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Abstract

Effective, scalable mental health programs are greatly needed for older adults. In this study, Mood Lifters—a peer-led, community-based program promoting mental well-being—was adapted to more specifically address the needs of older adults. Two groups completed the 14-week program via Zoom. A total of 24 participants enrolled (M_age = 72 years), with 20 (83%) completing the program. Compared to baseline, program completers showed significant improvements in depression symptoms (p < .01), perceived stress (p = .04), sleep quality (p < .01), physical activity (p < .01), and brain health behaviors (p = .01), with improvements maintained at 1-month follow-up. No significant changes were reported in participants’ anxiety, loneliness, or resilience. Participant ratings of program satisfaction were very high (M = 4.75/5). Results suggest Mood Lifters for Seniors is feasible to disseminate and acceptable to older adults, with preliminary evidence of benefits in several mental health domains. Future randomized trials with larger, more diverse samples are needed to confirm program benefits.

Keywords

aging mental health psychosocial resilience

What This Paper Adds

• This paper describes the development and initial evaluation of a new, innovative community-based group psychoeducation program to promote mental health in later life.

• The intervention described in the paper represents a novel approach to enhancing mental wellness among older adults.

Applications of Study Findings

• Preliminary results suggest the program has promise as an effective approach that can be widely disseminated to address growing mental health service needs among older adults.

• If future studies with larger, more diverse populations show similar results, the program could be offered for wider use in community settings.

Introduction

Mental health problems are relatively common among older adults, with high rates of clinical depression, depressive symptoms, and anxiety (Haigh et al., 2018; Wolitzky-Taylor et al., 2010). Compared to other age groups, older adults are more likely to report sleep disturbances and social isolation (Cudjoe et al., 2020; McLay et al., 2021; Miner & Kryger, 2017), especially during the COVID-19 pandemic (Creese et al., 2021; Gerlach et al., 2021; Kotwal et al., 2021). In addition, mental health challenges often accompany the health problems and physical limitations associated with later life (Wilson-Genderson et al., 2017). Although older adults often possess wisdom and coping skills from their life experiences and demonstrate resilience in the face of adversity (MacLeod et al., 2016), many could benefit from help and support for a wide range of mental health challenges (Houtjes et al., 2010).

Although several evidence-based mental health interventions have been developed for older adults (Niclasen et al., 2019), the majority of those in need do not seek or receive treatment (Bor, 2015). Several factors contribute to this problem. First, mental health services are often expensive and/or not covered by Medicare or other insurance plans (Byers et al., 2012; Gunja et al., 2022). Second, mental health services are not easily accessible, particularly for those residing in low income or rural areas (Brenes et al., 2015). Finally, many older adults are not interested in traditional mental health services, often because they are not aware of the benefits, perceive help-seeking as potentially stigmatizing, or prefer other forms of support (e.g., via family, community, and religious groups; Nair et al., 2020).

Several strategies have been considered to expand the reach of mental health services designed to meet the specific needs of older adults. Group programs may be cost-effective (compared to individual sessions with professionals) and especially appropriate because they also offer peer support (Thombs & Carboni-Jiménez, 2021). Service delivery by paraprofessionals in community-based settings may be especially appealing to older adults, for whom stigma of mental health care may be a deterrent to help-seeking, particularly among members of racial and ethnic minority groups (Conner et al., 2010).

Although designed for a general adult population, Mood Lifters is one program that has combined these approaches to address common barriers to mental health care and to improve mental health among its participants. It is an evidence-based, manualized psychoeducation program that can be delivered by trained peers either in person or online. Participants attend 15 weekly, 1-hour meetings led by a paraprofessional who has previously completed the program and leadership training. Meetings focus on biopsychosocial topics that have been shown to impact mood and quality of life (e.g., sleep, negative thoughts, and interpersonal relationships). Group leaders use a structured curriculum and program manual to cover these topics. Participants are encouraged in group meetings to ask questions and discuss barriers and facilitators to making progress. Between meetings, members practice skills taught in group sessions and track them through a point system (e.g., 30 minutes of aerobic exercise counts as one point). In the original trial of the program, participants reported statistically significant improvements in anxiety, and those who completed more points or homework also reported statistically significant reductions in depression and perceived stress (Votta & Deldin, 2022). In the current study, we describe our adaptation of the Mood Lifters program for older adults.

Methods

Program Development

Mood Lifters for Seniors was adapted from an existing mental wellness program developed by two study co-authors (PJD and CMV). The original Mood Lifters program was developed iteratively through reviews of best practices in behavior change, positive psychology, and clinical interventions (e.g., cognitive-behavioral therapy [CBT] and dialectical behavior therapy), along with several pilot groups and revisions that culminated in a randomized control trial (Votta & Deldin, 2022). The Mood Lifters program consists of 15 weekly, hour-long peer-led meetings, with a focus on peer support and accountability for at-home practice of skills learned during group meetings. In the meetings, trained layperson graduates of the program serve as group leaders and instruct participants on evidence-based, biopsychosocial approaches toward improved mental health.

The program covers a variety of topics in multiple domains: behavior (e.g., behavioral activation), body (e.g., exercise), mind (e.g., cognitive restructuring), mood (e.g., emotional regulation), sleep (e.g., sleep hygiene), and social (e.g., relationship repair). In between meetings, participants are encouraged to complete mentally healthy behaviors they learned in the group session. For each behavior they accomplish in between sessions, they earn one point. Participants are encouraged to engage in enough behaviors to reach a preset behavioral point goal that they determine for themselves. At the beginning of each meeting, participants check in individually with their group leaders and complete a brief questionnaire that measures their mood, thoughts, and behaviors. They also submit the “points” that were earned that prior week (i.e., skills practiced). This process continues cumulatively throughout the program, with participants learning and practicing the skills that impact them the most.

The development team for the Mood Lifters for Seniors (MLS) program consisted of an interdisciplinary group with expertise in mental health and aging. Team members included experts in clinical geropsychology, geriatric psychiatry, adult development and aging, health communication, and health behavior change. This team met weekly to develop the MLS curriculum and design a plan for program implementation and evaluation. We formed a Community Advisory Board that met monthly during the initial phase of the program to provide feedback on potential program revisions. Board members included older adults who had completed the original Mood Lifters program, as well as those with ties to community organizations (e.g., senior centers) that could disseminate the MLS program. We also drew on survey responses of prior Mood Lifters program participants over age 65 that indicated preferences for session topics, activities, and program format. Based on the feedback received, we revised the original program in the following ways:

• Extended the length of meetings from 60 to 75 minutes

• Shortened the program by 1 week

• Tailored existing modules to be more relevant to older adults

• Created new modules of special interest to older adults, including brain health, loss and transitions, physical changes, and purpose

• Combined several existing modules in order to allow time for new content

• Included new practice options

• Increased the number and variety of activities in each meeting

• Redesigned the visual appearance of the participant manual with input from a graphic designer; changes included adaptations for an older audience (e.g., larger font size, more spacing) and addition of diverse images of older adults

• Revised the facilitation guide for meeting leaders

• Provided tech-support as needed before and during Zoom sessions

In creating both new and revised material for the program manual, we applied principles of health education to make content clear to readers regardless of their health literacy level. For example, we used plain language instead of jargon, deleted unnecessary words and content, and highlighted important information with frequent use of tables, figures, and bulleted lists. After extensive review and revision by the development team, we tested the new modules (e.g., brain health, coping with physical changes) via role play with the Advisory Board to ensure that content was clear and relevant to the target audience and that material could be adequately covered in a 60 to 75 minute session. Table 1 provides a summary of each session’s content.

Table 1.

Mood Lifters for Seniors (MLS) Program Overview.

Meeting area	Topic	Main content	Sample practice options for strategy and skill development
1. Behavior	Engaging in positive activities	• Participant and facilitator introductions	1. Set general goals for MLS
		• MLS overview and procedures	2. Engage in pleasurable activities
		• Pleasurable and valuable activities	3. Engage in valuable activities
2. Behavior	Laying the foundation	• Thought, emotion, behavior cycle	1. Set SMART goals for MLS
		• Behaviors that facilitate change	2. Keep a thought or emotion log for a week
		• Goal setting and habit formation	3. Initiate a tiny habit
3. Body	Improving sleep	• General factors affecting sleep	1. Keep a sleep log
		• Internal clock, sleep cycles and sleep drive	2. Include a new sleep behavior
		• Strategies for improving sleep	3. Continue a positive sleep practice
4. Mind	Addressing thinking traps	• Automatic negative thoughts	1. Identify negative thoughts
		• Cognitive biases and ABCDE model	2. Challenge (dispute) a negative thought
		• Dispute and exchange strategies	3. Reframe or offer an exchange for a negative thought
5. Mood	Regulating negative emotions	• Managing negative emotions	1. Identify go-to emotion regulation strategy
		• Unhelpful strategies	2. Use radical acceptance to modify a negative emotion
		• Helpful emotion regulation strategies	3. Reframe a negative emotion or situation as positive
6. Social	Making social connections	• Isolation and loneliness	1. Take part in a social activity
		• Communication recommendations	2. Explore a new activity or educational experience
		• Ideas for connecting and contributing	3. Investigate volunteer opportunities
7. Mind	Solving problems	• Challenges, attitudes, and orientations	1. Complete a problem-solving plan
		• Problem-solving approaches	2. Implement your selected solution
		• Problem-solving plan	3. Evaluate the outcome of your problem-solving activity
8. Body	Living well with physical changes	• Physical changes with age	1. Apply ABDCE or W-PAGER to a physical challenge
		• Exercise and nutrition	2. Identify a physical change that’s a challenge and brainstorm strategies for adapting to it
		• Applying problem solving, ABCDE and W-PAGER	3. Make a positive eating or exercise change
9. Mood	Enhancing positive emotions	• Function and importance of positive emotions	1. Increase your engagement in positive experiences
		• Identifying positive emotions	2. Employ a new savoring strategy
		• Positive emotion enhancement strategies	3. Try mental time travel
10. Mood	Managing transitions and loss	• Transitions and Losses	1. Write a letter to a lost loved one
		• Aspects of grieving	2. Complete advance planning checklist
		• Resilience	3. Write about how you grew as a result of loss
11. Social	Repairing relationships	• Importance of repairing relationships	1. Plan (and deliver) an act of forgiveness
		• Apologizing and apologizing plan	2. Plan (and deliver) an apology
		• Forgiveness and forgiveness plan	3. Identify actions you could take to improve a relationship
12. Behavior	Sustaining brain health	• Cognitive decline and dementia	1. Initiate a new brain health activity
		• Reducing risk of cognitive decline	2. Support a friend who is a caregiver
		• Strategies for improving brain health	3. Schedule a brain health assessment for self or other
13. Mood	Enacting values and strengths	• Values	1. Engage in a value-related action
		• Character strengths	2. Use a character strength in a new way
		• Using values and strengths to achieve goals	3. Reflect on how your values and strengths have helped you
14. Behavior	Moving forward with purpose	• Life purpose	1. Create a life purpose statement
		• Purpose statement	2. Engage in a generative pursuit or activity
		• Wrap up and future goals	3. Set your goals for moving forward

Note. SMART = specific, measurable, attainable, relevant, and time-bound; ABCDE = activating event, beliefs, consequences, dispute, and exchange; W-PAGER = wisdom, positivity, acceptance, growth, engagement with life, and resilience.

Participants and Procedures

Eligible participants were community-dwelling, English-speaking adults aged 65 years and above who could participate in weekly group sessions held virtually. Participants provided written consent to participate in the study. Using brief validated measures, they were then screened for presence of neuropsychiatric symptoms and conditions (e.g., psychosis, cognitive impairment, and severe personality disorder) that might preclude meaningful involvement in, and/or prove disruptive to, group discussions (Brandt et al., 1988; Hirschfeld et al., 2000; Zanarini et al., 2003). We did not require a minimal level of depression or anxiety symptoms given that the Mood Lifters program is designed to benefit participants whether or not they are experiencing clinically significant mental health concerns. The primary referral source for study participants was a clinical research website hosted by Michigan Medicine. The study listing on this site generated considerable interest in the project such that recruitment goals were met in 2 weeks. All group sessions were held via Zoom, with participants receiving an orientation from study staff on how to use Zoom prior to the group’s first meeting. The first group took place from November 2020 to February 2021, while the second group ran from March to June 2021. Each group was facilitated by two group leaders.

Study Measures

Study measures included a set of validated questionnaires assessing psychological and behavioral outcomes administered via a Qualtrics online survey. Although most of these measures were used in the parent Mood Lifters program, we added others specific to an older adult population (e.g., depression and anxiety measures designed for a geriatric population). Data were collected at three timepoints: (1) within 2 weeks of the first group session; (2) within a week following the final group session; and (3) approximately 1 month after the second survey. Table 2 provides a summary of study measures and the timepoints at which they were administered):

Table 2.

Timing of Administration of Study Measures.

Variable	Time 1	Time 2	Time 3
Participant demographics	X
Program satisfaction		X
Psychological outcomes
Depression	X	X	X
Anxiety	X	X	X
Perceived stress	X	X	X
Emotion regulation	X	X	X
Loneliness	X	X	X
Resilience	X	X	X
Flourishing	X	X	X
Behavioral outcomes
Sleep	X	X	X
Physical activity	X	X	X
Brain health behaviors	X	X	X
Diet	X	X	X

Participant characteristics

Standard self-report survey items assessed participants’ demographic characteristics, including age, gender, race/ethnicity, and years of education.

Program satisfaction

Participants responded to a series of statements about the quality of the program and asked to appraise each statement (1 = completely false to 5 = completely true). In addition, participants rated their overall group experience on a 5-point scale (1 = poor to 5 = excellent). We also asked participants to rate various program features, including session and program content, length, and pace (e.g., “just right” vs. “too short” or “too long”) and the quality of the program manual (“not,” “somewhat,” or “very helpful/easy to understand”).

Depression

The short form (15 items) of the Geriatric Depression Scale (GDS) was used to measure symptoms of depression commonly experienced in older adults (Brown & Schinka, 2005). Scores range from 0 to 15, where 0 to 4 = normal, 5 to 8 = mild depression, 9 to 11 = moderate depression, and 12 to 15 = severe depression.

Anxiety

The short form of the Geriatric Anxiety Scale (GAS) was used to measure anxiety symptoms commonly experienced in older adults (Byrne & Pachana, 2011). Scores range from 0 to 30 where 1 to 6 = minimal anxiety, 7 to 9 = mild anxiety, 10 to 11 = moderate anxiety, and 12 to 30 = severe anxiety.

Perceived stress

The Perceived Stress Scale (PSS) was used to measure perception and degree of stress across life situations (Cohen et al., 1983). Scores range from 0 to 40, where 0 to 13 indicates low, 14 to 26 indicates moderate, and 27 to 40 indicates high perceived stress.

Emotional regulation

The Emotional Regulation Questionnaire (ERQ) was used to measure respondents’ tendency to regulate their emotions in two ways: (1) Cognitive Reappraisal and (2) Expressive Suppression (Gross & John, 2003). Scores range from 6 to 42 for the Cognitive Reappraisal subscale and from 4 to 28 for the Expressive Suppression subscale, with higher scores indicating greater use of this regulation style.

Loneliness

The UCLA Loneliness Scale was used to measure subjective feelings of loneliness and feelings of social isolation (Russell et al., 1978). Scores range from 0 to 60, with higher scores reflecting more feelings of loneliness.

Resilience

The Connor-Davidson Resilience Scale was used to measure aspects of resilience, including flexibility, self-efficacy, emotion regulation, and optimism (Campbell-Sills & Stein, 2007). Scores range from 0 to 40, with higher scores suggesting greater resilience.

Flourishing

This variable was assessed using a scale developed by Diener et al. (2010) to measure self-perceived success in areas such as relationships, self-esteem, purpose, and optimism. Scores range from 0 to 56, with higher scores representing greater psychological resources and strengths.

Sleep

The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality and patterns of sleep across multiple domains (e.g., sleep duration and efficiency; Buysse et al., 1989). Scores range from 0 to 21, with higher scores indicating worse sleep quality (a score of 5 or greater indicates a “poor” sleeper).

Physical activity

The Physical Activity Scale for the Elderly (PASE) was used to assess engagement in the types of activities typically chosen by older adults including walking, recreational activities, exercise, housework, and yard work (Washburn et al., 1993). The scale uses frequency, duration, and intensity of activity over the previous week to assign a score, ranging from 0 to 793, with higher scores indicating greater physical activity. Due to an error in web survey programming, this measure was not properly administered in our first group and so results are from second group participants only (n = 11).

Brain health behaviors

This variable was assessed using portions of a questionnaire from the Health and Retirement Study to assess frequency of engagement in activities related to improving and maintaining brain health (Smith et al., 2017). The measure included 10 items assessing cognitive activities (e.g., reading, word games) and 9 items assessing social engagement activities (e.g., volunteering, visiting with friends and family), with each activity rated on a 7-point scale (1 = never done to 7 = done daily). Scores range from 19 to 133, with higher scores indicating greater engagement in brain health activities.

Diet

A brief (eight item), validated dietary assessment was used to assess respondents’ eating habits (Paxton et al., 2011). Scores range from 0 to 16, with higher scores reflecting a less healthy diet.

Data Analyses

Descriptive statistics were used to characterize the study sample and its ratings of the MLS program. Descriptive statistics were also used to summarize survey responses, including mean scores on validated study measures. Paired t-tests assessed whether mean scores on key outcome variables differed across the study timepoints: baseline, immediate post-group, and 1-month follow-up.

Results

Program Completion

A total of 24 older adults enrolled in the program, with 12 in each group. Of these, 20 (83%) completed the 14-week program. Three of the four non-completers dropped out due to significant health concerns (e.g., diagnosis and treatment of a serious medical condition). Demographic characteristics of those who completed the program were as follows: M_age = 71.6 years (range: 66–80); 50% male, 50% female; 90% white; and 85% with a college degree. Demographic characteristics did not significantly differ between participants in the two groups.

Program Satisfaction

Participants rated the program highly, with a mean overall rating of 4.75 on a 5-point scale. Participants endorsed statements indicative of program strengths in terms of content, organization, and leadership, with each item having a mean of 4.1/5 or greater. The most highly endorsed items were “The facilitators cared about me as a person” (M = 4.9) and “The group was well organized” (M = 4.8), with the lowest rated item being “I learned what I was hoping to learn” (M = 4.1). A summary of survey responses in this domain is provided in Table 3. The vast majority of participants rated as “just right” the pace of group sessions (85%), the 75-minute length of sessions (90%), and overall program length of 14 weeks (75%). The vast majority of participants (19/20) found the program manual to be “somewhat” or “very helpful” and “somewhat” or “very easy to understand.”

Table 3.

Program Satisfaction Ratings (n = 20).

Survey item	M (SD)	Range
Overall rating of the group	4.75 (0.54)	3–5
Program content
The focus of the group was on the right issues	4.55 (0.74)	3–5
The information presented was easy to understand	4.30 (0.78)	2–5
I learned what I was hoping to learn	4.10 (0.83)	2–5
Group leadership
The facilitators cared about me as a person	4.90 (0.30)	4–5
The facilitators encouraged me to reach my goals	4.50 (0.87)	2–5
The facilitators understood me and my needs	4.35 (0.79)	3–5
Group process
The group was well organized	4.80 (0.40)	4–5
I was able to participate and express myself in the group	4.60 (0.49)	4–5

Psychological Outcomes

Participants reported a significant reduction in terms of depression symptoms, with mean scores on the GDS falling from 3.15 (SD = 2.78) at Time 1 to 1.8 (SD = 2.14) at Time 2 ( p < .01). These gains were maintained at 1-month follow-up, with Time 3 mean scores similar to those at Time 2. Participants also reported reductions in perceived stress, with mean scores decreasing from 11.55 (SD = 5.67) at Time 1 to 8.85 (SD = 4.74) at Time 2 ( p = .04). These gains were maintained at 1-month follow-up, with Time 3 mean scores similar to those at Time 2. We did not observe significant post-group differences in participants’ anxiety, loneliness, emotional regulation, resilience, or flourishing, although change in mean scores on each of these measures trended in a positive direction. A summary of participant scores on psychological outcome measures can be found in Table 4, with scores from selected measures also shown in Figure 1.

Table 4.

Participant Scores on Key Study Outcomes (n = 20).

Measure	Time 1	Time 2		Time 3
Measure	M (SD)	M (SD)	p-Value*	M (SD)	p-Value**
Psychological outcomes
Geriatric Depression Scale	3.15 (2.78)	1.8 (2.14)	0.00	1.65 (1.93)	0.55
Geriatric Anxiety Scale	3.8 (2.91)	3.1 (2.66)	0.21	3.4 (2.44)	0.38
Perceived Stress Scale	11.55 (5.67)	8.85 (4.74)	0.04	8.15 (4.25)	0.44
Emotional regulation	31.75 (6.31)	32.95 (5.98)	0.30	33.65 (5.61)	0.35
Flourishing	46.05 (7.57)	48.75 (5.12)	0.07	48.4 (4.71)	0.62
Connor-Davidson Resilience	31.8 (5.49)	32.7 (4.88)	0.37	33.65 (5.61)	0.35
UCLA Loneliness	11.4 (9.81)	10.6 (12.01)	0.67	8.85 (10.91)	0.32
Behavioral outcomes
Pittsburgh Sleep Quality Index	6.05 (2.78)	4.15 (2.37)	0.00	4.2 (2.14)	0.87
Physical Activity Scale for the Elderly***	103.35 (38.15)	167.52 (68.17)	0.00	177.26 (67.21)	0.59
Brain health behaviors	66.95 (10.98)	72.75 (8.4)	0.01	70.1 (12.02)	0.87
Starting the Conversation (diet)	6.5 (2.4)	5.7 (2.17)	0.20	5.85 (1.93)	0.69

t-Test comparing differences between mean scores at Time 1 and Time 2.

t-Test comparing differences between mean scores at Time 2 and Time 3.

***

Group 2 data only.

Figure 1.

Changes in selected study outcomes following program participation.

Behavioral Outcomes

Participants reported significant improvements in terms of sleep quality, with mean scores on the PSQI falling from 6.05 (SD = 2.78) at Time 1 to 4.15 (SD = 2.37) at Time 2 ( p < .01); mean scores of 5 or above on this measure are indicative of poor sleep quality. These improvements were maintained at 1-month follow-up, with Time 3 mean scores similar to those at Time 2. Participants also reported greater engagement in brain health behaviors, with mean scores increasing from 66.95 (SD = 10.98) at Time 1 to 72.75 (SD = 8.4) at Time 2 ( p = .01). Similar improvement was observed with regard to overall physical activity, with mean PASE scores increasing in Group 2 members from 103.35 (SD = 38.15) at Time 1 to 167.52 (SD = 68.17) at Time 2 (p < .01). These gains were maintained at 1-month follow-up, with Time 3 mean scores similar to those at Time 2. We did not observe significant post-group differences in participants’ dietary habits. A summary of participant scores on our behavioral outcome measures can be found in Table 4, with scores from selected measures also shown in Figure 1.

Discussion

Study results suggest that the adaptation of the Mood Lifters program for older adults was successful in term of community interest, program completion rates, and levels of participant satisfaction. In addition, the adapted program resulted in significant participant improvement in multiple domains related to mental health and wellness. Results indicate that the program was acceptable to participants and feasible to implement. The vast majority of participants (>80%) completed all sessions of the 14-week program, with attrition unrelated to the program (e.g., significant health problems). Participants rated the program highly across all domains assessed, including group leadership, group process (e.g., pace and content of sessions), and information provided. Although delivering the program in an online format was not our original intention (and required participants to have reliable internet access), the remote format offers advantages in terms of program reach and accessibility. For example, the format is preferable for participants with transportation barriers, mobility limitations, and/or scheduling restrictions and in settings where reserving requisite meeting space might be challenging or costly (Weinberg, 2021).

Program participants showed improvements in several key psychological outcomes. For example, they reported lower levels of depressive symptoms and perceived stress following the program, with gains sustained at the 1-month follow-up survey. These improvements may be due to the focus in multiple MLS group sessions on strategies to elevate mood and manage stress. For example, the Thinking Traps session covered proven techniques from CBT to identify and change thinking patterns that create and sustain depressive symptoms (Thoma et al., 2015). Other sessions highlighted ways to regulate negative emotions and enhance positive emotions, such as distraction, radical acceptance, mindfulness, and cognitive reappraisal. Significant changes were not observed on all study psychological outcomes. For example, participants did not report statistically significant improvements in anxiety, loneliness, emotional regulation, resilience, or flourishing.

Program participants also reported improvements in key behavioral outcomes, including improved sleep quality. Gains were sustained at the study’s 1-month follow-up survey. Sleep was the explicit focus of one of the early group sessions, with group leaders and the program manual providing information on the sleep cycle, sleep changes commonly associated with aging, and factors influencing sleep (e.g., room temperature, caffeine intake). After that session, participants were asked to practice good sleep hygiene on a weekly basis, with points awarded for behaviors such as maintaining consistent sleep and wake times and avoiding stimulating activities before bedtime. Such strategies have proven to be effective in enhancing sleep quality (Chung et al., 2018). Participants also reported significantly greater engagement in physical activity and other brain health behaviors following program participation. Practice options in the Brain Health module reinforced behaviors highlighted in the national Alzheimer’s Association “10 Ways to Love Your Brain” campaign (Alzheimer’s Association, 2022), such as engaging in cognitively stimulating activities and maintaining social connections. Participant scores on a validated measure of dietary habits stayed relatively stable over the course of the study. Changes in this domain may require interventions more intensively focused on diet, given that sustained behavior change in this area is relatively difficult to achieve (Middleton et al., 2013).

There are several limitations that should be kept in mind when interpreting study findings. First, results are based on a small sample, relatively lacking in diversity in terms of racial/ethnic and educational background and socioeconomic status. It is unclear whether study results would generalize to larger groups more representative of the general older adult population. Second, the study lacked a comparison or control group, meaning that improvements observed on key outcomes may be attributed to factors unrelated to the study intervention. Finally, some ceiling and floor effects may have occurred because participants were eligible to participate even if they did not report depressive symptoms or anxiety at baseline. In addition, the small sample size limited the power to detect statistically significant changes from baseline across study domains. The use of brief (vs. longer form) symptom inventories as outcome measures might have also constrained power to detect intervention effects.

In conclusion, our results suggest that the Mood Lifters for Seniors program was feasible to implement in an online format and that content was acceptable and helpful to participants. Pilot testing suggested numerous benefits for participants in multiple domains related to mental health and wellness. In addition, the peer-led, online format fosters scalability and sustainability. Future studies with larger, more diverse samples will be necessary to confirm program benefits and potentially refine program content and procedures. Comparing in-person versus online group offerings would also be of interest; although we have already noted benefits of the latter approach, the former may be more useful in addressing outcomes such as loneliness and social isolation. Such research would ideally use a randomized clinical trial design and follow participants beyond program participation to determine whether and how program benefits persist over time.

Footnotes

Acknowledgements

The authors would like to thank members of our Community Advisory Board for their helpful feedback on the development and revision of program content; these members include Elizabeth Hammer, Venkat Lakshminarayanan, Maurine Nelson, and Monica Prince.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Deldin is the founder and Chief Executive Officer of Mood Lifters LLC. Dr. Votta is the co-founder and Chief Scientific Officer of Mood Lifters LLC. Ms. Porte was formerly the Director of Clinical Operations for Mood Lifters LLC. The other authors declare no conflicts of interest.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The University of Michigan provided funding for this project through both its MCubed program and the Eisenberg Family Depression Center.

Ethical Approval

Approval was obtained for this study from the University of Michigan Health Sciences and Behavioral Sciences IRB (HUM00169614).

ORCID iD

J. Scott Roberts

References

Alzheimer’s Association. (2022). 10 ways to love your brain. https://www.alz.org/help-support/brain_health/10_ways_to_love_your_brain

Bor

J. S.

(2015). Among the elderly, many mental illnesses go undiagnosed. Health Affairs, 34(5), 727–731. https://doi.org/10.1377/hlthaff.2015.0314

Brandt

Spencer

Folstein

(1988). The telephone interview for cognitive status. Cognitive and Behavioral Neurology, 1(2), 111–117.

Brenes

G. A.

Danhauer

S. C.

Lyles

M. F.

Hogan

P. E.

Miller

M. E.

(2015). Barriers to mental health treatment in rural older adults. American Journal of Geriatric Psychiatry, 23(11), 1172–1178. https://doi.org/10.1016/j.jagp.2015.06.002

Brown

L. M.

Schinka

J. A.

(2005). Development and initial validation of a 15-item informant version of the Geriatric Depression Scale. International Journal of Geriatric Psychiatry, 20(10), 911–918. https://doi.org/10.1002/gps.1375

Buysse

D. J.

Reynolds

C. F.

III Monk

T. H.

Berman

S. R.

Kupfer

D. J.

(1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4

Byers

A. L.

Arean

P. A.

Yaffe

(2012). Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatric Services, 63(1), 66–72. https://doi.org/10.1176/appi.ps.201100121

Byrne

G. J.

Pachana

N. A.

(2011). Development and validation of a short form of the Geriatric Anxiety Inventory—The GAI-SF. International Psychogeriatrics, 23(1), 125–131. https://doi.org/10.1017/S1041610210001237

Campbell-Sills

Stein

M. B.

(2007). Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20(6), 1019–1028. https://doi.org/10.1002/jts.20271

10.

Chung

K. F.

Lee

C. T.

Yeung

W. F.

Chan

M. S.

Chung

E. W. Y.

Lin

W. L.

(2018). Sleep hygiene education as a treatment of insomnia: A systematic review and meta-analysis. Family Practice, 35(4), 365–375. https://doi.org/10.1093/fampra/cmx122

11.

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.

12.

Conner

K. O.

Copeland

V. C.

Grote

N. K.

Koeske

Rosen

Reynolds

C. F.

III Brown

(2010). Mental health treatment seeking among older adults with depression: The impact of stigma and race. American Journal of Geriatric Psychiatry, 18(6), 531–543. https://doi.org/10.1097/JGP.0b013e3181cc0366

13.

Creese

Khan

Henley

O’Dwyer

Corbett

Vasconcelos

Silva

Mills

Wright

Testad

Aarsland

Ballard

(2021). Loneliness, physical activity, and mental health during COVID-19: A longitudinal analysis of depression and anxiety in adults over the age of 50 between 2015 and 2020. International Psychogeriatrics, 33(5), 505–514. https://doi.org/10.1017/S1041610220004135

14.

Cudjoe

T. K. M.

Roth

D. L.

Szanton

S. L.

Wolff

J. L.

Boyd

C. M.

Thorpe

R. J.

(2020). The epidemiology of social isolation: National health and aging trends study. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 75(1), 107–113. https://doi.org/10.1093/geronb/gby037

15.

Diener

Wirtz

Tov

(2010). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247–266.

16.

Gerlach

L. B.

Solway

Maust

D. T.

Kirch

Kullgren

J. T.

Singer

D. C.

Malani

P. N.

(2021). The COVID-19 pandemic and mental health symptoms among US adults. Journal of General Internal Medicine, 36(10), 3285–3288. https://doi.org/10.1007/s11606-021-07046-3

17.

Gross

J. J.

John

O. P.

(2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348

18.

Gunja

M. Z.

Shah

Williams

R. A

. (2022). Comparing older adults’ mental health needs and access to treatment in the U.S. and other high-income countries. Commnwealth Fund. https://doi.org/10.26099/crks-9c82

19.

Haigh

E. A. P.

Bogucki

O. E.

Sigmon

S. T.

Blazer

D. G.

(2018). Depression among older adults: A 20-year update on five common myths and misconceptions. American Journal of Geriatrci Psychiatry, 26(1), 107–22.

20.

Hirschfeld

R. M.

Williams

J. B.

Spitzer

R. L.

Calabrese

J. R.

Flynn

Keck

P. E. J.

Lewis

McElroy

S. L.

Post

R. M.

Rapport

D. J.

Russell

J. M.

Sachs

G. S.

Zajecka

(2000). Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. American Journal of Psychiatry, 157(11), 1873–1875. https://doi.org/10.1176/appi.ajp.157.11.1873

21.

Houtjes

van Meijel

Deeg

D. J. H.

Beekman

A. T. F.

(2010). Major depressive disorder in late life: A multifocus perspective on care needs. Aging & Mental Health, 14(7), 874–880. https://doi.org/10.1080/13607861003801029

22.

Kotwal

A. A.

Holt-Lunstad

Newmark

R. L.

Cenzer

Smith

A. K.

Covinsky

K. E.

Escueta

D. P.

Lee

J. M.

Perissinotto

C. M.

(2021). Social isolation and loneliness among San Francisco Bay Area older adults during the COVID-19 shelter-in-place orders. Journal of the American Geriatrics Society, 69(1), 20–29. https://doi.org/10.1111/jgs.16865

23.

MacLeod

Musich

Hawkins

Alsgaard

Wicker

E. R.

(2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266–272. https://doi.org/https://doi.org/10.1016/j.gerinurse.2016.02.014

24.

McLay

Jamieson

H. A.

France

K. G.

Schluter

P. J.

(2021). Loneliness and social isolation is associated with sleep problems among older community dwelling women and men with complex needs. Scientific Reports, 11(1), 4877. https://doi.org/10.1038/s41598-021-83778-w

25.

Middleton

K. R.

Anton

S. D.

Perri

M. G.

(2013). Long-term adherence to health behavior change. American Journal of Lifestyle Medicine, 7(6), 395–404. https://doi.org/10.1177/1559827613488867

26.

Miner

Kryger

M. H.

(2017). Sleep in the aging population. Sleep Medicine Clinics, 12(1), 31–38. https://doi.org/10.1016/j.jsmc.2016.10.008

27.

Nair

Bhanu

Frost

Buszewicz

Walters

K. R.

(2020). A systematic review of older adults’ attitudes towards depression and its treatment. The Gerontologist, 60(1), e93–e104. https://doi.org/10.1093/geront/gnz048

28.

Niclasen

Lund

Obel

Larsen

(2019). Mental health interventions among odler adults: A systematic review. Scandinavian Journal of Public Health, 47(2), 240-50.

29.

Paxton

A. E.

Strycker

L. A.

Toobert

D. J.

Ammerman

A. S.

Glasgow

R. E.

(2011). Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. American Journal of Preventive Medicine, 40(1), 67–71. https://doi.org/10.1016/j.amepre.2010.10.009

30.

Russell

Peplau

L. A.

Ferguson

M. L.

(1978). Developing a measure of loneliness. Journal of Personality Assessment, 42(3), 290–294. https://doi.org/10.1207/s15327752jpa4203_11

31.

Smith

Ryan

L. H.

Fisher

G. G.

Sonnega

Weir

(2017). HRS psychosocial and lifestyle questionnaire 2006–2016. Health Retirment Study. https://hrs.isr.umich.edu/sites/default/files/biblio/HRS2006-2016SAQDocumentation_07.06.17_0.pdf

32.

Thoma

Pilecki

McKay

(2015). Contemporary cognitive behavior therapy: A review of theory, history, and evidence. Psychodynamic Psychiatry, 43(3), 423–461. https://doi.org/10.1521/pdps.2015.43.3.423

33.

Thombs

B. D.

Carboni-Jiménez

(2021). Peer-to-peer support for older adults—What do we know and where do we go? JAMA Network Open, 4(6), e2113941. https://doi.org/10.1001/jamanetworkopen.2021.13941

34.

Votta

C. M.

Deldin

P. J.

(2022). Mood lifters: Evaluation of a novel peer-led mental wellness program. Mental Health Review Journal. Advance online publication. https://doi.org/10.1108/MHRJ-11-2021-0084

35.

Washburn

R. A.

Smith

K. W.

Jette

A. M.

Janney

C. A.

(1993). The physical activity scale for the elderly (PASE): Development and evaluation. Journal of Clinical Epidemiology, 46(2), 153–162. https://doi.org/10.1016/0895-4356(93)90053-4

36.

Weinberg

(2021). Obstacles, challenges, and benefits of online group psychotherapy. American Journal of Psychotherapy, 74(2), 83–88. https://doi.org/10.1176/appi.psychotherapy.20200034

37.

Wilson-Genderson

Heid

A. R.

Pruchno

(2017). Onset of multiple chronic conditions and depressive symptoms: A life events perspective. Innovation in Aging, 1(2), igx022. https://doi.org/10.1093/geroni/igx022

38.

Wolitzky-Taylor

K. B.

Castriotta

Lenze

E. J.

Stanley

M. A.

Craske

M. G.

(2010). Anxiety disorders in older adults: A comprehensive review. Depression and Anxiety, 27(2), 190–211. https://doi.org/https://doi.org/10.1002/da.20653

39.

Zanarini

M. C.

Vujanovic

A. A.

Parachini

E. A.

Boulanger

J. L.

Frankenburg

F. R.

Hennen

(2003). A screening measure for BPD: The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Journal of Personality Disorders, 17(6), 568–573. https://doi.org/10.1521/pedi.17.6.568.25355

Mood Lifters for Seniors: Development and Evaluation of an Online,Peer-Led Mental Health Program for Older Adults

Abstract

Keywords

What This Paper Adds

Applications of Study Findings

Introduction

Methods

Program Development

Participants and Procedures

Study Measures

Participant characteristics

Program satisfaction

Depression

Anxiety

Perceived stress

Emotional regulation

Loneliness

Resilience

Flourishing

Sleep

Physical activity

Brain health behaviors

Diet

Data Analyses

Results

Program Completion

Program Satisfaction

Psychological Outcomes

Behavioral Outcomes

Discussion

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

Ethical Approval

ORCID iD

References