Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jul 19, 2022; 12(7): 970-981
Published online Jul 19, 2022. doi: 10.5498/wjp.v12.i7.970
Effect of distinct psychological interventions on changes in self-reported distress, depression and loneliness among older adults during COVID-19
Stav Shapira, Daphna Yeshua-Katz, Orly Sarid
Stav Shapira, School of Public Health, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
Daphna Yeshua-Katz, Orly Sarid, The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
Author contributions: Shapira S, Yeshua-Katz D and Sarid O designed and performed the research; Shapira S and Sarid O analyzed the data; Shapira S wrote the first draft of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by the institutional review board of Ben-Gurion University of the Negev, No. 1885-1.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code and dataset are available from the corresponding author at stavshap@bgu.ac.il. The data available include no identifiers.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stav Shapira, PhD, Academic Research, Lecturer, School of Public Health, Ben-Gurion University of the Negev, POB 653, Beer Sheva 8410501, Israel. stavshap@bgu.ac.il
Received: January 30, 2022
Peer-review started: January 30, 2022
First decision: April 18, 2022
Revised: April 24, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: July 19, 2022
Processing time: 169 Days and 21.4 Hours
ARTICLE HIGHLIGHTS
Research background

Older adults have been considered a primary at-risk population during the coronavirus disease 2019 (COVID-19) pandemic. Recent evidence has shown that enhancing proactive coping abilities through psychological interventions can support older adults throughout the pandemic. However, the underlying mechanisms by which specific intervention components affect various mental states among older adults remain unclear and warrant investigation.

Research motivation

We previously reported the results of a short-term, internet-based intervention which was found to alleviate symptoms of loneliness and depression among older adults during the initial COVID-19 outbreak and the first general lockdown in Israel. We focused then on the effectiveness and acceptability of the intervention as a whole, but did not explore whether the mechanisms of change in mental states were related to the use of those specific techniques that constituted the full protocol. We believe that a better understanding of the role of each interventional strategy can support the design of more concise and efficient interventions tailored to the needs of different populations and mental states.

Research objectives

To determine the effect of an intervention using cognitive-behavioral and mindfulness techniques on changes in distress, depression and loneliness. Furthermore, we explored the links between the different techniques that were learned in terms of changes in psychological distress during sessions, as well as the effect of these changes (in distress) on post-intervention depressive symptoms and loneliness.

Research methods

We performed a secondary analysis on data from the original intervention described above. The intervention included seven sessions during which various cognitive-behavioral and mindfulness techniques were learned and practiced. In-session changes in psychological distress were measured using the Subjective Units of Distress Scale (SUDS) which participants rated at the beginning and end of each session. In addition, levels of depression (Patient Health Questionnaire) and loneliness (UCLA Loneliness Scale) were assessed prior to and after the entire intervention process. The effect of in-session changes in the SUDS on changes in post-intervention depression and loneliness levels were assessed as a proxy for distinct technique effectiveness.

Research results

The findings indicated in-session differences in terms of decreases in psychological distress. Sessions during which the techniques of relaxation exercises and guided imagery were learned, and sessions during which cognitive restructuring and mindfulness meditation were learned, led to the highest reduction in distress, and these reductions were related to significant changes in levels of post-intervention loneliness and depression, correspondingly.

Research conclusions

Different psychological techniques seem to have different effects on the specific mental states that were assessed in the current study. The findings shed light on potential paths by which different therapeutic interventions might affect mental health outcomes among older adults specifically, and thus have implications for future intervention design. These insights may help in the enhancement of older individuals’ resilience during future outbreaks and other emergencies.

Research perspectives

Larger studies are needed to allow for subgroup analyses that would enable the determination of effectiveness for different program elements in a more robust manner.