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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (1) • 2023 • https://doi.org/10.1590/0034-7167-2021-0645 copy

Sexuality and its effects on older adults’ depressive symptoms and quality of life

La sexualidad y sus efectos sobre los síntomas depresivos y la calidad de vida de los ancianos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the effects of sexuality on depressive symptoms and quality of life in older adults.

Methods:

a cross-sectional and analytical study, developed with 596 older adults, who completed four instruments for data collection. Data were analyzed using the Kruskal-Wallis test and Structural Equation Modeling, with a 95% Confidence Interval.

Results:

among the sexuality dimensions, only physical and social adversities exerted statistically significant effects on depressive symptoms (SC=-0.095; p=0.003), but with low magnitude. Moreover, all sexuality dimensions had statistically significant effects on quality of life, being of low magnitude for sexual act (SC=0.171; p=0.010) and for physical and social adversities (SC=0.228; p<0.001), and moderate magnitude for affective relationships (SC=0.474; p<0.001).

Conclusions:

effects of different magnitudes were observed between sexuality dimensions on participants’ depressive symptoms and quality of life.

Descriptors:
Aged; Sexuality; Depression; Quality of Life; Health of the Elderly

Variáveis	n	%
Sex
Male	394	66.1
Female	202	33.9
Age (years)
60 - 64	295	49.5
65 - 69	188	31.5
70 - 74	80	13.4
75 - 79	28	4.7
≥ 80 years	5	0.8
Education
Primary	51	8.6
Elementary school	107	18.0
High school	220	36.9
Higher education	218	36.6
Ethnicity
White	389	65.3
Yellow	11	1.8
Black	30	5.0
Brown	151	25.3
Indigenous	5	0.8
Does not know	10	1.7
Religion
Catholicism	291	48.8
Protestantism	85	14.3
Spiritism	73	12.2
African religion	11	1.8
Other	66	11.1
Without religion	70	11.7
Marital status
Married	358	60.1
Stable union	120	20.1
With fixed partnership	118	19.8
Time living together
≤5 years	116	19.5
Between 6 and 10 years	46	7.7
Between 11 and 15 years	60	10.1
Between 16 and 20 years	35	5.9
> 20 years	339	56.9
Living with children
Yes	188	31.5
No	382	64.1
No children	26	4.4
Received sexual orientation
Yes	137	23.0
Never	459	77.0
Sexual orientation
Heterosexual	515	86.4
Homosexual	19	3.2
Bisexual	8	1.3
Others	54	9.1
Brazil region
Northeast	131	22.0
Midwest	78	13.1
Southeast	264	44.3
South	123	20.6

Variables	Depressive Symptomatology			H	p value
Variables	Absent Median (IQR)	Mild Median (IQR)	Severe Median (IQR)	H	p value
Sexuality
SA	76.00 (67.00 – 81.50)	62.00 (54.25 – 72.25)	58.00 (44.00 – 65.00)	112.863	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
AR	76.00 (67.00 – 82.00)	63.00 (55.00 – 71.25)	56.00 (42.50 – 66.00)	115.808	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
PSA	9.00 (8.50 – 11.00)	8.00 (7.00 – 11.00)	7.00 (5.00 – 9.00)	53.745	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
GS	159.00 (142.50 – 169.00)	134.50 (114.00 – 150.00)	122.00 (95.50 – 136.50)	111.817	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
Quality of life
SS	81.25 (68.75-93.75)	75.00 (56.25-87.50)	68.75 (43.75-81.25)	32.570	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
AUT	75.00 (62.50-81.25)	62.50 (50.00-68.75)	50.00 (34.37-62.50)	111.409	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
PPFA	75.00 (62.50-81.25)	50.00 (37.50-62.50)	31.25 (25.00-43.75)	173.166	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
SP	75.00 (56.25-81.25)	50.00 (37.50-62.50)	37.50 (21.87-50.00)	155.368	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
DD	75.00 (50.00-87.50)	56.25 (31.25-75.00)	50.00 (25.00-68.75)	44.550	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
INT	75.00 (68.75-87.50)	56.25 (37.50-75.00)	37.50 (25.00-46.87)	168.229	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.
GQoL	71.87 (64.06-80.20)	56.25 (50.00-62.50)	44.79 (38.02-51.56)	220.436	<0.001 ^* * Statistical significance by the Kruskal-Wallis H test (p<0.05); IQR – interquartile range; SA - sexual act; AR - affective relationships; PSA - physical and social adversities; SS - sensory skills; AUT - autonomy; PPFA - past, present and future activities; SP - social participation; DD - death and dying; INT - intimacy; GQoL - general quality of life.

	SC	95%CI	p
Measurement model
DOM 2 ← QoL	0.653	0.604 – 0.703	<0.001
DOM 3 ← QoL	0.787	0.750 – 0.824	<0.001
DOM 4 ← QoL	0.694	0.646 – 0.742	<0.001
DOM 6 ← QoL	0.845	0.816 – 0.874	<0.001
Structural model
Direct effects
EVASI1 → GDS	-0.024	-0.119 – 0.072	0.684
EVASI2 → GDS	0.042	-0.062 – 0.146	0.505
EVASI3 → GDS	-0.095	-0.147 – -0.043	0.003
EVASI1 → QoL	0.171	0.061 – 0.280	0.010
EVASI2 → QoL	0.474	0.366 – 0.583	<0.001
EVASI3 → QoL	0.228	0.170 – 0.286	<0.001
QoL → GDS	-0.749	-0.826 – -0.672	<0.001
Indirect effects
EVASI1 → QoL → GDS	-0.128	-0.210 – -0.046	0.011
EVASI2 → QoL → GDS	-0.355	-0.450 – -0.261	<0.001
EVASI3 → QoL → GDS	-0.171	-0.219 – -0.122	<0.001

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