2013. Vol.4, No.3, 178-182
Published Online March 2013 in SciRes (
Copyright © 2013 SciRes.
Spirituality and Quality of Life and Its Effect on Depression in
Older Adults in Mexico
Ana Luisa González-Celis1, Juana Gómez-Benito2
1Division of Research and Graduate, Faculty of Higher Education Iztacala, National University Autonomous of
Mexico, Mexico City, Mexico
2Department of Methodology of Behavioral Sciences, Faculty of Psychology, University of Barcelona,
Barcelona, Spain
Received December 20th, 2012; revised January 27th, 2013; accepted February 24th, 2013
The quality of life (QOL) appears as an object of study of psychology, as a central component of human
well-being. The quality of life in the elderly is especially relevant because as the years go the older per-
sons can have lost health, the social role, the cognitive functioning, the power financial and their family.
The purpose of the study is to evaluate the impact of psychological variables associated with quality of
life in Mexican elderly. A sample of 75 elderly people between 60 and 87 years (mean = 65, SD = 9.41),
45 women and 30 men, assigned to a health clinic. QOL was measured with the WHOQOL, and an ex
post facto design, three groups were formed by the level obtained with depressive symptoms GDS: (G1)
absent (n1 = 42), (G2) mild (n2 = 19) and (G3) moderate-severe (n3 = 14). An acceptable correlation be-
tween QOL and spirituality (r = .523, p < .0001). A negative association between QOL and depression (r
= .482, p < .0001). The QOL showed differences between groups with different levels of depressive
symptoms (F(2.72) = 15.212, p < .0001). The QOL exhibited differences between diseased subjects (QOL =
61.19) and non-diseased (QOL = 66.61) (t = 2.025, p < .046). There were differences in the level of spiri-
tuality (Sp) among elderly patients (Sp = 64.77) and non-elderly patients (Sp = 75.0) (t = 2.37, df = 97, p
< .02). The QOL in the elderly can be improved with psychological interventions to help reduce depres-
sion, where spirituality can be a resource and coping strategy to strengthen other areas of aging.
Keywords: Spirituality; Quality-of-Life; Depression; Older Adults Mexicans
Mexico is in a period of change in the trend of the population,
which is projected in the next years much of the population will
be elderly.
Several sources (CONAPO, 2001, 2006; Partida, 2006;
United Nations, 2007; World Bank, 2009) have given explana-
tion to this phenomenon, attributing it mainly to advances in the
medical field, thanks to this the mortality rate has decreased
and life expectancy has increased from 34 years old in 1930 to
over 75 years old in 2005 (INEGI, 2009), allowing one hand a
death to a later age and on the other a lower infant mortality.
Thus the combination of life expectancy increasing and a fall
in the fertility rate, causes a significant increase in the average
age, a rising proportion of older adults, and therefore a need for
greater attention to these individuals.
But if the life expectancy has increased it does not necessa-
rily indicate that conditions have improved, also that living
more years, means more health risks and does not necessarily
represent a complete satisfaction (González-Celis, 2010).
Thus the quality of life (QOL) appears as an object of study
of psychology, as a central component of human well-being
that is closely related to other aspects of functioning, such as
health (Johansson, Grant, Plomin, Pederson, Ahem, Berg et al.,
2001; Litwin & Shiovitz-Ezra, 2006), the coping, the problem
solving, the self-efficacy (Bandura, 1977, 1999; González-Celis,
2009a, 2012b), the development of social skills (Acuña-Gurrola
& González-Celis, 2011) and the depressive symptoms (Gon-
zález-Celis, 2009b).
Evaluate the quality of life in the elderly is especially rele-
vant because according to the years go in the life of an individ-
ual, is undergoing a series of transformations that result in gains
and losses, including health, the social role, cognitive function-
ing, the family and the economic status, loneliness, and anxiety,
among others (Nieto, Abbot, & Torres, 1998; Pinquart &
Sörensen, 2001; Rivera-Ledesma, Montero, González-Celis, &
Sanchez-Sosa, 2007; Rowe & Kahn, 1997; Sanchez-Sosa &
González-Celis, 2002, 2006).
One of the dimensions of quality of life is social support, and in
the elderly appears as a measure of the well-being (Burnett, Regev,
Pickens, Prati, Aung, Moore, & Bitondo, 2006; Jackson, 2006).
One of the most common problems found in the elderly, is
the presence of depressive symptoms.
One strategy to coping with the loss in the elderly is spiritu-
ality (González-Celis, 2012a; González-Celis & Araujo, 2010;
González-Celis & Lázaro, 2007; González-Celis & Padilla, 2006).
It is from this kind of approach that studies on quality of life
(QOL) come to know and give better service to the needs of the
So the purpose of the study is to evaluate the impact of psy-
chological variables associated with the QOL in older adults
The principal objective is to examine if the social support
and spirituality are measures of the quality of life in the elderly
and its effect on depression.
Other objective is to test the association between the social
support, depression and spirituality.
As well as to evaluate the differences in QOL, social support,
depression, and other additional measures, gender and condi-
tion of health.
And to test the differences in the domains of QOL in older
people with different groups depressive symptoms.
A sample of 75 elderly, aged between 60 and 87 years old
(mean = 65, SD = 9.41), 45 were women and 30 men, assigned
to a health clinic in a lower-class urban area of Mexico State.
The average educational level was of basic education. Regard-
ing marital status, 63% were married or with partners, 34%
widowed and 3% singles.
They completed three instruments plus a sheet socio demo-
graphic data also they gave voluntarily, their informed consent.
Under an ex post facto design, formed three groups of sub-
jects by the level of depressive symptoms according to the
score obtained by the Geriatric Depression Scale: (G1) absent
(n1 = 42), (G2) mild (n2 = 19) and (G3) moderate-severe (n3 =
It was applied a battery composed of three measuring in-
struments psychological and sheet socio demographic data.
Sociodemographic questionnaire. As an interview through 20
both open and closed questions, general data were obtained
from subjects who participated in the study (name, age, gender,
marital status and condition about health).
Quality of Life (WHOQOL-100), prepared by the World
Health Organization (WHO-Group, 1996, 1997, 1998a, 1998b),
in its extended version (Power, Bullinger, & Harper, 1999),
translated and adapted to Spanish-Mexican by González-Celis
(2002). It features 100 items, with which measures the quality
of life in general. It includes six domains of quality of life:
physical health, independence, psychological health, social
relationships, environment and spirituality. Contains 24 specific
facets with four questions each (96 items) and a general facet of
four items designed for to measure “Quality of Life Global”
and “Overall Health”. It was got a total score from 0 to 100,
with higher scores indicating better quality of life. Also the
score of the QOL has six specific scores one for each domain.
To answer the questionnaire asked the participants that their
responses they referred to two weeks earlier.
Subjective Well-being Scale PCG (Philadelphia Geriatric
Center) for the elderly, written and reviewed by Lawton in
1975 which measures the overall subjective well-being older
adults (Andrews & Robinson, 1991) (Spanish version by Gon-
zález-Celis, 2002). The scale is composed of three factors: agi-
tation, attitude to their own aging and loneliness. The scale
values range from 0 (lowest level of well-being) to 22 (highest),
which refers to the values of satisfaction, peace or achievement.
The answer choices are dichotomous and nominal -yes/no-, and
two open questions in the factor 3, items 1 and 5.
Geriatric Depression Scale, GDS, (Yesavage, Brink, Rose,
Lum, Huang, Adey, & Leiver, 1983). The short version with 15
items of the Geriatric Depression Scale (GDS), adapted to
Mexican older population by González-Celis & Sánchez-Sosa
(2003). The total qualification is obtained by adding scores of 0
(zero), which equals to lack of depression, to a maximum of 15
points. Scores of five points or more indicate a presence of
depressive symptoms.
It requested authorization to a health clinic located in the
state of Mexico, for the implementation of quality of life as-
sessments to seniors.
It contacted people to invite them to participate in the study,
reporting the assessment of the QOL, in order to know how it
was in their physical, psychological and emotional. Those in-
terested in participating were given by the interviewers and
were programmed according to appointment availability.
Later, in a cubicle of the health clinic, there was a single ses-
sion lasting approximately one hour, where it conducted the
reading and signing the informed consent, followed by filling
the data sheet and socio demographic implementation of the
three questionnaires as an interview, in the same order for all.
An acceptable correlation between QOL and social support (r
= .599, p < .0001), and quality of life and spirituality (r = .523,
p < .0001).
The results also revealed a moderate but significant negative
association between QOL and depression (r = .482, p
< .0001).
Also found moderate, significant and negative correlation
between depression and social support (r = .397, p < .0001),
but not with depression and spirituality.
The QOL showed differences between groups with different
levels of depressive symptoms (F(2,72) = 15.212, p < .0001)
(Figure 1).
The quality of life exhibited difference between diseased
subjects (QOL = 61.19) and non-diseased (QOL = 66.61) (t =
2.025, p < .046).
The quality of life showed gender differences significant (t =
2.005, df = 74, p < .049) (QOL of women = 60.80, QOL of men
= 65.42).
Score of support social was statistic and significantly differ-
ence between groups with different levels of depressive symp-
toms (F(2,84)=6.710, p < .002).
Figure 1.
Quality of life scores for each group with different levels of depressive
Copyright © 2013 SciRes. 179
Copyright © 2013 SciRes.
Table 1.
Comparison of quality of life scores for each domain between the various groups with depressive symptoms.
Quality of life domains
Groups with depressive
symptoms Physical health Psychological health Independence Social relations Environment Spirituality
Absent (G1) 68.29 68.80 68.96 64.89 64.16 70.31
Mild (G2) 49.37 51.47 51.34 54.08 54.87 64.44
Moderate-severe (G3) 47.40 51.13 50.89 53.39 55.30 67.56
Total 59.64 60.06 60.32 59.79 60.29 68.08
F 19.843 29.018 19.543 6.710 9.221 .764
p <.0001 <.0001 <.0001 <.0002 <.0001 >.469
No differences in social support, spirituality and and the
number of depressive symptoms between gender. In a report prepared by the WHO (Power, Bullinger, &
Harper, 1999), the global standard established by 15 countries
to consider a good QOL, is a score ranging from 70 to 75 in
each of the domains, which, the results of the study are not very
flattering. In analyzing the results, spirituality highlighted as an
important element in the functioning of the QOL, agreeing with
Viamonte (1993) on the inclusion of this aspect as one of five
to maintain a balance in the well-being of the individual,
possibly as a strategy coping used by older adults. Spirituality
not only as belonging to any group or association of a religious,
but as a belief in something that affects daily life and sense of
transcendence (Montero & Sierra, 1996).
No differences in social support and depressive symptoms
between elders who report being sick and healthy elderly.
There was difference in the level of spirituality (Sp), among
elderly ill (Sp = 64.77) and healthy elderly (Sp = 75.0) (t = 2.37,
df = 97, p < .02).
Comparing levels of quality of life in each of the six domains
of quality of life with the average obtained by standard
WHOQOL-Group (1998a, 1998b) (Range = 62.25 - 71.75), was
observed in the case of elderly sample Mexican, the quality of
life scores were lower in all domains (Physical Health, Psy-
chological Health, Independence, Social Relations and the
Environment), except for the domain of Spirituality (68.07)
(Figure 2). Although no significant association was found between
scores on the domain of spirituality and attending a religious
group, it was observed that the people who do attend a group
scored higher in the domain of spirituality than those who do
not, what may reflect that membership in a group helps to
increase the level of spirituality, which would impact the
quality of life of people.
Finally, when comparing the quality of life scores for each
domain, between groups with different levels of depressive
symptoms (Table 1). Note that there is enough statistical
evidence to prove the difference in quality of life scores
between groups with different levels of depressive symptoms,
in the domains of Physical Health, Psychological Health, In-
dependence, Social Relations, and Environment; found higher
scores for quality of life in the elderly group without depressive
symptoms, and lower scores for quality of life in groups of
elders who had mild, moderate or severe depressive symptoms;
not for the domain of spirituality, where the quality of life score
was the same and slightly higher for all groups of elderly
without depressive symptoms, or for those who showed
symptoms of mild depression, moderate or severe.
Also it can be concluded that depression is a modulating
variable of QOL in older adults. Elderly without depressive
symptoms had higher levels of quality of life than those with
mild, moderate or severe. However, the QOL was not differ for
older people with different levels of depression, exclusively to
the domain of spirituality, hence it is interesting to ask, if
spirituality can be used as a protective factor when used as a
resource for coping with the depressive symptoms.
Finally QOL in elderly probably be improved with psy-
chological interventions (González-Celis, Chavez, & Tron, 2011,
Gonzalez-Celis & Sanchez-Sosa, 2003) to help reduce the
presence of depressive symptoms. Spirituality can be used as a
resource and also as a coping strategy (González-Celis, 2012a;
Rivera-Ledesma, 2003) to strengthen other areas of aging.
This paper is product of a research sponsored by National
University Autonomous of Mexico, through a grant of the Pro-
gram PASPA 2012, for to work half of sabbatical in the Uni-
versity of Barcelona, who obtained the first author under the
guidance of the second.
Figure 2.
Comparison of quality of life scores for each domain, in a sample of 75
elders of the State of Mexico and the standard (62.25 - 71.75) of WHO. Acuña-Gurrola, M. R., & González-Celis, R. A. L. (2011). Habilidades
sociales y calidad de vida en adultos mayores mexicanos de un
centro recreativo. In J. M. Román-Sánchez, M. A. Carbonero-Martín,
& J. D. Valdivieso-Pastor (Eds.), Educación, Aprendizaje y
Desarrollo en una Sociedad Multicultural (pp. 1304-1316). Madrid:
Ediciones de la Asociación Nacional de Psicología y Educación.
Andrews, F. M., & Robinson, J. P. (1991). Measures of subjective
well-being. In J. P. Robinson, P. R. Shaver, & L. S. Wrightsman
(Eds.), Measures of personality and social psychological attitudes
(pp. 61-114). San Diego: Academic Press, Inc.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behav-
ioral change. Ps ych ologi cal Review, 84, 191-215.
Bandura, A. (1999). Autoeficacia: cómo afrontamos los cambios de la
sociedad actual. Bilbao: Desclée de Brouwer.
Burnett, J., Regev, T., Pickens, S., Prati, L., Aung, K., Moore, K., &
Bitondo, C. (2006). Social networks: A profile of the elderly who
self-neglect. Jour nal of Elder Abuse & Neglect, 18, 35-49.
CONAPO (2001). Índices de desarrollo 2000. URL (last checked 10
July 2011).
CONAPO (2006). Proyecciones de la población de México 2005-2050.
URL (last checked 23 October 2012).
González-Celis, R. A. L. (2002). Efectos de intervención de un
programa de promoción a la salud sobre la calidad de vida en
ancianos. Ph.D. Thesis, México: Facultad de Psicología, UNAM.
González-Celis, R. A. L. (2009a). Autoeficacia para realizar actividades
cotidianas (AeRAC) en ancianos mexicanos. In A. L. González-Celis,
R. (Ed.), Evaluación en psicogerontología (pp. 47-74). México:
Editorial Manual Moderno.
González-Celis, R. A. L. (2009b). Composición factorial del inventario
de depresión de Beck en ancianos mexicanos. Journal of Behavior,
Health & Social Issues, 1, 15-28.
González-Celis, R. A. L. (2010). Calidad de vida en el adulto mayor. In
L. M. Gutiérrez-Robledo, & J. H. Gutiérrez-Ávila (Eds.), Envejec imient o
Humano. Una Visión Transdisciplinaria (pp. 365-378). México:
Instituto de Geriatría. Secretaría de Salud.
González-Celis, R. A. L. (2012a). Ch. 9: Estilos de afrontar el estrés
ante el envejecimiento. In S. Galán-Cuevas & E. J. F. Camacho-
Gutiérrez (Eds.), Estrés y salud: Investigación básica y aplicada (pp.
115-130). México: Editorial Manual Moderno. Universidad Autó-
noma de San Luis Potosí.
González-Celis, R. A. L. (2012b). La autoeficacia en las actividades
cotidianas. In L. M. Gutiérrez-Robledo & D. Kershenobich-
Stalnikowitz (Eds.), Envejecimiento y salud. Una propuesta para un
plan de acción (pp. 179-191). México: Academia Nacional de
Medicina de México, Academia Mexicana de Cirugía, A. C. Instituto
de Geriatría, Universidad Nacional Autónoma de México.
González-Celis, R. A. L., & Araujo, V. A. V. (2010). Estrategias de
afrontamiento ante la muerte y calidad de vida en adultos mayores.
Revista Kairós-Gerontolo gia, São Paulo, 13, 167-190.
González-Celis, R. A. L., Chávez, B. M., & Trón, A. R. (2011). Calidad
de vida y adaptación psicológica en una muestra de ancianos que
habitan en la ciudad de México. Revista Memorialidades.
Universidade Estadual De Santa Cruz. DFCH—Núcleo De Estudos
Do Envelhecimento, 16, 29-53.
González-Celis, R. A. L., & Lázaro, L. G. (2007). Espiritualidad y
sentimientos de soledad sobre la calidad de vida en adultos mayores.
Revista Psicología y Cie n c ia Social, 9, 44-55.
González-Celis, R. A. L., & Padilla, A. (2006). Calidad de vida y
estrategias de afrontamiento ante problemas y enfermedades en
ancianos de la ciudad de México. Universitas Psychological, 5, 501-
González-Celis, R. A. L., & Sánchez-Sosa, J. J. (2003). Efectos de un
programa cognitivo-conductual para mejorar la calidad de vida en
adultos mayores. Revista Mexicana de Psicología, 20, 43-58.
INEGI (2009). Instituto Nacional de Estadística, Geografía e
Informática. Indicadores Sociodemográficos de México. URL (last
checked 23 October 2012).
Jackson, T. (2006). Relationships between perceived close social sup-
port and health practices within community samples of American
women and men. The Journal of Psychology, 140, 229-246.
Johansson, B., Grant, J. D., Plomin, R., Pederson, N. L., Ahem, F.,
Berg, S. et al. (2001). Health locus of control in late life: A study of
genetic and environmental influences in twins aged 80 year and older.
Health Psychology, 20, 33-40. doi:10.1037/0278-6133.20.1.33
Lawton, M. P. (1975). The Philadelphia Geriatric Center morale scale:
A revision. Journal of Gerontology, 30, 85-89.
Litwin, H., & Shiovitz-Ezra, S. (2006). Network type and mortality risk
in later life. The Gero nt ol ogist, 46, 735-743.
Montero, L.-L. M., & Sierra, C. L. (1996). Escala de bienestar
espiritual. Un estudio de validación. La Psicología Social en México,
AMEPSO, 6, 28-83.
Nieto, J., Abad, A., & Torres, A. (1998). Dimensiones psicosociales
mediadoras de la conducta de enfermedad y calidad de vida en
población geriátrica. Anales de Psicología, 14, 75-81.
Partida, B. V. (2006). Proyecciones de la población de México 2005-
2050. URL (last checked 1 October 2012).
Pinquart, M., & Sörensen S. (2001). Gender differences in self-concept
and psychological well-being in old age: A meta análisis. The Jour-
nals of Gerontology Series B: Pshychological Sciences and Social
Sciences, 56, 195-213. doi:10.1093/geronb/56.4.P195
Power, M., Bullinger, M., & Harper, A. (The World Health Organiza-
tion Quality of Life Group) (1999). The World Health Organization
WHOQoL-100: Tests of the universality of quality of life in 15 dif-
ferent cultural groups worldwide. Health Psychology, 8, 495-505.
Rivera-Ledesma, A. (2003). Espiritualidad y salud mental en adultos
mayores. Sc.Ms. Thesis, México: Facultad de Psicología, UNAM.
Rivera-Ledesma, A., Montero, L.-L. M., González-Celis, R. A. L., &
Sánchez-Sosa, J. J. (2007). Escala de ansiedad ante el envejecimiento
de Lasher y Faulkender: Propiedades psicométricas en adultos
mayores mexicanos. Revista Salud Mental, 30, 55-61.
Rowe, J., & Kahn, R. (1997). Successful aging. Gerontologist, 37, 433-
440. doi:10.1093/geront/37.4.433
Sánchez-Sosa, J. J., & González-Celis, R. A. L. (2002). La calidad de
vida en ancianos. In L. E. Reynoso, & I. N. Seligson (Eds.),
Psicología y salud (pp. 191-218). México: UNAM-Conacyt.
Sánchez-Sosa, J. J., & González-Celis, R. A. L. (2006). Evaluación de
la calidad de vida desde la perspectiva psicológica. In V. Caballo
(Ed.), Manual para la evaluación clínica de los trastornos
psicológicos. Trastornos de la edad adulta e informes psicológicos
(pp. 473-492). Madrid: Pirámide.
United Nations (2007). World economic and social survey 2007. De-
velopment in an ageing world. United Nations Publication, 50, 5-
Viamonte, M. (1993). Al encuentro de la salud y longevidad (pp.
163-179). México: Trillas.
WHOQOL-Group (1996). WHOQOL-BREF. Introduction, admini-
stration, scoring and generic version of the assessment. Programme
on Mental Health, Geneva: World Health Organization.
WHOQOL-Group (1997). WHOQOL Measuring Quality of Life.
Programme on Mental Health. World Health Organization. URL
(last checked 1 October 2012).
WHOQOL-Group (1998a). Development of the World Health Organi-
zation WHOQOL-BREF quality of life assessment. Psychological
Medicine, 28, 551-558. doi:10.1017/S0033291798006667
WHOQOL-Group (1998b). The World Health Organization quality of
Copyright © 2013 SciRes. 181
Copyright © 2013 SciRes.
life assessment (WHOQOL): Development and general psychometric
properties. Socia l S c i en c e a n d M ed i c i n e , 46, 1569-1585.
World Bank (2009). Indicadores de desarrollo mundial. URL (last
checked 22 October 2012).
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey,
M., & Leiver, V. O. (1983). Development and validation of a geriat-
ric depression screening scale: A preliminary report. Journal of Psy-
chiatric Research, 18, 37-49. doi:10.1016/0022-3956(82)90033-4