Relationships among coping, loneliness, and depression in Chinese older patients with major depressive disorder: a case-control study.

Abstract

Objectives: To investigate the relationships among loneliness, maladaptive coping, and depressive symptoms in Chinese older patients with major depressive disorder (MDD), and to compare differences in loneliness and coping between Chinese older individuals with and without depression.

Methods: Chinese patients aged ≥60 years who were diagnosed with MDD were approached in a randomised sequence during follow-up appointments at psychiatric outpatient clinics. Attendees of general outpatient clinics and elderly community centres matched for age, sex, and education level were recruited by convenience sampling as controls. Both groups completed a questionnaire that included the six-item De Jong Gierveld Loneliness Scale, the Brief Coping Orientation to Problem Experiences Inventory, the Social Readjustment Rating Scale, the Hamilton Depression Rating Scale, the Hong Kong version of the Montreal Cognitive Assessment, the Cumulative Illness Rating Scale-Geriatric, and the Lawton Instrumental Activities of Daily Living scale. Hierarchical multiple linear regression was performed to examine relationships among coping, loneliness, and depressive symptoms, followed by correlation and mediation analyses.

Results: In total, 100 cases and 100 matched controls were included in the analysis. Cases reported significantly greater overall, emotional, and social loneliness relative to controls. Among patients with MDD, emotional loneliness and avoidant coping were associated with depressive symptoms. Among controls, only emotional loneliness was associated with depressive symptoms. Among all participants, avoidant coping partially mediated the relationship between emotional loneliness and depressive symptoms. Depressive symptoms were positively correlated with overall, emotional, and social loneliness, and avoidant coping and negatively correlated with problem-focused coping.

Conclusion: Loneliness and coping should be considered in comprehensive clinical assessments, psychiatric formulations, and individualised treatment plans for older patients with MDD. Targeted interventions addressing emotional loneliness and maladaptive coping strategies are warranted in MDD management.