Spirituality and Quality of Life and Its Effect on Depression in Older Adults in Mexico

doi:10.4236/psych.2013.43027

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Psychology

2013. Vol.4, No.3, 178-182

Published Online March 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.43027

178

Spirituality and Quality of Life and Its Effect on Depression in

Older Adults in Mexico

Ana Luisa González-Celis1, Juana Gómez-Benito2

1Division of Research and Graduate, Faculty of Higher Education Iztacala, National University Autonomous of

Mexico, Mexico City, Mexico

2Department of Methodology of Behavioral Sciences, Faculty of Psychology, University of Barcelona,

Barcelona, Spain

Email: [email protected], [email protected]

Received December 20th, 2012; revised January 27th, 2013; accepted February 24th, 2013

The quality of life (QOL) appears as an object of study of psychology, as a central component of human

well-being. The quality of life in the elderly is especially relevant because as the years go the older per-

sons can have lost health, the social role, the cognitive functioning, the power financial and their family.

The purpose of the study is to evaluate the impact of psychological variables associated with quality of

life in Mexican elderly. A sample of 75 elderly people between 60 and 87 years (mean = 65, SD = 9.41),

45 women and 30 men, assigned to a health clinic. QOL was measured with the WHOQOL, and an ex

post facto design, three groups were formed by the level obtained with depressive symptoms GDS: (G1)

absent (n1 = 42), (G2) mild (n2 = 19) and (G3) moderate-severe (n3 = 14). An acceptable correlation be-

tween QOL and spirituality (r = .523, p < .0001). A negative association between QOL and depression (r

= −.482, p < .0001). The QOL showed differences between groups with different levels of depressive

symptoms (F(2.72) = 15.212, p < .0001). The QOL exhibited differences between diseased subjects (QOL =

61.19) and non-diseased (QOL = 66.61) (t = 2.025, p < .046). There were differences in the level of spiri-

tuality (Sp) among elderly patients (Sp = 64.77) and non-elderly patients (Sp = 75.0) (t = 2.37, df = 97, p

< .02). The QOL in the elderly can be improved with psychological interventions to help reduce depres-

sion, where spirituality can be a resource and coping strategy to strengthen other areas of aging.

Keywords: Spirituality; Quality-of-Life; Depression; Older Adults Mexicans

Introduction

Mexico is in a period of change in the trend of the population,

which is projected in the next years much of the population will

be elderly.

Several sources (CONAPO, 2001, 2006; Partida, 2006;

United Nations, 2007; World Bank, 2009) have given explana-

tion to this phenomenon, attributing it mainly to advances in the

medical field, thanks to this the mortality rate has decreased

and life expectancy has increased from 34 years old in 1930 to

over 75 years old in 2005 (INEGI, 2009), allowing one hand a

death to a later age and on the other a lower infant mortality.

Thus the combination of life expectancy increasing and a fall

in the fertility rate, causes a significant increase in the average

age, a rising proportion of older adults, and therefore a need for

greater attention to these individuals.

But if the life expectancy has increased it does not necessa-

rily indicate that conditions have improved, also that living

more years, means more health risks and does not necessarily

represent a complete satisfaction (González-Celis, 2010).

Thus the quality of life (QOL) appears as an object of study

of psychology, as a central component of human well-being

that is closely related to other aspects of functioning, such as

health (Johansson, Grant, Plomin, Pederson, Ahem, Berg et al.,

2001; Litwin & Shiovitz-Ezra, 2006), the coping, the problem

solving, the self-efficacy (Bandura, 1977, 1999; González-Celis,

2009a, 2012b), the development of social skills (Acuña-Gurrola

& González-Celis, 2011) and the depressive symptoms (Gon-

zález-Celis, 2009b).

Evaluate the quality of life in the elderly is especially rele-

vant because according to the years go in the life of an individ-

ual, is undergoing a series of transformations that result in gains

and losses, including health, the social role, cognitive function-

ing, the family and the economic status, loneliness, and anxiety,

among others (Nieto, Abbot, & Torres, 1998; Pinquart &

Sörensen, 2001; Rivera-Ledesma, Montero, González-Celis, &

Sanchez-Sosa, 2007; Rowe & Kahn, 1997; Sanchez-Sosa &

González-Celis, 2002, 2006).

One of the dimensions of quality of life is social support, and in

the elderly appears as a measure of the well-being (Burnett, Regev,

Pickens, Prati, Aung, Moore, & Bitondo, 2006; Jackson, 2006).

One of the most common problems found in the elderly, is

the presence of depressive symptoms.

One strategy to coping with the loss in the elderly is spiritu-

ality (González-Celis, 2012a; González-Celis & Araujo, 2010;

González-Celis & Lázaro, 2007; González-Celis & Padilla, 2006).

It is from this kind of approach that studies on quality of life

(QOL) come to know and give better service to the needs of the

elderly.

So the purpose of the study is to evaluate the impact of psy-

chological variables associated with the QOL in older adults

Mexicans.

Objectives

The principal objective is to examine if the social support

A. L. GONZÁLEZ-CELIS, J. GÓMEZ-BENITO

and spirituality are measures of the quality of life in the elderly

and its effect on depression.

Other objective is to test the association between the social

support, depression and spirituality.

As well as to evaluate the differences in QOL, social support,

depression, and other additional measures, gender and condi-

tion of health.

And to test the differences in the domains of QOL in older

people with different groups depressive symptoms.

Method

Participants

A sample of 75 elderly, aged between 60 and 87 years old

(mean = 65, SD = 9.41), 45 were women and 30 men, assigned

to a health clinic in a lower-class urban area of Mexico State.

The average educational level was of basic education. Regard-

ing marital status, 63% were married or with partners, 34%

widowed and 3% singles.

They completed three instruments plus a sheet socio demo-

graphic data also they gave voluntarily, their informed consent.

Under an ex post facto design, formed three groups of sub-

jects by the level of depressive symptoms according to the

score obtained by the Geriatric Depression Scale: (G1) absent

(n1 = 42), (G2) mild (n2 = 19) and (G3) moderate-severe (n3 =

14).

Measures

It was applied a battery composed of three measuring in-

struments psychological and sheet socio demographic data.

Sociodemographic questionnaire. As an interview through 20

both open and closed questions, general data were obtained

from subjects who participated in the study (name, age, gender,

marital status and condition about health).

Quality of Life (WHOQOL-100), prepared by the World

Health Organization (WHO-Group, 1996, 1997, 1998a, 1998b),

in its extended version (Power, Bullinger, & Harper, 1999),

translated and adapted to Spanish-Mexican by González-Celis

(2002). It features 100 items, with which measures the quality

of life in general. It includes six domains of quality of life:

physical health, independence, psychological health, social

relationships, environment and spirituality. Contains 24 specific

facets with four questions each (96 items) and a general facet of

four items designed for to measure “Quality of Life Global”

and “Overall Health”. It was got a total score from 0 to 100,

with higher scores indicating better quality of life. Also the

score of the QOL has six specific scores one for each domain.

To answer the questionnaire asked the participants that their

responses they referred to two weeks earlier.

Subjective Well-being Scale PCG (Philadelphia Geriatric

Center) for the elderly, written and reviewed by Lawton in

1975 which measures the overall subjective well-being older

adults (Andrews & Robinson, 1991) (Spanish version by Gon-

zález-Celis, 2002). The scale is composed of three factors: agi-

tation, attitude to their own aging and loneliness. The scale

values range from 0 (lowest level of well-being) to 22 (highest),

which refers to the values of satisfaction, peace or achievement.

The answer choices are dichotomous and nominal -yes/no-, and

two open questions in the factor 3, items 1 and 5.

Geriatric Depression Scale, GDS, (Yesavage, Brink, Rose,

Lum, Huang, Adey, & Leiver, 1983). The short version with 15

items of the Geriatric Depression Scale (GDS), adapted to

Mexican older population by González-Celis & Sánchez-Sosa

(2003). The total qualification is obtained by adding scores of 0

(zero), which equals to lack of depression, to a maximum of 15

points. Scores of five points or more indicate a presence of

depressive symptoms.

Procedure

It requested authorization to a health clinic located in the

state of Mexico, for the implementation of quality of life as-

sessments to seniors.

It contacted people to invite them to participate in the study,

reporting the assessment of the QOL, in order to know how it

was in their physical, psychological and emotional. Those in-

terested in participating were given by the interviewers and

were programmed according to appointment availability.

Later, in a cubicle of the health clinic, there was a single ses-

sion lasting approximately one hour, where it conducted the

reading and signing the informed consent, followed by filling

the data sheet and socio demographic implementation of the

three questionnaires as an interview, in the same order for all.

Results

An acceptable correlation between QOL and social support (r

= .599, p < .0001), and quality of life and spirituality (r = .523,

p < .0001).

The results also revealed a moderate but significant negative

association between QOL and depression (r = −.482, p

< .0001).

Also found moderate, significant and negative correlation

between depression and social support (r = −.397, p < .0001),

but not with depression and spirituality.

The QOL showed differences between groups with different

levels of depressive symptoms (F(2,72) = 15.212, p < .0001)

(Figure 1).

The quality of life exhibited difference between diseased

subjects (QOL = 61.19) and non-diseased (QOL = 66.61) (t =

2.025, p < .046).

The quality of life showed gender differences significant (t =

2.005, df = 74, p < .049) (QOL of women = 60.80, QOL of men

= 65.42).

Score of support social was statistic and significantly differ-

ence between groups with different levels of depressive symp-

toms (F(2,84)=6.710, p < .002).

Figure 1.

Quality of life scores for each group with different levels of depressive

symptoms.

A. L. GONZÁLEZ-CELIS, J. GÓMEZ-BENITO

180

Table 1.

Comparison of quality of life scores for each domain between the various groups with depressive symptoms.

Quality of life domains

Groups with depressive

symptoms Physical health Psychological health Independence Social relations Environment Spirituality

Absent (G1) 68.29 68.80 68.96 64.89 64.16 70.31

Mild (G2) 49.37 51.47 51.34 54.08 54.87 64.44

Moderate-severe (G3) 47.40 51.13 50.89 53.39 55.30 67.56

Total 59.64 60.06 60.32 59.79 60.29 68.08

F 19.843 29.018 19.543 6.710 9.221 .764

p <.0001 <.0001 <.0001 <.0002 <.0001 >.469

Discussion

No differences in social support, spirituality and and the

number of depressive symptoms between gender. In a report prepared by the WHO (Power, Bullinger, &

Harper, 1999), the global standard established by 15 countries

to consider a good QOL, is a score ranging from 70 to 75 in

each of the domains, which, the results of the study are not very

flattering. In analyzing the results, spirituality highlighted as an

important element in the functioning of the QOL, agreeing with

Viamonte (1993) on the inclusion of this aspect as one of five

to maintain a balance in the well-being of the individual,

possibly as a strategy coping used by older adults. Spirituality

not only as belonging to any group or association of a religious,

but as a belief in something that affects daily life and sense of

transcendence (Montero & Sierra, 1996).

No differences in social support and depressive symptoms

between elders who report being sick and healthy elderly.

There was difference in the level of spirituality (Sp), among

elderly ill (Sp = 64.77) and healthy elderly (Sp = 75.0) (t = 2.37,

df = 97, p < .02).

Comparing levels of quality of life in each of the six domains

of quality of life with the average obtained by standard

WHOQOL-Group (1998a, 1998b) (Range = 62.25 - 71.75), was

observed in the case of elderly sample Mexican, the quality of

life scores were lower in all domains (Physical Health, Psy-

chological Health, Independence, Social Relations and the

Environment), except for the domain of Spirituality (68.07)

(Figure 2). Although no significant association was found between

scores on the domain of spirituality and attending a religious

group, it was observed that the people who do attend a group

scored higher in the domain of spirituality than those who do

not, what may reflect that membership in a group helps to

increase the level of spirituality, which would impact the

quality of life of people.

Finally, when comparing the quality of life scores for each

domain, between groups with different levels of depressive

symptoms (Table 1). Note that there is enough statistical

evidence to prove the difference in quality of life scores

between groups with different levels of depressive symptoms,

in the domains of Physical Health, Psychological Health, In-

dependence, Social Relations, and Environment; found higher

scores for quality of life in the elderly group without depressive

symptoms, and lower scores for quality of life in groups of

elders who had mild, moderate or severe depressive symptoms;

not for the domain of spirituality, where the quality of life score

was the same and slightly higher for all groups of elderly

without depressive symptoms, or for those who showed

symptoms of mild depression, moderate or severe.

Also it can be concluded that depression is a modulating

variable of QOL in older adults. Elderly without depressive

symptoms had higher levels of quality of life than those with

mild, moderate or severe. However, the QOL was not differ for

older people with different levels of depression, exclusively to

the domain of spirituality, hence it is interesting to ask, if

spirituality can be used as a protective factor when used as a

resource for coping with the depressive symptoms.

Finally QOL in elderly probably be improved with psy-

chological interventions (González-Celis, Chavez, & Tron, 2011,

Gonzalez-Celis & Sanchez-Sosa, 2003) to help reduce the

presence of depressive symptoms. Spirituality can be used as a

resource and also as a coping strategy (González-Celis, 2012a;

Rivera-Ledesma, 2003) to strengthen other areas of aging.

Acknowledgements

This paper is product of a research sponsored by National

University Autonomous of Mexico, through a grant of the Pro-

gram PASPA 2012, for to work half of sabbatical in the Uni-

versity of Barcelona, who obtained the first author under the

guidance of the second.

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