The Relationship Between Aging Anxiety and Depression in Middle-Aged Adults: The Moderating Effect of Gratitude Disposition
Article information
Abstract
Objective
This study aimed to examine the moderating effect of gratitude disposition on the relationship between aging related anxiety and depression in middle-aged adults. Gratitude disposition was divided into two subfactors, and the moderating effect was analyzed for each.
Methods
A total of 489 participants aged 40 to 64 years completed an online self-report questionnaire. Data from 28 participants who did not meet the recruitment criteria or provide insincere responses were excluded, resulting in a final analysis of 461 participants (mean age=51.15 years, standard deviation=6.99 years, 216 males, 245 females). The PROCESS Macro for SPSS version 2.16 was used to verify the moderating effect.
Results
First, aging anxiety was positively related to depression. Second, gratitude disposition moderated the relationship between aging, anxiety, and depression. Third, recognition and acknowledgment of objects of gratitude moderated the relationship between aging, anxiety, and depression. Fourth, the “experience of gratitude emotion and response tendency” moderated the relationship between aging anxiety and depression.
Conclusion
These results provide a theoretical basis for the development and application of intervention programs targeting middle-aged individuals experiencing psychological problems related to aging anxiety and depression.
INTRODUCTION
Life expectancy in Korea has significantly increased to 83.5 years, compared to the estimate 63.1 years in 1970–1975. This indicates a higher proportion of old age in the life cycle compared to the past [1]. As a result, the importance of successful development and adaptation during middle age is emphasized as it is a crucial for preparing for life in old age [2]. With the increasing life expectancy in Korea, there is a growing interest in successful aging.
According to Berk (2007) [3], middle age can be defined as the period between approximately 40, when individuals have achieved some of their initial life goals, and 65, when they beeISSN 1976-3026 OPEN ACCESS gin to enter old age. Consistently, recent studies generally consider individuals aged 40 to 64 as middle-aged [4-6]. Therefore, in this study, middle age is defined as 40 to 64 years, in reference to Berk’s definition and the Welfare of Senior Citizens Act, which classifies individuals aged 65 and older as elderly.
Successful aging encompasses physical, psychological, and social health, and refers to the extent to which individuals are aware of their current state of life and effectively adapt to changes brought about by aging [7-9]. Middle age is a critical period as individuals experience physical and mental changes associated with aging, making their perception of aging closely related to successful aging [10,11]. However, modern society tends to perceive the natural aging process negatively, perceiving it as a threat to youthfulness [12,13]. Negative thoughts and attitudes towards aging and the elderly can influence the aging process, leading to a fear of aging and, a negative impact on successful aging [14,15].
Aging anxiety refers to the anxiety surrounding phenomena related to aging that such as the fear of old age and fear of getting old [16,17]. It plays a significant role in individual’s adaptation to the aging process, and is considered the opposite con-cept of successful aging [17-19]. While aging anxiety can be experienced across all age groups, it is highest in middle age, where individuals experience aging-related symptoms [20-22]. Aging anxiety in middle-aged individuals is a significant cause of psychological instability and associated with an increased risk of depression [10,18,23-25].
According to the World Health Organization (WHO), depression is one of the most common mental illnesses worldwide [26]. While depression can affect individuals of all ages, the Korean Health Insurance Review and Assessment Service (HIRA), reports that in 2022, the highest percentage of individuals treated for depression belonged to the middle-aged group account for approximately 39.2% of all ages and showing a gradual increase [27]. Middle-aged individuals experiencing depression may also exhibit physical symptoms such as decreased appetite, sleep disorders, and cognitive decline, in which can significantly impact their quality of life [28,29].
Numerous studies have confirmed the relationship between aging anxiety and depression [17,30-34]. According to Cho [35], aging anxiety is perceived as a significant stressor that poses a threat to psychological well-being. If not properly addressed, it can lead to increased entrapment in the current situation and eventually result in depression, characterized by negative emotional experiences such as discouragement, helplessness, and sadness. Bergman and Segel-Karpas [36] further explained that various physical experiences associated with aging in middle age can induce anxiety and apprehensions about the future. These, in turn, contribute to a limited future time perspective, loneliness, and depressive symptoms [37].
Positive psychology has recently attracted attention in the field of psychology, with studies focusing on adaptive coping mechanisms that influence successful aging adaptation, wellbeing and well-dying [13]. Previous studies have found a negative relationship between aging anxiety and self-efficacy, life satisfaction, and meaning in life, suggesting that positive emotions and attitudes toward aging can a rolein reducing aging anxiety [13,14,18,33,38-40]. Notably, gratitude has been identified as one of the key psychological factors associated with successful aging among Koreans [41]. Gratitude is considered an internal resource that facilitates meaningful integration of life in the latter half of life, and experiencing gratitude in everyday life can significantly improve mental well-being [42]. While early studies focused on the emotional response of gratitude, it has been regarded as a multidimensional variable that encompassing cognitive, behavioral, and emotional characteristics [43]. In particular, experiencing gratitude involves the cognitive process of recognizing others’ benevolent actions, understanding the associated effort or cost, and perceiving these actions as meaningful [44]. Based on previous studies, the present study defines gratitude in terms of two dimensions: a cognitive dimension, reflecting having a grateful mindset toward others, and a responsive dimension, reflecting the emotional experience of gratitude and its behavioral expression [45-48].
According to Fredrickson’s [49] broaden-and-build theory, positive emotions such as gratitude have the function of expanding an individual’s list of thoughts and behaviors, while also enhancing physical, intellectual, psychological, and social resources. In contrast, negative emotions tend to limit thinking and behavior. By experiencing pleasant emotions, negative emotions can instantaneously reduce, leading to flexible and adaptive thinking, and increase psychological and social resources [50,51]. Several studies have demonstrated that gratitude can alleviate symptoms of depression [52-56].
Previous studies have examined the moderating effect of gratitude disposition on the aging process. Kim’s [30] conducted a study on the elderly and found that positive perceptions of others significantly moderated the relationship between aging anxiety and depression. Noh and Lee [45] confirmed the moderating effect of gratitude disposition on the relationship between stress and psychological well-being of college students. Additionally, Jun et al. [57] confirmed that gratitude disposition can buffer the effects of life stress on depression. The results suggest that maintaining positive perceptions and attitudes during the process of adapting to various changes can serve as protective factors against depression.
In summary, previous studies have shown that aging anxiety can be a significant risk factor for depression in middleaged adults. Gratitude disposition has also been recognized as a key psychological resource that promotes positive emotions and psychological well-being. However, the moderating role of gratitude disposition in the relationship between aging anxiety and depression has not been sufficiently verified. Accordingly, the present study aims to empirically examine the moderating effect of gratitude disposition on the relationship between aging anxiety and depression, as well as the potential moderating influence of its subdimensions. The main hypotheses are as follows: First, aging anxiety will have a positive effect on middle-aged depression. Second, gratitude disposition will moderate the relationship between aging anxiety and depression in middle-aged individuals. Third, the subfactors of gratitude disposition will moderate the relationship between aging anxiety and depression levels in middle age.
METHODS
Participants and survey
This study was conducted after obtaining approval from Dankook University’s Institutional Review Board (approval number: 2021-05-045-003). In this study, a self-report questionnaire was administered to 489 adults aged 40 to 64 years, living in Korea. Due to the COVID-19 situation, the survey was conducted online using Google Forms. Prior to the survey, all participants were provided with a study participation notice and gave their consent to participate. They were also informed that they could stop the survey at any time if they wished. As compensation, participants were offered bakery gifts as compensation. Out of the 489 respondents, 461 (mean age=51.15 years, standard deviation [SD]=6.99 years) were included in the analysis after excluding 28 subjects who either did not complete the questionnaire or did not fall within the appropriate age range.
Looking at the general characteristics of the participants, 216 men (46.9%) and 245 women (53.1%). In terms of age groups, 207 (44.9%) participants were in their 40s, 174 (37.7%) were in their 50s, and 80 (17.4%) were in their 60s. Regarding residential areas, 174 individuals (37.7%) lived in Gyeonggido, 116 individuals (25.2%) lived in Seoul, and 171 individuals (37.1%) lived in other areas.
Measures
The Anxiety about Aging Scale
To measure aging anxiety, the researchers utilized the aging anxiety scale. This scale was initially developed by Lasher and Faulkender [17] and later adapted and modified by Kim [58]. The scale consist of four sub-factors: fear of older people, psychological concerns, physical appearance, and fear of loss. There are a total of 20 questions, with 5 questions for each sub-factor. These questions are answered on a 5-point Likert scale (1=not at all to 5=very much). The scoring is such that, the higher score indicates higher level of aging anxiety. In the original study by Lasher and Faulkender [17], Cronbach’s α was 0.82, and in this study, it was 0.87.
Depression scale
To measure depression, the researchers utilized the Center of Epidemiologic Studies Depression Scale (CES-D). The CESD was originally developed Radloff [59] and a modified version known as CES-D-11 was used in this study, as modified by Kohout et al. [60] In Korea, Hoe et al. [61] validated the Korean version. This scale is a question about feelings and behaviors over the past week, and examples of questions include “I did not feel like eating and poor appetite” and “I felt depressed.” Eleven questions were answered on a 4-point Likert scale (1=less than 1 day in the past week, 4=more than 5 days per week). Questions 5 and 8 were reverse-scored to measure positive emotions, which means that the higher the score of all items, the more depressive symptoms. In the study by Hoe et al. [61], Cronbach’s α was 0.90; in this study, it was 0.89.
Gratitude Disposition Scale
To measure gratitude disposition, the researchers utilized Gratitude Disposition Scale developed by Lim [46] based on GQ-6 (Gratitude Questionnaire) [62], the GRAT (Gratitude, Resentment, Appreciation Test) [63], and the Appreciation Scale [64]. The scale consisted of 30 questions, which were divided into two sub-factors: 15 questions about recognition and acknowledgment of gratitude objects and 15 questions about the experience of gratitude and response tendency. Examples of questions include “I would not have been present without the help of many people” and “I often think about how to express my feelings to a grateful person.” Of the 30 questions, two negative questions were included, and the responses were made on a 5-point Likert scale (1=not at all to 5=very much); the higher the total score, the higher the gratitude disposition. In the final analysis, one item with a factor loading of less than 0.30 was excluded. In this study, Cronbach’s α was 0.92, recognition and acknowledgment of gratitude objects was 0.85, and experience of gratitude and response tendencies was 0.86.
Statistical analysis
The collected data were analyzed using IBM SPSS Statistics version 23.0 (IBM Corp.) and PROCESS Macro for SPSS version 2.16 developed by Hayes [65]. The data analysis process involved the following steps: First, a frequency analysis was conducted using SPSS 23.0 to examine the demographic characteristics of the participants. Next, descriptive statistics were calculated to confirm the mean, SD, skewness, and kurtosis of each variable. Additionally, Pearson’s correlation analysis was conducted to assess the relationship between major variables such as aging anxiety, depression, and gratitude disposition. Finally, the PROCESS Macro 1 model was utilized to verify the moderating effect of dispositional gratitude between aging anxiety and depression. To minimize issues related to multicollinearity, the moderating effect, the independent variable, and the moderator variables [66]. Additionally, following the suggestion of Frazier et al. [67], the significance of a simple regression between independent and dependent variables was verified in the specific values of the moderator variables (Mean-1SD, Mean, Mean+1SD). Moreover, the Johnson-Neyman (J-N) technique was employed to identify the regions of significance for the moderating effect.
RESULTS
Mean, SD, and correlation analysis
The descriptive statistics of the main variables and the correlation between each variable are presented in Table 1. Aging anxiety showed a significant positive correlation with depression (r=0.242, p<0.01). There was also a significant negative correlation with gratitude disposition (r=-0.113, p<0.05). According to aging anxiety and sub-factors of gratitude disposition, there was a significant negative correlation between the experience of gratitude and response tendency (r=-0.144, p<0.01), but there was no significant correlation with recognition and acknowledgment of gratitude objects. Gratitude disposition was negatively correlated with depression (r=-0.295, p<0.01). Looking at each subfactor, recognition and acknowledgment of gratitude objects (r=-0.273, p<0.01) and experience of gratitude and response tendency (r=-0.274, p<0.01) all showed a significant negative correlation with depression. Additionally, the recognition and acknowledgment of gratitude objects, as a sub-factor, showed a significant positive correlation with the experience of gratitude and response tendency (r=0.626, p<0.01).
Descriptive statistics and correlation analysis of variables (N=461)
Moderating effect of gratitude disposition
The results of the analysis of the moderating effect of gratitude disposition are presented in Table 2. Aging anxiety had a positive effect on depression (B=0.098, t=4.655, p<0.001), and gratitude disposition had a negative effect on depression (B=-0.236, t=-13.878, p<0.001). Additionally, the moderating effect of gratitude disposition on the relationship between aging anxiety and depression was significant (B=-0.002, t=-2.794, p<0.01). These results indicate that the effect of aging anxiety on depression depends on the level of gratitude. In the group with a low-gratitude disposition, the higher the aging anxiety, the higher the depression. In the high-gratitude disposition group, depression did not increase significantly, even if aging anxiety was high (Figure 1). Moreover, the J-N technique (Figure 2) showed that gratitude disposition significantly moderated the association between aging anxiety and depression. Specifically, aging anxiety was positively associated with depression when the gratitude disposition score was below 125.34, as the 95% confidence interval did not include zero. Beyond this value, the effect of aging anxiety on depression was no longer statistically significant, indicating that gratitude disposition moderates the impact of aging anxiety on depression.
The moderating effect of gratitude disposition in the relationship between aging anxiety and depression (N=461)
The moderating effect of gratitude disposition in the relationship between aging anxiety and depression.
The conditional association between aging anxiety and depression as a function of gratitude disposition. CI, confidence interval.
Moderating effect of recognition and acknowledgment of gratitude objects
Aging anxiety was found to have a positive effect on depression (B=0.113, t=5.328, p<0.001), and the recognition and acknowledgment of gratitude objects had a negative effect on depression (B=-0.430, t=-13.440, p<0.001). Additionally, the moderating effect of the recognition and acknowledgment of gratitude objects was significant (B=-0.006, t=-3.266, p<0.05). These results indicate that the effect of aging anxiety on depression depends on the level of recognition and acknowledgment of gratitude objects. In the group with low recognition and acknowledgment of gratitude objects, the higher the aging anxiety, the higher the depression. In the group with high recognition and acknowledgment of gratitude objects, depression did not increase significantly, even when aging anxiety was high. The results of the analysis of the moderating effects of the recognition and acknowledgment of gratitude objects are presented in Table 3 and Figure 3. Moreover, the J-N technique (Figure 4) indicated that aging anxiety was positively associated with depression when recognition and acknowledgment of gratitude objects score was below 64.68, as the 95% confidence interval did not include zero. Above this value, the effect of aging anxiety on depression was no longer statistically significant, suggesting that higher recognition and acknowledgment of gratitude objects moderates the impact of aging anxiety on depression.
The moderating effect of recognition and acknowledgment of gratitude objects in the relationship between aging anxiety and depression (N=461)
The moderating effect of recognition and acknowledgment of gratitude objects in the relationship between aging anxiety and depression.
The conditional association between aging anxiety and depression as a function of recognition and acknowledgment of gratitude objects. CI, confidence interval.
Moderating effect of experience of gratitude emotion and response tendency
Aging anxiety has a positive effect on depression (B=0.088, t=4.052, p<0.001), experience of gratitude emotion and response tendency also has a negative effect on depression (B=-0.439, t=-12.859, p<0.001). Additionally, the moderating effect of the experience of gratitude emotion and response tendency was significant (B=-0.005, t=-2.853, p<0.01). These results indicate that the effect of aging anxiety is influenced by the level of experience of gratitude emotion and response tendency. In the group with low experience of experience of gratitude emotion and response tendency, depression increased more as aging anxiety increased; however, in the group with average experience of gratitude emotion and response tendency, depression did not significantly increase, even in the presence of high levels of aging anxiety. The results of the analysis of the moderating effect of the experience of gratitude emotion and response tendencies are presented in Table 4 and Figure 5. Moreover, the J-N technique (Figure 6) revealed that aging anxiety was positively associated with depression when experience of gratitude emotion and response tendency scores were below 59.90. Above this value, the effect was no longer statistically significant, indicating that higher levels of experience of gratitude emotion and response tendency moderate the impact of aging anxiety on depression.
The moderating effect of experience of gratitude emotion and response tendency in the relationship between aging anxiety and depression (N=461)
The moderating effect of experience of gratitude emotion and response tendency in the relationship between aging anxiety and depression.
The conditional association between aging anxiety and depression as a function of experience of gratitude emotion and response tendency. CI, confidence interval.
DISCUSSION
The purpose of this study was to investigate the moderating effect of gratitude disposition on the relationship between aging anxiety and depression among middle-aged Koreans. The study investigated how gratitude disposition divided into two subfactors, influences the relationship between aging anxiety and depression. The main results of the study are discussed below.
First, the findings of this study found that aging anxiety in middle-aged adults has a positive impact on depression in this population. These results are consistent with previous studies that have shown a correlation between the higher the middleaged anxiety, the higher the level of depression [68-70]. Based on cognitive theory, high level of aging anxiety means reflect a negative cognitive type of aging and aging anxiety. In modern society where youths is always seen as desirable, the recognition of aging as a threat, can activate negative perceptions and cognitive schemas, leading to middle-aged depression [68]. Furthermore, middle-aged aging anxiety may also experience increased depression through heightened levels of anxiety and worries about the future. These concerns may contribute to a limited perception of the remaining time in life [4,37].
The findings of this study indicate that dispositional gratitude, plays a significant moderating role in the relationship between aging anxiety and depression among middle-aged individuals. These results are consistent with previous studies that have shown decrease in aging anxiety and depression as gratitude disposition increased [13,52,54]. Middle-aged people often experience loneliness due to physical changes, burdens and alienation of social roles, worries about the future, and are more vulnerable to emotional problems, such as depression, than other age groups [71-74]. Gratitude can help reduce negative thoughts associated with the fear of aging. Focusing on positive emotions, such as gratitude and remembering-related events, can reduce the effect of negative aspects of life [63,75]. The results of this study suggest that cultivating a sense of gratitude in daily life can be effective in preventing depression and promoting a more positive view of oneself and the future [76].
The results of this study indicate that the sub-factors of gratitude disposition related to the recognition and acknowledgment of gratitude objects moderates the relationship between aging-related anxiety and depression. These findings are consistent with previous studies that have shown that recognizing objects to be grateful for can significantly reduce depression [53]. Individuals who recognize gratitude are less critical and better to acknowledge the contributions to the positive outcomes they experience. This ability to acknowledge and recognize can lead to higher levels of psychological well-being by helping individuals better control negative emotions such as depression, anxiety, and stress [77-79]. Choi and Jeon [13] further suggest that developing a cognitive schema that allows individuals to find something to be grateful for in various situations can act as an adaptive coping mechanism that gives positive meaning to the overall life of middle-aged people facing aging anxiety.
The findings of this study indicate that the sub factors of gratitude disposition related to the experience of gratitude and response tendencies moderates the relationship between aging anxiety and depression. These results align with previous studies that have demonstrated the effectiveness of gratitude interventions such as, writing a gratitude journal, in reducing negative mood and alleviating depression [76]. Furthermore, research by Lambert et al. [80] suggests that the behavioral expression of gratitude can promote positive interpersonal relationships by reinforcing t others behavior and increasing their responsiveness. The development of social support resulting from this increase in prosocial behavior can help reduce feelings of depression [47,56,81-83].
The main contributions and implications of this study are as follows: Firstly, this study highlights the importance of expressing gratitude as a means to view at aging positively and to prepare for a successful old age. Secondly, previous studies have focused on specific subjects, such as college students, the elderly, and women. This study contributes to the field by demonstrating the effectiveness of gratitude-based interventions in improving the well-being of the elderly [84-86]. This study is significant in that it proves that gratitude is an important resource not only for adult and old age but also for middle-aged mental health. Therefore, in middle-aged individuals with high aging anxiety, depression can be alleviated through a gratitude enhancement program—such as writing a gratitude list, composing gratitude letters, or keeping a gratitude diary—over a period of 2 to 3 weeks, even in clinical settings [87,88]. Moreover, various types of training, including group-based programs or internet-based interventions, can produce sustained positive effects [89]. Lastly, this study provides a detailed analysis of the moderating effect of gratitude disposition by examining two subfactors. Previous studies have focused on the limitations in identifying the psychological strength and value of gratitude as they focus on the degree of emotional experience [46,90].
The limitations of this study and suggestions for follow-up research are as follows: Firstly, in this study, aging anxiety was measured using four psychological factors. However, recent study suggests that it is important to consider not only psychological characteristics but also economic and physical health aspects when assessing aging anxiety [91]. Middle-aged individuals, in particular, may experience more diverse aspects related to aging, such as physically experiencing aging symptoms and social retirement. Therefore, future studies should investigate the relationship between depression and gratitude disposition by subdividing the concepts of aging anxiety, including psychological anxiety. Secondly, aging anxiety may be influenced by various sociodemographic factors, including marital status, presence of children, cohabitation, employment, and income; however, this study did not fully control for these potential confounders. Future research should account for these variables to provide more precise and reliable findings. In addition, middle-aged adults (40–64 years) were analyzed as a single group, yet the relationships among aging anxiety, gratitude disposition, and depression may differ across age subgroups (40s, 50s, 60s). Therefore, future studies should examine these subgroups separately to better capture developmental variations within middle adulthood.
In conclusion, gratitude disposition significantly moderates the relationship between aging anxiety and depression, suggesting its potential as a key target for interventions to enhance mental health in middle-aged adults.
Notes
Availability of Data and Material
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: Seon-Gyeong Kang, Sung-Man Bae. Data curation: Seon-Gyeong Kang, Sung-Man Bae. Formal analysis: Seon-Gyeong Kang. Funding acquisition: Sung-Man Bae. Investigation: Seon-Gyeong Kang. Methodology: Seon-Gyeong Kang, Sung-Man Bae. Project administration: Seon-Gyeong Kang, Sung-Man Bae. Supervision: Sung-Man Bae. Validation: Seon-Gyeong Kang. Visualization: Seon-Gyeong Kang. Writing—original draft: Seon-Gyeong Kang. Writing—review & editing: Sung-Man Bae.
Funding Statement
The present research was supported by the research fund of Dankook University in 2025.
Acknowledgments
This paper has revised and submitted the first author’s master’s thesis.