At the edge of existence: Unravelling the associations between existential suffering, disconnection and geriatric depression in nursing home residents

Alarming high prevalence rates of depression are reported among nursing home residents (NHRs) (4% to 25% for major depression) which is twice as high as for community-dwelling older adults. Etiological factors for late life depression often reflect reasons for a nursing home (NH) transition (e.g., physical disability, functional impairment) but these factors do not fully explain the elevated prevalence of depressive symptoms. Simultaneously with reports of high depressive burden are reports of NHRs struggling with existential concerns. In contrast with the reports on depressed symptomatology, these reports have received little attention in gerontological literature. Another concept that is sporadically mentioned throughout geriatric and existential literature is the concept of disconnection, an experience that can be manifested across different dimensions such as the self, body, others, time and place. However, to our knowledge, no research has yet focused on these different disconnection dimensions among NHRs. Given the current insufficient understanding of the etiological factors of depressive symptoms in NHRs on one hand, and the lack of research attention for existential suffering and disconnection experiences on the other hand, this PhD project aims to unravel how these experiences are related to each other over time in in this population.

More specifically, this PhD project has two main research objectives: first, we strive to clarify how existential suffering and depressive symptoms are related over time and whether existential suffering might be a vulnerability factor in the development of depressive symptoms among NHRs. Second, we will investigate how different disconnection dimensions (self, body, others, time and space) are related to these experiences of existential suffering and depressive symptoms. This knowledge will provide insights for intervention and prevention strategies in NH-settings, since it will clarify the temporal order among  existential struggles, disconnection experiences and depressive symptoms or reveals the bidirectionality.

These main research objectives will be addressed by using a longitudinal quantitative study design. This longitudinal quantitative study consists of three measurement waves in which NHRs are interviewed (with a yearly interval) using structured questionnaires. These questionnaires target depressive symptoms, meaning in life, existential loneliness and disconnection from the self, body, others, time and space. The first (n = 242) and second (n = 174) waves have been completed. This study will be supplemented by 1) a scoping review to explore more in depth how meaning in life in older adults is conceptualised in the existing literature and 2) a cross-sectional quantitative study to explore whether NH-caregivers and NHRs have divergent views on the experience of existential suffering versus depressive symptoms.