Op de rand van het bestaan: Het ontrafelen van de verbanden tussen existentiële zorgen en depressieve symptomen in oudere volwassenen die in woonzorgcentra wonen

Depressive symptoms seem to be common in older adults living in nursing homes, with rates ranging from 14% to 82%. To identify and support nursing home residents who may be struggling with depressive symptoms, it is essential to understand the risk factors contributing to these symptoms. Although various risk factors have been proposed, existential concerns - particularly meaning in life and existential loneliness - have received limited attention despite their relevance in the nursing home context. The dissertation aimed to investigate the relationship between these existential concerns and depressive symptoms, combining cross-sectional, longitudinal and qualitative approaches. The Introduction outlines the current state of research on meaning in life, existential loneliness, and depressive symptoms. Chapter 1 offers a conceptual exploration of meaning in life in older adults through a scoping review. Our findings indicated that current conceptualisations of meaning in life are generally not tailored to older adults, despite some studies suggesting potentially unique components relevant to this life stage. Chapter 2 presents the cross-sectional relationship between meaning in life and depressive symptoms, with a specific focus on the experience of bodily disconnection, in 242 residents from 22 Flemish (Belgian) nursing homes. Residents experiencing greater bodily disconnection reported less meaning in life and more depressive symptoms, suggesting that moving beyond purely physical terms may be crucial when approaching and caring for the body of older adults. Chapter 3 qualitatively explores the entanglement between meaning in life, existential loneliness and depressive symptoms by analysing 24 residents' narratives to identify whether, and which, depressive symptoms were present in their narratives. We also examined whether these depressive references differed between residents with a high versus low score on a depressive symptom questionnaire. We found that certain depressive symptoms are more frequently used to express existential concerns, yet, at the same time, depressive symptoms and existential concerns are much entangled. Chapter 4 longitudinally examines the relationships between meaning in life, existential loneliness, and depressive symptoms across three annual measurement points in the sample of 243 nursing home residents from the 22 Flemish nursing homes, using random-intercept cross lagged panel models. At the between-level, residents who reported more meaning in life and less existential loneliness tended to experience fewer depressive symptoms. However, at the within-person level, these relationships were inconsistent and unexpected, suggesting the need to further explore these within-person dynamics, potentially on a shorter timescale. The Discussion of this dissertation integrates our findings into the broader literature, and discusses some limitations and directions for future research.