Distinguishing worry from rumination in older people: a preliminary investigation

Socioeconomic Background and Self-Reported Sleep Quality in Older Adults during the COVID-19 Pandemic: An Analysis of the English Longitudinal Study of Ageing (ELSA)

The COVID-19 pandemic negatively impacted sleep quality. However, research regarding older adults' sleep quality during the pandemic has been limited. This study examined the association between socioeconomic background (SEB) and older adults' sleep quality during the COVID-19 pandemic. Data on 7040 adults aged ≥50 were acquired from a COVID-19 sub-study of the English Longitudinal Study of Ageing (ELSA). SEB was operationalized using educational attainment, previous financial situation, and concern about the future financial situation. Sociodemographic, mental health, physical health, and health behavior variables were included as covariates. Chi-squared tests and binary logistic regression were used to examine associations between SEB and sleep quality. Lower educational attainment and greater financial hardship and concerns were associated with poor sleep quality. The relationship between educational attainment and sleep quality was explained by the financial variables, while the relationship between previous financial difficulties and sleep quality was explained by physical health and health behavior variables. Greater financial concerns about the future, poor mental health, and poor physical health were independent risk factors for poor sleep quality in older adults during the pandemic. Healthcare professionals and service providers should consider these issues when supporting older patients with sleep problems and in promoting health and wellness.

Coping Flexibility and Health-Related Quality of Life Among Older Adults: The Compensatory Effect of Co-rumination

Background: Coping flexibility, defined as a wide range of coping strategies, may be a promising construct in determining coping effectiveness, especially in conjunction with a person-centered approach. However, no studies have focused on these issues. The study aimed to identify the distinct, multidimensional patterns of strategies for coping with chronic health conditions and their association with changes in physical and psychological health-related quality of life (HRQoL) among older adults over a one month period.

Methods: Coping strategies (brooding, reflection, co-rumination, and positive reappraisal) and HRQoL psychological and physical domains were assessed twice (at the baseline and one month later) among 210 older adults (age 76.12 ± 9.09 years, 66% women).

Findings: The parallel process analysis demonstrated the sample heterogeneity regarding coping. In multidimensional latent class growth analysis (MLCGA), four coping classes of overall strategies were identified: consistently low (46%), medium and decreasing (18%), medium and increasing (20%), and consistently high (16%). The last two can be considered the coping flexibility. Participants in the medium and increasing subgroup reported enhancement in HRQoL psychological domain, whereas members of the consistently high subgroup indicated its decrease. The favorable effects were related to an increase in co-rumination.

Discussion: The findings shed light on the longitudinal patterns of coping in older adults, showing that coping flexibility is more adaptive when it relies on modifying coping efforts rather than coping complexity. Co-rumination played a key role, compensated by the effect of maladaptive strategies.

Assessing maladaptive repetitive thought in clinical disorders: A critical review of existing measures

Rumination and worry have recently been grouped under the broader transdiagnostic construct of repetitive thought (Watkins, 2008). The purpose of this review is to provide an overview of scales used to assess repetitive thinking across a broad range of contexts: depression, anxiety, trauma, stress, illness, interpersonal difficulties, positive affect, and so forth. We also include scales developed or adapted for children and adolescents. In the extant literature, measures of repetitive thinking generally show small-to-moderate correlations with measures of psychopathology. This review highlights problems with the content validity of existing instruments; for example, confounds between repetitive thought and symptomatology, metacognitive beliefs, and affect. This review also builds on previous reviews by including newer transdiagnostic measures of repetitive thinking. We hope that this review will help to expand our understanding of repetitive thinking beyond the mood and anxiety disorders, and suggest ways forward in the measurement of repetitive thinking in individuals with comorbid conditions.

A lifespan view of anxiety disorders

Neurodevelopmental changes over the lifespan, from childhood through adulthood into old age, have important implications for the onset, presentation, course, and treatment of anxiety disorders. This article presents data on anxiety disorders as they appear in older adults, as compared with earlier in life. In this article, we focus on aging-related changes in the epidemiology, presentation, and treatment of anxiety disorders. Also, this article describes some of the gaps and limitations in our understanding and suggests research directions that may elucidate the mechanisms of anxiety disorder development later in life. Finally we describe optimal management of anxiety disorders across the lifespan, in "eight simple steps" for practitioners.

Rumination and age: some things get better

Rumination has been defined as a mode of responding to distress that involves passively focusing one's attention on symptoms of distress without taking action. This dysfunctional response style intensifies depressed mood, impairs interpersonal problem solving, and leads to more pessimistic future perspectives and less social support. As most of these results were obtained from younger people, it remains unclear how age affects ruminative thinking. Three hundred members of the general public ranging in age from 15 to 87 years were asked about their ruminative styles using the Response Styles Questionnaire (RSQ), depression and satisfaction with life. A Mokken Scale analysis confirmed the two-factor structure of the RSQ with brooding and reflective pondering as subcomponents of rumination. Older participants (63 years and older) reported less ruminative thinking than other age groups. Life satisfaction was associated with brooding and highest for the earlier and latest life stages investigated in this study.

Ethnic differences in women's worries about labour and birth

OBJECTIVE

To describe the worries experienced by pregnant Black and Minority Ethnic (BME) women about labour and birth and compare their experience to that of White women.

DESIGN

Data were collected in England in a survey of experience of maternity care. A random sample of 4800 women selected from birth registration records and questionnaires were mailed at three months postpartum. A total of 2960 (63%) completed a checklist of common worries about labour and birth. For 2765 there were complete data on ethnicity and all potential confounders. Chi(2) tests and logistic regression models were used to investigate the associations of ethnicity with worries about labour. Unadjusted and adjusted models were run for each worry outcome. Adjustment was made for age, education, parity, relationship status and area deprivation (Index of Multiple Deprivation, IMD).

RESULTS

Overall, the pattern of worries was similar, however, larger proportions of BME women worried about almost all the aspects of labour and birth investigated, including pain, uncertainty about labour onset and duration, possible medical interventions and embarrassment. After adjustment for age, education, relationship status, parity and socioeconomic position, the higher odds of worry in the BME group were most marked in relation to pain and discomfort, not knowing how long labour would take, embarrassment and having more worries overall. Further adjustment for factors likely to affect women's worries, namely depression, being admitted to hospital during the pregnancy, or having experienced medical problems in a previous pregnancy did not alter these findings.

CONCLUSION

Compared with White women, twice as many ethnic minority women worried about pain and discomfort, not knowing how long labour would take and about embarrassment during labour and birth. Additional research is needed to understand these concerns and how they might be ameliorated by the health professionals working directly with women and any services changes needed to improve the quality of maternity care. Implications for practice include improved information-giving and support in providing the individualised care that women need.

Worry and rumination in older adults: Differentiating the processes

OBJECTIVES

This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults.

METHOD

A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour.

RESULTS

A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways.

CONCLUSION

The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.

Unforgiveness, rumination, and depressive symptoms among older adults

The experience of feeling unforgiven for past transgressions may contribute to depressive symptoms in later life. This article tests a model in which feeling unforgiven by God and by other people have direct effects on depressive symptoms while self-unforgiveness and rumination mediate this relationship. The sample consisted of 965 men and women aged 67 and older who participated in a national probability sample survey, the Religion, Aging, and Health survey. Results from a latent variable model indicate that unforgiveness by others has a significant direct effect on depressive symptoms and an indirect effect via self-unforgiveness and rumination. However, rather than having a direct effect on depressive symptoms, unforgiveness by God operates only indirectly through self-unforgiveness and rumination. Similarly, self-unforgiveness has an indirect effect on depressive symptoms through rumination.