رابطه خودمراقبتی با افسردگی سالمندان در دوران پساکرونا: نقش میانجی ناامیدی و حمایت اجتماعی

Aging is an important issue in psychological health and quality of life. Older people are vulnerable members of the society, prone to mental disorders, especially depression. Therefore, the aim of the present study was to examine the relationship between self-care and depression through hopelessness and social support in older people in the post-COVID period. This was a correlational study, using structural equation modeling (SEM). The statistical population consisted of all older people in Tehran, Iran with a sample of 260 individuals selected through convenience sampling. The measures used in this study included the second edition of Beck’s depression inventory, Younesi Borojeni’s elderly self-care questionnaire, Zimet et al.’s multidimensional scale of perceived social support, and Beck’s hopelessness scale. The data obtained from the questionnaires were analyzed using Pearson’s correlation coefficient and SEM in SPSS-26 and AMOS-24 software. The results indicated that the relationship between self-care and depression was significant through hopelessness (P<0.001, β=-0.87), and the relationship between self-care and depression was also significant through social support (P<0.001, β=-0.126). Based on the findings and the clarification of the relationships between self-care and depression in older people through the mediation of hopelessness and social support, effective actions can be taken to reduce depression and its psychological consequences in pandemic periods for this population.
EXTENDED ABSTRACT 
Introduction
Older adults are among the vulnerable members of society and are prone to mental health disorders, particularly depression. Research indicates that depression is a significant predictor of impairment in interpersonal relationships and daily activities, including self-care, among older adults. Additionally, studies show a correlation between self-care behaviors and the incidence of depression in older individuals. Various factors influence self-care in older adults, with social support and hope being among the most critical. Research has demonstrated that self-care education can improve or reduce disabilities in older adults, thereby increasing their sense of hope and quality of life. The significance of this study lies in elucidating the role of self-care models through social support and hopelessness as mediating variables, which could lead to important findings in the prevention and control of depression among the growing older population. This understanding paves the way for precise and targeted intervention studies aimed at enhancing the mental health of older adults. Therefore, given the existing gaps in the literature, the present study aims to investigate the relationship between self-care and depression in older individuals, considering the mediating role of hopelessness and social support.
Method
This research was a correlational study using structural equation modeling (SEM). The statistical population comprised all individuals over 60 years old residing in Tehran, Iran. A sample of 260 individuals (108 men and 152 women) was selected through convenience sampling. The inclusion criteria were (1) age over 60 years, (2) physical ability to participate in the study, and (3) willingness to participate in the study. The exclusion criteria included (1) inability to respond to questions, (2) diagnosed psychological disorders, and (3) cognitive impairments or mental conditions limiting cognitive abilities. Participants completed Beck’s depression inventory, Younesi Borojeni’s elderly self-care questionnaire, Zimet et al.’s multidimensional scale of perceived social support, and Beck’s hopelessness scale. Upon obtaining the necessary permissions, the research was conducted in locations frequented by older individuals, such as parks and retirement centers. Participants meeting the inclusion criteria were invited to join the study. After explaining the objectives of the study and ensuring the confidentiality of participants’ information for them, we obtained consent, and distributed the questionnaires. Participants completed the questionnaires with the assistance and guidance from the researcher. Given the large number of questions (82) and the specific conditions of older individuals, most questionnaires were completed with the help of the researcher. The data collected from the questionnaires were analyzed using Pearson’s correlation coefficient and SEM in SPSS-26 and Amos-24.
Results
Before conducting data analysis, it was determined that the distribution of all variable scores was normal. Results indicated no correlation between errors and no multicollinearity among the variables. To test the research hypotheses, model fitting was assessed using SEM. Results of Pearson's correlation test showed a significant positive relationship between self-care and social support (P<.01, ɣ =.418) and between depression and hopelessness (P<.05, β=.195). Additionally, there was a significant negative relationship between self-care and hopelessness (P<.001, ɣ=-.458), self-care and depression (P<.05, ɣ = -.377), and social support and depression (P<.01, β=-.298). The model fit indices obtained were CMIN=111.15, CMIN/DF=2.85, RMSEA= .07, NFI = 0.90, TLI =.91, IFI =.93, and CFI =.93, indicating a good model fit. Results from the Sobel test showed that hopelessness had a significant mediating role in the relationship between self-care and depression (P<.05, Z=-2.57) and social support had a significant mediating role in the relationship between self-care and depression (P< .01, Z =-3.27).
Conclusion
The primary aim of this research was to explain the relationship among self-care, as the criterion variable, hopelessness and social support as mediators, and depression as the predictor variable in older adults during the post-COVID-19 period. This study found significant relationships between self-care and depression through hopelessness and social support in older adults. Additionally, social support and hopelessness were identified as mediators in the relationship between self-care and depression. Considering that older adults are a vulnerable segment of the population and are prone to mental health disorders, particularly depression, which significantly impairs their quality of life, understanding factors related to depression can help reduce unwanted consequences in older adults. For example, higher perceived social support is associated with better physical and mental health outcomes, increased well-being, and reduced symptoms of depression. Hopelessness, self-care, and perceived social support are predictors of depression that should be given special attention in older age. Older adults can reduce hopelessness and depression by enhancing self-care and social support. Ultimately, based on the results of this study, effective measures can be taken to improve the quality of life of older adults.
Ethical Consideration
Ethical Code
This research was authorized by the Research Deputy of Ardakan University for the Master’s thesis of Ms. Masoumeh Ebadi in General Psychology.
Financial Support
This research did not receive any financial support.
Authors’ Contributions
M.A: Conceptualization, Methodology, Software, Data Collection and Statistical Analysis; A.M: Project Administration, Supervision, Data Management; Z.M: Writing - Original Draft, Writing - Review & Editing
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
This article is derived from a Master’s thesis in General Psychology at Ardakan University. The researchers extend their gratitude to the Research Deputy of Ardakan University, all the older adults who participated in the research, and all individuals and institutions that facilitated the participation of older adults in this study.
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