The Relationship of Early Maladaptive Schema with Depression and Social Anxiety in Older Adults

The ever-increasing growth of older population and its consequences have led aging to become a significant social issue in most societies. Old age is an unavoidable and critical period in human life, impacting all aspects of living. Therefore, this study aimed to determine the relationship of early maladaptive schemas (EMS) with depression and social anxiety in older adults. This was a descriptive-correlational study in which 150 individuals were selected through convenience sampling from all older adults aged 60 and over living in Tehran, Iran. The measures included Young’s 75-item EMS questionnaire, Yesavage et al.’s geriatric depression scale and Connor et al.’s social anxiety questionnaire. The data were analyzed using SPSS-28, indicating a significant direct relationship of early maladaptive schemas with both depression and social anxiety (p<0.05). The results of Pearson’s correlation test revealed that EMS of abandonment, emotional deprivation, social isolation, and failure had the strongest correlation with depression. While, EMS of perfectionism, defect/shame, social isolation, and vulnerability to harm were associated with social anxiety. Additionally, the results from multiple linear regression analysis showed that four EMS, namely abandonment, emotional deprivation, defect/shame, and emotional inhibition, were able to significantly predict depression, whereas three EMS, namely social isolation, defect/shame, and perfectionism, were proven to significantly predict social anxiety. It can be concluded that implementing preventive programs during childhood and adolescence to examine schemas and conducting comprehensive educational courses focused on schemas can serve as effective strategies for psychoeducation and improving well-being in old age.
EXTENDED ABSTRACT
 Introduction
Various variables related to depression and social anxiety in older adults have been examined in the research literature, with one of the most important being early maladaptive schemas (EMS_s). EMS_s are the deepest cognitive structures that encode and evaluate new information based on their pre-existing structures. They lie at the core of personality disorders, mood problems, and many chronic Axis I disorders. Operating outside of conscious awareness, EMS_s make individuals psychologically vulnerable to disturbances such as depression, anxiety, and dysfunctional relationships. Depression and anxiety also affect the quality of life of older adults as they age, particularly in response to life events. Although studies have explored the relationship of EMS with depression and social anxiety in older age, few have examined how this relationship unfolds and which specific schemas impact depression and social anxiety in this age group. Therefore, given the gaps in the research literature, the present study aims to investigate the relationship of EMS with depression and social anxiety in older adults.
Method
The present study employed a descriptive-correlational design. The statistical population of this study included all older adults aged 60 and above living in Tehran. Based on the predictive variables of the present study, a sample of 150 individuals (93 women and 57 men) was selected through convenience sampling. Inclusion criteria were (1) age 60 and above, (2) residing in Tehran, (3) at least middle school education, (4) participant consent and cooperation. Exclusion criteria included acute psychological or physical disorders, as reported by themselves, that might prevent participants from answering the questions or understanding their meaning. Participants completed Young’s 75-item EMS questionnaire, Yesavage et al.’s geriatric depression scale and Connor et al.’s social anxiety questionnaire. The questionnaires were in a printed format and distributed among older adults visiting counseling centers, health houses, and certain public places in District 5 of Tehran, using convenience sampling. Finally, the data obtained from the questionnaires were analyzed using Pearson’s correlation coefficient and multiple linear regression analysis in SPSS software version 28.
Results
Prior to data analysis, it was confirmed that the distribution of scores for all variables was normal, and the results indicated no correlation between errors and no multicollinearity among variables. To test the research hypotheses, Pearson’s correlation coefficient and multiple linear regression analysis were used. The results of the Pearson’s correlation coefficient showed a significant positive correlation between depression and EMS, as well as between social anxiety and EMS.
The model fit indices obtained were as follows: F (28.7) =p<.05, indicating a good fit for the regression model. R²=.427, showing that EMS explained 42.7% of the variance or changes in depression. The Durbin-Watson test value was 1.60, which falls within the acceptable range of 1.5 to 2.5, confirming the assumption of residual independence. Tolerance values>0.20 and VIF values<5 were tested, indicating no severe multicollinearity. Regarding social anxiety, F (28.7)=p<.05 also indicated a good fit for the regression model. R²=.427, showing that EMS explained 42.7% of the variance or changes in depression. The Durbin-Watson test value was 1.60, falling within the acceptable range of 1.5 to 2.5, confirming the assumption of residual independence. Tolerance values>.20 and VIF values<5 were tested, indicating no severe multicollinearity. The Pearson’s correlation coefficient results indicated that the relationship between EMS and depression was positive (m=47.62, p<.01), and the relationship between early maladaptive schemas and social anxiety was also positive (m=43.02, p<.01) and significant. Moreover, the correlation intensity analysis showed that the strongest correlation with depression was related to the EMS of abandonment (r=.56), emotional deprivation (r=.53), social isolation (r=.51), and failure (r=.49). The strongest correlation with social anxiety was related to the schemas of perfectionism (r=.53), defectiveness /shame (r=.47), social isolation (r=.47), and vulnerability to harm (r=.44).
Conclusion
The global population is rapidly moving towards aging. Therefore, older adults make up a significant portion of the population pyramids in both developed and developing countries. This stage of life is accompanied by a wide range of physiological and psychological changes, leading to an increase in the prevalence of mental disabilities during this period. The aim of the present study was to determine the relationship between EMSs and depression and social anxiety in older adults. According to the results, higher levels of EMSs were associated with increased depression in older adults. Specifically, among EMSs, abandonment, emotional deprivation, defectiveness/shame, and emotional inhibition were able to predict depression in older adults. Furthermore, higher levels of EMSs were related to increased social anxiety in older adults. Among EMSs, social isolation, defectiveness/shame, and perfectionism were able to predict social anxiety in older adults. The strongest impact was found in the relationship between the social isolation schema and social anxiety.
Ethical Consideration
Ethical Code
Educational Unit, Faculty of Humanities, Islamic Azad University, West Tehran Branch
Financial Support
This research did not receive any financial support.
Authors’ Contributions
N.M: Conceptualization, Software, Validation, Formal Analysis, Data Curation, Visualization; S.B: Methodology, Writing-Review & Editing, Project Administration; S.Gh: Conceptualization, Methodology, Writing-Orginal Draft
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
We extend our gratitude to the respected older adults for their participation in completing the questionnaires.
References
Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2022). The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 132, 1067-1073. [Persian]
Ahmady, M., Bagheri, M. (2013). Mediating role of cognitive distortions in the relationship between body image and social anxiety in adolescents. Journal of Behavioral Sciences,7(4), 321-329. [Persian]
Ahmadpanah, M., Astinsadaf, S., Akhondi, A., Haghighi, M., Sadeghi Bahmani, D., Nazaribadie, M., Jahangard, L., Holsboer-Trachsler, E., & Brand, S. (2017). Early maladaptive schemas of emotional deprivation, social isolation, shame and abandonment are related to a history of suicide attempts among patients with major depressive disorders. Comprehensive Psychiatry, 77, 71–79. [Persian]
Ahai, G., Mohammadifar, M., & Basharat, M. (2007). Reliability and validity of the short form of Young’s schema questionnaire. Psychology and Educational Sciences, 37(3), 5-20. [Persian]
Alimoradi B, Nejat H. (2019). Brain behavioral systems, early maladaptive schema, and premenstrual in mothers with postpartum depression disorder. IJRN.6 (2), 56-65. [Persian]
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5^th ed., text rev.).
Arifin, M., & Rohan, H. (2023). Meta-Analysis the effects of loneliness on depression in elderly. Indonesian Journal of Global Health Research. 5(2), 335-344. https://doi.org/10.37287/ijghr.v5i2.1733
Asmari, Y., Dolatshahi, B., Poursharifi, H., & Barahmand, U. (2022). Early negative memories, humiliation and defectiveness/shame schema: An emotion-focused therapeutic approach to social anxiety.  Journal of Evidence-Based Psychotherapies, 22(1). 117-136. [Persian]
Brouwer, A., van de Ven, P. M., Kok, A., Snoek, F. J., Beekman, A. T. F., & Bremmer, M. A. (2022). Symptoms of depression and insomnia in older age: A within-individual analysis over 20 years. Journal of the American Geriatrics Society, 70(7), 2051–2059. https://doi.org/10.1111/jgs.17765
Beyrani, M., Hashemi, T., Pourmahmood Hajilari, K., & Saeedi Dehagani, S. (2019). Comparative study of the components of maladaptive schemas in individuals with subclinical symptoms of anxiety, depression, and healthy individuals. Journal of New Psychological Research, 14(54), 41-55. [Persian]
Bär, A., Bär, H. E., Rijkeboer, M. M., & Lobbestael, J. (2023). Early maladaptive schemas and schema modes in clinical disorders: a systematic review. Psychology and psychotherapy, 96(3),716–747. https://doi.org/10.1111/papt.12465
Connor KM, Davidson JR, Churchill LE, Sherwood A, Weisler RH, FOA E. (2000) Psychometric properties of the social phobia inventory (SPIN). The British Journal of Psychiatry.176(4), 379-86. DOI: 10.1192/bjp.176.4.379
Cousineau, (2004). Early Maladaptive Schemas Predisposing Anxiety, Sante Ment Que, 29(1),53-60. https://doi.org/10.7202/008819ar
Domènech-Abella, J., Mundó, J., Haro, J. M., & Rubio-Valera, M. (2019). Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish longitudinal study on ageing (TILDA). Journal of Affective Disorders, 246, 82–88. https://doi.org/10.1016/j.jad.2018.12.043
Dehghani Y, hekmatian fard S. (2020) The role of early maladaptive schemas, behavioral activation/inhibition system and cognitive emotion regulation strategies predicting social anxiety in students with learning disorder. 19 (4), 90-77. [Persian]
Delattre, V., Servant, D., Rusinek, S., Lorette, C., Parquet, P. J., Goudemand, M., & Hautekeete, M. (2004). The Early maladaptive schemas: a study in adult patients with anxiety disorders. L'encephale, 30(3), 255-258. https://doi.org/10.1016/s0013-7006(04)95437-1
Eynaki S, Sadeghi A. (2021) Correlation of rejection perception and depression syndrome with the mediating role of emotional schemas in elderly. 16 (2), 79-88. [Persian]
Tabachnick, B., & Fidell, L. (2007). Using multivariate statistics (5thedn) New York. NY: Allyn and Bacon. https://doi.org/10.4236/ojm.2013.33016
Esfahani, Afshin M, mohammadi F, Arefnezhad M. (2021). Prevalence of depression among Iranian elderly: A Systematic review and Meta-analysis. 5 (4), 66-77. [Persian]
Gong, J., & Chan, R. C. K. (2018). Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress among Chinese college students. Psychiatry Research, 259, 493-500. https://doi.org/10.1016/j.psychres.2017.11.019
Gonzalez, D.Z., Calvete, Z.E., Orue, I.S. (2012). Early maladaptative schemas and social anxiety: the moderating effect of avoidant vs. over compensation coping, European Psychiatry, 27,1‌ http://dx.doi.org/10.1016/S0924-9338(12)74296-7
Hawke, L. D., and Provencher, M. D. (2011). Schema theory and schema therapy in mood and anxiety disorders: A review. Journal of Cognitive Psychotherapy, 25(4), 257-76. https://doi.org/10.1891/0889-8391.25.4.257
Khodayarinejad T, Mohammadi Arya, Ph.D. A R, Rezaee Dogaheh, Ph.D. E. (2021). A Comparison of perceived parental rearing styles and early maladaptive schemas in students with social anxiety and normal students. 18 (3), 43-66. [Persian]
Kouchi S, Mami S, Ahmadi V. (2021). The Mediating role of cognitive emotion regulation strategies and social self-efficacy in the relationship between early maladaptive schemas and social anxiety in adolescent girls. Journal of Psychological Science. 20(102), 953-966. [Persian]
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593
Kirmizioglu, Y., Doğan, O., Kuğu, N., & Akyüz, G. (2009). Prevalence of anxiety disorders among elderly people. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 24(9), 1026-1033.‌ https://doi.org/10.1002/gps.2215
Mu, T. Y., Xu, R. X., Xu, J. Y., Dong, D., Zhou, Z. N., Dai, J. N., & Shen, C. Z. (2022). Association between self-care disability and depressive symptoms among middle-aged and elderly Chinese people. Plos one, 17(4), e0266950. https://doi.org/ 10.1371/journal.pone.0266950
Malakouti K, Fathollahi P, Mirabzadeh A, Salavati M, Kahani S. (2006). Validation of Geriatric Depression Scale (GDS-15) in Iran. Pajouhesh Dar Pezeshki.30(4), 361-9. [Persian]
Mirza M. (2020) ANFIS system: An algorithm for diagnosing and classifying the levels of depression in the elderly. 5 (2), 61-70. [Persian]
Melling, T. M. B., and Alden, L. E. (2000). Cognitive processes in social anxiety: The effects of self-focus, rumination and anticipatory processing. Journal of Behaviour Research and Therapy, 38(3), 243-257. https://doi.org/10.1016/s0005-7967(99)00040-6
nazari S, sharifi F, gashtili N. (2021). Investigating the relationship between aging perception with stress, anxiety and depression in the elderly members of the Tehran's social security retirees in 2020.6 (3), 78-88. [Persian]
Orang S, Hashemi Razini H, Abdollahi M H. (2017). Relationship Between Early Maladaptive Schemas and Meaning of Life and Psychological Well-Being of the Elderly. Salmand: Iranian Journal of Ageing.12 (3), 326-345. [Persian]
 Orimo, H., Ito, H., Suzuki, T., Araki, A., Hosoi, T., & Sawabe, M. (2006). Reviewing the definition of “elderly”. Geriatrics & gerontology international, 6(3), 149-158. https://doi.org/10.1111/j.1447-0594.2006.00341.x
Popolo, R., Lysaker, P. H., Salvatore, G., Montano, A., Buonocore, L., Sirri, L., ... & Dimaggio, G. (2014). Emotional inhibition in personality disorders. Psychotherapy and Psychosomatics, 83(6), 377-378. https://doi.org/10.1159/000365110
Rafati, S., Baniasadi, T., Dastyar, N., Zoghi, G., Ahmadidarrehsima, S., Salari, N., & Rafati, F. (2023). Prevalence of self-medication among the elderly: A systematic review and meta-analysis. Journal of Education and Health Promotion, 12.67. [Persian]
Shahbeik S, Moazedian A, Sabahi P, Khanmohammadi Otaghsara A. (2023). A Structural Model of Depression based on Early Maladaptive Schemas and Perceived Social Support Mediated by Hope in Cancer Patients. 18 (1), 48-58. [Persian]
Turner, M. J., Aspin, G., & Gillman, J. (2019). Maladaptive schemas as a potential mechanism through which irrational beliefs relate to psychological distress in athletes. Psychology of Sport and Exercise, 44, 9-16. https://doi.org/10.1016/j.psychsport.2019.04.015
Wróblewska, I., Bartyzel, M., Chmielowiec, B., Puścion, M., & Chmielewski, J. P. (2021). The impact of depression on the quality of life in elderly people. Medycyna Ogólna i Nauki o Zdrowiu, 27(2), 199. https://doi.org/10.26444/monz/136243
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M.B., & Leirer, V.O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37-49.  https://doi.org/10.1016/0022-3956(82)90033-4
 Young, J. E. (1998). Young Schema Questionnaire--Short Form (YSQ-SF, YSQ-S, YSQ) https://psycnet.apa.org/doi/10.1037/t12644-000
 Zhang, S., Chen, J., Yang, F., Xu, B., Tang, Y., & Lu, Y. (2023). Prevalence rates of cataract and cataract surgery in elderly Chinese people living in suburban Shanghai: The Pujiang Cataract Cohort Study. The British Journal of Ophthalmology, 107(5), 683-689. https://doi.org/10.1136/bjophthalmol-2021-319991