Meaning in life: bidirectional relationship with depression, anxiety, and loneliness in a longitudinal cohort of older primary care patients with multimorbidity

BACKGROUND: Depression, anxiety and loneliness are common among older patients. As a potential psychological buffer against these challenges, meaning in life (MIL) remains underexplored in longitudinal studies within this population. This study aims to examine the longitudinal relationship of MIL with depression, anxiety, and loneliness among older adults with multimorbidity in Hong Kong. METHODS: In a prospective cohort of 1077 primary care patients aged 60 or above with multimorbidity in Hong Kong, MIL was assessed using an item from the Chinese Purpose in Life test at baseline, the 1st follow-up (median: 1.3 years), and the 2nd follow-up (median: 3.1 years). Depression, anxiety, and loneliness were assessed using the Patient Health Questionnaire, Generalized Anxiety Disorder, and De Jong Gierveld Loneliness scales, respectively, at each time point. Cross-lagged relationships between MIL and these measures were examined using cross-lagged panel models. RESULTS: Participants had an average age of 70.0 years, with 70.1% being female. Higher MIL predicted lower depression (β = -0.15), anxiety (β = -0.13), overall loneliness (β = -0.18), emotional loneliness (β = -0.15), and social loneliness (β = -0.16) at the 1st follow-up. Additionally, higher MIL predicted lower overall loneliness (β = -0.12), emotional loneliness (β = -0.11), and social loneliness (β = -0.10) at the 2nd follow-up. At baseline, higher depression (β = -0.21), overall loneliness (β = -0.15), emotional loneliness (β = -0.11), and social loneliness (β = -0.11), but not anxiety, predicted lower MIL at the 1st follow-up. At the 1st follow-up, depression (β = -0.23), anxiety (β = -0.16), overall loneliness (β = -0.10), and emotional loneliness (β = -0.11), but not social loneliness, predicted lower MIL at the 2nd follow-up. CONCLUSIONS: The findings suggest a bidirectional relationship between MIL and mental health outcomes in older patients with multimorbidity in Hong Kong. Emotional loneliness demonstrated a more consistent bidirectional association with MIL than social loneliness. Further research is needed to understand the underlying mechanisms and develop targeted interventions addressing both MIL and mental health problems.