Presenting a Structural Model of Psychological Health of the Elderly Based on Loneliness, Death Thoughts, and Rumination: Testing the Mediating Role of Spiritual Intelligence

Qorbanalipour, Masoud; Mahjoub, Mahdiyeh

doi:10.18502/ehj.v11i2.20704

Volume 11, Issue 2 (December 2025) Elderly Health Journal 2025, 11(2): 118-126 | Back to browse issues page

‎ 10.18502/ehj.v11i2.20704

Mendeley

Zotero

RefWorks

Qorbanalipour M, Mahjoub M. Presenting a Structural Model of Psychological Health of the Elderly Based on Loneliness, Death Thoughts, and Rumination: Testing the Mediating Role of Spiritual Intelligence. Elderly Health Journal 2025; 11 (2) :118-126
URL: http://ehj.ssu.ac.ir/article-1-363-en.html

Presenting a Structural Model of Psychological Health of the Elderly Based on Loneliness, Death Thoughts, and Rumination: Testing the Mediating Role of Spiritual Intelligence

Masoud Qorbanalipour ^*

, Mahdiyeh Mahjoub

Department of Psychology, Khoy Branch, Islamic Azad University, Khoy, Iran , masoudqorbanalipour@gmail.com

Abstract: (35 Views)

Introduction: The present study aimed to propose a structural model of psychological well-being among older adults based on the components of loneliness, death thought, and rumination, with a focus on the mediating role of spiritual intelligence.
Methods: This research employed a descriptive, quantitative, and correlational design using structural equation modeling. The statistical population included all older adults in the city of Khoy in 2025, from which 200 participants were selected through purposive sampling. Data were collected using the UCLA Loneliness Scale (Version 3), Ryff’s Psychological Well-Being Scale – Short Form (RPWB-SF), Death Thought Questionnaire (DTQ), Ruminative Response Scale (RRS), Spiritual Intelligence Self-Report Inventory (SISRI). Data analysis was conducted through structural equation modeling and bootstrapping techniques using SmartPLS software.
Results: The findings indicated that loneliness (β = -0.40), rumination (β = -0.38), and death thought (β = -0.30) had significant negative effects on psychological well-being in older adults. Conversely, spiritual intelligence (β = 0.50) exerted both direct and indirect positive effects by mitigating the negative impacts of loneliness (β = -0.10), rumination (β = -0.13), and death thought (β = -0.11) on psychological well-being.
Conclusion: These results highlight the protective role of spiritual intelligence against factors that threaten psychological well-being in older adults. Overall, the findings suggest that strengthening spiritual intelligence may serve as an effective strategy to reduce the adverse effects of loneliness, death thought, and rumination, thereby enhancing psychological well-being in this population.

Keywords: Loneliness, Psychological Health, Aged, Rumination, Spiritual Intelligence

Full-Text [PDF 475 kb] (22 Downloads) | | Full-Text (HTML) (3 Views)

Type of Study: Research | Subject: Special
Received: 2025/10/1 | Accepted: 2025/12/13 | Published: 2025/12/19

References

1. Lee G, Chulwoo K. Social isolation and mental well-being among Korean older adults: a focus on living arrangements. Frontiers in Public Health. 2024; 12(6): 684–703.

2. Bondarchuk O, Balakhtar V, Pinchuk N, Pustovalov I, Pavlenok K. Coping with stressfull situations using coping strategies and their impact on mental health. Multidisciplinary Reviews. 2024; 7

3. Zhao K. A preliminary study of the factors affecting college students’ sense of well-being: Self-concept, mental health, interpersonal relationships, and the cultivation of all-round development ability. Studies in Psychological Science. 2024; 2(1): 48–58.

4. Quill G. Navigating the Challenges of Aging-A Mental Health Guide: Practical Mental Health Tips for Seniors: Gaius Quill Publishing: 2024.

5. Sharma G, Morishetty SK. Common mental and physical health issues with elderly: a narrative review. ASEAN Journal of Psychiatry. 2022; 23(1): 1–11.

6. Győri Á. The impact of social-relationship patterns on worsening mental health among the elderly during the COVID-19 pandemic: evidence from Hungary. SSM-Population Health. 2023; 21: 1-13.

7. Newman-Norlund RD, Newman-Norlund SE, Sayers S, McLain AC, Riccardi N, Fridriksson J. Effects of social isolation on quality of life in elderly adults. PloS One. 2022; 17(11): 1-14.

8. Brandt L, Liu S, Heim C, Heinz A. The effects of social isolation stress and discrimination on mental health. Translational Psychiatry. 2022; 12(1): 1-11.

9. Reynolds 3rd CF, Jeste DV, Sachdev PS, Blazer DG. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry. 2022; 21(3): 336–63.

10. O‘G‘Li ASN. The importance of social activity in old age: a key factor for psychological well-being. Eurasian Journal of Social Sciences, Philosophy and Culture. 2024; 4(10): 12–6.

11. da Silva THR. Loneliness in older adults. British Journal of Community Nursing. 2024; 29(2): 60–6.

12. Prizeman K, Weinstein N, McCabe C. Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms. BMC Psychiatry. 2023; 23(1): 1-15.

13. Yuldasheva MB, Samindjonova ZI. Socio-psychological meta-analysis of the concepts of “Loneliness”, “Solitude” and “Isolation”. Turkish Journal of Computer and Mathematics Education. 2023; 9(4): 471–7.

14. Thompson A, Smith MA, McNeill A, Pollet TV. Friendships, loneliness and psychological wellbeing in older adults: a limit to the benefit of the number of friends. Ageing & Society. 2024; 44(5): 1090–115.

15. Meng L, Xu R, Li J, Hu J, Xu H, Wu D, et al. The silent epidemic: exploring the link between loneliness and chronic diseases in China’s elderly. BMC Geriatrics. 2024; 24(1): 1-14.

16. Hards E, Loades ME, Higson‐Sweeney N, Shafran R, Serafimova T, Brigden A, et al. Loneliness and mental health in children and adolescents with pre‐existing mental health problems: A rapid systematic review. The British Journal of Clinical Psychology. 2022; 61(2): 313–34.

17. Haslam SA, Haslam C, Cruwys T, Jetten J, Bentley SV, Fong P, et al. Social identity makes group-based social connection possible: Implications for loneliness and mental health. Current Opinion in Psychology. 2022; 43: 161–5.

18. Freak-Poli R, Kung CS, Ryan J, Shields MA. Social isolation, social support, and loneliness profiles before and after spousal death and the buffering role of financial resources. The Journals of Gerontology: Series B. 2022; 77(5): 956–71.

19. Kotwal AA, Cenzer IS, Waite LJ, Covinsky KE, Perissinotto CM, Boscardin WJ, et al. The epidemiology of social isolation and loneliness among older adults during the last years of life. Journal of the American Geriatrics Society. 2021; 69(11): 3081–91.

20. Wolters NE, Mobach L, Wuthrich VM, Vonk P, Van der Heijde CM, Wiers RW, et al. Emotional and social loneliness and their unique links with social isolation, depression and anxiety. Journal of Affective Disorders. 2023; 329: 207–17.

21. Zhang Y, Kuang J, Xin Z, Fang J, Song R, Yang Y, et al. Loneliness, social isolation, depression and anxiety among the elderly in Shanghai: Findings from a longitudinal study. Archives of Gerontology and Geriatrics. 2023; 110: 104980.

22. Kastenbaum R, Moreman CM. Death, society, and human experience. Routledge; 2024.

23. Phan HP, Chen SC, Ngu BH, Hsu CS. Advancing the study of life and death education: theoretical framework and research inquiries for further development. Frontiers in Psychology. 2023; 14: 1-13.

24. Pandya Ak, Kathuria T. Death anxiety, religiosity and culture: Implications for therapeutic process and future research. Religions. 2021; 12(1): 1-13.

25. Phan HP, Ngu BH, Chen SC, Wu L, Shih JH, Shi SY. Life, death, and spirituality: A conceptual analysis for educational research development. Heliyon. 2021; 7(5): 1-10.

26. Littman-Ovadia H, Russo-Netzer P. Exploring the lived experience and coping strategies of Fear of Missing Out (FoMO) among emerging adults. Current Psychology. 2024; 43: 1–21.

27. Halifax J. Being with dying: Cultivating compassion and fearlessness in the presence of death. Shambhala Publications; 2024.

28. Zhang J, Cao Y, Su M, Cheng J, Yao N. The experiences of clinical nurses coping with patient death in the context of rising hospital deaths in China: a qualitative study. BMC Palliative Care. 2022; 21(1): 1-9.

29. Üzar-Özçetin YS, Budak SE, editors. The relationship between attitudes toward death, rumination, and psychological resilience of oncology nurses. Seminars in Oncology Nursing; Elsevier: 2024.

30. Joubert AE, Moulds ML, Werner‐Seidler A, Sharrock M, Popovic B, Newby JM. Understanding the experience of rumination and worry: A descriptive qualitative survey study. British Journal of Clinical Psychology. 2022; 61(4): 929–46.

31. Watkins E. Rumination. In: Dozois DJA, Dobson KS, editors. Treatment of psychosocial risk factors in depression American Psychological Association; 2023. p. 305-31.

32. Wong SM, Chen EY, Lee MC, Suen Y, Hui CL. Rumination as a Transdiagnostic phenomenon in the 21st century: the flow model of rumination. Brain Sciences. 2023; 13(7): 1-17.

33. Ciobotaru D, Jones CJ, Cohen Kadosh R, Violante IR, Cropley M. “Too much of a burden”: Lived experiences of depressive rumination in early adulthood. Journal of Counseling Psychology. 2024; 71(4): 255-67.

34. Rickerby N, Krug I, Fuller-Tyszkiewicz M, Forte E, Davenport R, Chayadi E, et al. Rumination across depression, anxiety, and eating disorders in adults: A meta-analytic review. Clinical Psychology: Science and Practice. 2024; 31(2): 251-68.

35. Bean CA, Ciesla JA. Ruminative variability predicts increases in depression and social anxiety. Cognitive Therapy and Research. 2024; 48(3): 511–25.

36. McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy. 2011; 49(3): 186–93.

37. Ye N, Peng L, Deng B, Hu H, Wang Y, Zheng T, et al. Repetitive negative thinking is associated with cognitive function decline in older adults: a cross-sectional study. BMC Psychiatry. 2025; 25(1): 1-8.

38. Mancone S, Celia G, Bellizzi F, Zanon A, Diotaiuti P. Emotional and cognitive responses to romantic breakups in adolescents and young adults: the role of rumination and coping mechanisms in life impact. Frontiers in Psychiatry. 2025; 16: 1-13.

39. Ibrahim N, Burhan NM, Mohamed A, Mahmud M, Abdullah SR. Emotional intelligence, spiritual intelligence and psychological well-being: Impact on society. Malaysian Journal of Society and Space. 2022; 18(3): 90–103.

40. Hosseinbor M, Jadgal MS, Kordsalarzehi F. Relationship between spiritual well-being and spiritual intelligence with mental health in students. International Journal of Adolescent Medicine and Health. 2021; 35(2): 197–201.

41. Pant N, Srivastava SK. The impact of spiritual intelligence, gender and educational background on mental health among college students. Journal of Religion and Health. 2019; 58(1): 87–108.

42. Pinto CT, Guedes L, Pinto S, Nunes R. Spiritual intelligence: a scoping review on the gateway to mental health. Global Health Action. 2024; 17(1): 1-16.

43. Jouybari FT, Ghoreishi MK. Predicting rumination based on spiritual intelligence, cognitive flexibility, and self-esteem. Journal of Fundamentals of Mental Health. 2025; 27(2): 131-8.

44. Zoghi L, Salmani M. The relationship between spiritual intelligence and general health in the elderly: the mediating role of mindfulness. Aging Psychology. 2022; 8(4): 349–60.

45. Polemikou A, Vantarakis S. Death anxiety and spiritual intelligence as predictors of dissociative posttraumatic stress disorder in Greek first responders: A moderation model. Spirituality in Clinical Practice. 2019; 6(3): 182-93.

46. Salmani M, Zoghi L. The relationship between loneliness, spiritual intelligence and general health with death anxiety in the elderly: the mediating role of mindfulness. Psychology. 2022; 8(1): 39–54.

47. Kline RB. Principles and practice of structural equation modeling. Guilford publications: 2023.

48. Russell D, Peplau LA, Ferguson ML. Developing a measure of loneliness. Journal of Personality Assessment. 1978; 42(3): 290–4.

49. Larijani M, Moslehi M. Older women's perception of loneliness and virtual actions adapt to it. Women s Studies (Sociological & Psychological). 2022; 20(1): 65–98.

50. Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology. 1989; 57(6): 1069-81.

51. Ryff CD, Singer BH. Best news yet on the six-factor model of well-being. Social Science Research. 2006; 35(4): 1103–19.

52. Vafanoush M, Farah Bakhsh K, Bajestani HS, Farrokhi N. Investigating the lived experiences of the elderly in Tehran in relation to psychological well-being and comparing it with the psychological well-being of Ryff. Journal of Applied Research in Counseling. 2024; 6(3): 53–67. [Persian]

53. Templer DI. The construction and validation of a death anxiety scale. The Journal of General Psychology. 1970; 82(2): 165–77.

54. Downey L, Curtis JR, Lafferty WE, Herting JR, Engelberg RA. The Quality of Dying and Death Questionnaire (QODD): empirical domains and theoretical perspectives. Journal of Pain and Symptom Management. 2010; 39(1): 9–22.

55. Sharif Nia H, Sharif SP, Goudarzian AH, Haghdoost AA, Ebadi A, Soleimani MA. An evaluation of psychometric properties of the Templer's Death Anxiety Scale-Extended among a sample of Iranian chemical warfare veterans. Journal of Hayat. 2016; 22(3): 229–44. [Persian]

56. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology. 1991; 61(1): 115-21.

57. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research. 2003; 27(3): 247–59.

58. Babaahmadi Milani F, Momeni K, Dehghani-Arani F, Beyramvand Y, Setoudehmaram S, Saffarifard R. The mediating role of rumination in the relationship between high school students with borderline personality disorder and self-Injury. Journal of Applied Psycology Research. 2023; 14(1): 85–98. [Persian]

59. King DB, DeCicco TL. A viable model and self-report measure of spiritual intelligence. International Journal of Transpersonal Studies. 2009; 28(1): 68-85.

60. Sharif Nia H, Haghdoost AA, Ebadi A, Soleimani MA, Yaghoobzadeh A, Abbaszadeh A, et al. Psychometric properties of the king spiritual intelligence questionnaire (ksiq) in physical veterans of iran-iraq warfare. Journal of Military Medicine. 2015; 17(3): 145–53. [Persian]

61. Somes J. The loneliness of aging. Journal of Emergency Nursing. 2021; 47(3): 469–75.

62. Tragantzopoulou P, Giannouli V. Social isolation and loneliness in old age: Exploring their role in mental and physical health. Psychiatriki. 2021; 32(1): 59–66.

63. Mann F, Wang J, Pearce E, Ma R, Schlief M, Lloyd-Evans B, et al. Loneliness and the onset of new mental health problems in the general population. Social Psychiatry and Ppsychiatric Epidemiology. 2022; 57(11): 2161–78.

64. Wang S, Quan L, Chavarro JE, Slopen N, Kubzansky LD, Koenen KC, et al. Associations of depression, anxiety, worry, perceived stress, and loneliness prior to infection with risk of post–COVID-19 conditions. JAMA Psychiatry. 2022; 79(11): 1081–91.

65. Van Wilder L, Pype P, Mertens F, Rammant E, Clays E, Devleesschauwer B, et al. Living with a chronic disease: insights from patients with a low socioeconomic status. BMC Family Practice. 2021; 22(1): 1-11.

66. Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology. 2000; 109(3): 504-11.

67. Constantin K, English MM, Mazmanian D. Anxiety, depression, and procrastination among students: Rumination plays a larger mediating role than worry. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2018; 36(1): 15–27.