Loneliness, Self-Efficacy and Adaptive Coping: Mixed Methods Analysis of Mediation in a Peer Support Intervention for Depression

Abstract

Objective

We assessed social connection, self-efficacy, and coping as mediators in a peer support intervention for depressed low-income and minoritized older adults.

Methods

Convergent mixed methods analysis of data collected in an RCT with at-risk older adults (N = 149) comparing the effectiveness of PEERS, an 8-week peer support, self-care intervention on depression to telephone calls providing social interaction for the control group. Assessments occurred at baseline, postintervention, and every 3 months up to 12 months. Mediation effects of loneliness, self-efficacy, and coping were analyzed using longitudinal mixed effects modeling after z-score standardization, complemented by semi-structured interviews. We report results in regression coefficients, i.e. in standard deviation units.

Results

Loneliness had an indirect effect on depression in both intervention (−0.32 [95% CI: −0.48, −0.19]) and control groups (−0.16 [95% CI: −0.27, −0.04]). Self-efficacy had an indirect effect of −0.17 (95% CI: [−0.24, −0.05]) at postintervention and −0.20 (95% CI: [−0.30, −0.08]) at 12 months for the PEERS group. Adaptive coping had an indirect effect with −0.15 (95% CI: [−0.26, −0.06]) at postintervention and −0.15 (95% CI: [−0.32, −0.04]) at 12 months for the PEERS group, No evidence of mediation for self efficacy nor coping was found for the control group. Qualitative results indicated reduced loneliness, improved coping and behavior change among intervention participants. Control group participants reported social support from telephone calls but did not mention improved self-efficacy and coping skills.

Conclusions

Social engagement and peer support intervention have a common pathway, e.g. alleviation of loneliness in reducing depression, but the PEERS intervention can also decrease depression by improving self-efficacy and adaptive coping.