Depression, Disability & Coping in Midlife

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DESCRIPTION (provided by applicant): NIH R03 (PA-03-108). The primary goal of the proposed research is to better understand the implications and consequences of a chronic disability in middle adulthood. Vision impairment is the second most prevalent disability among middle-aged and older adults (NCHS, 1993), affecting 9.3 million Americans between the ages of 45 and 64 (The Lighthouse, Inc., 1995). Although little is known about how middle-aged adults deal with such a disability, recent evidence from a prior study conducted by the principal investigator (NIMH 1 R03 MH65382, K. Boerner, PI) shows that the risk for subsequent mental health problems such as clinically relevant levels of depression tends to be higher for middle-aged compared to older adults (Boerner, 2004). Also, the disability is likely to interfere with the pursuit of goals common during this point of adult life, which can result in a significant interruption of daily routines and emotional distress (Wheeler & Munz, 1990). Research addressing the process of adaptation over the life span has shown that, in the case of loss and decline, adaptive coping approaches involve the ability to adjust one's goals and preferences to what is feasible instead of trying to pursue blocked goals (e.g., Brandtstadter, 1999). Prior work by the PI demonstrated that such coping tendencies were particularly beneficial for the mental health of middle-aged adults who reported high levels of vision-related disability (Boerner, 2004). There is also preliminary evidence from a study of vision loss among older adults suggesting that a person's concrete day-to-day coping with goal interference should be assessed in addition to dispositional coping tendencies (Horowitz et al, 2005). Thus, the proposed research seeks to characterize the situation of a thus far understudied group, middle-aged adults with visual impairment, by assessing their important life goals, the extent to which their disability interferes with these goals, and how they cope with this goal interference. Specific aims are: 1.To identify the life goals that are important to middle-aged adults with a visual impairment. 2. To explore the extent to which visual impairment and functional disability interfere with particular life goals, and how individuals with visual impairment deal with this interference. 3. To examine the effect of vision-related goal interference on mental health, as mediated by both general coping tendencies as well as situation-specific coping. 4. To explore the links between general coping tendencies and situation-specific coping, as well as the differential effects of dispositional and situational coping on mental health. 200 middle-aged adults will be recruited from a community-based vision rehabilitation agency. Structural Equation Modeling (SEM) will be employed to test the direct and indirect effects of impairment status, goal interference, and coping on mental health outcome.