Social Alienation and Psychological Capital in Predicting Psychological Distress Among Older Adults: The Mediating Role of Self-Neglect

Background: Psychological distress among older adults is a major mental health challenge influenced by a range of individual and social factors. Accordingly, the present study was conducted to examine the roles of social alienation and psychological capital in predicting psychological distress among older adults, with self-neglect as a mediating variable.
Method: In terms of purpose, this was an applied study; in terms of method, it was a descriptive correlational study using structural equation modeling. The statistical population comprised all older adults who attended rehabilitation centers in the city of Mashhad during the summer of 2025. A total of 280 participants (90 men and 190 women) were selected through convenience sampling and completed the Kessler et al.’s Psychological Distress Questionnaire, the Wang et al.’s Self-Neglect Questionnaire, the Jessor et al.’s Social Alienation Questionnaire, and the Luthans et al. Psychological Capital Questionnaire. Data were analyzed using structural equation modeling in SPSS version 26 and LISREL version 8.8.
Results: The results of the structural model analysis indicated that social alienation had a direct, positive, and significant effect on psychological distress. In addition, psychological capital showed a direct, negative, and significant effect on psychological distress. Regarding indirect effects, the findings demonstrated that social alienation had an indirect, positive, and significant effect on psychological distress through self-neglect. Likewise, psychological capital exerted an indirect, negative, and significant effect on psychological distress through self-neglect.
Conclusion: Overall, in light of the findings, the design and evaluation of practical interventions aimed at strengthening older adults’ psychological capital while reducing self-neglect and psychological distress represent an important and applicable direction for future research.
 
EXTENDED ABSTRACT
Introduction
Psychological distress is a major issue in later life that can adversely affect older adults’ mental health, daily functioning, and quality of life. A variety of social and psychological factors contribute to the development of this condition. In this regard, social alienation, as an experience of separation, isolation, and diminished social connectedness, may create the conditions for increased psychological distress. In contrast, psychological capital, encompassing hope, self-efficacy, optimism, and resilience, may serve as an individual’s internal resource, playing a protective role against psychological stress and reducing levels of psychological distress. However, the relationships among these variables may not be solely direct and may be better explained through mediating mechanisms. One variable that may play such a role is self-neglect. Older adults who experience greater social alienation or possess lower levels of psychological capital may neglect self-care and fail to attend to basic life needs, which in turn may lead to increased psychological distress. Accordingly, understanding the mechanisms underlying psychological distress in older adults is of particular importance. Therefore, the present study aimed to examine the roles of social alienation and psychological capital in predicting psychological distress among older adults, with self-neglect as a mediating variable.
Method
The present study employed a correlational design using structural equation modeling. The statistical population included all older adults who attended rehabilitation centers in the city of Mashhad during the summer of 2025. From this population, 280 individuals (90 men and 190 women) were selected purposively as the study sample. The inclusion criteria were: (1) adequate speaking and hearing ability to respond to the questionnaires, (2) sufficient literacy to understand the questions, and (3) age 60 years or older. The exclusion criteria included: (1) the presence of acute psychiatric disorders and (2) unstable physical illnesses. Participants completed the Kessler et al. Psychological Distress Questionnaire, the Wang et al. Self-Neglect Questionnaire, the Jessor et al. Social Alienation Questionnaire, and the Luthans et al. Psychological Capital Questionnaire. The questionnaires were administered in person in paper-and-pencil format, and the researcher remained present throughout completion to provide clarification and supervise the response process. Data analysis was conducted using descriptive statistics (mean and standard deviation) and Pearson’s correlation coefficient in SPSS version 25. In addition, the structural equation model was tested using the maximum likelihood approach in LISREL version 8.8.
Results
The Durbin-Watson statistic was calculated to examine the independence of residuals, and the values obtained for psychological distress, social alienation, and psychological capital fell within the acceptable range of 1.5 to 2.5. Therefore, the assumption of independence of residuals was confirmed. In addition, multicollinearity indices, including the variance inflation factor and tolerance coefficient, were within acceptable limits. Accordingly, there was no serious multicollinearity among the predictor variables, and the assumption of absence of multicollinearity was met.
The results of the structural model indicated that social alienation had a direct and positive effect on psychological distress, whereas psychological capital showed a direct and negative effect on psychological distress. In addition, social alienation was positively associated with self-neglect, while psychological capital was negatively associated with self-neglect. Self-neglect was also positively associated with psychological distress.
Conclusion
Overall, the findings of this study suggest that psychological distress in older adults can be explained within the framework of the interplay among social resources, psychological resources, and the degree of attention individuals pay to self-care. Within this framework, social alienation, as a stress-inducing factor, reduces the sense of belonging, social support, and meaning in interpersonal relationships, thereby creating conditions that diminish motivation for self-care and increase neglect of personal needs; this, in turn, may lead to greater psychological distress. In contrast, psychological capital, including hope, optimism, resilience, and self-efficacy, as a set of positive internal resources, enhances older adults’ ability to cope with the challenges and pressures associated with later life and helps them adopt a more active and adaptive attitude toward life and self-care. Therefore, older adults with stronger psychological resources are less likely to experience self-neglect and, consequently, report lower levels of psychological distress. Taken together, self-neglect may be understood as a mechanism through which the effects of social conditions and psychological resources on older adults’ mental health become manifest, such that reduced social support and diminished psychological resources may increase self-neglect and ultimately exacerbate psychological distress in this population.
Ethical Consideration
Ethical Code
This study was conducted independently after obtaining the necessary permissions to access rehabilitation centers in the city of Mashhad.
Funding
This study received no financial support.
Authors’ Contributions
Sh. A.: Conceptualization, methodology, software, validation, formal analysis, project administration, writing - review & editing; M. K.: data curation, writing - review & editing; H. S.: Writing - Review & editing
Conflict of Interest
 The authors declared no conflicts of interest.
Acknowledgments
We sincerely thank the participants and all those who contributed to the implementation of this study.
 
References
Aihong, W. A. N. G. (2024). Development of social alienation scale for cancer patients and its reliability and validity test. Journal of Chinese Nursing Research, 38(20), 3609 – 3613.
Amini, S., Dehghani cham piri, A., Salehi, A., & Soltani zadeh, M. (2019). The Role of Psychological Capital and Psychological Flexibility in Predicting Loneliness in Elderly. Journal of Aging Psychology, 5(1), 77-88. doi: 10.22126/jap.1970.1178 [Persian]
Arshad, A., Ali, S., & Khan, M. (2024). Exploring the impact of psychological capital and social support on mental health: The Role of self-compassion. Journal of Policy Research Journal, 7(1), 45–58.
Barman, P., Rahut, D. B., & Mishra, R. (2024). Mediating role of social disengagement and loneliness in the nexus between functional health and mental well-being in older individuals. Journal of Scientific Reports, 14(1), 16232.https://doi.org/10.1038/s41598-024-66919-9
Benatov, J., & Itzhaky, H. (2021). Social alienation and psychological distress in Israeli adolescents. Tel Aviv University. Retrieved from https://cris.tau.ac.il/en/publications/social-alienation-and-psychological-distress-in-israeli-adolescen
Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. American journal of Epidemiology, 109(2), 186-204.
Cacioppo, J. T., & Cacioppo, S. (2018). The Growing problem of loneliness. The Lancet, 391(10119), 426-427.
Carver, C. S., & Scheier, M. F. (1998). On the self-regulation of behavior. New York, NY: Cambridge University Press.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Journal of Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
Curelaru, M., & Curelaru, V. (2024). Psychological distress and online academic difficulties: Development and validation of a scale to measure students’ mental health problems in online learning. Behavioral Sciences, 15(1), 26. https://doi.org/10.3390/bs15010026
Day, M. R., Leahy-Warren, P., & McCarthy, G. (2013). Perceptions and views of self-neglect: A Client-centered perspective. Journal of Elder Abuse & Neglect, 25(1), 76–94. https://doi.org/10.1080/08946566.2012.712864
Dong, Y., Cheng, L., & Cao, H. (2024). Impact of informal social support on the mental health of older adults. Journal of Frontiers in Public Health, 12, 1446246 doi: 10.3389/fpubh.2024.1446246.
Fan, Z., Shi, X., Lu, X., Zhang, J., & Li, L. (2025). Impact of self-stigma of loneliness on psychological distress in older adults: Mediation effect of relative deprivation and moderation effect of positive solitude. Journal of BMC geriatrics, 25(1), 309. doi: 10.1186/s12877-025-05904-x.
Fan, Z., Shi, X., Lu, X., Zhang, J., & Li, L. (2025). Impact of self-stigma of loneliness on psychological distress in older adults: mediation effect of relative deprivation and moderation effect of positive solitude. Journal of Scientific Reports BMC geriatrics, 25(1), 309-323. https://doi.org/10.1186/s12877-025-05904-x
Forouhar, M., & Hovaida, R. (2012). Psychological capital and intrapreneurship among faculty members. Quarterly Journal of Career & Organizational Counseling, 2(8), 83–100. [Persian]
Furukawa, T. A., Kessler, R. C., Slade, T., & Andrews, G. (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Journal of Psychological medicine, 33(2), 357-362.
 
George, E. S., Kecmanovic, M., Meade, T., & Kolt, G. S. (2020). Psychological distress among carers and the moderating effects of social support. Journal of BMC Psychiatry, 20(1), 154. https://doi.org/10.1186/s12888-020-02564-4
Gibbons, S., Lauder, W., & Ludwick, R. (2006). Self-neglect: A Proposed new NANDA diagnosis. International Journal of Nursing Terminologies and Classifications, 17(1), 10–18. https://doi.org/10.1111/j.1744-618X.2006.00018.x
Gresele, B. S., Pereira, J. L., Rosa, A. D. S., Lyrio-Carvalho, H. C., Ulisses, S. M., & da Silva, A. R. (2025). Risk factors and protection associated with well-being and psychological distress of veterinarians in Brazil. Journal of Veterinary Sciences, 12(9), 835. https://doi.org/10.3390/vetsci12090835
Guo, C., Lv, J., Deng, M., Song, H., & Yu, M. (2024). Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A Cross-sectional correlational study. Journal of Geriatric Nursing, 59, 86-93. https://doi.org/10.1016/j.gerinurse.2024.06.037
Hansen, M. C., Flores, D. V., Coverdale, J., & Burnett, J. (2016). Correlates of depression in self-neglecting older adults: A Cross-sectional study examining the role of alcohol abuse and pain in increasing vulnerability. Journal of elder abuse & neglect, 28(1), 41-56. doi:10.1080/08946566.2015.1136252
Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513–524.
Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. 
Jia, Y., Yue, Y., & Sheng, Y. (2025). The Mediating role of aging attitudes between social isolation and self-neglect: A Cross-sectional study of older adults living alone in rural China. Journal of BMC nursing, 24(1), 4.
Jiang, Z., Ren, H., Sun, Q., Zhang, H., & Zhou, S. (2025). Attitude towards aging and anxiety in the relationship between social alienation and depression in Chinese rural empty-nest older adults: A Chained mediation modeling analysis. Journal of BMC Public Health, 25(1), 1435.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S.-L. T., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of general psychiatry, 60(2), 184-189. doi:10.1001/archpsyc.60.2.184
Kline, R. B. (2016). Principles and practice of structural equation modeling (4th Ed). Guilford Publications.
Kotwal, A., Mullen, R., Cenzer, I., Burnett, J., Perissinotto, C., & Hawkley, L. (2023). The Relationship of social isolation to self-neglect among older adults: Results of a national survey. Innovation in Aging, 7(1), 474-474. doi: 10.1093/geroni/igad104.1559
Kugler, S., Kuonath, A., Mausz, I., & Frey, D. (2025). The Role and development of psychological capital in the context of academia. International Journal of Applied Positive Psychology, 10(2), 38.
Kun, A., & Gadanecz, P. (2022). Workplace happiness, wellbeing and their relationship with psychological capital: A Study of Hungarian teachers. Journal of Current Psychology, 41(1), 185–199. https://doi.org/10.1007/s12144-019-00550-0
Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Li, K., Rauktis, M. E., & Ohmer, M. L. (2024). Social isolation, loneliness, and depressive symptoms among older adults: The Moderating effect of resilience. The Gerontologist, 64(7). https://doi.org/10.1093/geront/gnae056
Luthans, F., & Broad, J. D. (+2025). Positive organizational behavior and psychological capital: An Evidence-based 20-year journey. In Advancing Positive Organizational Behaviour 7–36. Routledge.
Luthans, F., Youssef, C. M., & Avolio, B. J. (2007). Psychological capital: Developing the human competitive edge. New York, NY: Oxford University Press.
McIlveen, R., Mitchell, R., Curran, D., Dyer, K., Corry, M., DePrince, A., Dorahy, M., & Hanna, D. (2022). Exploring The Relationship between alienation appraisals, trauma, posttraumatic stress, and depression. Psychological Trauma: Theory, Research, Practice, and Policy, 14(6), 998–1006. https://doi.org/10.1037/tra0000523
Naik, A. D., Lai, J. M., Kunik, M. E., & Dyer, C. B. (2008). Assessing capacity in suspected cases of self-neglect. Journal of Geriatrics, 63(2), 24–31. https://pmc.ncbi.nlm.nih.gov/articles/PMC2847362/
Navaneetham, K., & Arunachalam, D. (2025). Global population aging, 1950–2050. In Handbook of aging, health and public policy: perspectives from Asia (pp. 99-116). Singapore: Springer Nature Singapore.
Noda, T., Takahashi, Y., & Murai, T. (2018). Coping mediates the association between empathy and psychological distress among Japanese workers. Journal of Personality and Individual Differences, 124, 178–183. https://doi.org/10.1016/j.paid.2017.12.009
Orem, D. E. (1991). Nursing: Concepts of practice (4th ed). St. Louis, MO: Mosby.
Sherman, D. W., Alfano, A. R., Alfonso, F., Duque, C. R., Eiroa, D., Marrero, Y., Muñecas, T., Radcliffe‑Henry, E., Rodriguez, A., & Sommer, C. L. (2024). A systematic review of the relationship between social isolation and physical health in adults. Healthcare, 12(11), 1135. https://doi.org/10.3390/healthcare12111135
Takashi A. Furukawa, Ronald C. Kessler, Slade, T., & Andrews, G. (2003). The Performance of the K6 and K10 Screening Scales for Psychological Distress in the Australian National Survey of Mental Health and Well-Being. Journal of Psychological Medicine, 33(2), 357–362. https://doi.org/10.1017/S0033291702006700
Tan, Y., Huang, Z., Wang, Y., Huang, X., & Hu, B. (2025). Mediating role of psychological resilience in the relationship between self-neglect and frailty among older adults. Journal of Geriatric Nursing, 62, 168-174. https://doi.org/10.1016/j.gerinurse.2025.01.019
Turliuc, M. N., & Candel, O. S. (2022). The Relationship between psychological capital and mental health during the COVID-19 pandemic: A Longitudinal mediation model. Journal of Health Psychology, 27(8), 1913–1925. https://doi.org/10.1177/13591053211012771
Wang, H. (2018). Research on Chinese Version of the Elder Self-Neglect Assessment Scale and its Application. China: Hangzhou Normal University. https://doi.org/10.1111/opn.12569
Wang, L., Wang, Y., Wang, Y., Wang, L., Luo, S., & Liu, Y. (2025). Depression and self-neglect among community-dwelling older adults in China: the mediating role of psychological capital. Journal of Geriatric Nursing, 66, 103668. https://doi.org/10.1016/j.gerinurse.2025.103668
Wang, N. (2022). Research on healthy aging and influencing factors among community-dwelling empty‑nest elderly based on the health ecological model (Master’s thesis, Qingdao University). https://doi.org/10.3390/ijerph191911885
Wanning, J., Qinqlai, Z., Ping, G., Qiuxia, G., Fang, W., Dan, C., ... & Wenwen, H. (2025). Association rules of social alienation in maintenance hemodialysis patients: an Apriori algorithm analysis and intervention strategies. International Urology and Nephrology,58(1), 1-9. https://doi.org/10.1007/s11255-025-04848-w
World Health Organization. Ageing and health. Available: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed: 1 June 2022.
Xiao, S., Shi, L., Dong, F., Zheng, X., Xue, Y., Zhang, J., ... & Zhang, C. (2022). The impact of chronic diseases on psychological distress among the older adults: the mediating and moderating role of activities of daily living and perceived social support. Journal of Aging & mental health, 26(9), 1798-1804. https://doi.org/10.1080/13607863.2021.1947965
Xin, Y., & Li, D. (2023). Introducing a new concept: Psychological capital of older people and its positive effect on mental health. Journal of Frontiers in Psychology, 14, 1083077. https://doi.org/10.3389/fpsyg.2023.1083077
Yu, M., Gu, L., Jiao, W., Xia, H., & Wang, W. (2019). Predictors of self-neglect among community-dwelling older adults living alone in China. Geriatric Nursing, 40(5), 457-462.
Yu, M., Gu, L., Shi, Y., & Wang, W. (2021). A Systematic review of self-neglect and its risk factors among community-dwelling older adults. Journal of Aging & Mental Health, 25(12), 2179-2190. https://doi.org/10.1080/13607863.2020.1821168
Zeng, X., & Wei, B. (2023). The Relationship between the psychological capital of male individuals with drug abuse and relapse tendency: A Moderated mediation model. Journal of Current Psychology, 42(12), 10334–10343. https://doi.org/10.1007/s12144-021-02325-y
Zhang, M., & Zhang, X. (2025). Self-neglect in older adults: an evolutionary concept analysis. International Journal of Nursing Studies Advances, 100350. doi: 10.1016/j.ijnsa.2025.100350
Zhang, X., Chen, S., Zheng, Z., Zhao, M., Song, L., Zhao, Y., & Wang, Z. (2024). The Relationship between psychological capital, burnout and perceived stress in junior nurses: A latent profile analysis. Journal of Frontiers in Public Health, 12, 1374941. https://doi.org/10.3389/fpubh.2024.1374941
Zhao, B., Wang, H., Xie, C., Huang, X., & Cao, M. (2022). Mediating role of psychological capital in the relationship between social support and self-neglect among Chinese community-dwelling older adults. Journal of Frontiers in Psychology, 13, 903625. https://doi.org/10.3389/fpsyg.2022.903625
Zheng, J., Xu, J., Wu, Y., Xu, S., & Gao, Y. (2024). Intergenerational support, activities of daily living, and the interaction on psychological distress in older adults. Journal of Frontiers in Psychology, 15, 1-17. https://doi.org/10.3389/fpsyg.2024.1454662