The Relationship of Self-Criticism and Loneliness with Depression in Older Adults: The Mediating Role of Rumination

Considering the rapid aging process of the population, it seems necessary to investigate important factors in the formation and control of depression. Therefore, the aim of this study was to investigate the relationship between self-criticism and loneliness with depression in older adults through the mediating role of rumination. This was a descriptive research with the structural equation modeling (SEM) method. The statistical population consisted of all people over 60 living in Shahryar and Quds nursing homes in Karaj, Iran, 2022-2023, among whom 195 people (119 women, 76 men) were selected using convenience sampling method. In order to collect information, Nolen Hoeksma and Maro’s rumination, Thomson and Zarav’s self-criticism, Russell et al.’s loneliness, and Beck’s depression questionnaires were used. SEM was used to test the hypotheses. Data analysis was conducted using SPSS-24 and Smart-PLS 3.2.8. The findings indicated that there is a positive and significant relationship between internal and comparative self-criticism and depression, as well as between rumination and depression, but the relationship between loneliness and depression did not reach significance level, and rumination plays a mediating role in the relationship between inner self-criticism and loneliness with Depression. According to the results of the present study, psychologists are recommended to train the techniques of controlling and stopping rumination, and self-critical thoughts in the treatment of depression in older adults, so that the loneliness of older adults may not lead them to feel depresssion.
EXTENDED ABSTRACT
Introduction
Based on studies in the field of depression, old age is a stressful period due to the presence of multiple factors, and the prevalence of depression among older adults has been reported to be high. Understanding the factors contributing to the development of depression plays a significant role in its prevention and control. Various psychological factors can influence the onset of depression, and examining these factors is crucial for improving and managing the condition. Previous studies have identified relationships between depression and shame, self-criticism, guilt, and attachment styles, indicating that depression results from the interaction of several different factors. Research findings have confirmed a direct relationship between loneliness and self-criticism with depression. However, no study has investigated the mediating role of rumination in the relationship between self-criticism and loneliness with the level of depression among older residents in nursing homes, who are at risk of depression due to being away from their family members and loved ones. Therefore, given the existing gap, the present study seeks to answer the question of whether rumination mediates the relationship between self-criticism and loneliness with the level of depression in older adults.
Method
This was a descriptive research, of structural equation modeling (SEM) type. The statistical population consisted of all individuals over 60 years old residing in nursing homes Shahriar and Qods in in Karaj, Iran during the years 2022-2023. Regarding sample size, Steven’s analysis recommends considering 15 cases for each predictor variable in multiple regression analysis using the ordinary least squares method, which is considered a good rule of thumb. Based on this, 195 individuals (119 women, 76 men) were selected from this population using convenience sampling. To collect data, Nolen Hoeksma and Maro’s rumination, Thomson and Zarav’s self-criticism, Russell et al.’s loneliness, and Beck’s depression questionnaires were applied. Out of 210 distributed questionnaires, 15 were excluded due to being incomplete, resulting in 195 questionnaires being considered as the final data for the study. The inclusion criteria were: (1) being over 60 years old, (2) having at least six years of formal education, and (3) the ability to communicate verbally. The exclusion criteria included: (1) a history of severe physical illnesses such as stroke, (2) cognitive impairments such as Alzheimer’s and dementia, and (3) the presence of other psychological disorders besides depression. In order to test the research question, SEM was used in in SPSS-24 and Smart-PLS 3.2.8 software.
 Results
To evaluate the measurement model, three criteria were used: reliability, convergent validity, and discriminant validity. Composite reliability and Cronbach’s alpha were assessed to measure the model’s reliability. The validity of the questionnaire was examined using convergent and discriminant validity criteria. The AVE (Average Variance Extracted) values for all constructs were above 0.50, confirming the convergent validity of the model and the adequacy of the measurement models’ fit. The coefficient of determination (R²) for the variables of depression and rumination was found to be at a moderate level (0.33< R²< 0.67). The Q² value indicated that the average predictive power of the model was at a moderate and acceptable level (0.15<Q²<0.35). Therefore, the predictive power of the model’s constructs was satisfactory. The average shared variance was 0.231, and the average coefficient of determination for the mentioned variables was 0.547. Loneliness and internal self-criticism had a positive indirect relationship with the level of depression through rumination. There was a positive relationship between loneliness (β=0.413) and internal self-criticism with a coefficient of (β=0.206) with the rumination, which in turn is associated with depression (β=0.239). Therefore, rumination mediates the relationship between internal self-criticism and loneliness with the level of depression. However, the relationship between comparative self-criticism and depression through rumination was not significant and was not confirmed. There was a direct positive relationship between (1) internal self-criticism and the level of depression with a coefficient of 0.14 (P<0.05) and comparative self-criticism and the level of depression with a coefficient of 0.34 (p < 0.01). (2) There was no direct relationship between loneliness and the level of depression. (3) Rumination had a direct relationship with the level of depression with a coefficient of 0.23 (P< 0.01).
 Conclusion
The presence of rumination significantly increases the tendency to dwell on negative issues. When an individual constantly thinks about the possibility of bad luck or adverse events, the process of negative thinking gradually intensifies, leading to a profound sense of depression. Moreover, the lack of control over thoughts about past mistakes, flaws, or failures results in the recollection of negative memories, overshadowing positive present experiences and thereby fostering hopelessness and depression. In general, it can be stated that rumination, by amplifying negative emotions and feelings, creates conditions where individuals feel considerable anxiety and worry in various situations and when facing new challenges, eventually leading to depression. Individuals experiencing loneliness often harbor numerous negative thoughts about different aspects of their lives. For instance, a person might think they are alone because they are not worthy of others spending time with them. Such negative thoughts lead to self-criticism and the belief that they cannot connect with others, perpetuating rumination on these issues. Rumination leads to introspection and increases feelings of loneliness. Therefore, it can be concluded that rumination stemming from feelings of loneliness causes dissatisfaction with one’s life, feelings of inadequacy, anger, and humiliation, thereby paving the way for the onset of depression.
Ethical Consideration
Ethical Code
This study was conducted as part of a Master’s thesis at Payame Noor University
Financial Support
This study had no financial support
Authors’ Contributions
M.M: Conceptualization, methodology, writing – original draft, writing – review & editing, project administration, supervision, visualization; H.D: Software, validation, statistical analysis, data curation, data management
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
We extend our heartfelt gratitude to all the elderly participants, as well as the staff, nurses, and doctors at the nursing homes, for their patient cooperation throughout all stages of this research. 
References
Ahmadi Tahor, M., Daneshvarpour, Z., and Karimi, L. (2012). The relationship between attachment styles and depression in students. Sabzevar University of Medical Sciences, 18(3), 217-223. https://www.sid.ir/paper/59560/fa.  [Persian]
Bagheri, H., Sadeghi, M., Esmaeili, N & Naeimi, Z. (2016). Relationship between spiritual health and depression and quality of sleep in the older adults in Shahroud. Journal of Gerontology (joge), 1(1), 55-62. http://joge.ir/article-1-73-en.html [Persian]
Bagherinezhad, M., Salehi Fadardi, J., & Tabatabayi, S. M. (2010). The relationship between rumination and depression in a sample of Iranian student. Research in Clinical Psychology and Counseling, 11(1). https://doi.org/10.22067/ijap.v11i1.6910 [Persian]
Bartoskova, M., Ševčíková, M., Durisko, Z., & Maslej, M. (2018). The form and function of depressive rumination. Evolution and Human Behavior, 39(3), 277-289. https://doi.org/10.1016/j.evolhumbehav.2018.01.005
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory – II. The Psychological Corporation. Harcourt Brace & Company San Antonio.
Beutel, M. E., Klein, E. M., & Brähler, E. et al. (2017). Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry 17, 97. https://doi.org/10.1186/s12888-017-1262-x 
Bisconer, S. W., & McGill, M. B. (2023). Undergraduate students and the COVID-19 pandemic: A look-back at first-year constructs of psychological adjustment, implications for clinicians and college administrators. Professional Psychology: Research and Practice, 54(1), 83–92. https://doi.org/10.1037/pro0000490
Chin, W., W. (1998). The partial least squares approach for structural equation modeling. In G. A. Marcoulides (Eds.), Modern methods for business research (pp. 295 236). London: Lawrence Erlbaum Associates.
Davari, A., and Rezazadeh, A. (2012). Structural equation modeling with PLS software. Tehran: Academic Jihad Publication. [Persian] 
Duarte, C., Stubbs, J., Pinto-Gouveia, J., Matos, M., Gale, C., Morris, L., & Gilbert, P. (2017). The impact of self-criticism and self-reassurance on weight-related affect and well-being in participants of a commercial weight management programme. Obesity Facts, 10(2), 65–75. https://doi.org/10.1159/000454834
Fox, K. R., O'Sullivan, I. M., Wang, S. B., & Hooley, J. M. (2019). Self-criticism impacts emotional responses to pain. Behavior Therapy, 50 (2), 410–420. https://doi.org/10.1016/j.beth.2018.07.008
Gilbert P., Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6),353-79. https://doi.org/10.1002/cpp.507 
Ge, L., Yap, C. W., Ong, R., & Heng, B. H. (2017). Social isolation, loneliness and their relationships with depressive symptoms: A population-based study. PLoS ONE, 12 (8), 23-47. http://dx.doi.org/10.1371/journal.pone.0182145
Graham, B. M., Denson, T. F., Barnett, J., Calderwood, C., & Grisham, J. R. (2018). Sex Hormones Are Associated with Rumination and Interact with Emotion Regulation Strategy Choice to Predict Negative Affect in Women Following a Sad Mood Induction. Frontiers in psychology, 9(52), 937. https://doi.org/10.3389/fpsyg.2018.00937 
Hair, J. F., Ringle, C. M., & Sarstedt, M. (2011). PLS- SEM: Indeed, a silver bullet. Journal of marketing theory and practice, 19(2), 139-151. https://doi.org/10.2753/MTP1069-6679190202
Hamidi, R., Fekrizadeh, Z., Azadbakht, M., Garmaroudi, G., Taheri Tanjani, P., Fathizadeh, S., & Ghisvandi, E. (2015). Validity and reliability Beck Depression Inventory-II among the Iranian elderly Population. Journal of Sabzevar University of Medical Sciences, 22(1), 189-198. https://jsums.medsab.ac.ir/article_550_en.html [Persian]
Halamová, J., Kanovský, M., Varšová, K., & Kupeli, N. (2018). Randomised controlled trial of the new short-term online emotion focused training for self-compassion and self-protection in a nonclinical sample. Current Psychology, 63(2), 1-11. https://doi.org/10.1007/s12144-018-9933-4
Henseler, J., Ringle, C. M., & Sinkovics, R. R. (2009). The use of partial least squares path modeling in international marketing, In Rudolf R. http://dx.doi.org/10.1108/S1474-7979(2009)0000020014
Islam, M. A., Barna, S. D., Raihan, H., Khan, M. N. A., & Hossain, M. T. (2020). Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey. PloS one, 15(8), 1-16. https://doi.org/10.1371/journal.pone.0238162
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). http://doi.org/10.1111/ppc.12572
Jalilian, F., Emdadi, S., Karimi, M., Barati, M., and Gharib Nawaz, H. (2012). Depression among students; investigating the role of general self-efficacy and perceived social support. Ibn Sina Clinical Medicine Journal (Scientific Journal of Hamedan University of Medical Sciences and Health Services), 18 (4), 66-62. https://sid.ir/paper/17733/en. [Persian]
Khan Ahmadi, O., Kaveh, M., and Qadri Bege Jan, K. (2015). A comparative study of the feeling of loneliness and the source of internal and external control among female heads of the household and non-headed women. International research conference in science and technology.  https://sid.ir/paper/858406/fahttps://sid.ir/paper/858406/fa. [Persian]
Kopala-Sibley, D., & Zuroff, D. (2017). Self-Criticism and Dependency. Front Psychology, 10(12), 35-41. http://dx.doi.org/10.4135/9781483365817.n1208 
Krause-Parello, C.A. (2008).” Loneliness in the school setting.” Journal of School Nursing, 24(2), 60-70. https://doi.org/10.1177/10598405080240020301
Luminet, O. (2004). Measurment of Depressive Rumination and Associated Constructs. In C. Papageorgiou & A. Wells (Eds.), Depressive Rumination: Nature, Theory and Treatment (pp. 187-215). New York: Wiley. http://dx.doi.org/10.1002/9780470713853.ch10
Llorens-Aguilar, S., Arnáez, S., Aardema, F., & García-Soriano, G. (2021). The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive–compulsive disorder sample. Clinical psychology psychotherapy, 29(2), 642-651. Doi: 10.1002/cpp.2656. Epub 2021 Aug 10. PMID: 34342058. https://doi.org/10.1002/cpp.2656
Madanchi, F., and Rasai, S. (2021). The effectiveness of choice theory on intellectual-practical obsession and mental rumination during the period of corona virus disease in housewives of Hamadan city. Quarterly Journal of Studies and Research in Behavioral Sciences, 7, 53-66. https://civilica.com/doc/1669574. [Persian]
Mahdavi Rad, H., Zahedi Tajrishi, K., Ramezanifarani, A., Asgharnejad, F. A. (2023). The Mediating Role of Shame and Self-criticism in the Relationship between Attachment Styles and Severity of Depressive Symptoms. Iranian Journal of Psychiatry and Clinical Psychology. 28(4), 480-495. https://dx.doi.org/10.32598/ijpcp.28.4.4429. [Persian]
Mehrafzon, D., Sotoude ASL, N., and Makund Hosseini, Sh. (2019). Development of a causal model of self-criticism based on perfectionism with the mediation of personality traits in students of Islamic Azad University of Tehran. Islamic lifestyle based on health, 4, 149-156. https://sid.ir/paper/412555/en. [persian]
Moayedfar, H., Yaqoubi, H., Hassanabadi, H., Mahdovian, A. (2017). Correlation between perfectionism and depression in students with the mediation of rumination. Health Promotion Management Quarterly, 7(6), 1-8. URL: http://jhpm.ir/article-1-981-en.html. [Persian]
Momeni, Kh., Amani, R., Janjani, P., Majzoobi, M. R., & Hadian Hamedani, K. (2021). The Relationship between attachment styles with positive and negative affect in the elderly: The Mediating role of reminiscence styles. Aging Psychology, 7(4), 407-422. https://doi.org/10.1037/t12353-000. [Persian]
Momeni, K., Amani, R., Janjani, P.  (2022). Attachment styles and happiness in the elderly: the mediating role of reminiscence styles. BMC Geriatr 22, 349-355.https://doi.org/10.1186/s12877-022-03053-z. [Persian]
Mousavi, A. A., and Ghorbani, N. (2006). Self-knowledge, self-criticism and mental health. Psychological Studies, 2(3-4), 91-75. https://sid.ir/paper/67608/en. [Persian]
Mikaeili, N., & Beheshti Motlagh, A. (2023). The Relationship between Lifestyle and Depression in the Elderly: The Mediating Role of Loneliness. Aging Psychology, 9(2), 192-181. https://doi.org/10.22126/jap.2023.9210.1707.[Persian]
Mirdrikund, F.A. (2000). Investigating the feeling of loneliness with academic performance, anxiety, depression and self-esteem in male middle school students of Poldakhter city. Master's thesis of Shahid Chamran University of Ahvaz.
Nejati, V., and Ashairi, H. (2006). Investigating the relationship between cognitive disorders and depression in the elderly. Elderly, 1(2), 118-112. https://sid.ir/paper/95069/en. [Persian]
Nikolić. M., Hannigan, L.J., Krebs, G., Sterne, A., Gregory, A.M., Eley, T.C. (2022). Aetiology of shame and its association with adoles-cent depression and anxiety: Results from a prospective twinand sibling study. Journal of Child Psychology and Psychia-try, and Allied Disciplines. 63 (1), 99-108. https://doi.org/10.1111/jcpp.13465.
Nik Kho, M. R., and Avadis Yanes, H. (2011). American Psychiatric Association (2000), Revised Text of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Tehran: Sokhn. [Persian]
O'Connor, R. C., Cleare, S., Eschle, S., Wetherall, K., & Kirtley, O. J. (2016).The integrated motivational-volitional model of suicidal behavior. In R. C. O'Connor & J. Pirkis (Eds.), the international handbook of suicide prevention (pp. 220–240). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781118903223.ch13
Ohayon, M.M., Carskadon, M.A., Guilleminault, C., Vitiello, M.V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 1, 27(7), 1255-73. https://doi.org/10.1093/sleep/27.7.1255
 Papageorgiou, C. (2017). Marianne Saam, Patrick Schulte; Substitution between Clean and Dirty Energy Inputs: A Macroeconomic Perspectivethe Review of Economics and Statistics, 99 (2), 281–290. https://doi.org/10.1162/REST_a_00592
Pearce, E., Myles-Hooton, P., Johnson, S., Hards, E., Olsen, S., Clisu, D., Pais, S., Chesters, H.A., Shah, S., Jerwood, G., Politis, M., Melwani, J., Andersson, G., Shafran, R.  (2021). Loneliness as an active ingredient in preventing or alleviating youth anxiety and depression: a critical interpretative synthesis incorporating principles from rapid realist reviews. Translational Psychiatry. 10, 11(1), 628-835. https://doi.org/10.1038/s41398-021-01740-w
Rafati, N., Yavari, P., Mehrabi, Y., Montazeri, A. (2005). A Quality of life among Kahrizak Charity Institutionalizd elderly People. Journal of School of Public Health and Institue of Public Health Research, 3(2), 65-75. http://sjsph.tums.ac.ir/article-1-238-en.html. [Persian]
Rahimzadeh, S., Pouretamad, H., Asgari, A., and Hojjat, M. (2011). Conceptual foundations of loneliness: a qualitative study. Evolutionary Psychology (Iranian Psychologists), 8(30), 141-123. https://sid.ir/paper/101561/en
Russell‚ D., Curtona‚ C. E., & Peplau L. A. (1980). The revised UCLA loneliness scale: concurrent and discriminated validity. Journal of Personality and Social Psychology, 39(3), 472-480. https://doi.org/10.1037//0022-3514.39.3.472 
Sabouri, S., Talebian Sharif, J. and Abdakhodaei, M. s. (1400). Examining the relationship between critical thinking and self-perception on the level of depression. Master's Thesis of Educational Sciences, Hekmat Razavi Institute of Higher Education, Department of Psychology and Social Sciences- Madadkari. [Persian]
Saeidimehr, S., Geravandi, S., Izadmehr, A & Mohammadi, M. (2016). Relationship between the “quality of life” and symptoms of depression among older adults. Iranian Journal of Ageing, 11(1), 90-99. https://sid.ir/paper/95234/en . [Persian] 
Shahar, G. (2015). Erosion: The psychopathology of self-criticism. New York: Oxford University Press.
Stefan-Dabson, K., Mohammadkhani, P., Massah-Choulabi, O. (2007). Psychometrics Characteristic of Beck Depression Inventory-II in Patients with Magor Depressive Disorder. Journal of rehabilitation, 8, 82-90. http://rehabilitationj.uswr.ac.ir/article-1-135-fa.html. [Persian]
Trincas, R., Schepisi, C., Leombruni, E., Di Mauro, V. E., & Mancini, F. (2018). Goals and functions of rumination: A review. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 15(6), 360–372. https://doi.org/10.1037/t07094-000. [Persian]
Santos, S., do Céu Salvador, M. (2021). Depression in institutional-ized adolescents: The role of memories of warmth and safe-ness, shame and self-criticism. The Spanish Journal of Psychol-ogy. 24, 29-38. https://doi.org/10.1017/SJP.2021.27
Thompson, R. & Zuroff, D. C. (2004). The Levels of Self-Criticism Scale: Comparative self-criticism and internalized self-criticism. Personality and Individual Differences, 36(2), 419-430. https://doi.org/10.1016/S0191-8869(03)00106-5
Tunheim, K., Dammen, T., Baardstu, T., Moum, T., Munkhaugen, J., & Papageorgiou, C. (2022). Relationships between depression, anxiety, type D personality, and worry and rumination in patients with coronary heart disease. Health Psychology, (12), 1-23. https://doi.org/10.3389/fpsyg.2022.929410
Valtorta, N. K., Kanaan, M., Gilbody, S., & Hanratty, B. (2016). Lone-lines, social isolation and social relationships: what are we measuring? A novel framework for classifying and comparing tools. British Journal of Sports Medicine, 6 (4), 1-8. https://doi.org/10.1136/bmjopen-2015-010799
Wakefield, J. R. H., Bowe, M., Kellezi, B.,Butcher, A., & Groeger, J. A. (2020).Longitudinal associations between family identification, loneliness, depression, and sleep quality. British Journal of Health Psychology.25 (1), 1-16. http://doi.org/10.1111/bjhp.12391
Werner, A. M., Tibubos, A. N., Rohrmann, S., & Reiss, N. (2019). The clinical trait self-criticism and its relation to psychopathology: A systematic review – Update. Journal of Affective Disorder, 246 (1), 530-547. https://doi.org/10.1016/j.jad.2018.12.069
Wu, C.-h., & Yao, G. (2008). Psychometric analysis of the short-form UCLA Loneliness Scale (ULS-8) in Taiwanese undergraduate students. Personality and Individual Differences, 44(8), 1762–1771. https://doi.org/10.1016/j.paid.2008.02.003
Yamaguchi, A., & Kim, M. S. (2013). Effects of self-Criticism and Its Relationship with Depression across Cultures. International Journal of Psyhological Studies, 5(1), 1-10. https://doi.org/10.5539/ijps.v5n1p1
Yari, M., Bahrololoum, H., & Mokaberian, M. (2022). The Relationship between Physical-Environmental Factors and Motivation for Physical Activity in the Elderly: The Mediating Role of Place Attachment (Case Study: Shahrud Health Road). Aging Psychology, 8(4), 327-311. https://doi.org/10.22126/jap.2022.8045.1638 [Persian]  
Yazdakhadi, F. (2010). A study on cognitive and depression disorders in the elderly and the correlation with each other. Advances in cognitive science, 11 (4), 12-17. http://icssjournal.ir/article-1-67-en.html [Persian]
Zakizadeh, R., Bahraini, M., Farhadi, A., and Bagherzadeh, R. (1401). Investigating the mediating role of depression in the relationship between feelings of loneliness and social functioning of the elderly in Bushehr city. Elderly, 17(4), 595-580. http://dx.doi.org/10.32598/sija.2022.3339.1 [Persian]
Zeeck, A., von Wietersheim, J., Weiss, H., Hermann, S., Endorf, K., Lau, I., & Hartmann, A. (2020). Self-Criticism and Personality Functioning Predict Patterns of Symptom Change in Major Depressive Disorder. Front Psychiatry, 12 (11), 147-154. https://doi.org/10.3389/fpsyt.2020.00147
Zhang, H., Watson-Singleton, N., Pollard, S., & Pittman, D. (2017). Self-Criticism and Depressive Symptoms: Mediating Role of Self-Compassion. Journal of Death and Dying, 80 (2), 30-56. http://dx.doi.org/10.1177/0030222817729609
Zhang, Y., Huang, L., Luo, Y., & Ai, H. (2021). The Relationship between State Loneliness and Depression among Youths during COVID-19 Lockdown: Coping Style as Mediator. Sec. Health Psychology, 1(14), 12-23. https://doi.org/10.3389/fpsyg.2021.701514