By: Nikki Nies 
Yesterday, I had the pleasure to present my Master’s in Nutrition and Wellness thesis presentation with my fellow colleagues! With the generous help and mentoring from Dr. Bonnie Beezhold, we successfully presented on the Associations with stress: A cross-sectional comparison of wellness in older adults. My main focus on the study was health and lifestyle factors’ affect on depressive symptoms of the two sites: vowed religious community and independent retirement community.
Background: In the U.S., we have an aging population; the U.S. Census Bureau projects that by 2050, 20% of the U.S. population will be over the age of 65. According to the American Psychological Association, older adults are likely to report less stress than younger generations, but still report stress levels higher than what they think of as a healthy range. In older adults, increased stressful life events can lead to an increase in depressive symptoms.
Many lifestyle factors, including diet, can impact our mood and stress levels. Older adults do not meet dietary guidelines for their age, they often eat less fruits, vegetables and whole grains, and more total fat and saturated fat than recommended. Poor dietary choices in the elderly can have negative outcomes on physical and mental health. Aging is also associated with increasing BMI and body fat which are related to increased blood pressure, blood glucose and lipids.
We were given an opportunity through our contact with Father David to work with the Benedictine Monks at St. Procopius Abbey, the institution that founded our university. This is a group of older men who live in a cohesive community based in religious values. This opportunity made us curious about the impact of living environment on stress and other health and lifestyle factors, and so our research question was shaped by this population. Past literature indicated that a religious community can positively impact wellness, a 32 year follow up study of 144 nuns and 138 laypersons in Italy found that those living in a religious community had a more stable blood pressures, a common measure of stress, throughout the study compared to the control group. Another study, in the Netherlands focused on the relationship between a Monastic lifestyle and mortality. In the 1,523 Benedictine and Trappist Monks, the religious lifestyle was associated with longer life expectancy. Based on the previous literature, we hypothesized that older adults living in a vowed religious community would have less stress and healthier dimensions of mental and physical wellness than those living in a retirement community.
Major Results: When analyzing the data, we found that the distribution of the data was not normal therefore we used nonparamtetric tests to assess the data. The sample consisted of 67 independent older adults aged 65 years and older. Of whom, 52% were in the vowed religious community and 48% were living in the independent retirement community. 39% of our sample were men and 61% of our sample were women. 75% of our sample was white. Activity hours or hours spent related to paid work or volunteer hours was significantly different by group with a large effect size. The vowed religious community spent significantly more time in work-related activity than compared to the independent retirement community. Additionally, we hypothesized that the vowed religious community would have higher scores on the spirituality and well-being scale. Interestingly, no significant differences were observed by group. There was also no significant associations found with the social support scale.
Depression: 5.5% of older Americans have been diagnosed with depression. The DSM-V provides standard criteria for the classification of mental disorders. In addition, past literature repeatedly finds women report more depression than men. Symptoms include low mood, physical symptoms and evidence of chronic diseases. The consequences can be costly and serious. A quote that characterizes this condition well states, “…everyone feels blue sometimes, but depression is sadness that persists and interferes with daily life.”
We used the Geriatric Depression Scale 15 questionnaire (GDS-15) as it’s been identified as appropriate to use with older adults to successfully diagnose depression, but has high reliability and validity. The fifteen questions are scored based on a point system, with a higher GDS score indicative of depression. 7.6% of our participants reported depression, which was higher than the overall reported depression for older adults in America at 5.5%.
Based on review of literature, we wanted to investigate whether reported depressive symptoms differed between the two major living sites. Our hypothesis was that older adults living in a vowed religious environment would report less depression. We conducted a Mann-Whitney U test and found there was a significant difference between the living groups, with the vowed religious group reported a higher mean depression score than the community group, indicating they were more depressed. The null hypothesis was rejected. Since research shows that depression differs by gender, we conducted another test by gender, but there was NO difference in depression scores when we compared males and females in the whole sample (p=.297).
We went on to investigate relationships between depressive symptoms and health and lifestyle factors since there is a lot of research showing depression is multifactorial. We conducted Pearson’s correlations with higher GDS scores and the significant correlations are shown here. Depression scores were associated with associated with higher perceived stress, and negatively associated with social support, indicating that as stress increased, depression increased, and as social support decreased, depression increased. Depression scores were also associated with living in the vowed religious community. The alternative hypothesis was accepted. Again, depression is usually associated with gender, but in this population it was not.
Since these factors were significantly related to the GDS scores, we conducted a multiple linear regression to investigate how much of the variance in depression scores we observed between living groups. We entered perceived stress, social support, and living environment into the regression model, and found that 21% of the variance in depression scores between the two living groups was explained. Perceived stress makes the strongest unique contribution, and is the only statistically significant contribution to depression scores when gender and social support are controlled for. Perceived stress uniquely explained 8% of the total variance in depression scores in our population. The alternative hypothesis was accepted.
So coming back to our result of the vowed religious group reporting significantly more depression based on what we measured, we ran correlations with depression scores in the vowed religious group alone, and found that as stress and trans fat intake increased, depressive symptoms increased. Furthermore, those that consume a large amount of trans fats have been found to have a 48% risk of depression due to the low grade inflammatory status and endothelial dysfunction (Villegas et al., 2011).
These results show a linear relationship between these variables and we cannot draw causal conclusions. Therefore, my null hypothesis was rejected.
Our study was the first to compare levels of depression in different cohesive environments in older adults, surprisingly, our vowed religious participants reported more depression than those living in a retirement community. We obviously did not measure all factors related to development of depression, but did find stress was a contributor. For example, in study led by Fagundes et al. they evaluated relationships between depressive symptoms and stress-induced inflammation. Of the 138 participants, the more depressive symptoms produced more interleukin-6 in response to the stressor.
Another study led by Aziz et al., 2013 looked at how perceived stress, social support and home based physical activity affect older adults’ fatigue, loneliness and depression on 163 participants. The findings indicated higher social support predicted lower levels of loneliness, fatigue and depression.
Conclusions: Our results suggest that the vowed religious community had a lower level of wellness than the independent retirement community. They consumed more sweets, drank less alcohol, reported more depression & had higher body fat & heart rates. Spirituality was similar in both environments, and that factor was the biggest predictor of lower stress. Dietary practices may also be related to lower stress, such as eating less sweets, getting more vitamin D and drinking responsibly.
While there is still work to be done on the manuscript, it was a great relief to get this portion of the thesis complete! We want to thank all the participants, the Benedictine Nutrition department and Dr. Bonnie Beezhold for their extensive involvement!
Photo Credit: Highland Hospital and Fairfield County
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