Document Type



Doctor of Philosophy


Psychology, Clinical-Community

Date of Defense


Graduate Advisor

Ann Steffen


Ann Steffen

Kamila White

Steven Bruce

Eric Lenze


The purpose of this study was to examine the factors that are associated with psychological well-being in older adults with late-life depression and determine if social participation moderates and/or mediates these relationships. This dissertation study utilized secondary pre-treatment data collected from the “Optimum: Optimizing Depression Treatment in Older Adults” study (Cristancho et al. (2019). Community dwelling older adults (N = 369) were included if they currently met criteria for MDD, had failed at least two prior trials of MDD medication treatment, and were able to visit the study site to participate in cognitive and physical functioning assessments. Hierarchical multiple regressions were used to analyze the correlates of psychological well-being. Cognitive functioning and physical functioning measured by a 4-meter gait speed test were not significantly correlated with psychological well-being. Social participation (B = .19, p < .001) and levels of anxiety (B = -.40 , p < .001) were found to be significant predictors of psychological well-being in the model (F(9,359), p < .001, adjusted R2 = .228). Results indicated that social participation was not a significant moderator (DR2 = .002, p = .892) of these relationships but was a significant partial mediator for the relationship between anxiety and psychological well-being [Indirect Effect = -.06, 95% C.I. (-.1022, -.0233)]. Exploratory analyses revealed that self-reported physical functioning and hand grip strength were additional significant predictors of psychological well-being in this sample. Overall, the findings from this study highlight the importance of social participation for psychological well-being in older adults with treatment resistant depression. Continued research is needed to gain a clearer understanding of factors that may promote psychological well-being in diverse populations of older adults with major depressive disorder.