How Do We Understand the Relationship Between Social Role and Psychological Well-Being

How Do We Understand The Relationship Between Social Role and Psychological Well-Being in Older Women?:

A Qualitative Study

Michaela Litchmore-Dunbar

Submitted for the Degree of

Doctor of Psychology

(Clinical Psychology)

School of Psychology

Faculty of Health and Medical Sciences

University of Surrey

Guildford, Surrey

United Kingdom

September 2016

Abstract

Objective: This research investigates how older women understand their social roles, and the part that social roles play in their well-being, to underpin the development of interventions aimed at increasing social role participation in order to improve the well-being of older women in the United Kingdom.

Methods: Five focus groups were analysed using Inductive Thematic Analysis. Snowball sampling was used to identify 20 female participants, residing in the United Kingdom, aged 60 and above.

Results: The analysis generated four themes: the nature of a social role; social roles support well-being in older age; societal expectations of age and gender lead to role loss; and freedom to choose meaningful social roles leads to well-being.

Conclusions: Participants reported that social roles facilitate well-being through the prevention of isolation, increased levels of activity, improved cognitive health through brain activity, and increased confidence and flexibility.Freedom to choose meaningful social roles was reported as having the most positive impact on well-being. Results provide a framework from which to design social role interventions that facilitate choice of meaningful social roles, which can be facilitated through joined-up working with external agencies, including those that provide volunteering opportunities. Appropriate psychological interventions include those that address relationships with others, such as Interpersonal Psychotherapy.

Keywords: social role, older adults, older women, health promotion, mental health

Acknowledgements

I would like to thank everyone who contributed to the development, implementation and writing of this research project as well as all those that have offered support over the last two and a half years.

I would particularly like to thank:

The participants who kindly volunteered their time and thoughts
Dr Kate Gleeson and Dr Paul Davis for their supervision and encouragement
My mother for her amazing contribution to this project, and for a lifetime of support
My fellow trainees for support and guidance
Members of the qualitative research group for all their support and discussions throughout this process
Friends and family for their constant encouragement

Contents Table

MRP Empirical Paper / Page 5
MRP Empirical Paper Appendices / Page 61
MRP Proposal (without appendices) / Page 99
MRP Literature Review (with appendices if appropriate) / Page 110
Over view of Clinical Experience / Page 154
Table of Assessments / Page 156

How Do We Understand The Relationship Between Social Role and Psychological Well-Being in Older Women?

A Qualitative Study

Michaela Litchmore-Dunbar

Submitted in partial fulfillment of the degree of Doctor of Psychology (Clinical Psychology)

School of Psychology

Faculty of Health and Medical Sciences

University of Surrey

April 2016

Word count: 9,085

Abstract

Methods: Five focus groups were analysed using Inductive Thematic Analysis. Snowball sampling was used to identify 20 female participants, residing in the United Kingdom, aged 60 and above.

Keywords: social role, older adults, older women, health promotion, mental health

Introduction / 66
Method / 74
Design / 74
Methodology / 74
Ethical approval / 77
Risk / 77
Participants / 77
Procedure / 78
Data Analysis / 79
Credibility of analysis / 80
Results / 81
Social roles are valuable to well-being in older age / 84
Societal expectations of age and gender influence loss of roles and ability to replace them / 87
Freedom and control to choose meaningful social roles are important for well-being / 90
Discussion / 96
References / 107
Appendices / 119

Contents

Introduction

It is anticipated that more than two thirds of people in the UK could spend their retirement years with poor physical and psychological health. Evidence suggests, that compared with younger adults, older people are disproportionately high users of health and social care services (Allen, 2008). Older people’s psychological well-beingis now recognised as a significant public health issue in the UK (Joint Commissioning Panel for Mental Health, 2013).

Some evidence regarding social roles and health and well-being outcomes, suggest the potential value of “social role” interventions aimed at older adults, including volunteering schemes (Heaven, 2013). Such interventions, if facilitated using joined-up social care services as recommended by NICE (2015), could be provided at an early stage in ageing; working to reduce the number of older adults presenting at mental health services. However, as the literature reviewed shows below, the research evidence is limited in a number of ways. There are few good quality studies that seek to explore the links between social role and psychological well-being in older people. There is no clear theoretical explanation for the relationship between social role and psychological well-being in older people. There are no studies of social role interventions with a UK population. There are key discrepancies between studies, with some suggesting that multiple role engagement in older adulthood enhances psychological well-being (Adelman, 1994; Cochran et al, 1999; Thoits, 1991), whilst others agree that psychological well-being is achieved through releasing social roles in older age to concentrate on one (Plach, 2008; Tamakoshi, 2012). In light of these discrepancies and deficit in the body of literature, specifically with a UK population, an exploratory study is needed to gain rich in-depth data, to develop an understanding of the processes whereby social roles may impact on well-being, and provide an evidence base on which to develop further research. There is an indication that social roles may work differently for men and women (Tamakoshi et al., 2012), although further research is needed for both genders. Because this study is a small-scale exploratory qualitative study, it will focus on one gender. The study aims to investigate older women’s experiences, and shared understanding of social roles, and their understanding of how they relate to individual well-being.

Psychological well-being in older adults

Psychological well-being can be conceptualised as a combination of positive affective states, such as happiness, and the ability to function with optimal effectiveness in individual and social life (Ryan, HutaDeci, 2008). People with high levels of psychological well-being report feeling happy, capable, and experience better physical health (Huppert, 2009).The current study uses a broad definition of psychological well-being, and includes as an indicator, the absence of mental health problems, including dementia, anxiety, depression and stress, along with levels of happiness and life satisfaction.

Evidence suggests that, due to demographic changes, there are increasing numbers of older people living with low levels of satisfaction, and psychological well-being. Moderate to severe depression occurs in 3-4% of the UK’s older adult population (Joint Commissioning Panel for Mental Health, 2013). This is associated with increased risk of suicide, and decreased cognitive, physical and social functioning, and is an important public health problem (Blazer, 2003).

A review of the research literature into the links between social role and psychological well-being in older people

A systematic review of the literature identified links between social role and the psychological well-being of older adults. Three electronic databases were searched (Web of Science, PubMed and Psychinfo) between January 1994 and February 2014. The following search terms were used: "older people*" OR "older adult*" OR elder* OR geriatric* OR "old* age" OR "late* life" OR "late*-life" OR retire* AND “well being” OR “well-being” AND “social role*” OR “role*”. Following exclusion criteria and duplication checks, ultimately 19 articles were included in the review. Two were qualitative, and 17 were quantitative (See literature review for a more detailed account of searches). Of the 17 quantitative studies, only three of the studies used measures that explicitly addressed social roles; the Social Role Participation Questionnaire (SRPQ), and the Role Quality Measure (Baruch and Barnet, 1986). However, these were not validated measures, and there was no commonalty of measurement amongst studies.

The relationship between social role and psychological well-beingin older people

The concept of social role is broad, and the use of the term varies across different types of literature. Social roles, as we use the term in this study, refer to the part people play as members of a social group. Each social role is associated with expected behaviours called norms. With each social role adopted, the behaviour changes to fit the expectations the individual and others have of that role (McLeod, 2016). Examples of social roles include, but are not limited to, roles such as wife, mother, grandmother, employee, volunteer and friend.

There are two key areas of important research regarding social role and well-being in older people that will be discussed in this section. The first, salient social roles, suggests that occupying meaningful social roles is crucial to well-being as an older person. The second, multiple social roles, suggests that occupying multiple social roles could be beneficial to well-being as an older person. However, as mentioned earlier, the literature suggests that social roles work differently for men and women; as a result there are mixed findings in both of these areas with regards to their utility for women. This will be discussed further below.

Salient social roles and psychological well-being in older women

Previous research found mixed results about the relationship between salient social roles and psychological well-being in women. Krause’s (1994) study revealed that roles with higher levels of perceived meaningfulness had a positive impact on the well-being of older women. However, this study is limited in that only three roles for each person were explored, and there was limited assessment of the nature of roles and involvement in roles. Other research suggests that roles that are deemed meaningful are not always beneficial to the well-being of older women. For example, grand parenting in contemporary Asia is seen as a meaningful social role, rooted in traditional family values and norms (Thang and Mehta, 2012). However, in their 2007 study, Jeon et al. found that compared to living with children, living alone appeared detrimental to men, but beneficial to women. They explained that grandmothers are expected to provide more support and care for their grandchildren than grandfathers, which could negatively impact well-being.

This supports Eagly's (1987) social role theory of gender differences, which explains that cultural and social norms create distinctions between male and female roles. However, like many of the studies included in the review, this study was conducted using an Asian population, and cultural differences between Asia and the UK may mean social roles entail different levels of involvement and meaningfulness. Additionally, the study did not address the impact of the grandparent role when not living with the grandchild.

Interestingly, Krause (1994) found that the effects of stress on life satisfaction in older age were almost entirely related to stressors in salient roles. They reported that this was in part, because of eroding feelings of personal control over the roles in which the stressors have arisen, and claimed that the impact is nearly five times stronger than those in subjectively less important roles. This study is limited however, as the data was gathered at a single point of time preventing a causal interpretation (Krause, 1994).

Multiple social roles and psychological well-being in older women

Previous research has found mixed results regarding the relationship between occupying multiple social roles and psychological well-being in older women.A number of studies (Adelman et al., 1994; Cochran et al., 1999; Thoits, 1991) conclude that multiple role involvement is beneficial for psychological well-being, arguing that engaging in multiple roles is preferable as it has benefits, including enhanced self-esteem, fewer depressive symptoms, and self-security. These studies are also limited by their cross-sectional data collection, preventing causal inferences. Findings appear to support Mark’s (1977) Enhancement hypothesis, which suggests that having several social roles provides the individual with a range of sources of positive social interaction, status and achievement, and thus benefits well-being. Tamakoshi et al. (2012) also found that the risk of all-cause mortality in older adults in Japan was higher in those with three or less roles.

In contrast, however, the scarcity hypothesis holds that having more than one social role can cause ill-health and stress in women, to the extent that the demands of those roles interfere with each other, or create an excessive overall workload (Marshall & Barnett, 1993). In line with this, Tamokoshi et al. (2012) reported that women experienced higher levels of ‘role overload’ than men. However, more detailed assessments regarding the level of role involvement would have been useful, as this may have had an impact on experience of role overload.

Plach et al. (2004, 2008), found that for older women especially, the opportunity to release roles, and unburden themselves of social role obligations which they have taken on during adult life, had positive effects on their well-being, as they were able to concentrate on roles that were salient to them. It is important to note however, that Plach et al.’s (2004) study consisted only of women with rheumatoid arthritis, which may have imposed limitations on how active they can be in their social roles. Nevertheless, these findings support Cummings and Henry’s (1961) disengagement theory, which suggests that older adults actually report higher levels of psychological well-being when they are able to shift roles and concentrate on one role that is important to them.

Interestingly, Havighurst’s (1961) activity theory arose in opposition to the disengagement theory (Bengston and Putney, 2009). It proposes that instead of withdrawing from roles and society, successful aging occurs when older adults stay active and maintain social roles and interactions. However, it is important to bear in mind that these theories are 55 years old, and advancements in culture, technology and longevity have changed, meaning Lee’s more recent Enhancement hypothesis may be more relevant today, and therefore needs further exploration.

Rationale for the current study

In the light of global concerns about the well-being of an increasingly aging population, and the relative scarcity of resources, policy decisions regarding investment in health and social services should be based on the best available evidence. The current evidence suggests that social roles may be an area for intervention to facilitate psychological well-being in older adults. However, social roles have been neglected as an area for assessment and intervention development, despite holding some promise as a means of improving health and well-being (Heaven, 2013).

At present, there are vast discrepancies within the literature regarding the links between social role and psychological well-being in older people. Some literature indicates that engaging in multiple roles can have a positive impact on well-being, and others suggest that reducing the number of social roles to concentrate on one has a positive impact on well-being. Some literature also suggests that occupying salient social roles is important for well-being in older age, while others suggests that stressors in salient social roles have a larger negative impact on well-being than roles that are less salient.