari N, Sadeghi R. [Measuring of older adults’ well-being in Iranian provinces using age watch index (Persian)]. Salmand: Iran J Ageing. 2022:16(4):1-23. https://doi.org/10.32598/sija.2022.16.4.2814.1 [Persian] با توجه جمعیت رو به افزایش سالمندان در سالهای اخیر، پرداختن به وضعیت روان‌شناختی این بخش از جامعه از اهمیت ویژه‌ای برخوردار است. بنابراین این مطالعه با هدف بررسی رابطه انعطاف‌پذیری شناختی، کیفیت زندگی و معنا در زندگی با رضایت از زندگی در سالمندان با میانجیگری نیازهای بنیادین روان‌‌شناختی انجام شد. روش پژوهش حاضر بر حسب هدف کاربردی و از لحاظ شیوه گردآوری داده‌ها توصیفی- همبستگی از نوع معادلات ساختاری بود. جامعه آماری این پژوهش همه سالمندان بالای 60 سال شهر بوشهر در سال 1403-1402 می‌باشند. نمونه پژوهش 200 نفر از سالمندان شهر بوشهر بودند که به روش نمونه‌گیری در دسترس انتخاب شدند. ابزارهای استفاده شده در این پژوهش مقیاس انعطاف‌‌پذیری شناختی دنیس و واندروال، کیفیت زندگی سازمان بهداشت جهانی، معنا در زندگی استگر، رضایت از زندگی سالمندان نیوگارتن و همکاران و نیازهای بنیادین روان‌شناختی دسی و ریان بودند. داده‌های گردآوری شده با استفاده مدل‌یابی معادلات ساختاری و با نرم افزار AMOS24 تجزیه و تحلیل شد. نتایج نشان داد انعطاف‌پذیری شناختی، کیفیت زندگی و معنا در زندگی رابطه مستقیم و غیر مستقیمی (از طریق نیازهای بنیادین روان‌شناختی) معناداری با رضایت از زندگی داشتند. بدین ترتیب که انعطاف‌پذیری شناختی، کیفیت زندگی و وجود معنا در زندگی رابطه مثبت معنادار، و جستجوی معنا رابطه منفی معناداری با نیازهای بنیادین روان‌شناختی داشتند، که خود با رضایت از زندگی رابطه مثبت معناداری داشت. بنابراین نتیجه‌گیری می‌شود که با آموزش و بهبود انعطاف‌پذیری شناختی، کیفیت زندگی و معنا در زندگی و همچنین برآورده نمودن نیازهای بنیادین روان‌شناختی می‌توان رضایت از زندگی در بین سالمندان افزایش داد.

https://jap.razi.ac.ir/article_3770_ac31adb42c8c6a8dc0254f107a27f5af.pdf

دانشگاه رازی روان‌شناسی پیری 2423-7647 11 1 2025 04 06 The Relationship Between Health Anxiety and Illness Perception with Quality of Life of the Older Adult Living in Nursing Homes: The Mediating Role of Perceived Social Support رابطه اضطراب سلامت و ادراک بیماری با کیفیت زندگی سالمندان مقیم مراکز سالمندان: نقش میانجی حمایت اجتماعی ادراک شده 136 117 3803 10.22126/jap.2025.11676.1832 FA علی شیخ الاسلامی گروه مشاوره، دانشکدۀ علوم‌تربیتی و روان‌شناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0000-0002-7700-7206 مهشید کیوانلو گروه مشاوره، دانشکدۀ علوم‌تربیتی و روان‌شناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0000-0002-4831-6675 حانیه سعیدی چوان گروه مشاوره، دانشکدۀ علوم‌تربیتی و روان‌شناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0000-0001-5439-1762 فاطمه گوهری گروه مشاوره، دانشکدۀ علوم‌تربیتی و روان‌شناسی، دانشگاه محقق اردبیلی، اردبیل، ایران 0009-0002-1594-7398 Journal Article 2024 09 24 With the rapid growth of older adults and the decline in quality of life (QOL) due to physical, psychological, and social challenges, the need to investigate factors that contribute to improving this condition has become increasingly important. Accordingly, the present study aimed to examine the relationship of health anxiety and illness perception with QOL among older adults residing in nursing homes, with the mediating role of perceived social support (PSS). This research employed a descriptive-correlational design using structural equation modeling (SEM). The statistical population included all older residents of nursing homes in Ardabil, Iran during the Autumn, 2024. A total of 335 participants were selected through convenience sampling and completed the World Health Organization QOL Questionnaire, Salkovskis et al.’s Health Anxiety Inventory, Broadbent et al.’s Illness Perception Questionnaire, and Zimet et al.’s PSS Multidimensional Scale. Data were analyzed using SEM in SPSS version 26 and SmartPLS 3. The results indicated that health anxiety and illness perception had a significant negative direct relationship with QOL. Furthermore, PSS played a significant mediating role in the relationship of health anxiety and negative illness perception with the QOL among older adults. Specifically, both health anxiety and negative illness perception were significantly negatively associated with PSS, which, in turn, had a significant positive association with QOL. These findings suggest that better illness perception and higher levels of PSS are significantly related to lower health anxiety and improved QOL among older adults. Therefore, designing and implementing psychosocial interventions aimed at enhancing these components may play a pivotal role in promoting mental health and QOL in older adults. EXTENDED ABSTRACT Introduction With the growing population of older adults, increasing attention has been directed toward the quality of life (QOL) in this age group. QOL is influenced by a range of psychological factors, among which health anxiety and illness perception play a pivotal role. Health anxiety can lead to excessive concerns about physical well-being, while negative illness perceptions affect how individuals cope with their physical conditions. These factors are directly associated with a decline in the QOL among older adults. However, perceived social support (PSS) may serve as a mediating variable that moderates this relationship. By fostering a sense of security, being understood, and receiving emotional and instrumental support, social support may mitigate the adverse effects of health anxiety and negative illness perceptions, thereby enhancing QOL. Accordingly, the present study aimed to examine the mediating role of PSS in the relationship of health anxiety and illness perception with QOL among older adults. Method The present study was applied in terms of its objective and descriptive-correlational in terms of its nature and method, using structural equation modeling (SEM). The statistical population consisted of all older adults residing in nursing homes in Ardabil, Iran during the autumn of 2024. A total of 350 participants were selected using a convenience sampling method and based on predefined inclusion criteria. The inclusion criteria were: (1) willingness to participate in the study, (2) sufficient hearing and speaking ability to engage with the study and questionnaire, (3) minimum literacy to read and comprehend the questions, and (4) being at least 60 years old. The exclusion criteria included: (1) presence of acute psychiatric disorders, identified through clinical interviews conducted by the centers’ counselors, and (2) suffering from unstable acute physical illnesses that would prevent participation in the study. Given the maximum of three independent variables in the measurement and structural model, a minimum of 124 observations was required to achieve a statistical power of 80% and a minimum coefficient of determination (R²) of 0.10 at a 5% significance level (Hoyle, 1995). However, to enhance the accuracy and consistency of estimates in the partial least squares (PLS) method and to account for potential sample attrition, 350 individuals were selected. Ultimately, 335 valid questionnaires were included in the statistical analysis. Data analysis was conducted using SEM through SPSS version 26 and SmartPLS 3 software. Results Prior to model analysis, it was confirmed that the distribution of scores for all variables was normal, and the results indicated no correlation among the residuals and no multicollinearity among the variables. The results of the correlation analysis revealed significant relationships among the main variables of the study, namely, QOL, health anxiety, illness perception, and PSS. To test the research hypotheses, the model fit was examined using SEM. The findings indicated that PSS was a significant positive predictor of QOL. Furthermore, health anxiety showed a negative relationship, while illness perception demonstrated a positive relationship with QOL. The analysis of indirect paths indicated that PSS plays a significant mediating role in the relationships of health anxiety and illness perception with QOL. This mediation effect was confirmed through the Sobel test. PSS had a significant positive relationship with QOL (β=0.647, p<.01). Health anxiety had a significant negative relationship with QOL (β=–0.510, p<.001), while illness perception also had a significant negative relationship with QOL (β=–0.563, p<.001). Furthermore, both health anxiety (β=.380, p<.05) and illness perception (β=.340, p<.05) had significant indirect relationships with QOL through the mediation of PSS. Based on these findings, the final model demonstrated an adequate explanatory power for predicting QOL among older adults. Conclusion The findings of this study revealed that health anxiety and illness perception are significant psychological factors that can influence the QOL among older adults both directly and indirectly. Specifically, higher levels of health anxiety and negative illness perception were associated with lower QOL. Moreover, PSS served as an effective mediator, mediating these relationships. Path analysis further confirmed that PSS can be positively related to QOL of older adults by mitigating the adverse relationship of this variable with health anxiety and illness perception. In other words, the more social support older adults receive, the less they experience the negative consequences of anxiety and negative attitudes toward illness, ultimately leading to improved quality of life. These results suggest that enhancing the QOL in older adults requires more than addressing physical health alone. Psychosocial interventions must also be prioritized. Strengthening social support, particularly from family members, friends, caregivers, and support organizations, can be considered a key strategy for reducing anxiety and promoting more positive illness perceptions among older adults. Accordingly, policymakers and aging-sector planners can take meaningful steps toward improving the well-being of this population by designing and implementing programs that foster social capital, teach effective coping strategies, and create psychologically safe environments for older adults. From a theoretical perspective, the conceptual model proposed in this study may serve as a useful framework for explaining the psychological mechanisms that influence QOL among older adults within the socio-cultural context of Iran. Moreover, these findings open new avenues for future research in the field of geriatric psychology, particularly in exploring the roles of other potential mediators or moderators such as hope, resilience, and meaning in life. Therefore, identifying and intervening in the psychological and social factors associated with older adults’ QOL is essential not only at the individual level but also at the broader policy level. Ethical Consideration Ethical Code This study was conducted independently with the necessary approval obtained from the Research Deputy of Mohaghegh Ardabili University and with permission to access nursing homes in Ardabil County. Financial Support This research received no financial support. Authors’ Contributions F.G: Conceptualization, Methodology, Validation, Formal analysis, Writing - Original Draft; M.K: Data curation, Writing-Review & Editing; H.S.: Writing-Review & Editing, Visualization; A.Sh: Project administration, Supervision, Visualization. Conflict of Interest The author had no conflicts of interest. Acknowledgments The authors would like to express their sincere gratitude to the Research Deputy of Mohaghegh Ardabili University and the administrators of the nursing homes in Ardabil County for their moral support and cooperation in conducting this study. They also extend heartfelt thanks to the older participants who completed the scales. References Abdelghani, M., Mahdy, R., & El-Gohari, H. (2021). Health anxiety to COVID-19 virus infection and relationship to quality life in a sample of health care workers in Egypt: a cross-sectional study. Psychiatry and Psychotherapy, 23(1), 19- 28. Acoba E. F. (2024). Social support and mental health: The mediating role of perceived stress. Frontiers in psychology, 15, Article 1330720. Aydın Sayılan, A., & Demir Doğan, M. (2020). Illness perception, perceived social support and quality of life in patients with diagnosis of cancer. European Journal of Cancer Care, 29(4), Article e13252. Bailer, J., Kerstner, T., Witthöft, M., Diener, C., Mier, D., & Rist, F. (2016). Health anxiety and hypochondriasis in the light of DSM5. Anxiety, Stress, & Coping, 29(2), 219-239. http://dx.doi.org/10.1080/10615806.2015.1036243 Barghi Irani, Z., & Ranjbar, S. (2024). The lived experiences of older adults in nursing homes: A phenomenological study. Aging Psychology, 10(1), 111–127. https://doi.org/10.22126/jap.2024.10330.1763 [Persian] Bassak Nejad, S., Shakeri Nejad, G., Moradi, B., Shirmardi, S., & Fathi, K. (2022). Treatment and predicting life expectancy for women with breast cancer based on perception of the disease, perceived social support, and coping styles. Razi Journal of Medical Sciences, 29(2), 28–38. https://sid.ir/paper/1002818/en [Persian] Bilondi, S. S., Noghabi, A. D., & Aalami, H. (2022). The relationship between illness perception and medication adherence in patients with diabetes mellitus type II: illness perception and medication adherence. Journal of Preventive Medicine and Hygiene, 62(4), E966–E971. https://doi.org/10.15167/2421-4248/jpmh2021.62.4.2277 Bou-Hamad, I., Hoteit, R., & Harajli, D. (2021). Health worries, life satisfaction, and social well-being concerns during the COVID-19 pandemic: Insights from Lebanon. PloS one, 16(7), Article e0254989. https://doi.org/10.1371/journal.pone.0254989 Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, 60(6), 631-637.‏ https://doi.org/ 10.1016/j.jpsychores.2005.10.020 Cobo-Rendón, R., López-Angulo, Y., Pérez-Villalobos, M. V., & Díaz-Mujica, A. (2020). Perceived social support and its effects on changes in The Affective and eudaimonic well-being of chilean university students. Frontiers in Psychology, 11, Article 590513. https://doi.org/10.3389/fpsyg.2020.590513 Daniels, J., Parker, H., & Salkovskis, P. M. (2020). Prevalence and treatment of chronic fatigue syndrome/myalgic encephalomyelitis and co-morbid severe health anxiety. International Journal of Clinical and Health Psychology: IJCHP, 20(1), 10–19. https://doi.org/10.1016/j.ijchp.2019.11.003 Davaridolatabadi, E., & Abdeyazdan, G. (2016). The Relation between perceived social support and anxiety in patients under hemodialysis. Electronic Physician, 8(3), 2144–2149. https://doi.org/10.19082/2144 Diamond, P. R., Dysch, L., & Daniels, J. (2023). Health anxiety in stroke survivors: a cross-sectional study on the prevalence of health anxiety in stroke survivors and its impact on quality of life. Disability and Rehabilitation, 45(1), 27-33.‏ https://doi.org/10.1080/09638288.2021.2022778 Eraslan, P., & Ilhan, A. (2023). The relationships between health anxiety and intolerance of uncertainty with quality of life in caregivers of cancer patients. Family Practice and Palliative Care, 8(1), 10-15. http://dx.doi.org/10.22391/fppc.1172873 Ginnerup-Nielsen, E., Harreby, M., Christensen, R., Bliddal, H., & Henriksen, M. (2022). The correlation between illness perception, pain intensity and quality of life in oldage with low back pain in Denmark: a cross-sectional study. The Journal of Life and Environmental Sciences: PeerJ, 10, Article e14129. https://doi.org/10.7717/peerj.14129 Gohari, F., Qamari, H., & Sheykholeslami, A. (2024). The Effectiveness of computerbased cognitive rehabilitation on the rumination of older adult with death anxiety living in nursing homes. Aging Psychology, 10(2), 199-219.https://doi.org/10.22126/jap.2024.10485.1768 [Persian] Haig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2021). Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic. Behavioural and Cognitive Psychotherapy, 49(2), 129–143. https://doi.org/10.1017/S1352465820000636 Hill P. L., Payne B. R., Jackson J. J., Stine-Morrow E. A., Roberts B. W. (2014). Perceived social support predicts increased conscientiousness during older adulthood. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(4), 543–547. https://doi.org/10.1093/geronb/gbt024 Homayuni, A. (2023). Investigating the correlation between perceived stress and health anxiety with obsessive–compulsive disorder and quality of life during COVID-19 pandemic. BMC psychology, 11(1), Article 54.‏ https://doi.org/10.1186/s40359-023-01090-w Huang, W. L., Leventhal, B., Lin, C. C., & Chien, Y. L. (2025). Health anxiety and somatic symptoms in adults on the autism spectrum. Psychiatry Research, 350, Article 116550. Advance online publication. https://doi.org/10.1016/j.psychres.2025.116550 Huang, Z., & Chair, S. Y. (2025). Disease severity, illness perceptions, depression, and health-related quality of life in patients with heart failure. Journal of Clinical Nursing. Advance online publication.https://doi.org/10.1111/jocn.17653 Karimi-Ghasemabad, S., Akhbari, B., Saeedi, A., Talebian Moghaddam, S., & Nakhostin Ansari, N. (2021). The Persian brief illness perception questionnaire: Validation in patients with chronic nonspecific low back pain. The Scientific World Journal, 2021(1), Article 3348011.‏ https://doi.org/10.1155/2021/3348011 Kazemi, N., Sajjadi, H., & Bahrami, G. (2019). Quality of life in Iranian elderly. Salmand: Iranian Journal of Ageing, 13(5), 518–533. http://dx.doi.org/10.32598/SIJA.13.Special-Issue.518 [Persian] Khattak, A. Z., Zaman, S., Shah, S. U., Fatima, N., Nazir, J., & Abdullah, M. (2025). The Mediating role of coping strategies in the Relationship between illness perception and quality of life among hashish users. Advances in Dual Diagnosis, 18(1), 26–34. https://doi.org/10.1108/ADD-09-2024-0026 Leventhal, H., Meyer, D., Nerenz, D., & Rachman, S. (1980). Contributions to medical psychology. Contributions to medical psychology, 17, Article 30. https://www.academia.edu/259452/The_Common_Sense_Representation_of_Illness_Danger Li, J., Luo, C., Liu, L., Huang, A., Ma, Z., Chen, Y., Deng, Y., & Zhao, J. (2024). Depression, anxiety, and insomnia symptoms among Chinese college students: A network analysis across pandemic stages. Journal of Affective Disorders, 356, 54–63. https://doi.org/10.1016/j.jad.2024.04.02 Li, L., & Yu, L. (2022). The Influence of Pension Mode on The Mental Health of Older Adults—Evidence from Older Adults in China. International Journal of Environmental Research and Public Health, 19(1), Article 119.‏ https://doi.org/10.3390/ijerph19010119 Liu, Q. W., Qin, T., Hu, B., Zhao, Y. L., & Zhu, X. L. (2021). Relationship between illness perception, fear of progression and quality of life in interstitial lung disease patients: A cross‐sectional study. Journal of Clinical Nursing, 30(23-24), 3493-3505.‏ https://doi.org/10.1111/jocn.15852 Marafioti, G., Cardile, D., Culicetto, L., Quartarone, A., & Lo Buono, V. (2024). The impact of social cognition deficits on quality of life in multiple sclerosis: a scoping review. Brain Sciences, 14(7), Article 691.‏ https://doi.org/10.3390/brainsci14070691 Minshall, C., Ski, C. F., Apputhurai, P., Thompson, D. R., Castle, D. J., Jenkins, Z., & Knowles, S. R. (2020). Exploring the impact of illness perceptions, self-efficacy, coping strategies, and psychological distress on quality of life in a post-stroke cohort. Journal of Clinical Psychology in Medical Settings, 28(1), 174–180. https://doi.org/10.1007/s10880-020-09700-0 Moisoglou, I., Katsiroumpa, A., Kolisiati, A., Vraka, I., Kosiara, K., Siskou, O., Kaitelidou, D., Konstantakopoulou, O., Katsoulas, T., Gallos, P., & Galanis, P. (2024). Resilience and Social Support Improve Mental Health and Quality of Life in Patients with Post-COVID-19 Syndrome. European Journal of Investigation in Health, Psychology and Education, 14(1), 230–242. https://doi.org/10.3390/ejihpe14010015 Nargesi, F., Izadi, F., Kariminejad, K., & Rezaii Sharif, A. (2017). The investigation of the reliability and validity of Persian version of Health anxiety questionnaire in students of Lorestan University of Medical Sciences. Quarterly of Educational Measurement, 7(27), 147-160.‏ https://doi.org/10.22054/jem.2017.19621.1495 [Persian] Nejat, S., Montazeri, A., Holakouie Naieni, K., Mohammad, K., & Majdzadeh, S. (2006). The World Health Organization Quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Student Journal of School of Public Health and Institute of Public Health Research, 4(4), 1–12. http://sjsph.tums.ac.ir/article-1-187-en.html [Persian] Ośmiałowska, E., Staś, J., Chabowski, M., & Jankowska-Polańska, B. (2022). Illness Perception and Quality of Life in Patients with Breast Cancer. Cancers, 14(5), Article 1214. https://doi.org/10.3390/cancers14051214 Pfund, G. N., & Allemand, M. (2024). Correlated change between personality traits and perceived social support in oldage. Personality and Social Psychology Bulletin, 50(2), 167-181.‏ https://doi.org/10.1177/01461672221120493 Pourrostami, A., Zarbakhsh Bahri, M. R., & Bahram, S. (2023). Presenting the quality-of-life model related to the health of patients with type 2 diabetes based on disease perception, BMI and demographic characteristics with the mediating role of self-care behaviors. Applied Family Therapy Journal (AFTJ), 4(5), 353-377. https://doi.org/10.61838/kman.aftj.4.5.21 [Persian] Qorbanpoor Lafmejani A, nahvinejad T, rezaei S. (2024). Structural Model of Psychological Capital and Perceived Social Support with Quality of Life: Mediating Role of Psychological Empowerment. Social Welfare Quarterly. 24(92), Article 5. https://doi.org/10.32598/refahj.24.92.4020.2 [Persian] Rostami, R., Shahmohamadi, K., Ghaedi, G., Besharat, M. A., Akbari Zardkhaneh, S., & Nosratabadi, M. (2010). Relations among self-efficacy, emotional intelligence, and perceived social support in university students. Internal Medicine Today, 16(3), 46–54. http://imtj.gmu.ac.ir/article-1-964-fa.html [Persian] Şahin, D. S., Özer, Ö., & Yanardağ, M. Z. (2019). Perceived social support, quality of life and satisfaction with life in oldage people. Educational Gerontology, 45(1), 69-77.‏ https://doi.org/10.1080/03601277.2019.1585065 Salkovskis, P. M., & Warwick, H. M. C. (2001). Meaning, misinterpretations, and medicine: A cognitive-behavioral approach to understanding health anxiety and hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 202–222). Oxford University Press. https://doi.org/10.1093/oso/9780195126761.003.0009 Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(5), 843–853. http://dx.doi.org/10.1017/S0033291702005822 Shams, J. H., Mohammadzadeh, K. A., & Maher, A. (2020). Correlation between health literacy and quality of life with health anxiety in outpatient patients referred to Shahid Beheshti Specialized Polyclinic in Karaj. Journal of Health Promotion Management (JHPM), 9(1), 1-9.‏ https://sid.ir/paper/395473/en Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World health organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. Quality of Life Research, 13(2), 299–310. https://doi.org/10.1023/B:QURE.0000018486.91360.00 Soong, R. Y., Low, C. E., Ong, V., Sim, I., Lee, C., Lee, F., Chew, L., Yau, C. E., Lee, A. R. Y. B., & Chen, M. Z. (2025). Exercise Interventions for Depression, Anxiety, and Quality of Life in Older Adults with Cancer: A Systematic Review and Meta-Analysis. JAMA network open, 8(2), Article e2457859. https://doi.org/10.1001/jamanetworkopen.2024.57859 Striberger, R., Axelsson, M., Zarrouk, M., & Kumlien, C. (2021). Illness perceptions in patients with peripheral arterial disease: A systematic review of qualitative studies. International journal of nursing studies, 116, Article 103723. https://doi.org/10.1016/j.ijnurstu.2020.103723 Sunderland, M., Newby, J. M., & Andrews, G. (2013). Health anxiety in Australia: prevalence, comorbidity, disability and service use. The British journal of psychiatry: the journal of mental science, 202(1), 56–61. https://doi.org/10.1192/bjp.bp.111.103960 Tenenhaus, M., Vinzi, V. E., Chatelin, Y. M., & Lauro, C. (2005). PLS path modeling. Computational statistics & data analysis, 48(1), 159-205.‏ https://doi.org/10. 1016/j.csda.2004.03.005 Tharwat, S., Nagy, E., Elsayed, A. M., Salem, K. M., Salah, A. M., Mohamed, S. Z., & Nassar, M. K. (2025). Prevalence of Knee Pain and Its Relation to Depression, Anxiety, and Health-Related Quality of Life Among Maintenance Hemodialysis Patients. Journal of Clinical Medicine, 14(2), Article 368.‏ https://doi.org/10.3390/jcm14020368 Tsai, L. Y., Lee, S. C., Wang, K. L., Tsay, S. L., & Tsai, J. M. (2018). A correlation study of fear of cancer recurrence, illness representation, self-regulation, and quality of life among gynecologic cancer survivors in Taiwan. Taiwanese Journal of Obstetrics and Gynecology, 57(6), 846-852.‏ https://doi.org/10.1016/j.tjog.2018.10.014 Tsai, L. Y., Lee, S. C., Wang, K. L., Tsay, S. L., & Tsai, J. M. (2018). A correlation study of fear of cancer recurrence, illness representation, self-regulation, and quality of life among gynecologic cancer survivors in Taiwan. Taiwanese Journal of Obstetrics and Gynecology, 57(6), 846-852.‏ https://doi.org/10.1016/j.tjog.2018.10.014 United Nations, Department of Economic and Social Affairs, Population Division. (2019). World population prospects 2019: Highlights (ST/ESA/SER.A/423). https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf Warwick, H. M., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117. https://doi.org/10.1016/0005-7967(90)90023-c Younis, N. M., Ibrahim, R. M., & Ahmed, M. M. (2024). Relationship between Quality of Life and Lifestyle of Health Old Age. Current Clinical and Medical Education, 2(8), 18-28.‏ Zimet, G.D., Dahlem, N.W., Zimet, S.G., & Farley, G.K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41. http://dx.doi.org/10.1207/s15327752jpa5201_2 با رشد روزافزون جمعیت سالمندان و کاهش کیفیت زندگی ناشی از مشکلات جسمی، روانی و اجتماعی، لزوم بررسی عوامل مؤثر بر بهبود این وضعیت بیش از پیش احساس می‌شود. بر این اساس، پژوهش حاضر با هدف بررسی رابطه اضطراب سلامت و ادراک بیماری با کیفیت زندگی سالمندان مقیم مراکز سالمندان با نقش میانجی حمایت اجتماعی ادراک شده انجام شد. روش پژوهش حاضر، توصیفی-همبستگی با استفاده از مدل‌یابی معادلات ساختاری بود. جامعۀ آماری شامل تمامی سالمندان ساکن در مراکز نگهداری از سالمندان شهر اردبیل در پاییز سال 1403 بود. حجم نمونه نیز براساس روش نمونه‌گیری در دسترس 335 نفر انتخاب شدند که افراد به پرسش‌نامه‌های کیفیت زندگی سازمان جهانی بهداشت، اضطراب سلامت سالکوسکیس و همکاران، ادراک بیماری بردبنت و همکاران و حمایت اجتماعی ادراک شده زیمت و همکاران پاسخ دادند. تجزیه‌ و تحلیل داده‌ها با استفاده از مدل‌یابی معادلات ساختاری و در نرم‌افزارهای SPSS نسخۀ 26 و Smart pls3 انجام شد. نتایج نشان داد که اضطراب سلامت و ادراک بیماری رابطۀ منفی و معنادار مستقیمی با کیفیت زندگی دارند. به‌علاوه، حمایت اجتماعی ادراک شده نقش میانجی معناداری بین اضطراب سلامت و ادراک منفی از بیماری با کیفیت زندگی سالمندان ایفا می‌کند. بدین ترتیب که اضطراب سلامت و ادراک منفی از بیماری هر دو رابطه منفی معناداری با حمایت اجتماعی ادراک شده دارند، که به نوبه خود رابطه مثبت معناداری با کیفیت زندگی دارد. بنابراین، طراحی و اجرای مداخلات روانی-اجتماعی مبتنی بر ارتقای این مؤلفه‌ها می‌تواند نقش محوری در ارتقای و کیفیت زندگی سالمندان ایفا نماید.

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