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‘Does it matter how old I feel?’ The role of subjective age in a psychosocial intervention for improving depressive symptomatology among older adults in Brazil (PROACTIVE)

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posted on 2024-05-14, 13:25 authored by M. Clara de Paula Couto, Klaus Rothermund, Carina A. Nakamura, Nadine Seward, Pepijn van de VenPepijn van de Ven, William Hollingworth, Tim J. Peters, Ricardo Araya, Marcia Scazufca

Objectives: Depression is a prevalent mental health condition that also often affects older adults. The PROACTIVE psychosocial intervention was developed to reduce depressive symptomatology among older adults within primary care settings in Brazil. An important psychological marker that affects individuals’ aging experience relates to how old people feel. Known as subjective age, this marker has been shown to be a risk factor for experiencing greater depressive symptoms if individuals report feeling older than their (chronological) age. In this study, we perform secondary analyses of the PROACTIVE cluster-randomized controlled trial to examine the role of subjective age.

Method: The sample included 715 Brazilian older adults (74% female, Mage 68.6, SD = 6.9, age range: 60–94 years) randomized to intervention (n = 360, 74% female, Mage 68.4, SD = 6.6, age range: 60–89 years) or control (n = 355, 74% female, Mage 68.9, SD = 7.2, age range: 60–94 years) arms. Here our primary outcome was depressive symptoms at the 8-month follow-up assessed with the 9-item Patient Health Questionnaire (PHQ-9) as a continuous variable. Our previous analyses demonstrated improved recovery from depression at follow-up in the intervention compared with the control arm.

Results: Relevant main effects and interactions in regression models for PHQ-9 presented here found that those reporting older subjective age had worse depressive symptoms at follow-up but that they benefitted more from the intervention when initial levels of depression were high. For participants who reported younger subjective ages the intervention showed positive effects that were independent of initial levels of depression.

Conclusion: Our findings emphasize the importance of investigating possible underlying mechanisms that can help clarify the impact of mental health interventions.


Cluster randomised controlled trial (RCT) for late life depression in socioeconomically deprived areas of São Paulo, Brazil (PROACTIVE)

Medical Research Council

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Aging & Mental Health, 2024


Routledge Taylor and Francis

Other Funding information

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. This study was funded by the São Paulo Research Foundation (process number 2017/50094–2) and the Joint Global Health Trials initiative, jointly funded by the Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome (process number MR/R006229/1). MS is supported by the CNPq-Brazil (307579/2019–0), and CAN is supported by the São Paulo Research Foundation (2018/19343–0 and 2022/05107–7). MCPC and KR are supported by the VolkswagenStiftung (Az. 93 272). Open Access funding enabled and organized by the ZBW (Forum13+) Agreement (Friedrich-Schiller-Universität Jena, Thüringer Universitäts- und Landesbibliothek

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