Self-Perceptions of Aging Mediate the Associations of 12-Year Change in Depressive Symptoms With Life Satisfaction and Disability

Self-Perceptions of Aging Mediate the Associations of 12-Year Change in Depressive Symptoms With Life Satisfaction and Disability | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-Perceptions of Aging Mediate the Associations of 12-Year Change in Depressive Symptoms With Life Satisfaction and Disability Serena Sabatini, Katya Numbers, Nicole Kochan, Perminder S. Sachdev, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6890364/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study estimates the associations of 12-year change in depressive symptoms with follow-up Self-Perceptions of Aging (SPAs), life satisfaction, and disability; and tests whether SPAs mediate the associations of change in depressive symptoms with follow-up life satisfaction and disability. Methods Participants were 174 Australian older adults (Mean age = 87.41). Measures used were the Geriatric Depression Scale; the informant-rated World Health Organisation Disability Assessment Schedule; the Diener Satisfaction with Life Scale; and the Laidlaw’ Attitudes to Aging Questionnaire (assessing SPAs). Results In adjusted linear regression models, greater 12-year increase in depressive symptoms was associated with more negative SPAs (β= +0.41; p < .001), lower life satisfaction (β= +0.30; p < .001), and greater disability (β= +0.26; p = .001). In structural equation models, SPAs partially mediated the association of change in depressive symptoms with follow-up life satisfaction and disability. Conclusions Negative SPAs may be one of the reasons why depression in very old age contributes to lower life satisfaction and disability. Hence, strategies aiming to decrease negative SPAs, such as psychoeducational interventions, could help preventing depressive symptoms in very old age. Subjective aging attitudes to aging views on one’s aging depression mood satisfaction with life functional abilities daily functioning very old age Figures Figure 1 Figure 2 Background As a consequence of societal and medical advancements, the proportion of older people is rapidly increasing ( 1 ). In western countries, the fastest growing age group is that of very old individuals (i.e., aged 75 years and over), which is expected to double in the next 30 years ( 1 – 3 ). Whereas individuals in early old age typically experience a mix of positive and negative age-related changes, individuals in very old age generally experience an increasing number of negative changes and fewer positive changes ( 4 , 5 ). Very old individuals are also at great risk of multimorbidity and disability. For example, in Europe 75% of individuals aged between 75 and 84 years have multiple health conditions ( 6 ). The physical challenges that very old individuals are likely to face can undermine their psychological wellbeing and lead to either new depressive symptoms or to an exacerbation of the depressive symptoms their already had ( 7 – 10 ). According to the Diagnostic and Statistical manual of mental disorders (DSM-5, 11), major depression is a mental health disorder characterised by depressed mood and/or loss of interest or pleasure and additional symptoms such as significant weight loss or weight gain, insomnia or hypersomnia, fatigue or loss of energy, and recurrent thoughts of death or suicide attempt. Older people typically experience a specific constellation of depressive symptoms such as somatic symptoms (e.g., weight loss, aches, and psychomotor retardation), low motivation, high anxiety, severe cognitive dysfunction, and insomnia ( 12 – 14 ). Apathy is also very common in late-life depression ( 15 ). Even though diagnosing depression in old and very old age is difficult due to underassessment, misdiagnosis, and public stigma, empirical evidence suggests that, whereas the incidence and prevalence of major depression are lower in early old individuals compared to middle-aged individuals, they increase again among very old individuals ( 16 ). For example, a study found the incidence of depression among individuals aged 79–85 years (44 per 1,000) to be more than the double than the incidence of depression among people aged 70–79 years (17 per 1,000) ( 17 , 18 ). Moreover, estimations suggest that in very old age the number of individuals experiencing mild depressive symptoms without meeting criteria for major depressive disorder may be higher compared to early old individuals ( 8 ). Although experiencing some depressive symptoms in old and very old age may be a common and expected reaction to physical illnesses and other life challenges (e.g., death of a friend or family member), the insurgence and/or increase of depressive symptoms in very old age can, in turn, have a range of negative consequences on people’s lives. Indeed, late-life depressive symptoms may further exacerbate decline in cognitive and physical health and functioning ( 15 , 19 – 21 ). Moreover, depressive symptoms in old and very old age are related to poorer social network ( 22 ). In addition, depression and all the negative changes associated with it, are related with higher levels of disability in very old individuals ( 23 ). Disability has been defined by the World Health Organization (WHO) as impaired functioning in one or more domains including cognition; mobility; self-care (e.g., hygiene); getting along with other people; life activities such as domestic responsibilities and work; and participation in community activities ( 24 ). Finally, depressive symptoms in very old age can lead to lower levels of life satisfaction ( 25 , 26 ), which refers to individuals’ cognitive and affective evaluations of their own lives ( 27 ). The effect of depressive symptoms over life satisfaction and disability may be mediated by a malleable psychological variable: Self-Perceptions of Aging (SPAs). SPAs is an umbrella term comprising several concepts, such as Felt Age ( 28 ), Attitudes Towards Own Aging ( 29 , 30 ), and Awareness of Age-Related Changes ( 31 ). All these concepts describe an individual’s subjective experiences, beliefs, and evaluations of their own aging and of the changes they experience in their lives as they age ( 32 ). Examples of positive SPAs are recognizing increased knowledge and life experience, greater self-confidence, and better ability to deal with people and difficult situations. Examples of negative SPAs are experiencing forgetfulness, greater dependency on others, and less energy. The Awareness of Aging theory ( 31 , 33 ) postulates that past and current mental health shapes individuals’ SPAs which, in turn, can have an effect on life satisfaction and disability. This hypothesized pathway has never been empirically tested and it is therefore one of the aims of the current study. SPAs are hypothesized to have an impact on one’s overall health and disability due to the influence that SPAs have on individuals’ daily behaviors ( 34 ). For example, individuals with negative SPAs are less likely to engage in health-enhancing behaviors such as physical activity and following a balanced diet ( 35 – 37 ). Initial evidence in support of this reasoning has reported cross-sectional and longitudinal associations between depressive symptoms and SPAs ( 38 – 42 ) and between life satisfaction and disability ( 38 , 40 , 43 – 47 ). In sum, there is research in support of the predictive role of depressive symptoms over SPAs, life satisfaction, and disability; and of the predictive role of SPAs over life satisfaction and disability, but to the best of our knowledge the potential mediating role of SPAs in the associations of depressive symptoms with life satisfaction and disability has never been investigated. In fact, most existing evidence on SPAs has investigated SPAs as either predictor or outcome of health indicators ( 46 , 48 ). Identifying potentially modifiable variables (e.g., SPAs) that may explain, at least partially, the negative effects of depressive symptoms over life satisfaction and disability is highly important, not only to empirically test some of the SPAs pathways that have so far only been theorized ( 33 ), but also because at clinical level these variables can be targeted to promote life satisfaction and decrease disability in very old age. More positive SPAs can indeed be promoted through psychoeducation interventions even among very old and frail individuals ( 49 , 50 ). This study has two aims. First, it aims to estimate the associations of 12-year change in depressive symptoms with follow-up scores on SPAs, life satisfaction, and informant-rated disability. Second, aiming to provide empirical evidence for one of the mechanisms outlined in Diehl, Wahl ( 33 ) Awareness of Aging model, this study tests whether SPAs mediate the associations of 12-year change in depressive symptoms with follow-up scores on life satisfaction and informant-rated disability. Imporantly, the study focuses on very old individuals, and age-group understudied in the SPAs literature and with regard to depressive symptoms and their consequences. Study hypotheses are two. First, it is hypothesized that greater 12-year increase in participants’ depressive symptoms is associated with lower follow-up scores on life satisfaction, higher follow-up scores on disability, and more negative SPAs. Second, it is hypothesised that SPAs at least partially mediate the associations of change in depressive symptoms with life satisfaction and disability. Methods Study Design and Participants Study analyses rely on a cross-sectional and longitudinal study design. This study uses data of the Memory and Ageing Study (MAS) ( 51 ), which is one of the biggest Australian studies investigating aging and cognitive health. In MAS participants were recruited from Eastern Sydney. MAS aims to identify factors are associated with normal and pathologic aging. Over the last 12 years, MAS has collected data on biomarker, genetic/epigenomic, neuroimaging, cognitive, proteomics/lipidomics, health, and lifestyle. At baseline/wave 1 (September 2005- December 2007), participants were aged between 70 and 90 years and had no dementia. In MAS participants were assessed every two years. The assessment included a detailed cognitive and medical examination and comprised the option to donate a blood sample for clinical chemistry and genomics. When possible, for participants, a knowledgeable informant (i.e., a close friend or family member) was also interviewed. A total of 258 participants took part at wave 7, equating to 12-year follow-up assessment, (September 2018 – December 2020), in addition to having taken part at previous MAS assessments/waves. For the purpose of this study, we included in the current study sample only those individuals who participated to wave 7 of MAS and also completed the AAQ. Hence, we included 174 participants. MAS received institutional approval by the Human Research Ethics Committee of the University of New South Wales (project no. HC190962) and the current study analyses were approved by the same committee on date 20-02-2023. Both MAS and the current study was approved in accordance with the National Statement on Ethical Conduct in Human Research (2007) and the Declaration of Helsinki. In MAS onformed written consent were obtained from all participants prior to participation. Measures Attitudes to Aging. Participants’ SPAs were measured with the well-validated 12-item Attitudes to Aging Questionnaire (AAQ; 30). The AAQ assesses Attitudes to Aging across three domains/subscales: psychological growth, psychosocial loss, and physical change. Each subscale comprises four items. Each item is answered on a five-point Likert scale (1 = strongly disagree; 5 = strongly agree). The psychological growth subscale captures positive aspects of aging (e.g., continued development) and an example item for this subscale is It is a privilege to grow old. The psychosocial loss subscale captures negative aspects of aging (e.g., feelings of social loss and decreasing self-worth) and an example item for this subscale is I feel excluded from things because of my age. The physical change subscale captures attitudes towards physical changes associated with aging (e.g., changes related to health and fitness) and an example item for this subscale is I have more energy now than I expected for my age. Subscales scores are obtained by summing the responses to their respective four items (possible range for each subscale: 4–20). Higher scores on the psychological growth and physical change subscales indicate more positive SPAs, whereas higher scores on the psychosocial loss subscale indicate more negative SPAs. In the current study sample, Cronbach’s alpha for the perceived physical change scale was 0.70, for the perceived psychosocial loss scale it was 0.74, and for the perceived psychological growth scale it was 0.75. Depressive Symptoms. The Geriatric Depression Scale ( 52 ) was used to assess depressive symptoms over the past week. It comprises 15 items. Sample items are are you basically satisfied with your life? and do you feel your situation is hopeless?. For each item participants can answer either yes (scored as one) or no (scores as zero). The total score is obtained from the sum of items. In the current study sample Cronbach’s alpha for the Geriatric Depression Scale was 0.98. Informant-Rated Disability. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-II) ( 24 ) was used to assess informant-rated disability. This assessment includes 14 questions answered by an informant, covering the participant's overall health, ability to stand for long periods, handle household responsibilities, learn new tasks, join community activities, emotional impact of health, ability to concentrate, walk long distances, wash their whole body, get dressed, interact with unfamiliar people, maintain friendships, conduct day-to-day work, and the extent to which difficulties interfere with their life. Each question has five answer options: for the first item, 1 = very good, 2 = good, 3 = moderate, 4 = bad, 5 = very bad; for items 2 to 14, 1 = none, 2 = mild, 3 = moderate, 4 = severe, 5 = extreme/can’t do; and for item 15, 1 = not at all, 2 = mildly, 3 = moderately, 4 = severely, 5 = extremely. The total score, ranging from 14 to 70, is the sum of all item scores. Higher scores indicate greater informant-rated disability. In the current study sample Cronbach’s alpha for the WHODAS-II was 0.88. Life Satisfaction was assessed with the Life Satisfaction scale ( 53 ). Example questions are “In most ways my life is close to my ideal” and “The conditions of my life are excellent”. The total score ranges from 0 to 100, with a higher score indicating greater life satisfaction. In the current study sample Cronbach’s alpha for the Life Satisfaction scale was 0.84. Socio-Demographic Variables comprised age; sex (women; men); marital status; main occupation when working/before retirement; and race (Caucasian; other). Marital status comprised the following categories: never marries; married de facto; separated; divorced; widowed. Main occupation when working/before retirement comprised the following categories: manager administrative; professional; associate professional; tradesperson; advanced clerical service; intermediate clerical sales service; intermediate products transport; elementary clerical/ sales service; intermediate laborers and related; home duties. Number of Health Conditions. Participants’ number of health conditions consisted in a count score based on the following conditions reported between waves 1 and 7 of MAS: stroke/cerebrovascular accident, mini stroke/transient ischemic attack, heart attack, angina, atrial fibrillation, high blood pressure, diabetes, respiratory or lung disease, severe head injuries, asthma, emphysema, chronic obstructive pulmonary disease, chronic bronchitis, cough, cancer, Parkinson’s disease, epilepsy, dementia, and other brain disorders. The total score can range from 0 to 17. Data Analyses Descriptive statistics were conducted for all study variables. Linear regression models were used to investigate the associations of 12-year change in depressive symptoms with follow-up scores on SPAs, life satisfaction, and informant-rated disability. Structural equation modelling (SEM) was used to investigate whether SPAs mediate the associations of 12-year change in depressive symptoms with follow-up scores on life satisfaction and informant-rated disability. Change in depressive symptoms consisted in a change-score obtained by subtracting participants’ follow-up scores on depressive symptoms from their baseline scores on depressive symptoms. For all analyses we conducted unadjusted and adjusted (for age, sex, marital status, main occupation when working, and number of health conditions) models. We adjusted/controlled for the above-reported variables because they can all correlate with the independent variable (depressive symptoms) and with the outcome variables (life satisfaction and disability) ( 10 , 18 , 23 , 26 , 54 ). We did not control for education as we used main occupation when working as a proxi for education and to avoid multicollinearity. The assumptions of linear regression models were tested and met (e.g., linearity, normality, and multicollinearity). Multicollinearity was tested through estimation of correlation coefficients among study variables/independent variables, with correlations coefficients of moderate size or above considered as indicators of multicollinearity. To quantify associations between study variables we reported standardized regression coefficients (β; effects sizes). Values ≤ .09 indicated very small effects; between .10 and .29 indicated small effects, between .30 and .49 indicated moderate effects, and ≥ .50 indicated large effects ( 55 ). Complete case analyses were conducted using STATA version 18 ( 56 ). Results Descriptive Statistics at Wave 7 Participants’ mean (M) age at wave 7 was 87.41 (Standard Deviation, SD = 3.67; Table 1 ). Among participants 59.77% were women. Among participants 9.2% never married; 41.4% were married de facto; 0.6% were separated; 10% were divorced; and 39.1% were widowed. All participants were retired. Before retirement, 13.9% worked as manager admin; 38.7% as professional; 6.9% as associate professional; 2.9% as tradesperson; 11.6% as advanced clerical service; 16.8% as intermediate clerical sales service; 0.6% as intermediate products transport; 4.6% as elementary clerical/sales service; 0.6% as labourers and related; and 3.5% did howe duties. Almost all participants were Caucasian (98.9%). On average participants had between two and tree health conditions each. Mean score on life satisfaction was 55.72 (SD = 15.28) on a range from 0 to 100. Informant-rated disability mean score was 22.99 (SD = 8.04), meaning that on average participants had low disability. On average participants reported few depressive symptoms (M = 2.87; SD = 2.37). However, depressive symptoms increased of -1.34 (SD = 2.17) over the 12-year study period. In sum the study sample comprised almost entrirely White and retired very old individuals from the Sydney area with two to three health conditions each. Table 1 Descriptive Statistics for the Study Sample at 12-Year Follow-up Variables Statistics Age, M (SD; Range) 87.41 (3.67; 83–97) Sex, n (%) Women 104 (59.77) Men 70 (40.23) Marital status, n (%) Never married 16 (9.2) Married de facto 72 (41.4) Separated 1 (0.6) Divorced 17 (10.0) Widowed 68 (39.1) Main occupation when working, n (%) Manager admin 24 (13.9) Professional 67 (38.7) Associate professional 12 (6.9) Tradesperson 5 (2.9) Advanced clerical service 20 (11.6) Intermediate clerical sales service 29 (16.8) Intermediate prod transport 1 (0.6) Elementary clerical, sales service 8 (4.6) Labourers and related 1 (0.6) Home duties 6 (3.5) Race, n (%) Caucasian 172 (98.9) Other 1 (0.6) Number of health conditions, M (SD) 2.6 (1.6) Depressive symptoms, M (SD) 2.87 (2.37) Attitudes to aging/Self-perceptions of aging, M (SD) 42.05 (8.41) Life satisfaction, M (SD) 55.72 (15.28) Informant-rated disability, M (SD) 22.99 (8.04) Notes. Study sample of 174 individuals. Associations Between 12-Year Change in Depressive Symptoms and Self-Perceptions of Aging, Life Satisfaction, And Disability Both in the unadjusted and in the adjusted (for age, sex, marital status, occupation before retirement, and number of health conditions) regression models, greater increase in depressive symptoms over 12 years was related to more negative SPAs (adjusted beta, B = + 1.54; 95% CI: +0.97, + 2.10; R 2 = 16%; Table 2 ). This association was of moderate size (standardised beta of + 0.41). Both in the unadjusted and in the adjusted regression models, greater increase in depressive symptoms over 12 years was associated with lower life satisfaction (adjusted beta, B = + 1.51; 95% CI: +0.76, + 2.26; R 2 = 9%). This association was of small-to-moderate size (standardised beta of + 0.30). Both in the unadjusted and in the adjusted regression models, greater increase in depressive symptoms over 12 years was associated with greater informant-rated disability (adjusted beta, B= -1.41; 95% CI: -1.93, -0.89; R 2 = 14%). This association was of moderate size (standardised beta of -0.38). Table 2 Associations of 12-Year Change in Depressive Symptoms With Follow-up Self-Perceptions of Aging, Life Satisfaction, and Informant-Rated Disability Association of 12-Year Change in Depressive Symptoms With Follow-up Self-Perceptions of Aging Unadjusted models Adjusted models B (95% CI); p -value ß R 2 B (95% CI); p -value ß R 2 + 1.48 (+ 0.92; +2.03); <.001 + 0.39 15% + 1.54 (+ 0.97; +2.10); p < .001 + 0.41 16% Association of 12-Year Change in Depressive Symptoms With Follow-up Life Satisfaction B (95% CI); p -value ß R 2 B (95% CI); p -value ß R 2 + 1.53 (+ 0.78; +2.28); <.001 + 0.31 9% + 1.51 (+ 0.76; +2.26); p < .001 + 0.30 9% Association of 12-Year Change in Depressive Symptoms With Follow-up Informant-Rated Disability B (95% CI); p -value ß R 2 B (95% CI); p -value ß R 2 -1.36 (-1.91; -0.82); <.001 -0.37 14% -1.41 (-1.93; -0.89); <.001 -0.38 14% Notes. Adjusted models were adjusted for age, sex, marital status, occupation before retirement, and number of health conditions. Analyses are based on linear regression models. B = Unstandardized beta. ß= Standardized regression coefficient. R 2 = Coefficient of Determination. Self-Perceptions of Aging as a Partial Mediator in the Associations of Depressive Symptoms with Life Satisfaction and Disability Using structural equation modelling, after having adjusted for age, sex, marital status, occupation before retirement, and number of health conditions we found that SPAs, partially mediated the association of 12-year change in depressive symptoms with life satisfaction at follow-up (Fig. 1 ). More specifically, greater 12-year increase in depressive symptoms was significantly associated with lower life satisfaction at follow-up (ß= +0.20; 95% CI: +0.05, + 0.35). Greater 12-year increase in depressive symptoms was significantly associated with more positive SPAs at follow-up (ß= +0.41; 95% CI: +0.28, + 0.54). More negative SPAs at follow-up, in turn, were significantly associated with poorer life satisfaction at follow-up (ß= +0.26; 95% CI: +0.11, + 0.41). Similarly, using structural equation modelling and after having adjusted for age, sex, marital status, occupation before retirement, and number of health conditions we found that SPAs, partially mediated the association of 12-year change in depressive symptoms with informant-rated disability at follow-up (Fig. 2 ). More specifically, greater 12-year increase in depressive symptoms was significantly associated with greater informant-rated disability at follow-up (ß= -0.29; 95% CI: -0.43, -0.15). Greater 12-year increase in depressive symptoms was significantly associated with more negative SPAs at follow-up (ß= 0.42; 95% CI: 0.30, 0.55). More negative SPAs at follow-up, in turn, were significantly associated with greater informant-reported disability at follow-up (ß= -0.23; 95% CI: -0.37, -0.09). Discussion This study of very old Australians is among the few that have investigated the associations of 12-year change in depressive symptoms with follow-up scores on SPAs, life satisfaction, and informant-rated disability. As hypothesized, the study found that on average participants’ depressive symptoms increased over 12 years, and greater 12-year increase in participants’ depressive symptoms was associated with more negative SPAs, poorer life satisfaction, and greater disability. Also, as hypothesized, more negative SPAs partially mediated the associations of greater 12-year change in depressive symptoms with poorer life satisfaction and greater disability. Some of the patterns observed in this study are consistent with and enrich the limited previous evidence focusing on very old adults. First, the current study finding that over the 12-year study period very old individuals experienced a small increase in depressive symptoms builds up on the limited evidence suggesting that depressive symptoms increase in very old age ( 17 , 18 ). Even though there can be great variability in the health state and life experiences of very old individuals, this finding may be due to the age-related health and life challenges individuals in very old age often experience ( 6 , 9 , 10 ). When interacting with very old individuals, general practictioners / family doctors should be particularly vigilant about the existence of depressive symptoms, and could perhaps verge their discussions with very old patients around the possible impact that objective physical symptoms and illnesses may have on patient’s mood and mental health. Second, the finding that 12-year increase in depressive symptoms is associated with more negative SPAs at follow-up is aligned with existing UK and German evidence finding that a greater increase in depressive symptoms is associated with more negative SPAs ( 39 , 48 ). This finding is also in support of SPAs theories such as the Awareness of Aging theory that postulates that lifetime and current mental health shape SPAs ( 33 ). While most evidence has so far showed that SPAs have an effect of future mental health ( 46 ), our study suggests that mental health may also have an effect on SPAs. There are several reasons that may explain why individuals experiencing more depressive symptoms report more negative SPAs. Even though depressive symptoms in old and very old age can be triggered and exacerbated by illnesses and age-related challenges, depressive symptoms, in turn, can lead to poorer physical and cognitive health and decreased social engagement ( 19 – 22 ). All these factors generally make individuals more susceptible to negative SPAs ( 39 , 48 ). More negative SPAs reported by very old individuals experiencing more depressive symptoms may also be due to individuals with low mood having the tendency to focus on and ruminate over negative changes ( 57 ). At clinical level, helping very old adults to acknowledge age-related losses and challenges, without remaining fixated on them, may help promoting more positive SPAs and, consequently, mainatance of greater quality of life in very old age ( 58 ). Third, the current study finding that greater 12-year increase in participants’ depressive symptoms is also associated with lower follow-up scores on life satisfaction is aligned with existing evidence ( 25 , 26 ); further highlighting the negative impact of depressive symptoms into very old people’s experience of their overall life. The importance of reframing how people with depressive symptoms perceive and evaluate their own lives has been widely discussed and researched in the field of Cognitive Behavioral Therapy ( 59 ). Fourth and finally, our result that 12-year increase in depressive symptoms is associated with greater disability in very old age is consistent with and broadens the little available existing evidence reporting associations between more negative SPAs and greater disability ( 23 ) and mortality risk ( 60 ) among very old individuals. Indeed, research on the associations of SPAs with functioning outcomes, such as disability, in very old adults is scarce in the SPAs literature ( 46 ). These results highligh one more time the urgence of detecting and treating depressive symptoms in very old age (due to their likely impact on peoples’ functioning) rather than assuming they are a normal part of growing older. A novel finding of this study is that follow-up scores for SPAs partially mediated the associations of 12-year change in depressive symptoms with follow-up scores for life satisfaction and disability. In other words, increased depressive symptoms over 12 years were related to more negative SPAs at follow-up and these, in turn, were related to poorer life satisfaction and greater disability at follow-up. Previous studies have related more negative SPAs to poorer life satisfaction ( 38 , 40 , 43 , 44 ) and indicators of greater disability ( 45 – 47 ). Moreover, SPAs have previously been related to components of disability (e.g., perception of one’s overall health, ability to learn new tasks and concentrate) ( 61 – 64 ). However, SPAs was never investigated as mediator in the association of change in depressive symptoms with life satisfaction and disability. Although SPAs, depressive symptoms, and disability were all assessed at follow-up, this study provides some initial insight into the mechanisms with whom depressive symptoms may lead to poorer life satisfaction and greater disability in very old age. This pattern of results also provides some initial empirical support for Diehl, Wahl ( 33 ) theoretical model of Awareness of Aging where SPAs is considered a mediating variable in the associations of health indicators, including mental health, and developmental outcomes including disability. Current strategies and interventions (at clinical and public health level) used to decrease depressive symptoms in old and very old age may benefit from the inclusion of a component decreasing negative SPAs and promoting more positive SPAs, as a change in individuals’ SPAs may limit the negative consequences of age-related depressive symptoms on life satisfaction and disability. In the past few years several interventions targeting SPAs have been developed and showed effective to promote positive SPAs, better mood, and even engagement in behaviors such as physical activity which, over time, can further reinforce positive SPAs and better mood ( 49 , 50 ). Moreover, interventions targeting SPAs have been showed feasible even in samples of very old and frail individuals ( 49 , 50 ). A limitation of existing interventions is that so far they have been delivered in person, but to increase their scalability and reachability to a wider group of older people, there is the need of develping intevrentions that target SPAs and that can also be easily delivered in online settings. Overall, given the rapid increase in the number of individuals who will reach very old age and experience some sort of depressive symptoms, SPAs may be an important novel modifiable risk factor for low life satisfaction and disability that should be further investigated and considered when addressing the challenges that very old age can bring with biopsychological lenses ( 65 ). This study has several strengths including the 12-year length of the follow-up which potentially allowed to detect long-term significant changes in participants' depressive symptoms and for most participants during the passage from early old age to very old age. Another strength of this study is the focus on very old individuals as this is an age group where changes in depression and correlates of SPAs have been less studied compared to younger age groups. Even though study analyses were based on an overall score for AAQ, a strength of this study is that we used a multidimensional measure of AAQ ( 30 , 66 , 67 ) assessing/capturing both positive and negative perceptions of aging in different aspects of people’s lives such as physical and social losses and ongoing personal development. This study has however several limitations too. First, assessment of SPAs occurred only at follow-up which mean that the mediating factor (SPAs) was assessed at the same point as the outcomes (i.e., life satisfaction and informant-rated disability). Hence, based on the current study results we cannot infer causality from depressive symptoms to SPAs. Future studies should therefore replicate these analyses with assessment of SPAs and life satisfaction and disability at different timepoints using data from three timepoints. Still the assessment of SPAs at follow-up rather than at baseline made it possible to detect its relationship with change in depressive symptoms, using two different assessment points. Second, as most studies conducted using cohort data the study sample was entirely Caucasian; hence generalizability of study results to individuals with other ethnical backgrounds should be done with caution. Because of this, study results were interpreted/commented in relation to evidence coming from other mostly White samples. Third, this study made use of data for very old individuals from a longitudinal study that had been ongoing for 12 years; hence the study sample may have comprised a selective group of healthier individuals who stayed in the study from wave one to wave seven. Hence, it is possible that only those healthier and therefore likely to experience a lower increase in depressive symptoms, more positive experiences of aging, greater life satisfaction, and less disability remained in the study sample at 12-year follow-up. As a consequence of this, the associations and pathways that we have detected in the current study sample may be even larger in cohort of less healthy odler adults. Conclusions To conclude, using 12-year data for a sample of very old individuals at follow-up this study found that depressive symptoms on average increase from early old age to very old age, and a greater increase in depressive symptoms is associated with more negative personal evaluations of one’s aging, poorer life satisfaction, and greater informant-rated disability. Importantly, this study found for the first time that more negative personal evaluations of one’s aging partially mediated the associations of greater 12-year decline in depressive symptoms with poorer life satisfaction and greater disability. Targeting SPAs through existing psychoeducational interventions that make use of cognitive behavioral strategies (such as 68) and/or behavioral interventions ( 69 , 70 ) aimed at very old and frail individuals may help limit the negative consequence of depressive symptoms in very old age. Abbreviations WHO World Health Organization SPAs Self-Perceptions of Aging MAS Memory and Ageing Study MCI Mild Cognitive Impairment AAQ Attitudes to Aging Questionnaire WHODAS-II World Health Organization Disability Assessment Schedule 2.0 SEM Structural Equation Modelling M Mean SD Standard Deviation B Adjusted Beta CI Confidence Intervals R 2 Coefficient of Determination ß Standardized Beta Declarations Availability of data and material The terms of consent for research participation stipulate that an individual's data can only be shared outside of the MAS investigators group if the group has reviewed and approved the proposed secondary use of the data. This consent applies regardless of whether data have been de‐identified. Access is mediated via a standardized request process managed by the CHeBA Research Bank, who can be contacted at [email protected] , or via the corresponding author at [email protected] . Acknowledgments The authors have reviewed and edited the output and take full responsibility for the content of this publication. Funding The Sydney Memory and Ageing Study was funded by three National Health & Medical Research Council (NHMRC) of Australia Program Grants (ID350833, ID568969, and APP1093083; https://www.nhmrc.gov.au/funding). Contributions Conceptualization: S.S. and K.N. Methodology: S.S. and K.N. Formal analysis: S.S. Writing—original draft preparation: S.S. Writing—review and editing: K.N., N.K., P.S.S, and H.B. Funding acquisition: P.S.S and H.B. All authors have read and agreed to the published version of the manuscript. Ethics declarations MAS received institutional approval by the Human Research Ethics Committee of the University of New South Wales (project no. HC190962) and the current study analyses were approved by the same committee on date 20-02-2023. The study was approved in accordance with the National Statement on Ethical Conduct in Human Research (2007) and the Declaration of Helsinki. Informed written consent were obtained from all participants prior to participation. Consent for publication In MAS informed consent was obtained from all subjects involved in the study. In MAS written informed consent was obtained from participants to publish papers using MAS data. Competing interests H. B. has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. P. S. has been on the expert advisory panels for Biogen and Roche Australia in 2020-21. Clinical trial number Not applicable References World Health Organization. Ageing and health 2024 [Available from: www.who.int/news-room/fact-sheets/detail/ageing-and-health. AgeUK. Briefing: Health and Care of Older People in England 2019. 2019. He W. An aging world: 2015. 2016. Baltes PB. Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Developmental Psychology. 1987;23(5):611-26. Kaspar R, Wahl H-W, Diehl MK, Zank S. Subjective views of aging in very old age: Predictors of 2-year change in gains and losses. Psychology and Aging. 2022;37(4):503-16. Kingston A, Robinson L, Booth H, Knapp M, Jagger C, for the Modem project. Projections of multi-morbidity in the older population in England to 2035: Estimates from the Population Ageing and Care Simulation (PACSim) model. Age and Ageing. 2018;47(3):374-80. Bugental EK, Bugental JF. Dispiritedness: A new perspective on a familiar state. 1984;24:49-67. Butcher H, McGonigal-Kenney M. Depression & dispiritedness in later life: A "gray drizzle of horror" isn't inevitable. American Journal of Nursing. 2005;105:52-61. Brodaty H, Luscombe G, Parker G, Wilhelm K, Hickie I, Austin MP, et al. 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Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary-care patients. The American Journal of Geriatric Psychiatry 2005;13(9):748-55. Bunce D, Batterham PJ, Christensen H, Mackinnon AJ. Causal associations between depression symptoms and cognition in a community-based cohort of older adults. The American Journal of Geriatric Psychiatry. 2014;22(12):1583-91. Szanto K, Dombrovski AY, Sahakian BJ, Mulsant BH, Houck PR, Reynolds CF, et al. Social emotion recognition, social functioning, and attempted suicide in late-life depression. The American Journal of Geriatric Psychiatry. 2012;20(3):257-65. Kivelá S-L, Pahkala K. Depressive disorder as a predictor of physical disability in old age. Journal of the American Geriatrics Society. 2001;49(3):290-6. World Health Organization. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0). Ustun TB, Kostanjesek N, Chatterji S, Rehm J, editors2010. Adams TR, Rabin LA, Da Silva VG, Katz MJ, Fogel J, Lipton RB. Social support buffers the impact of depressive symptoms on life satisfaction in old age. Clinical Gerontologist. 2016;39(2):139-57. Berg AI, Hassing LB, McClearn GE, Johansson B. What matters for life satisfaction in the oldest-old? Aging & Mental Health. 2006;10(3):257-64. Diener E, Lucas RE, Oishi S, Suh EM. Looking up and looking down: Weighting good and bad information in life satisfaction judgments. Personality and Social Psychology Bulletin. 2002;28(4):437-45. Barrett AE. Socioeconomic status and age identity: The role of dimensions of health in the subjective construction of age. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 2003;58(2):101-9. Lawton MP. The Philadelphia Geriatric Center Morale Scale: A revision. Journal of Gerontology. 1975;30(1):85-9. Laidlaw K, Power MJ, Schmidt S. The attitudes to ageing questionnaire (AAQ): Development and psychometric properties. International Journal of Geriatric Psychiatry. 2007;22(4):367-79. Diehl MK, Wahl H-W. Awareness of age-related change: Examination of a (mostly) unexplored concept. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 2010;65B(3):S340-S50. Wurm S, Diehl M, Kornadt AE, Westerhof GJ, Wahl H-W. How do views on aging affect health outcomes in adulthood and late life? Explanations for an established connection. Developmental Review. 2017;46:27-43. Diehl MK, Wahl H-W, Barrett AE, Brothers AF, Miche M, Montepare JM, et al. Awareness of aging: Theoretical considerations on an emerging concept. Developmental Review. 2014;34(2):93-113. Levy BR. Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science. 2009;18(6):332-6. Sabatini S, Ukoumunne OC, Ballard C, Collins R, Corbett A, Brooker H, et al. Cross-sectional and longitudinal associations between subjective sleep difficulties and self-perceptions of aging. Behavioral Sleep Medicine. 2021;20(6):732-61. Klusmann V, Sproesser G, Wolff JK, Renner B. Positive self-perceptions of aging promote healthy eating behavior across the life span via social-cognitive processes. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 2019;74(5):735-44. Caudroit J, Stephan Y, Chalabaev A, Le Scanff C. Subjective age and social-cognitive determinants of physical activity in active older adults. Journal of Aging and Physical Activity. 2012;20(4):484-96. Sabatini S, Silarova B, Martyr A, Collins R, Ballard C, Anstey KJ, et al. Associations of awareness of age-related change with emotional and physical well-being: A systematic review and meta-analysis. The Gerontologist. 2020;60(6):e477-e90. Sabatini S, Wahl H-W, Diehl M, Clare L, Ballard C, Brooker H, et al. Testing bidirectionality in associations of awareness of age-related gains and losses with physical, mental, and cognitive functioning across one year: The role of age. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 2023;78(12):2026-36. Tully-Wilson C, Bojack R, Millear PM, Stallman HM, Allen A, Mason J. Self-perceptions of aging: A systematic review of longitudinal studies. Psychology and Aging. 2021;36(7):773-89. Debreczeni AF, Bailey PE. A systematic review and meta-analysis of subjective age and the association with cognition, subjective well-being, and depression. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 2021;76(3):471-82. Stephan Y, Sutin AR, Luchetti M, Aschwanden D, Terracciano A. Subjective age and verbal fluency among middle aged and older adults: A meta-analysis of five cohorts. Archives of Gerontology and Geriatrics. 2021;97:104527. Stephan Y, Caudroit J, Chalabaev A. Subjective health and memory self-efficacy as mediators in the relation between subjective age and life satisfaction among older adults. Aging & Mental Health. 2011;15(4):428-36. Kiarsipour N, Borhani F, Esmaeili R, Zayeri F. The correlation of aging perceptions and life satisfaction in Iranian older adults. Annals of Tropical Medicine and Public Health. 2017;10(4). Boehmer S. Relationships between felt age and perceived disability, satisfaction with recovery, self-efficacy beliefs and coping strategies. Journal of Health Psychology. 2007;12(6):895-906. Westerhof GJ, Nehrkorn-Bailey AM, Tseng H-Y, Brothers A, Siebert JS, Wurm S, et al. Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis. Psychology and Aging. 2023;38(3):147-66. Kaspar R, Wahl H-W, Diehl M. Awareness of Age-Related Gains and Losses in a national sample of adults aged 80 years and older: Cross-sectional associations with health correlates. Innovation in Aging. 2023;7(4):igad044. Sabatini S, Siebert JS, Diehl MK, Brothers A, Wahl H-W. Identifying predictors of self-perceptions of aging based on a range of cognitive, physical, and mental health indicators: Twenty-year longitudinal findings from the ILSE study. Psychology and Aging. 2022;37(4):486-502. Knight RL, Chalabaev A, McNarry MA, Mackintosh KA, Hudson J. Do age stereotype‐based interventions affect health‐related outcomes in older adults? A systematic review and future directions. British Journal of Health Psychology. 2021;27(2):338-73. Zhu M, Chen H, Ding X, Li Z. Effects of self-perception of aging interventions in older adults: A systematic review and meta-analysis. The Gerontologist. 2024:gnae127. Sachdev PS, Brodaty H, Reppermund S, Kochan NA, Trollor JN, Draper B, et al. The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70-90 years. International Psychogeriatrics. 2010;22(8):1248-64. Greenberg SA. The geriatric depression scale (GDS). Best Practices in Nursing Care to Older Adults. 2012;4(1):1-2. Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. Journal of Personality Assessment. 1985;49(1):71-5. Braam AW, Copeland JR, Delespaul PA, Beekman AT, Como A, Dewey M, et al. Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: Results from the EURODEP concerted action. Journal of Affective Disorders. 2014;155:266-72. Cohen J. Statistical power analysis for the behavioral sciences. II ed. Hillsdale, NJ, United States: Lawrence Earlbaum Associates; 1988. StataCorp. Stata Statistical Software: Release 19 2025 [ Brinker JK, Dozois DJ. Ruminative thought style and depressed mood. Journal of Clinical Psychology. 2009;65(1):1-19. Sabatini S, Rupprecht F, Kaspar R, Klusmann V, Kornadt A, Nikitin J, et al. Successful aging and subjective aging: Toward a framework to research a neglected connection. The Gerontologist. 2025;65(1):gnae051. Laidlaw K. Are attitudes to ageing and wisdom enhancement legitimate targets for CBT for late life depression and anxiety? Nordic Psychology. 2010;62(2):27-42. Kotter-Grühn D, Kleinspehn-Ammerlahn A, Gerstorf D, Smith J. Self-perceptions of aging predict mortality and change with approaching death: 16-year longitudinal results from the Berlin Aging Study. Psychology and Aging. 2009;24(3):654-67. Sabatini S, Ukoumunne OC, Ballard C, Brothers AF, Kaspar R, Collins R, et al. International relevance of two measures of awareness of age-related change (AARC). BMC Geriatrics. 2020;20(1):359. Sabatini S, Ukoumunne OC, Ballard C, Collins R, Anstey KJ, Diehl MK, et al. Cross-sectional association between objective cognitive performance and perceived age-related gains and losses in cognition. International Psychogeriatrics. 2021;33:727-41. Stephan Y, Sutin AR, Terracciano A. “Feeling younger, walking faster”: Subjective age and walking speed in older adults. Age. 2015;37:1-12. Cohn-Schwartz E, Schafer MH, Ayalon L. Age integration in later life social networks and self-perceptions of aging: Examining their reciprocal associations. European Journal of Ageing. 2022:1-9. Pachana NA, Wahl H-W. Healthy aging: Current and future frameworks and developments. In: Asmundson G, editor. Comprehensive clinical psychology: Elsevier; 2022. Laidlaw K, Kishita N, Shenkin SD, Power MJ. Development of a short form of the Attitudes to Ageing Questionnaire (AAQ). International Journal of Geriatric Psychiatry. 2018;33(1):113-21. Faudzi FNM, Armitage CJ, Bryant C, Brown LJE. A systematic review of the psychometric properties of self-report measures of attitudes to aging. Research on Aging. 2019;41(6):549-74. Beyer AK, Wolff JK, Freiberger E, Wurm S. Are self-perceptions of ageing modifiable? Examination of an exercise programme with vs. without a self-perceptions of ageing-intervention for older adults. Psychology & Health. 2019;34(6):661-76. Klusmann V, Evers A, Schwarzer R, Heuser I. Views on aging and emotional benefits of physical activity: Effects of an exercise intervention in older women. Psychology of Sport and Exercise. 2012;13(2):236-42. Brothers AF, Diehl MK. Feasibility and efficacy of the Aging(Plus) program: Changing views on aging to increase physical activity. Journal of Aging and Physical Activity. 2017;25(3):402-11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6890364","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489894014,"identity":"53f90356-d2af-493e-b14a-9207954116aa","order_by":0,"name":"Serena Sabatini","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYDADAyA+wGBgA2ZIEKmFGaQljUQtQHCYsBb59t6Hjwtq6uTN2c8fPFxQcD5xOwPzwds8+Aw/c9zYeMaxw4Y7e5IZDs8wuJ24s4Et2RqvFok0NmketgOMGw4AtfAAtWw4wGMmjU+L/Pxn7L95/tXZbzj/GKTlHFAL/ze8WhhusLEx87YxJ264AbblAMgWNrxaDM6kMUvz9h1O3jnjsQFQS7LxzmY2Y8s5+BzWfozxM8+3Otvt/ImPP/P8sZPdzt788MYbfA7DBMykKR8Fo2AUjIJRgAUAABA0S6j8MECtAAAAAElFTkSuQmCC","orcid":"","institution":"University of Barcelona","correspondingAuthor":true,"prefix":"","firstName":"Serena","middleName":"","lastName":"Sabatini","suffix":""},{"id":489894015,"identity":"de714b17-d0e0-4435-993e-278bc2723284","order_by":1,"name":"Katya Numbers","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Katya","middleName":"","lastName":"Numbers","suffix":""},{"id":489894018,"identity":"a0337838-cb5a-4c51-a127-3451db22797b","order_by":2,"name":"Nicole Kochan","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Kochan","suffix":""},{"id":489894019,"identity":"9900d51a-48f5-4600-99c0-945aeaf79eaf","order_by":3,"name":"Perminder S. Sachdev","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Perminder","middleName":"S.","lastName":"Sachdev","suffix":""},{"id":489894022,"identity":"a384a66c-229b-48f8-820a-3f2aebd7b7d7","order_by":4,"name":"Henry Brodaty","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Henry","middleName":"","lastName":"Brodaty","suffix":""}],"badges":[],"createdAt":"2025-06-13 18:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6890364/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6890364/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87728894,"identity":"841d5e3b-6eae-4265-b91c-9b0559156d90","added_by":"auto","created_at":"2025-07-28 11:14:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34316,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMediating Role of Self-Perceptions of Aging in the Association of 12-Year Change in Depressive Symptoms With Follow-up Life Satisfaction\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003eStatistics are standardized beta coefficients. Results are adjusted for age, sex, marital status, occupation before retirement, and number of health conditions.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6890364/v1/db4324c30ae9202006ae8340.png"},{"id":87727954,"identity":"cad7b7bf-e275-45d5-81eb-9b67a3f39491","added_by":"auto","created_at":"2025-07-28 11:06:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35461,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMediating Role of Self-Perceptions of Aging in the Association of 12-Year Change in Depressive Symptoms With Informant-Rated Disability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e Statistics are standardized beta coefficients. Results are adjusted for age, sex, marital status, occupation before retirement, and number of health conditions.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6890364/v1/a4c2dc28994dba4395cbf5fa.png"},{"id":102745640,"identity":"64230526-9727-4fd0-ba9c-27da6771e7c5","added_by":"auto","created_at":"2026-02-16 08:53:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1014174,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6890364/v1/38b72035-c801-45f3-94f0-7911d37076ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-Perceptions of Aging Mediate the Associations of 12-Year Change in Depressive Symptoms With Life Satisfaction and Disability","fulltext":[{"header":"Background","content":"\u003cp\u003eAs a consequence of societal and medical advancements, the proportion of older people is rapidly increasing (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In western countries, the fastest growing age group is that of very old individuals (i.e., aged 75 years and over), which is expected to double in the next 30 years (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Whereas individuals in early old age typically experience a mix of positive and negative age-related changes, individuals in very old age generally experience an increasing number of negative changes and fewer positive changes (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Very old individuals are also at great risk of multimorbidity and disability. For example, in Europe 75% of individuals aged between 75 and 84 years have multiple health conditions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The physical challenges that very old individuals are likely to face can undermine their psychological wellbeing and lead to either new depressive symptoms or to an exacerbation of the depressive symptoms their already had (\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the Diagnostic and Statistical manual of mental disorders (DSM-5, 11), major depression is a mental health disorder characterised by depressed mood and/or loss of interest or pleasure and additional symptoms such as significant weight loss or weight gain, insomnia or hypersomnia, fatigue or loss of energy, and recurrent thoughts of death or suicide attempt. Older people typically experience a specific constellation of depressive symptoms such as somatic symptoms (e.g., weight loss, aches, and psychomotor retardation), low motivation, high anxiety, severe cognitive dysfunction, and insomnia (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Apathy is also very common in late-life depression (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEven though diagnosing depression in old and very old age is difficult due to underassessment, misdiagnosis, and public stigma, empirical evidence suggests that, whereas the incidence and prevalence of major depression are lower in early old individuals compared to middle-aged individuals, they increase again among very old individuals (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For example, a study found the incidence of depression among individuals aged 79\u0026ndash;85 years (44 per 1,000) to be more than the double than the incidence of depression among people aged 70\u0026ndash;79 years (17 per 1,000) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Moreover, estimations suggest that in very old age the number of individuals experiencing mild depressive symptoms without meeting criteria for major depressive disorder may be higher compared to early old individuals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough experiencing some depressive symptoms in old and very old age may be a common and expected reaction to physical illnesses and other life challenges (e.g., death of a friend or family member), the insurgence and/or increase of depressive symptoms in very old age can, in turn, have a range of negative consequences on people\u0026rsquo;s lives. Indeed, late-life depressive symptoms may further exacerbate decline in cognitive and physical health and functioning (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Moreover, depressive symptoms in old and very old age are related to poorer social network (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In addition, depression and all the negative changes associated with it, are related with higher levels of disability in very old individuals (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Disability has been defined by the World Health Organization (WHO) as impaired functioning in one or more domains including cognition; mobility; self-care (e.g., hygiene); getting along with other people; life activities such as domestic responsibilities and work; and participation in community activities (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Finally, depressive symptoms in very old age can lead to lower levels of life satisfaction (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), which refers to individuals\u0026rsquo; cognitive and affective evaluations of their own lives (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe effect of depressive symptoms over life satisfaction and disability may be mediated by a malleable psychological variable: Self-Perceptions of Aging (SPAs). SPAs is an umbrella term comprising several concepts, such as Felt Age (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), Attitudes Towards Own Aging (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), and Awareness of Age-Related Changes (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). All these concepts describe an individual\u0026rsquo;s subjective experiences, beliefs, and evaluations of their own aging and of the changes they experience in their lives as they age (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Examples of positive SPAs are recognizing increased knowledge and life experience, greater self-confidence, and better ability to deal with people and difficult situations. Examples of negative SPAs are experiencing forgetfulness, greater dependency on others, and less energy.\u003c/p\u003e\u003cp\u003eThe Awareness of Aging theory (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) postulates that past and current mental health shapes individuals\u0026rsquo; SPAs which, in turn, can have an effect on life satisfaction and disability. This hypothesized pathway has never been empirically tested and it is therefore one of the aims of the current study. SPAs are hypothesized to have an impact on one\u0026rsquo;s overall health and disability due to the influence that SPAs have on individuals\u0026rsquo; daily behaviors (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). For example, individuals with negative SPAs are less likely to engage in health-enhancing behaviors such as physical activity and following a balanced diet (\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Initial evidence in support of this reasoning has reported cross-sectional and longitudinal associations between depressive symptoms and SPAs (\u003cspan additionalcitationids=\"CR39 CR40 CR41\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) and between life satisfaction and disability (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44 CR45 CR46\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn sum, there is research in support of the predictive role of depressive symptoms over SPAs, life satisfaction, and disability; and of the predictive role of SPAs over life satisfaction and disability, but to the best of our knowledge the potential mediating role of SPAs in the associations of depressive symptoms with life satisfaction and disability has never been investigated. In fact, most existing evidence on SPAs has investigated SPAs as either predictor or outcome of health indicators (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Identifying potentially modifiable variables (e.g., SPAs) that may explain, at least partially, the negative effects of depressive symptoms over life satisfaction and disability is highly important, not only to empirically test some of the SPAs pathways that have so far only been theorized (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), but also because at clinical level these variables can be targeted to promote life satisfaction and decrease disability in very old age. More positive SPAs can indeed be promoted through psychoeducation interventions even among very old and frail individuals (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study has two aims. First, it aims to estimate the associations of 12-year change in depressive symptoms with follow-up scores on SPAs, life satisfaction, and informant-rated disability. Second, aiming to provide empirical evidence for one of the mechanisms outlined in Diehl, Wahl (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) Awareness of Aging model, this study tests whether SPAs mediate the associations of 12-year change in depressive symptoms with follow-up scores on life satisfaction and informant-rated disability. Imporantly, the study focuses on very old individuals, and age-group understudied in the SPAs literature and with regard to depressive symptoms and their consequences. Study hypotheses are two. First, it is hypothesized that greater 12-year increase in participants\u0026rsquo; depressive symptoms is associated with lower follow-up scores on life satisfaction, higher follow-up scores on disability, and more negative SPAs. Second, it is hypothesised that SPAs at least partially mediate the associations of change in depressive symptoms with life satisfaction and disability.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eStudy analyses rely on a cross-sectional and longitudinal study design. This study uses data of the Memory and Ageing Study (MAS) (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), which is one of the biggest Australian studies investigating aging and cognitive health. In MAS participants were recruited from Eastern Sydney. MAS aims to identify factors are associated with normal and pathologic aging. Over the last 12 years, MAS has collected data on biomarker, genetic/epigenomic, neuroimaging, cognitive, proteomics/lipidomics, health, and lifestyle. At baseline/wave 1 (September 2005- December 2007), participants were aged between 70 and 90 years and had no dementia. In MAS participants were assessed every two years. The assessment included a detailed cognitive and medical examination and comprised the option to donate a blood sample for clinical chemistry and genomics. When possible, for participants, a knowledgeable informant (i.e., a close friend or family member) was also interviewed. A total of 258 participants took part at wave 7, equating to 12-year follow-up assessment, (September 2018 \u0026ndash; December 2020), in addition to having taken part at previous MAS assessments/waves. For the purpose of this study, we included in the current study sample only those individuals who participated to wave 7 of MAS and also completed the AAQ. Hence, we included 174 participants.\u003c/p\u003e\u003cp\u003e MAS received institutional approval by the Human Research Ethics Committee of the University of New South Wales (project no. HC190962) and the current study analyses were approved by the same committee on date 20-02-2023. Both MAS and the current study was approved in accordance with the National Statement on Ethical Conduct in Human Research (2007) and the Declaration of Helsinki. In MAS onformed written consent were obtained from all participants prior to participation.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eAttitudes to Aging.\u003c/b\u003e Participants\u0026rsquo; SPAs were measured with the well-validated 12-item Attitudes to Aging Questionnaire (AAQ; 30). The AAQ assesses Attitudes to Aging across three domains/subscales: psychological growth, psychosocial loss, and physical change. Each subscale comprises four items. Each item is answered on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree; 5\u0026thinsp;=\u0026thinsp;strongly agree). The psychological growth subscale captures positive aspects of aging (e.g., continued development) and an example item for this subscale is \u003cem\u003eIt is a privilege to grow old.\u003c/em\u003e The psychosocial loss subscale captures negative aspects of aging (e.g., feelings of social loss and decreasing self-worth) and an example item for this subscale is \u003cem\u003eI feel excluded from things because of my age.\u003c/em\u003e The physical change subscale captures attitudes towards physical changes associated with aging (e.g., changes related to health and fitness) and an example item for this subscale is \u003cem\u003eI have more energy now than I expected for my age.\u003c/em\u003e Subscales scores are obtained by summing the responses to their respective four items (possible range for each subscale: 4\u0026ndash;20). Higher scores on the psychological growth and physical change subscales indicate more positive SPAs, whereas higher scores on the psychosocial loss subscale indicate more negative SPAs. In the current study sample, Cronbach\u0026rsquo;s alpha for the perceived physical change scale was 0.70, for the perceived psychosocial loss scale it was 0.74, and for the perceived psychological growth scale it was 0.75.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDepressive Symptoms.\u003c/b\u003e The Geriatric Depression Scale (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) was used to assess depressive symptoms over the past week. It comprises 15 items. Sample items are \u003cem\u003eare you basically satisfied with your life?\u003c/em\u003e and \u003cem\u003edo you feel your situation is hopeless?.\u003c/em\u003e For each item participants can answer either yes (scored as one) or no (scores as zero). The total score is obtained from the sum of items. In the current study sample Cronbach\u0026rsquo;s alpha for the Geriatric Depression Scale was 0.98.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInformant-Rated Disability.\u003c/b\u003e The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-II) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) was used to assess informant-rated disability. This assessment includes 14 questions answered by an informant, covering the participant's overall health, ability to stand for long periods, handle household responsibilities, learn new tasks, join community activities, emotional impact of health, ability to concentrate, walk long distances, wash their whole body, get dressed, interact with unfamiliar people, maintain friendships, conduct day-to-day work, and the extent to which difficulties interfere with their life. Each question has five answer options: for the first item, 1\u0026thinsp;=\u0026thinsp;very good, 2\u0026thinsp;=\u0026thinsp;good, 3\u0026thinsp;=\u0026thinsp;moderate, 4\u0026thinsp;=\u0026thinsp;bad, 5\u0026thinsp;=\u0026thinsp;very bad; for items 2 to 14, 1\u0026thinsp;=\u0026thinsp;none, 2\u0026thinsp;=\u0026thinsp;mild, 3\u0026thinsp;=\u0026thinsp;moderate, 4\u0026thinsp;=\u0026thinsp;severe, 5\u0026thinsp;=\u0026thinsp;extreme/can\u0026rsquo;t do; and for item 15, 1\u0026thinsp;=\u0026thinsp;not at all, 2\u0026thinsp;=\u0026thinsp;mildly, 3\u0026thinsp;=\u0026thinsp;moderately, 4\u0026thinsp;=\u0026thinsp;severely, 5\u0026thinsp;=\u0026thinsp;extremely. The total score, ranging from 14 to 70, is the sum of all item scores. Higher scores indicate greater informant-rated disability. In the current study sample Cronbach\u0026rsquo;s alpha for the WHODAS-II was 0.88.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLife Satisfaction\u003c/b\u003e was assessed with the Life Satisfaction scale (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Example questions are \u0026ldquo;In most ways my life is close to my ideal\u0026rdquo; and \u0026ldquo;The conditions of my life are excellent\u0026rdquo;. The total score ranges from 0 to 100, with a higher score indicating greater life satisfaction. In the current study sample Cronbach\u0026rsquo;s alpha for the Life Satisfaction scale was 0.84.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSocio-Demographic Variables\u003c/b\u003e comprised age; sex (women; men); marital status; main occupation when working/before retirement; and race (Caucasian; other). Marital status comprised the following categories: never marries; married de facto; separated; divorced; widowed. Main occupation when working/before retirement comprised the following categories: manager administrative; professional; associate professional; tradesperson; advanced clerical service; intermediate clerical sales service; intermediate products transport; elementary clerical/ sales service; intermediate laborers and related; home duties.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNumber of Health Conditions.\u003c/b\u003e Participants\u0026rsquo; number of health conditions consisted in a count score based on the following conditions reported between waves 1 and 7 of MAS: stroke/cerebrovascular accident, mini stroke/transient ischemic attack, heart attack, angina, atrial fibrillation, high blood pressure, diabetes, respiratory or lung disease, severe head injuries, asthma, emphysema, chronic obstructive pulmonary disease, chronic bronchitis, cough, cancer, Parkinson\u0026rsquo;s disease, epilepsy, dementia, and other brain disorders. The total score can range from 0 to 17.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData Analyses\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDescriptive statistics were conducted for all study variables. Linear regression models were used to investigate the associations of 12-year change in depressive symptoms with follow-up scores on SPAs, life satisfaction, and informant-rated disability. Structural equation modelling (SEM) was used to investigate whether SPAs mediate the associations of 12-year change in depressive symptoms with follow-up scores on life satisfaction and informant-rated disability. Change in depressive symptoms consisted in a change-score obtained by subtracting participants\u0026rsquo; follow-up scores on depressive symptoms from their baseline scores on depressive symptoms. For all analyses we conducted unadjusted and adjusted (for age, sex, marital status, main occupation when working, and number of health conditions) models. We adjusted/controlled for the above-reported variables because they can all correlate with the independent variable (depressive symptoms) and with the outcome variables (life satisfaction and disability) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). We did not control for education as we used main occupation when working as a proxi for education and to avoid multicollinearity. The assumptions of linear regression models were tested and met (e.g., linearity, normality, and multicollinearity). Multicollinearity was tested through estimation of correlation coefficients among study variables/independent variables, with correlations coefficients of moderate size or above considered as indicators of multicollinearity. To quantify associations between study variables we reported standardized regression coefficients (β; effects sizes). Values\u0026thinsp;\u0026le;\u0026thinsp;.09 indicated very small effects; between .10 and .29 indicated small effects, between .30 and .49 indicated moderate effects, and \u0026ge;\u0026thinsp;.50 indicated large effects (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Complete case analyses were conducted using STATA version 18 (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive Statistics at Wave 7\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants\u0026rsquo; mean (M) age at wave 7 was 87.41 (Standard Deviation, SD\u0026thinsp;=\u0026thinsp;3.67; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among participants 59.77% were women. Among participants 9.2% never married; 41.4% were married de facto; 0.6% were separated; 10% were divorced; and 39.1% were widowed. All participants were retired. Before retirement, 13.9% worked as manager admin; 38.7% as professional; 6.9% as associate professional; 2.9% as tradesperson; 11.6% as advanced clerical service; 16.8% as intermediate clerical sales service; 0.6% as intermediate products transport; 4.6% as elementary clerical/sales service; 0.6% as labourers and related; and 3.5% did howe duties. Almost all participants were Caucasian (98.9%). On average participants had between two and tree health conditions each. Mean score on life satisfaction was 55.72 (SD\u0026thinsp;=\u0026thinsp;15.28) on a range from 0 to 100. Informant-rated disability mean score was 22.99 (SD\u0026thinsp;=\u0026thinsp;8.04), meaning that on average participants had low disability. On average participants reported few depressive symptoms (M\u0026thinsp;=\u0026thinsp;2.87; SD\u0026thinsp;=\u0026thinsp;2.37). However, depressive symptoms increased of -1.34 (SD\u0026thinsp;=\u0026thinsp;2.17) over the 12-year study period. In sum the study sample comprised almost entrirely White and retired very old individuals from the Sydney area with two to three health conditions each.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistics for the Study Sample at 12-Year Follow-up\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStatistics\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, M (SD; Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87.41 (3.67; 83\u0026ndash;97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104 (59.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (40.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (9.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried de facto\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (41.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (39.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain occupation when working, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManager admin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (13.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (38.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociate professional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (6.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTradesperson\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvanced clerical service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (11.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate clerical sales service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (16.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate prod transport\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary clerical, sales service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (4.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLabourers and related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHome duties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaucasian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e172 (98.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of health conditions, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressive symptoms, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.87 (2.37)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttitudes to aging/Self-perceptions of aging, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.05 (8.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLife satisfaction, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.72 (15.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformant-rated disability, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.99 (8.04)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNotes.\u003c/b\u003e Study sample of 174 individuals.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAssociations Between 12-Year Change in Depressive Symptoms and Self-Perceptions of Aging, Life Satisfaction, And Disability\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBoth in the unadjusted and in the adjusted (for age, sex, marital status, occupation before retirement, and number of health conditions) regression models, greater increase in depressive symptoms over 12 years was related to more negative SPAs (adjusted beta, B\u0026thinsp;=\u0026thinsp;+\u0026thinsp;1.54; 95% CI: +0.97, +\u0026thinsp;2.10; R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;16%; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This association was of moderate size (standardised beta of +\u0026thinsp;0.41). Both in the unadjusted and in the adjusted regression models, greater increase in depressive symptoms over 12 years was associated with lower life satisfaction (adjusted beta, B\u0026thinsp;=\u0026thinsp;+\u0026thinsp;1.51; 95% CI: +0.76, +\u0026thinsp;2.26; R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9%). This association was of small-to-moderate size (standardised beta of +\u0026thinsp;0.30). Both in the unadjusted and in the adjusted regression models, greater increase in depressive symptoms over 12 years was associated with greater informant-rated disability (adjusted beta, B= -1.41; 95% CI: -1.93, -0.89; R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;14%). This association was of moderate size (standardised beta of -0.38).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociations of 12-Year Change in Depressive Symptoms With Follow-up Self-Perceptions of Aging, Life Satisfaction, and Informant-Rated Disability\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eAssociation of 12-Year Change in Depressive Symptoms With Follow-up Self-Perceptions of Aging\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eUnadjusted models\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eAdjusted models\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB (95% CI); \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB (95% CI); \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e+\u0026thinsp;1.48 (+\u0026thinsp;0.92; +2.03); \u0026lt;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e+\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.54 (+\u0026thinsp;0.97; +2.10); p\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u0026thinsp;0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssociation of 12-Year Change in Depressive Symptoms With Follow-up Life Satisfaction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB (95% CI); \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB (95% CI); \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e+\u0026thinsp;1.53 (+\u0026thinsp;0.78; +2.28); \u0026lt;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e+\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.51 (+\u0026thinsp;0.76; +2.26); p\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssociation of 12-Year Change in Depressive Symptoms With Follow-up Informant-Rated Disability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB (95% CI); \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB (95% CI); \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e-1.36 (-1.91; -0.82); \u0026lt;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.41 (-1.93; -0.89); \u0026lt;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNotes.\u003c/b\u003e Adjusted models were adjusted for age, sex, marital status, occupation before retirement, and number of health conditions. Analyses are based on linear regression models. B\u0026thinsp;=\u0026thinsp;Unstandardized beta. \u0026szlig;= Standardized regression coefficient. R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;Coefficient of Determination.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelf-Perceptions of Aging as a Partial Mediator in the Associations of Depressive Symptoms with Life Satisfaction and Disability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUsing structural equation modelling, after having adjusted for age, sex, marital status, occupation before retirement, and number of health conditions we found that SPAs, partially mediated the association of 12-year change in depressive symptoms with life satisfaction at follow-up (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). More specifically, greater 12-year increase in depressive symptoms was significantly associated with lower life satisfaction at follow-up (\u0026szlig;= +0.20; 95% CI: +0.05, +\u0026thinsp;0.35). Greater 12-year increase in depressive symptoms was significantly associated with more positive SPAs at follow-up (\u0026szlig;= +0.41; 95% CI: +0.28, +\u0026thinsp;0.54). More negative SPAs at follow-up, in turn, were significantly associated with poorer life satisfaction at follow-up (\u0026szlig;= +0.26; 95% CI: +0.11, +\u0026thinsp;0.41).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSimilarly, using structural equation modelling and after having adjusted for age, sex, marital status, occupation before retirement, and number of health conditions we found that SPAs, partially mediated the association of 12-year change in depressive symptoms with informant-rated disability at follow-up (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). More specifically, greater 12-year increase in depressive symptoms was significantly associated with greater informant-rated disability at follow-up (\u0026szlig;= -0.29; 95% CI: -0.43, -0.15). Greater 12-year increase in depressive symptoms was significantly associated with more negative SPAs at follow-up (\u0026szlig;= 0.42; 95% CI: 0.30, 0.55). More negative SPAs at follow-up, in turn, were significantly associated with greater informant-reported disability at follow-up (\u0026szlig;= -0.23; 95% CI: -0.37, -0.09).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study of very old Australians is among the few that have investigated the associations of 12-year change in depressive symptoms with follow-up scores on SPAs, life satisfaction, and informant-rated disability. As hypothesized, the study found that on average participants\u0026rsquo; depressive symptoms increased over 12 years, and greater 12-year increase in participants\u0026rsquo; depressive symptoms was associated with more negative SPAs, poorer life satisfaction, and greater disability. Also, as hypothesized, more negative SPAs partially mediated the associations of greater 12-year change in depressive symptoms with poorer life satisfaction and greater disability.\u003c/p\u003e\u003cp\u003eSome of the patterns observed in this study are consistent with and enrich the limited previous evidence focusing on very old adults. First, the current study finding that over the 12-year study period very old individuals experienced a small increase in depressive symptoms builds up on the limited evidence suggesting that depressive symptoms increase in very old age (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Even though there can be great variability in the health state and life experiences of very old individuals, this finding may be due to the age-related health and life challenges individuals in very old age often experience (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). When interacting with very old individuals, general practictioners / family doctors should be particularly vigilant about the existence of depressive symptoms, and could perhaps verge their discussions with very old patients around the possible impact that objective physical symptoms and illnesses may have on patient\u0026rsquo;s mood and mental health.\u003c/p\u003e\u003cp\u003eSecond, the finding that 12-year increase in depressive symptoms is associated with more negative SPAs at follow-up is aligned with existing UK and German evidence finding that a greater increase in depressive symptoms is associated with more negative SPAs (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). This finding is also in support of SPAs theories such as the Awareness of Aging theory that postulates that lifetime and current mental health shape SPAs (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). While most evidence has so far showed that SPAs have an effect of future mental health (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), our study suggests that mental health may also have an effect on SPAs. There are several reasons that may explain why individuals experiencing more depressive symptoms report more negative SPAs. Even though depressive symptoms in old and very old age can be triggered and exacerbated by illnesses and age-related challenges, depressive symptoms, in turn, can lead to poorer physical and cognitive health and decreased social engagement (\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). All these factors generally make individuals more susceptible to negative SPAs (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). More negative SPAs reported by very old individuals experiencing more depressive symptoms may also be due to individuals with low mood having the tendency to focus on and ruminate over negative changes (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). At clinical level, helping very old adults to acknowledge age-related losses and challenges, without remaining fixated on them, may help promoting more positive SPAs and, consequently, mainatance of greater quality of life in very old age (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThird, the current study finding that greater 12-year increase in participants\u0026rsquo; depressive symptoms is also associated with lower follow-up scores on life satisfaction is aligned with existing evidence (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e); further highlighting the negative impact of depressive symptoms into very old people\u0026rsquo;s experience of their overall life. The importance of reframing how people with depressive symptoms perceive and evaluate their own lives has been widely discussed and researched in the field of Cognitive Behavioral Therapy (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFourth and finally, our result that 12-year increase in depressive symptoms is associated with greater disability in very old age is consistent with and broadens the little available existing evidence reporting associations between more negative SPAs and greater disability (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and mortality risk (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) among very old individuals. Indeed, research on the associations of SPAs with functioning outcomes, such as disability, in very old adults is scarce in the SPAs literature (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). These results highligh one more time the urgence of detecting and treating depressive symptoms in very old age (due to their likely impact on peoples\u0026rsquo; functioning) rather than assuming they are a normal part of growing older.\u003c/p\u003e\u003cp\u003eA novel finding of this study is that follow-up scores for SPAs partially mediated the associations of 12-year change in depressive symptoms with follow-up scores for life satisfaction and disability. In other words, increased depressive symptoms over 12 years were related to more negative SPAs at follow-up and these, in turn, were related to poorer life satisfaction and greater disability at follow-up. Previous studies have related more negative SPAs to poorer life satisfaction (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) and indicators of greater disability (\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Moreover, SPAs have previously been related to components of disability (e.g., perception of one\u0026rsquo;s overall health, ability to learn new tasks and concentrate) (\u003cspan additionalcitationids=\"CR62 CR63\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). However, SPAs was never investigated as mediator in the association of change in depressive symptoms with life satisfaction and disability. Although SPAs, depressive symptoms, and disability were all assessed at follow-up, this study provides some initial insight into the mechanisms with whom depressive symptoms may lead to poorer life satisfaction and greater disability in very old age. This pattern of results also provides some initial empirical support for Diehl, Wahl (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) theoretical model of Awareness of Aging where SPAs is considered a mediating variable in the associations of health indicators, including mental health, and developmental outcomes including disability.\u003c/p\u003e\u003cp\u003eCurrent strategies and interventions (at clinical and public health level) used to decrease depressive symptoms in old and very old age may benefit from the inclusion of a component decreasing negative SPAs and promoting more positive SPAs, as a change in individuals\u0026rsquo; SPAs may limit the negative consequences of age-related depressive symptoms on life satisfaction and disability. In the past few years several interventions targeting SPAs have been developed and showed effective to promote positive SPAs, better mood, and even engagement in behaviors such as physical activity which, over time, can further reinforce positive SPAs and better mood (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). Moreover, interventions targeting SPAs have been showed feasible even in samples of very old and frail individuals (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). A limitation of existing interventions is that so far they have been delivered in person, but to increase their scalability and reachability to a wider group of older people, there is the need of develping intevrentions that target SPAs and that can also be easily delivered in online settings. Overall, given the rapid increase in the number of individuals who will reach very old age and experience some sort of depressive symptoms, SPAs may be an important novel modifiable risk factor for low life satisfaction and disability that should be further investigated and considered when addressing the challenges that very old age can bring with biopsychological lenses (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study has several strengths including the 12-year length of the follow-up which potentially allowed to detect long-term significant changes in participants' depressive symptoms and for most participants during the passage from early old age to very old age. Another strength of this study is the focus on very old individuals as this is an age group where changes in depression and correlates of SPAs have been less studied compared to younger age groups. Even though study analyses were based on an overall score for AAQ, a strength of this study is that we used a multidimensional measure of AAQ (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e) assessing/capturing both positive and negative perceptions of aging in different aspects of people\u0026rsquo;s lives such as physical and social losses and ongoing personal development.\u003c/p\u003e\u003cp\u003eThis study has however several limitations too. First, assessment of SPAs occurred only at follow-up which mean that the mediating factor (SPAs) was assessed at the same point as the outcomes (i.e., life satisfaction and informant-rated disability). Hence, based on the current study results we cannot infer causality from depressive symptoms to SPAs. Future studies should therefore replicate these analyses with assessment of SPAs and life satisfaction and disability at different timepoints using data from three timepoints. Still the assessment of SPAs at follow-up rather than at baseline made it possible to detect its relationship with change in depressive symptoms, using two different assessment points. Second, as most studies conducted using cohort data the study sample was entirely Caucasian; hence generalizability of study results to individuals with other ethnical backgrounds should be done with caution. Because of this, study results were interpreted/commented in relation to evidence coming from other mostly White samples. Third, this study made use of data for very old individuals from a longitudinal study that had been ongoing for 12 years; hence the study sample may have comprised a selective group of healthier individuals who stayed in the study from wave one to wave seven. Hence, it is possible that only those healthier and therefore likely to experience a lower increase in depressive symptoms, more positive experiences of aging, greater life satisfaction, and less disability remained in the study sample at 12-year follow-up. As a consequence of this, the associations and pathways that we have detected in the current study sample may be even larger in cohort of less healthy odler adults.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo conclude, using 12-year data for a sample of very old individuals at follow-up this study found that depressive symptoms on average increase from early old age to very old age, and a greater increase in depressive symptoms is associated with more negative personal evaluations of one\u0026rsquo;s aging, poorer life satisfaction, and greater informant-rated disability. Importantly, this study found for the first time that more negative personal evaluations of one\u0026rsquo;s aging partially mediated the associations of greater 12-year decline in depressive symptoms with poorer life satisfaction and greater disability. Targeting SPAs through existing psychoeducational interventions that make use of cognitive behavioral strategies (such as 68) and/or behavioral interventions (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e) aimed at very old and frail individuals may help limit the negative consequence of depressive symptoms in very old age.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPAs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSelf-Perceptions of Aging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMemory and Ageing Study\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMild Cognitive Impairment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAAQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAttitudes to Aging Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHODAS-II\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization Disability Assessment Schedule 2.0\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSEM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStructural Equation Modelling\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted Beta\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Intervals\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCoefficient of Determination\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026szlig;\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandardized Beta\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe terms of consent for research participation stipulate that an individual\u0026apos;s data can only be shared outside of the MAS investigators group if the group has reviewed and approved the proposed secondary use of the data. This consent applies regardless of whether data have been de‐identified. Access is mediated via a standardized request process managed by the CHeBA Research Bank, who can be contacted at [email protected], or via the corresponding author at [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have reviewed and edited the output and take full responsibility for the content of this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Sydney Memory and Ageing Study was funded by three National Health \u0026amp; Medical Research Council (NHMRC) of Australia Program Grants (ID350833, ID568969, and APP1093083; https://www.nhmrc.gov.au/funding).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: S.S. and K.N.\u003c/p\u003e\n\u003cp\u003eMethodology: S.S. and K.N.\u003c/p\u003e\n\u003cp\u003eFormal analysis: S.S.\u003c/p\u003e\n\u003cp\u003eWriting\u0026mdash;original draft preparation: S.S.\u003c/p\u003e\n\u003cp\u003eWriting\u0026mdash;review and editing: K.N., N.K., P.S.S, and H.B.\u003c/p\u003e\n\u003cp\u003eFunding acquisition: P.S.S and H.B.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMAS received institutional approval by the Human Research Ethics Committee of the University of New South Wales (project no. HC190962) and the current study analyses were approved by the same committee on date 20-02-2023. The study was approved in accordance with the National Statement on Ethical Conduct in Human Research (2007) and the Declaration of Helsinki. Informed written consent were obtained from all participants prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn MAS informed consent was obtained from all subjects involved in the study. In MAS written informed consent was obtained from participants to publish papers using MAS data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH. B. has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP. S. has been on the expert advisory panels for Biogen and Roche Australia in 2020-21.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Ageing and health 2024 [Available from: www.who.int/news-room/fact-sheets/detail/ageing-and-health.\u003c/li\u003e\n\u003cli\u003eAgeUK. Briefing: Health and Care of Older People in England 2019. 2019.\u003c/li\u003e\n\u003cli\u003eHe W. An aging world: 2015. 2016.\u003c/li\u003e\n\u003cli\u003eBaltes PB. Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Developmental Psychology. 1987;23(5):611-26.\u003c/li\u003e\n\u003cli\u003eKaspar R, Wahl H-W, Diehl MK, Zank S. Subjective views of aging in very old age: Predictors of 2-year change in gains and losses. 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Journal of Aging and Physical Activity. 2017;25(3):402-11.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Subjective aging, attitudes to aging, views on one’s aging, depression, mood, satisfaction with life, functional abilities, daily functioning, very old age","lastPublishedDoi":"10.21203/rs.3.rs-6890364/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6890364/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study estimates the associations of 12-year change in depressive symptoms with follow-up Self-Perceptions of Aging (SPAs), life satisfaction, and disability; and tests whether SPAs mediate the associations of change in depressive symptoms with follow-up life satisfaction and disability.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eParticipants were 174 Australian older adults (Mean age\u0026thinsp;=\u0026thinsp;87.41). Measures used were the Geriatric Depression Scale; the informant-rated World Health Organisation Disability Assessment Schedule; the Diener Satisfaction with Life Scale; and the Laidlaw\u0026rsquo; Attitudes to Aging Questionnaire (assessing SPAs).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn adjusted linear regression models, greater 12-year increase in depressive symptoms was associated with more negative SPAs (β= +0.41; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), lower life satisfaction (β= +0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and greater disability (β= +0.26; p\u0026thinsp;=\u0026thinsp;.001). In structural equation models, SPAs partially mediated the association of change in depressive symptoms with follow-up life satisfaction and disability.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eNegative SPAs may be one of the reasons why depression in very old age contributes to lower life satisfaction and disability. Hence, strategies aiming to decrease negative SPAs, such as psychoeducational interventions, could help preventing depressive symptoms in very old age.\u003c/p\u003e","manuscriptTitle":"Self-Perceptions of Aging Mediate the Associations of 12-Year Change in Depressive Symptoms With Life Satisfaction and Disability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-28 11:06:17","doi":"10.21203/rs.3.rs-6890364/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d71cf93-5e5d-4750-bb1f-3d1dfc3d1115","owner":[],"postedDate":"July 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T09:41:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-28 11:06:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6890364","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6890364","identity":"rs-6890364","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}