Dezutter, J., Toussaint, L., & Leijssen, M., (2014).

Forgiveness, ego-integrity, and depressive symptoms in community-dwelling and residential elderly adults. Journals of Gerontology, Series B:
Psychological Sciences and Social Sciences, doi:10.1093/geronb/gbu146

Forgiveness, Ego-Integrity, and Depressive Symptoms in

Community-Dwelling and Residential Elderly Adults
Jessie Dezutter,1 Loren Toussaint,2 and Mia Leijssen1 

1
Faculty of Psychology and Educational Sciences, KU Leuven University of Leuven, Belgium.
2
Department of Psychology, Luther College Decorah, Iowa.

Objectives. This study aimed first, to investigate the relation between forgivingness and depressive symptoms in

Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015

elderly individuals and second, to explore whether the developmental task of integrity/despair is a possible underlying
process in this relation. Both aims were studied in a sample of community-dwelling elderly individuals as well as in a
sample of residential elderly individuals.

Methods.  Community-dwelling elderly individuals (n  =  280, M  =  75.98  years) and residential elderly individuals
(n = 205, M = 83.20 years) in Belgium filled out questionnaires on forgivingness, depressive symptoms, and the develop-
mental task of integrity/despair. Structural equation modeling was used to test the mediational role of integrity/despair in
the relation between forgivingness and depression in both samples. Furthermore, multigroup analyses tested the conver-
gence of the mediational models in the community-dwelling elderly individuals and the residential elderly individuals.

Results.  Forgivingness and depression were negatively associated in both residential elderly individuals and com-
munity-dwelling elderly individuals. The developmental task of finding integrity and avoiding despair showed to be a
significant mediator in this relationship.

Discussion. Framed within a life-span perspective, we showed that the developmental task of finding a balance
between integrity and despair is an important intrapersonal mechanism through which forgivingness is related with
depressed feelings for residential as well as community-dwelling elderly individuals.

Key Words:  Depression—Elderly—Erikson—Forgiveness—Psychosocial crisis.

H igh age is a very challenging life stage. The complex

array of physical, psychological, and social changes
that elderly individuals are confronted with is extremely
demanding for their psychosocial functioning and mental
health. In addition, aged people are often struggling with
existential issues, such as one’s own finality and meaning in
one’s life in light of a shortened life perspective (Westerhof,
Bohlmeijer, van Beljouw, & Margriet, 2010). Research
already indicated that several of these factors, such as loss
of loved ones, declining bodily functions, and impaired self-
esteem, are associated with the development of depression
in the elderly individuals (Beekman et  al., 1997; Kraaij,
Arensman, & Spinhoven, 2002). Several studies, indeed,
revealed high levels of depressive symptoms in the oldest
old, reporting prevalence rates up to 31% (Beekman et al.,
1997; Luppa et al., 2011; van’t Veer-Tazelaar et al., 2008).
In addition, depression is especially prevalent among the
elderly individuals living in institutional settings, such
as nursing homes, where 10%–15% suffer from a major
depression and 20%–30% experience significant depres-
sive symptoms (Chimich & Nekolaichuk, 2004; Jongenelis
et  al., 2003; Smalbrugge et  al., 2006). Depression in the
elderly population has a high risk towards chronicity as well
as towards suicide (e.g., Bonnewyn, Shah, Schoevaerts,
Bruffaerts, & Demyttenaere, 2011). Furthermore, depres-
sive symptoms impede the quality of life of elderly
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Received February 27, 2014; Accepted September 11, 2014
Decision Editor: Shevaun Neupert, PhD
individual, and there is strong evidence that depression is
related with higher risks of functional impairment, mor-
bidity, and greater self-neglect, which are in turn associ-
ated with increased mortality (Cuijpers et al., 2013; Saint
Onge, Krueger, & Rogers, 2014). Given the prevalence of
depression in old age as well as the detrimental affect on an
individual’s functioning, special attention is warranted to
identify individual resources that might act as supporting
factors when confronted with impaired capacities and mul-
tiple losses in old age and, as such, might protect against
depressive symptoms (Read, Aunola, Feldt, Leinonen, &
Ruoppila, 2005). Identification of these strengths might
offer useful tools for policy and health care, and might
stimulate the search for effective paths to successful aging
(Lewis, 1996; Phillips & Ferguson, 2013).
Forgiveness Definition and Connections to Mental Health
A psychosocial variable that has received increasing
interest and is linked with several aspects of health and indi-
vidual functioning is forgiveness (Fehr, Gelfand, & Nag,
2010; McCullough, 2000). Although a formal definition
of forgiveness has a long history of debate (Lawler-Row,
Scott, Raines, Edlis-Matityahou, & Moore, 2007), most
researchers currently agree that forgiveness consists of let-
ting go one’s right to retribution and many also suggest that
the offering of mercy, compassion, and love to the offender
Page 1 of 11
Page 2 of 11 DEZUTTER ET AL.

is an additional key element of forgiveness (Brown, 2003; adults (Toussaint et al., 2008), and adult patients of a pri-
Lawler-Row, Karremans, Scott, Edlis-Matityahou, & mary care clinic (Nsamenang, Webb, Cukrowicz, & Hirsch,
Edwards, 2008; Worthington, 2005). Fincham (2000), for 2013).
example, labeled these two dimensions of forgiveness “a
negative dimension” (with focus on reduction in resent-
Integrity-Despair and Connections to Mental Health
ment) and “a positive dimension” (with focus on foster-
The idea of forgiveness being pivotal in late life can be
ing compassion). Lawler and colleagues (2008) stated that
framed within the life stage theory of Erikson (1982). In
letting go of one’s right of resentment can be expressed in
Erikson’s model, adults in the final stage of life must come
a reduction in negative emotions (e.g., anger, hostility),
to terms with their past and need to find meaning in their
negative behaviors (e.g., revenge), or negative thoughts
lives in the face of mortality. The crucial task is to come to
(e.g., rumination). Offering undeserved compassion, on the
ego-integrity, which involves a process whereby individu-
other hand, involves a more positive process of increasing
als must “come to terms with the lives they have lived and

Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015

positive feelings and thoughts. Moreover, recent research
the people they have become” (p.  1005; Torges, Stewart,
focusing on the neural correlates of forgiveness showed
& Duncan, 2008) and get their inner life in order. This can
that granting forgiveness resulted in a heightened activation
only be done by reviewing and restructuring one’s past life.
of a brain cortical network responsible for perspective tak-
For some elderly people, the preoccupations with past fail-
ing, appraisal, and empathy, suggesting that these processes
ures and difficulties dominate the process resulting in regret
play an important role in the forgiveness process (Ricciardi
and bitterness. They feel as if their life has been wasted and
et al., 2013).
they ruminate about what went “wrong” with their lives.
Researchers acknowledge that forgiveness is a complex
Other elderly adults, however, are able to accept their past
phenomenon consisting of different aspects or dimensions
as unchangeable and they try to resolve life regrets. They
(Krause & Ingersoll-Dayton, 2001). Several studies have
achieve a deep level of self-acceptance and are able to
focused on forgiveness on the situational level of a specific
assign order and meaning to the whole of their life. Erikson
offense or on the level of a particular dyadic relationship
referred to these two poles as “despair” and “integrity.”
(McCullough, 2000). Other researchers take into consid-
According to Erikson, achieving a constructive balance
eration the source of forgiveness, including forgiveness by
between the polarities of integrity versus despair is the cru-
others or by God (Baumeister, Exline, & Sommer, 1998)
cial developmental task in this life stage and meeting these
or the subject of forgiveness such as forgiveness of self
challenges is important for the psychological well-being of
and forgiveness of others (Toussaint, Williams, Musick,
elderly population. Research has indeed confirmed this idea
& Everson-Rose, 2008). A  recent interesting approach is
and showed that ego-integrity and despair are significantly
examining forgiveness at the level of a global disposition,
associated with the level of depressive symptoms of elderly
across situations and relationships (Brown, 2003). This
population. Santor and Zuroff (1994), for example, found in
dispositional level (also called forgivingness) focuses on
a sample of elderly population that failing to accept the past
individual differences in emotions, cognitions, motivations,
and achieving ego-integrity were closely linked to depres-
and behaviors that might play a role in interpersonal trans-
sive symptoms. Rickwood and Rylands (2000) also demon-
gressions and implies that those differences are relatively
strated that difficulty with accepting the past was related to
stable across a variety of relationships, time, and situations
higher levels of depression in a group of older women living
(Allemand & Steiner, 2012). Moreover, Brown and Phillips
in a retirement village.
(2005) showed that “individual differences in forgiveness
do appear to exist and may enhance our ability to predict the
aftermath of interpersonal offenses” (p. 635). The Role of Forgiveness in the Developmental Task of
Differences in forgiveness seem indeed to be associated Ego-Integrity and Despair
with differences in psychosocial functioning and health. Research has indicated that individuals are likely
Hill and Allemand (2011), for example, revealed that for- to become more forgiving as they age (e.g., Krause &
givingness was positively related with well-being in a sam- Ingersoll-Dayton, 2001; Toussaint, Williams, Musick, &
ple of adults, and Green, Decourville, and Sadava (2012) Everson, 2001). Increasing levels of this personal virtue and
found similar results in a sample of students. Moreover, strength may well come at an ideal time, given the typical
studies have also indicated that forgiveness is not only posi- struggles of older age. Indeed, scholars have argued that for-
tively related with positive psychological functioning, but giveness might have a prominent place in the later stages of
forgiveness seems to have the potential to buffer the nega- life. Butler and Lewis (1982), for example, stated that when
tive side of life as well, showing consistent inverse associa- people enter late life, they need to conduct a life review pro-
tions between forgiveness and depression (for a review, see cess where themes of forgiveness play a crucial role. Also,
Toussaint and Webb, 2005). This relationship has been rep- Ingersoll-Dayton and Krause (2005) mention that forgive-
licated in student samples (Brown, 2003; Brown & Phillips, ness is important when elderly individuals review their past
2005; Ysseldyk, Matheson, & Anisman, 2007), healthy and try to integrate their life experiences. Indeed, one can
 FORGIVENESS, EGO-INTEGRITY, AND DEPRESSIVE SYMPTOMS Page 3 of 11

anticipate that forgiveness becomes more salient in light of
one’s own finality.
Within Erikson’s (1982) model of life-span develop-
ment, we argue that being able to forgive, as formalized in
dispositional forgiveness, might indeed facilitate the devel-
opmental task of integrity and despair. Past transgressions
are often associated with anger and hurt serving as road-
blocks for the process of life review. The painful memo-
ries associated with the transgressions can create feelings
of “unresolvedness,” bitterness, and rumination, all of them
blocking the process of accepting one’s life and leading,
ultimately, to despair. The ability to forgive, on the other
environmental control, and increased levels of formalized
care might reveal a different pattern of findings. Because to
our knowledge there are no earlier empirical studies avail-
able in this area, we do not have specific hypotheses with
regard to possible differences between living circumstances
and thus this part of the study is exploratory.
Method
Participants and Procedure
Participants were recruited with the help of nine psychol-
ogy students pursuing master’s degrees. Exclusion criteria

Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015

hand, might stimulate a successful life review, resulting in
for participation were: less than 70 years, geriatric cogni-
self-acceptance and ego-integrity. Empirical evidence, how-
tive disorders, and severe illness. The accompanying letter
ever, on the role of forgivingness in integrity and despair is
for the participants introduced the study as an investigation
scarce.
on successful aging. Confidentiality was guaranteed and
informed consent was obtained.
Community-dwelling elderly individuals were recruited
This Study
by four master degree students who contacted their grandpar-
The first aim of this study was to investigate the relation
ents’ social network and who administered questionnaires at
between forgivingness and depressive symptoms in elderly
weekly meetings of elderly social activity clubs in Flanders,
individuals. In line with previous findings from partici-
Belgium. A  total of 320 questionnaires were distributed
pants in earlier life stages, we expect an inverse association
and 280 were returned (80%). Participants’ mean age was
between forgivingness and depressive symptoms (Toussaint
75.98 years (standard deviation [SD] = 4.76, range = 70–91),
& Webb, 2005). The second aim is to focus on the devel-
56% were women and all had Belgian nationality. The high-
opmental task of integrity/despair as a possible underlying
est level of education was primary school for 31% of the
process in the relation between forgivingness and depres-
sample, secondary school for 35%, and higher education
sive symptoms. This is in line with the idea that forgiveness
(college or university) for 33% (1% left this question open).
may improve the outcome of the integrity/despair devel-
With regard to the civil state, 5% identified as single, 67%
opmental life task, and in so doing, resolution of this task
as married, 4% as cohabiting, 21% as widowed, and 2% as
toward integrity might in turn offer some protection against
divorced (1% left this question open).
the development of depression. Previous research supports
Residential elderly were contacted by five master degree
this type of mediation model. For instance, Toussaint and
students in psychology. The boards of the elderly homes were
colleagues (2008) found in a sample of adults that hopeless-
contacted by the first author to introduce the study and ask
ness partially mediated the relationship between forgiving-
for involvement. All elderly homes were located in Flanders,
ness and depressive symptoms. Because hopelessness and
Belgium. The questionnaires were filled out in the elderly
despair are conceptually similar constructs, we hypothesize
homes, more specifically in the private room of the participant
that integrity and despair will similarly mediate the forgive-
or in the leisure room of the elderly home. Because filling out
ness–depression relationship, especially for the older popu-
the questions was too difficult for the participants, the ques-
lation for whom the developmental task of finding a balance
tions were read out aloud and answers were noted on the ques-
between ego-integrity and despair is of utmost importance.
tionnaire. A  total of 205 questionnaires were administered
These hypotheses are tested in two samples. The first
(82%). Participants’ mean age was 83.20 years (SD = 6.94,
sample consisted of community-dwelling elderly individu-
range  =  70–103), 74% were women and all had Belgian
als aged 70 or older, and the second sample consisted of
nationality. The highest level of education was primary school
residential elderly individuals aged 70 or older who were
for 53% of the sample, secondary school for 33%, and higher
living in an elderly home or nursing home. We expected
education (college or university) for 14% (1% left this ques-
that the associations between forgivingness and depression,
tion open). With regard to the civil state, 8% identified as sin-
integrity, and despair would be consistent across both sam-
gle, 19% as married, 0.5% as cohabiting, 68% as widowed,
ples. However, McFarland, Smith, Toussaint, and Thomas
and 4% as divorced (0.5% left this question open).
(2012) already noted that the broader social context in
which forgiveness occurs might alter the nature of the asso-
ciation between forgivingness and health and they showed Instruments
that forgiveness interacted with neighborhood deterioration.
It is thus possible that the specific context of residential Ego-integrity/despair.—Participants completed a meas-
elderly with more experiences of loss of independence, less ure that was developed and validated by Van Hiel and
Page 4 of 11 DEZUTTER ET AL.
Vansteenkiste (2009). The measure has two subscales: ego-
integrity (8 items, e.g., “I can accept my faults and missed
opportunities” and “I’m able to accept the fine and the dif-
ficult moments of my life”) and despair (10 items, e.g., “I
look back upon my life with a feeling of discontent and
regret” and “I’m still feeling some bitterness on past rela-
tions”). Previous studies confirmed the factorial structure
and showed that both dimensions were related in meaning-
ful ways to late adults’ well-being, death attitudes, self-
esteem, and depressive symptoms (Dezutter, Wiesmann,
Apers, & Luyckx, 2013; Soenens & Duriez, 2012). To
reduce the participation burden for the elderly individuals,
the four highest loading items of the ego-integrity scale
and the five highest loading items of the despair scale are
used in this study. Items were rated on a 5-point Likert
scale ranging from 1 (totally disagree) to 5 (totally agree).
Depressive symptoms.—Participants completed a short
version of the Centre for Epidemiological Studies Depression
Scale (CES-D; Radloff, 1977). This 10-item version is espe-
cially developed for use with elderly respondents (Kohout,
Berkman, Evans, & Cornoni-Huntley, 1993). Participants
indicated on a 4-point scale (1 = seldom, 4 = most of the time
or always) how often they experienced cognitive, psycho-
logical, and somatic symptoms of depression during the last
week (e.g., “During the last week ... I felt everything I did
was an effort”). In the process of data collection, interview-
ers noticed that two items were causing confusion, especially
for the residential elderly individuals, and might be assess-
ing physical vitality instead of the experience of depressive
symptoms. These items were as follows: “I felt everything
I did was an effort” and “I could not get going.” Consequently,
we eliminated these two confounded items and computed the
depressive symptoms score using the remaining eight items.
Forgiveness.—Dispositional forgiveness was measured
with the Tendency to Forgive Scale (TTF; Brown, 2003).
The TTF is a 4-item scale on which participants report how
they usually respond when others offend them (e.g., “If
someone wrongs me, I often think about it a lot afterwards”).
Table 1.   Correlations Between the Study Variables for the Participants in Elderly Homes (Above the Diagonal) and the Participants
Living Independently (Below the Diagonal)
Measures
Depressive
symptoms Integrity
[1.67/.56] [3.36/.67]
Depressive symptoms [1.67/.48] — −.38**
Integrity [3.35/.53] −.31** — −.49**
Despair [1.98/.66] .31** −.28**
Forgiveness [2.59/.56] −.26** .16*
Age .00 −.15*
Cronbach’s α .79 .72
Notes. Means and standard deviations are shown between brackets.
*p < .05. **p < .01.
Items were rated in a 4-point Likert scale ranging from 1
(totally disagree) to 4 (totally agree).
Data Analysis
Descriptive analyses and structural equation modeling
were used as the analytic techniques. Descriptive analyses
were first conducted using SPSS 20.0. Amos 22 was used to
conduct confirmatory factor analyses and assess measure-
ment invariance across the residential elderly and commu-
nity-dwelling participants. Structural equation models were
tested to evaluate the extent to which associations between
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015
forgiveness and depressive symptoms were mediated by
integrity and despair. Structural equation models were also
evaluated for invariance across groups.
Results
Descriptive Analyses
Correlations and reliability coefficients are presented in
Table 1 for the residential elderly sample and the commu-
nity-dwelling elderly sample. As expected, forgiveness was
negatively related with depressive symptoms and despair,
and positively related with integrity in both samples.
Integrity was negatively related to depressive symptoms,
despair showed the opposite pattern of association. Age was
significantly correlated with integrity in the community-
dwelling elderly sample and with forgiveness and despair
in the residential elderly sample.
One-way analysis of variance showed no significant
differences between residential elderly and community-
dwelling elderly individuals with regard to integrity (F(1,
446) = 0.02, ns) or depressive symptoms (F(1, 446) = 0.04,
ns). Community-dwelling elderly individuals, however,
showed higher levels of despair (M = 1.98, SD = 0.65) in
comparison with their residential counterparts (M  =  1.69,
SD = 0.72), F(1,446) = 22.46, p < .001, ή2 = 0.05, as well
as lower levels of forgivingness (M = 2.59, SD = 0.56 for
community-dwelling elderly, M = 2.93, SD = 0.74 for resi-
dential elderly), F (1,446)  =  29.50, p < .001, ή2  =  0.07.
Despair Forgiveness
[1.69/.71] [2.93/.74] Age Cronbach’s α
.33** −.24** .02 .77
.40** .08 .83
— −.42** −.20** .76
−.18** — .18** .62
.11 .05
.74 .58 —
 FORGIVENESS, EGO-INTEGRITY, AND DEPRESSIVE SYMPTOMS
Subsequent mean-level analyses, using a set of multivari-
ate analysis of variance’s followed by Tukey’s Honestly
Significant Difference tests, showed no significant dif-
ferences between men and women on our study variables
(forgiveness, integrity, despair, and depressive symptoms)
in the community-dwelling elderly (F(4, 245)  =  1.84,
ns) or in the residential elderly sample (F(4, 193) = 2.40,
ns). Significant differences between the marital status
were found on depressive symptoms (F(4, 244)  =  3.02,
p < .05, ή2 = 0.05) and despair (F(4,244) = 3.45, p < .01,
ή2  =  0.05) in the community-dwelling elderly population
and on forgiveness (F(4,193) = 3.86, p < .01, ή2 = 0.07) and
despair (F(4,193) = 3.12, p < .05, ή2 = 0.06) in the residen-
tial elderly population (“cohabiting” as marital status was
not taken into account in the residential elderly population
because only one participant identified with this option).
For the residential participants, mean levels of despair were
significantly lower for single elderly individual (M = 1.26,
SD = 0.67) than for divorced elderly individual (M = 2.13,
SD = 0.50), and this was identical in the community-dwell-
ing elderly individuals for whom single elderly (M = 1.69,
SD  =  0.62) individuals had lower levels of despair than
divorced elderly individuals (M = 2.68, SD = 0.46) as well
as cohabiting elderly (M = 2.42, SD = 0.48). Single residen-
tial elderly had higher levels of forgiveness in comparison
with the other groups.
Furthermore, for the community-dwelling elderly sam-
ple, mean levels of depressive symptoms of single elderly
individuals (M = 1.41, SD = 0.37) were significantly lower
than for widowed elderly individuals (M = 1.83, SD = 0.60).
Married (residential or community-dwelling) elderly indi-
viduals did not differ on mean levels of depressive symp-
toms or of despair compared with the other groups. No
significant differences between levels of education on our
study variables (forgiveness, despair, integrity, and depres-
sive symptoms) were found in the residential elderly home
participants (Wilks’ λ = .95, F(2, 195) = 1.18, ns). For the
community-dwelling elderly sample, differences in mean
levels of education were only found for depressive symp-
toms (F(2, 244) = 6.36, p < .01, ή2 = 0.05) with higher edu-
cated elderly showing lower levels of depressive symptoms
(M = 1.53, SD = 0.38) in comparison with elderly individu-
als who obtained primary education (M = 1.79, SD = 0.52)
and secondary education (M = 1.71, SD = 0.51).
Measurement Invariance
Because the study relies on two distinctly different
groups of elderly adults and administration of the meas-
ures was not consistent across the groups, measurement
invariance was evaluated using confirmatory factor analy-
ses. Milfont and Fischer (2010) outline different levels of
measurement invariance that can be evaluated. Relevant
to our purposes here are four different types of invariance.
Configural invariance suggests that the same factor model
(i.e., number of factors and indicators) holds across groups.
Page 5 of 11
Metric invariance indicates that the factor loadings are con-
sistent across groups. Factor variance/covariance invariance
tests whether the variances and covariances of the latent
factors are equivalent across groups. Residual invariance
adds, further still, the requirement that all item residuals are
invariant across groups. Because of the complexity of mul-
tiple group confirmatory factor analysis models, root mean
square error of approximation (RMSEA) is the preferred
choice in assessing fit due to it known distributional prop-
erties and because it remains unaffected by model com-
plexity or sample size (Browne & Cudeck, 1989; Wu, Li,
& Zumbo, 2007). Browne and Cudeck (1989) recommend
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015
that RMSEA ≤ .08 be considered acceptable fit, but Chen,
Curran, Bollen, Kirby, and Paxton (2008) suggest that strict
cut-offs for RMSEA be viewed with caution and argue that
RMSEA values of up to .10 can be indicative of acceptable
fit. Factor loadings in multiple group confirmatory factor
analyses are typically reported in unstandardized units to
prevent confusion in interpreting standardized loadings that
may differ across groups due to different variances in each
group (Kline, 2004). Nevertheless, both unstandardized and
standardized loadings are provided for interpretation.
Table 2 shows RMSEA values and 90% RMSEA confi-
dence intervals (90% CI) for each of confirmatory models
assessing measurement invariance for the four constructs
in this study. Table  3 shows configural, metric, variance/
covariance, and residual invariant factor loadings. The base
model represents a confirmatory factor model with the
two depressive symptoms confounded with physical vital-
ity eliminated along with an additional depression item
(“People were unfriendly”) and a despair item (“I find it
difficult to accept that what happened is mainly the con-
sequence of my acts”) that were eliminated after running
an initial model that revealed unacceptably low factor load-
ings (i.e., <.30). Though the results are virtually identical
whether these additional two items are retained or not, we
chose the more psychometrically sound model to proceed
with. RMSEA statistics indicate acceptable fit for configu-
ral, metric, variance/covariance, and residual invariance
models (see Table  2). Factor loadings show that the for-
giveness, integrity, despair, and depression items each load
on their respective factors (see Table  3). Unstandardized
and standardized factor loadings with all coefficients con-
strained across groups (the most rigorous psychometric
test) ranged from 0.40 to 1.72 and 0.41 to 0.85, respectively
Table 2.  Goodness of Fit Indices for Invariance Measurement
Models
Invariance model RMSEA LCL UCL
Configural .05 .04 .05
Metric .05 .04 .05
Factor variance/covariance .05 .04 .06
Residual .05 .05 .06
Note. LCL = 90% lower confidence limit; RMSEA = root mean square error
of approximation; UCL = 90% upper confidence limit.
Page 6 of 11 DEZUTTER ET AL.

Table 3.  Configural, Metric, Variance/Covariance, and Residual Invariant Factor Loadings for Confirmatory Factor Model of Forgiveness,
Integrity and Despair, and Depressive Symptoms
Variance/
Configural Metric covariance Residual
Construct/item UL SL UL SL UL SL UL SL UL SL
Forgiveness
  1. Get over it quickly 1.00 0.51 1.00 0.59 1.00 0.53 1.00 0.59 1.00 0.57
  2. Harbor grudgesa 0.80 0.39 1.11 0.61 0.99 0.49 0.99 0.55 1.02 0.54
  3. Think about it a lot afterwardsa 1.22 0.57 0.92 0.64 0.99 0.49 1.10 0.61 1.00 0.60
  4. Just to forgive and forget 0.74 0.42 0.58 0.45 0.62 0.37 0.67 0.46 0.63 0.44
Integrity
  1. Accept fine and difficult moments of life 1.00 0.45 1.00 0.72 1.00 0.56 1.00 0.62 1.00 0.60
  2. Cope with negative experiences from past 1.32 0.48 1.17 0.63 1.20 0.56 1.20 0.62 1.27 0.59

Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015

  3. Accept faults and missed opportunities 2.34 0.88 1.13 0.76 1.50 0.80 1.52 0.85 1.48 0.80
  4. Accept bad moments in past life 2.24 0.77 1.47 0.91 1.72 0.79 1.75 0.84 1.72 0.85
Despair
  1. Wish had lived life differently 1.00 0.80 1.00 0.69 1.00 0.76 1.00 0.79 1.00 0.74
  2. Regret toward past has influenced present 0.93 0.78 1.07 0.75 0.99 0.76 0.98 0.79 1.00 0.76
  3. Look back with discontent and regret 0.83 0.78 1.14 0.89 0.97 0.82 0.97 0.84 1.00 0.84
  5. Feeling bitterness on past relations 0.49 0.43 0.72 0.56 0.60 0.47 0.60 0.51 0.61 0.50
Depressive symptoms
  1. I felt depressed 1.00 0.60 1.00 0.71 1.00 0.65 1.00 0.69 1.00 0.67
  3. I felt lonely 1.07 0.64 0.96 0.72 1.00 0.65 1.00 0.70 0.98 0.68
  4. My sleep was restless 1.03 0.48 0.65 0.38 0.81 0.43 0.82 0.48 0.77 0.42
  5. I was happya 0.83 0.38 0.76 0.59 0.81 0.41 0.82 0.46 0.78 .48
  7. I enjoyed lifea 0.89 0.44 1.00 0.64 0.97 0.52 0.98 0.56 0.94 0.55
  8. I felt sad 1.37 0.72 0.91 0.67 1.09 0.66 1.12 0.72 1.07 0.69
  9. I felt like people disliked me 0.69 0.51 0.24 0.33 0.38 0.33 0.40 0.38 0.40 0.41

Notes. UL = unstandardized loading, SL = standardized loading.

Reverse scored.
a

All loadings p < .001.

(see Table 3), and factor correlations ranged from r = .48
to r = −.59. All loadings (p < .001) and factor correlations
(p < .05) for all models were statistically significant.
Structural Models
Having established the invariant measurement model,
we next tested a series of latent structural models exam-
ining direct effects, indirect effects, and the invariance of
these parameters. All structural models showed accept-
able fit (RMSEA < .08) with measurement and structural
weights, factor variance/covariances, and structural and
measurement residuals constrained across groups. Hence,
all subsequent coefficients are reported from these fully
constrained models. The first structural model exam-
ined the associations between sociodemographic vari-
ables and depression. This model was an acceptable fit,
RMSEA  =  .07, 90% CI  =  0.06  – 0.08, but accounted for
only 5% of the variance in depressive symptoms and none
of the variables emerged as unique predictors (see Table 4).
The direct effect model of forgiveness on depression had an
acceptable fit, RMSEA = .06, 90% CI = 0.05 – 0.07, and
accounted for 20% of the variability in depressive symp-
toms. Higher levels of forgiveness were associated with
lower levels of depression (B = −0.45, β = −0.41, p < .001),
(see Table  4). The indirect effects model of forgiveness
through integrity and despair on depression had an accepta-
ble fit, RMSEA = .05, 90% CI = 0.05 – 0.06, and accounted
for 33% of the variability in depressive symptoms (see
Table 5). Higher levels of forgiveness were associated with
higher levels of integrity (B = 0.94, β = 0.49, p < .001) and
lower levels of despair (B = −0.99, β = −0.46, p < .001) and
forgiveness, along with the other nonsignificant sociodemo-
graphic predictors, accounted for 25% of the variability in
each variable. Higher levels in despair were associated with
higher levels of depressive symptoms (B = 0.15, β = 0.19,
p < .05), and higher levels of integrity were associated with
lower levels of depressive symptoms (B = −0.24, β = −0.28,
p < .001). The total indirect effect of forgiveness on depres-
sive symptoms through integrity and despair was significant
(B = −0.38, β = −0.23, p < .01). The direct effect of forgive-
ness on depression in this model was noticeably reduced
from the direct effect only model but remained statistically
significant (B = −0.32, β = −0.19, p < .05).
Single mediator models can be used to investigate the indi-
vidual indirect effects of forgiveness on depressive symp-
toms through integrity only and despair only. Tests of the
individual indirect effects in separate models allow one to
determine the extent to which each variable is responsible for
the overall indirect effect. The indirect effect model of for-
giveness through integrity on depression had an acceptable
 FORGIVENESS, EGO-INTEGRITY, AND DEPRESSIVE SYMPTOMS Page 7 of 11

fit, RMSEA = .05, 90% CI = 0.05 – 0.06, and accounted for levels of integrity (B  =  0.93, β  =  0.49, p < .001) and for-
31% of the variability in depressive symptoms (see Table 6). giveness accounted for 25% of the variability in integrity.
Higher levels of forgiveness were associated with higher Higher levels of integrity were associated with lower levels

Table 4.   Unstandardized and Standardized Coefficients for Sociodemographic Variables and Forgiveness, Controlling for Sociodemographics,
Predicting Depressive Symptoms
Dependent variable = Depressive symptoms Dependent variable = Depressive symptoms
B β B β
Women 0.07 0.06 0.02 0.02
Men (referent) — — — —
Age 0.00 −0.02 0.00 0.03

Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015

Education −0.07 −0.09 −0.06 −.08
Single −0.19 −0.09 0.04 0.02
Divorced −0.05 −0.02 −0.07 −0.02
Widowed 0.15 0.12 0.22* 0.17
Married/cohabitating (referent) — — — —
Forgiveness −0.45*** −0.41
R2 .05 .20

Note. *p < .05. ***p < .001.

Table 5.   Unstandardized and Standardized Coefficients for Forgiveness Predicting Integrity, Despair, and Depressive Symptoms and Partial
Effects of Forgiveness, Integrity, and Despair on Depressive Symptoms, Controlling Sociodemographics
Dependent variable
(DV) = Integrity DV = Despair DV = Depression
B β B β B β
Female −0.02 −0.02 −0.02 −0.01 0.02 0.01
Male (referent) — — — — — —
Age −0.01 −.04 −0.01 −0.04 0.00 0.03
Education 0.09 0.10 −0.07 −0.07 −0.03 −0.04
Single −0.07 −0.03 −0.17 −0.06 0.05 0.02
Divorced −0.29 −0.07 0.27 0.06 −0.17 −0.05
Widowed −0.13 −0.09 0.14 0.08 0.17* 0.13
Married/cohabitating (referent) — — — — — —
Forgiveness direct effect 0.94*** 0.49 −0.99*** −0.46 −0.32* −0.19
Integrity direct effect −0.24*** −0.28
Despair direct effect 0.15* 0.19
Total integrity/despair indirect effect −0.38** −0.23
R2 .25 .25 .33

Note. *p < .05. **p < .01. ***p < .001.

Table 6.   Unstandardized and Standardized Coefficients for Forgiveness Predicting Integrity and Depressive Symptoms and Partial Effects of
Forgiveness and Integrity on Depressive Symptoms, Controlling Sociodemographics
Dependent variable (DV) = Integrity DV = Depression
B β
Women −0.02 −0.01 0.01 0.01
Men (referent) — — — —
Age −0.01 −0.04 0.00 0.01
Education 0.09 0.10 −0.03 −0.05
Single −0.07 −0.03 0.01 0.00
Divorced −0.29 −0.07 −0.15 −0.04
Widowed −0.13 −0.09 0.17* 0.13
Married/cohabitating (referent) — — — —
Forgiveness direct effect 0.93*** 0.49 −0.37** −0.23
Integrity direct effect −0.32*** −0.38
Integrity indirect effect −0.30** −0.18
R2 .25 .31

Note. *p < .05. **p < .01. ***p < .001.

Page 8 of 11 DEZUTTER ET AL.
of depressive symptoms (B  =  −0.32, β  =  −0.38, p < .001).
The indirect effect of forgiveness on depressive symptoms
through integrity was significant (B  =  −0.30, β  =  −0.18,
p < .01). The direct effect of forgiveness on depression in
this model was modestly reduced from the direct effect only
model and remained statistically significant (B  =  −0.37,
β = −0.23, p = .01).
The indirect effect model of forgiveness through despair
on depression had an acceptable fit, RMSEA  =  .05, 90%
CI  =  0.05  – 0.06, and accounted for 28% of the variabil-
ity in depressive symptoms (see Table 7). Higher levels of
forgiveness were associated with lower levels of despair
(B = −1.09, β = −0.47, p < .001) and forgiveness accounted
for 26% of the variability in despair. Higher levels of
despair were associated with higher levels of depressive
symptoms (B = 0.25, β = 0.32, p < .001). The indirect effect
of forgiveness on depressive symptoms through despair was
significant (B = −0.27, β = −0.15, p = .01). The direct effect
of forgiveness on depression in this model remained statisti-
cally significant (B = −0.49, β = −0.27, p < .01).
Discussion
The aim of this study was twofold. First, we investi-
gated the relation between forgivingness and depressive
symptoms in elderly participants, expecting that elderly
individuals who show higher levels of forgivingness will
experience less depressive symptoms. Second, we focused
on the developmental task of integrity and despair as a pos-
sible underlying process in this relation and we assumed
that integrity and despair will mediate the forgivingness–
depressive symptoms relationship.
In accordance with our first hypothesis, forgivingness was
negatively related with depressive symptoms both in com-
munity-dwelling elderly individuals as well as in residen-
tial elderly individuals. It seems that earlier findings (e.g.,
Toussaint & Webb, 2005) focusing on the forgivingness–
depression relationship in other life stages can be extended
to the life stage of old age. Elderly individuals who report
Table 7.   Unstandardized and Standardized Coefficients for Forgiveness Predicting Despair and Depressive Symptoms and Partial Effects of
Forgiveness and Despair on Depressive Symptoms, Controlling Sociodemographics
Dependent variable (DV) = Despair
B β
Female −0.02 −0.01
Male (referent) — —
Age −0.01 −0.04
Education −0.07 −0.07
Single −0.16 −0.06
Divorced 0.14 0.08
Widowed 0.27 0.06
Married/cohabitating (referent) — —
Forgiveness direct effect −1.09*** −0.47
Despair direct effect
Despair indirect effect
R2
Note. *p < .05. **p < .01. ***p < .001.
higher levels of forgivingness suffer less of depressive
symptoms, and this relationship seems to be prevalent in
both residential elderly as in community-dwelling elderly
individuals. However, contrary to the existing literature,
we did not find higher levels of depressive symptoms in
residential elderly individuals than in community-dwelling
elderly individuals, but differences did appear with regard
to feelings of despair as well as to levels of forgivingness.
In line with Erikson’s theory that later life brings the issue
of integrity/despair as a central focus, we assumed that this
developmental process might play a crucial role in the rela-
tionship between forgivingness and depressive symptoms.
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015
Confirming our second hypothesis, the results indeed
show that coming to terms with the developmental task
of integrity and despair is an important underlying media-
tor to explain how forgivingness is related with depressed
symptoms in addition to the direct association between for-
givingness and depressive symptoms. In this process, both
the achievement of integrity and the experience of despair
are part of the mechanism. Elderly (residential and commu-
nity-dwelling) individuals with high levels of forgivingness
seem to achieve integrity more easily and are less hindered
by feelings of despair. This positive resolution of this late
life developmental task is associated with lower levels
of depressed symptomatology. Multiple group analyses
showed that the structural model containing both the direct
and indirect effects between forgivingness and depressive
symptoms fits the residential and the community-dwelling
elderly sample. In line with Erikson’s theorizing, the integ-
rity/despair process is important later in life and becomes an
important mechanism to explain the forgivingness–depres-
sive symptoms relationship.
Our study provides support for the empirical work con-
necting forgivingness and depressive symptoms and adds
theoretical insight framed within a developmental per-
spective. These findings seem to indicate that forgiving-
ness is not only linked with depressive symptoms through
interpersonal mechanisms but also through intrapersonal
DV = Depression
B β
0.03 0.02
— —
0.01 0.05
−0.04 −0.06
0.09 0.04
0.19* 0.14
−0.13 −0.04
— —
−0.49** −0.27
00.25*** 0.32
−0.27** −0.15
.26 .28
 FORGIVENESS, EGO-INTEGRITY, AND DEPRESSIVE SYMPTOMS
mechanisms. High levels of forgivingness might improve
healthy intrapersonal functioning which, in turn, has ben-
eficial associations with mental health. This is also in line
with the study of Toussaint and colleagues (2008) show-
ing that hopelessness is an explanatory mechanism in the
forgiveness–depression association in a large sample of
U.S.  adults. Given the similarities between despair and
hopelessness, a similar reasoning might be applicable.
However, in this study, we focused in on a specific life stage
where the feelings of hopelessness and despair might be of
pivotal importance. In this study, we focused explicitly on a
specific type of forgiveness—forgiveness of others. Future
research, however, should disentangle self-forgiveness
and other-forgiveness to investigate if differences appear
in the relationship with integrity/despair and depressive
symptoms.
Although our study shows that forgivingness is an impor-
tant predictor for depressive feelings in residential as well
as community-dwelling elderly individuals and it points to
the complex nature of forgivingness in its relationship to
mental health, some important limitations should be noted.
First, the cross-sectional design of the study does not allow
for drawing firm conclusions concerning directionality of
effect. Although we assume that forgivingness is a disposi-
tion that remains relatively stable, it is theoretically possible
that integrity/despair has effects on forgivingness and acts
through it to influence depression (Orth, Berking, Walker,
Meier, & Znoj, 2008). A  longitudinal design follow-
ing elderly individuals over time is needed to clarify this.
Second, we used a self-report measure of forgivingness,
which may have engendered socially desirable responses
and, furthermore, showed low levels of reliability in our
samples. Future studies might consider adopting a differ-
ent measure of forgivingness or other reports from family
members, although we then focus on forgiving behavior
and activities, which is not the same as having a forgiv-
ing attitude or disposition. A recent study also explored the
possibility to use behavioral methods of assessing forgive-
ness, a direction that needs more investigation in future
forgiveness research (Dorn, Hook, Davis, Van Tongeren, &
Worthington, 2013). Furthermore, the study samples may
not be representative of the total elderly population because
frail adults who require intensive assistance and nursing
care were not able to take part in the study. Finally, we
used CES-D (Radloff, 1977) to measure depressive symp-
tomatology. Although we used the short CES-D, which is
validated in a population of 65+ participants and is often
used in clinical settings, two items proved to be less appro-
priate, especially for the residential elderly population and
might be confounded with physical complaints (“I felt eve-
rything I did was an effort” and “I could not get going”).
Future studies might use, therefore, the 8-item version of
the Geriatric Depression Scale (Jongenelis et  al., 2007),
which is especially developed for elderly individuals, with-
out focusing on physical complaints.
Page 9 of 11
Our findings on the forgivingness–depressive symp-
toms association are consistent with previous work using
samples of students and adults, but expand it to the final
stage of life where the topic might be of pivotal impor-
tance. Framed within a life-span perspective, we showed
that the developmental task of finding a balance between
integrity and despair is an important intrapersonal mecha-
nism through which forgivingness is related with depressed
feelings for residential as well as community-dwelling
elderly population. Future work should be aimed at testing
this model in specific groups of elderly population, such as
elderly individual with severe medical illness or with cog-
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015
nitive decline. Attention to the role of other, simultaneous
mechanisms will further enhance our understanding of why
forgivingness has positive effects offering possibilities for
the establishment of evidence-based positive psychosocial
interventions.
Funding
This study was partially supported by the Fund for Scientific Research
Flanders (FWO) (grant number 1.2B71.12 to J.D.).
Acknowledgments
We would like to thank Debbie Baeten, Eva Coenen, Bart Goossens,
Laura Heyns, Annelene Pauwels, Anneleen Vandekeybus, Karen Van der
Heyden, and Annemarie Van Engeland for their assistance in data collec-
tion. We would like to thank the Flemish elderly care-and-nurse units for
their collaboration in this study. There is no conflict of interest.
Correspondence
Correspondence should be addressed to Jessie Dezutter, PhD, KULeuven -
University of Leuven, Research group Clinical Psychology, Tiensestraat 102
Bus 3722, 3000 Leuven, Belgium. E-mail: Jessie.Dezutter@ppw.kuleuven.
be.
References
Allemand, M., & Steiner, M. (2012). Situation-specific forgiveness and
dispositional forgiveness: A  lifespan development perspective. In
E. Kals & J. Maes (Eds.), Justice and conflicts. Berlin Heidelberg,
Germany: Springer.
Baumeister, R. F., Exline, J. J., & Sommer, K. L. (1998). The victim
role, grudge theory, and two dimensions of forgiveness. In E. L.
Worthington, Jr. (Ed.), Dimensions of forgiveness (pp. 79–104).
Philadelphia: Templeton.
Beekman, A. T., Deeg, D. J., Braam, A. W., Smit, J. H., & Van Tilburg, W.
(1997). Consequences of major and minor depression in later life:
A study of disability, well-being and service utilization. Psychological
Medicine, 27, 1397–1409. doi:10.1017/S0033291797005734
Bonnewyn, A., Shah, A., Schoevaerts, K., Bruffaerts, R., & Demyttenaere,
K. (2011). What drives a person to a suicide attempt in later life? An
explorative study. International Psychogeriatrics, 23, S389–S390.
Brown, R. P. (2003). Measuring individual differences in the ten-
dency to forgive: Construct validity and links with depres-
sion. Personality and Social Psychology Bulletin, 29, 759–771.
doi:10.1177/0146167203029006008
Brown, R. P., & Phillips, A. (2005). Letting bygones be bygones:
Further evidence for the validity of the Tendency to Forgive scale.
Personality and Individual Differences, 38, 627–638. doi:10.1016/j.
paid.2004.05.017
Browne, M.W., & Cudeck, R. (1989). Single sample cross-validation indi-
ces for covariance structures. Multivariate Behavioral Research, 24,
445–455.
Page 10 of 11 DEZUTTER ET AL.
Butler, R., & Lewis, M. (1982). Aging and mental health: Positive psycho-
social and biomedical approaches. St Louis, MO: Mosby.
Chen, F., Curran, P. J., Bollen, K. A., Kirby, J., & Paxton, P. (2008). An
empirical evaluation of the use of fixed cutoff points in RMSEA
test statistic in structural equation models. Sociological Methods &
Research, 36, 462–494.
Chimich, W. T., & Nekolaichuk, C. L. (2004). Exploring the links between
depression, integrity, and hope in the elderly. Canadian Journal of
Psychiatry, 49, 428–433.
Cuijpers, P., Vogelzangs, N., Twisk, J., Kleiboer, A., Li, J., & Penninx,
B. W. (2013). Differential mortality rates in major and subthresh-
old depression: Meta-analysis of studies that measured both. British
Journal of Psychiatry, 202, 22–27.
Dezutter, J., Wiesmann, U., Apers, S., & Luyckx, K. (2013). Sense of
coherence, depressive feelings and life satisfaction in older persons:
A  closer look at the role of integrity and despair. Aging & Mental
Health, 17, 839–843.
Dorn, K., Hook, J., Davis, D., Van Tongeren, D., & Worthington, E.
(2013). Behavioral methods of assessing forgiveness. Journal of
Positive Psychology, 9, 75–80. doi:10.1080/17439760.2013.8442
67
Erikson, E. (1982). The life cycle completed: A review. New York, NY: W.
W. Norton.
Fehr, R., Gelfand, M., & Nag, M. (2010). The road to forgiveness: A meta-
analytic synthesis of its situational and dispositional correlates.
Psychological Bulletin, 5, 894–914. doi:10.1037/a0019993
Fincham, F. D. (2000). The kiss of the porcupines: From attribut-
ing responsibility to forgiving. Personal Relationships, 7, 1–23.
doi:10.1111/j.1475–6811.2000.tb00001.x
Green, M., Decourville, N., & Sadava, S. (2012). Positive affect, nega-
tive affect, stress, and social support as mediators of the forgiveness-
health relationship. Journal of Social Psychology, 152, 288–307.
Hill, P. L., & Allemand, M. (2011). Gratitude, forgivingness, and well-
being in adulthood: Tests of moderation and incremental prediction.
Journal of Positive Psychology, 6, 397–407. doi:10.1080/17439760
.2011.602099
Ingersoll-Dayton, B., & Krause, N. (2005). Self-forgiveness - A compo-
nent of mental health in later life. Research on Aging, 27, 267–289.
doi:10.1177/0164027504274122
Jongenelis, K., Gerritsen, D. L., Pot, A. M., Beekman, A. T., Eisses, A.
M., Kluiter, H., & Ribbe, M. W. (2007). Construction and validation
of a patient- and user-friendly nursing home version of the Geriatric
Depression Scale. International Journal of Geriatric Psychiatry, 22,
837–842.
Jongenelis, K., Pot, A., Eisses, A., Beekman, A., Kluiter, H., van Tilburg,
W., &  Ribbe, M. (2003). Depression among older nursing home
patients. A  review. Tijdschrift voor Gerontologische Geriatrie, 34,
52–59.
Kline, R. B. (2004). Principles and practice of structural equation mod-
eling, (methodology in the social sciences). New York, NY: The
Guilford Press.
Kohout, F., Berkman, L., Evans, D., & Cornoni-Huntley, J. (1993). Two
shorter forms of the CES-D (Center for Epidemiological Studies
Depression) depression symptoms index. Journal of Aging and
Health, 5, 179–193. doi:10.1177/089826439300500202
Kraaij, V., Arensman, E., & Spinhoven, P. (2002). Negative life events
and depression in elderly persons: A meta-analysis. The Journals of
Gerontology, Series B: Psychological Sciences and Social Sciences,
57, 87–94. doi:10.1093/geronb/57.1.P87
Krause, N., & Ingersoll-Dayton, B. (2001). Religion and the process of
forgiveness in late life. Review of Religious Research, 42, 252–276.
doi:10.2307/3512569
Lawler-Row, K. A., Karremans, J. C., Scott, C., Edlis-Matityahou, M., &
Edwards, L. (2008). Forgiveness, physiological reactivity and health:
The role of anger. International Journal of Psychophysiology, 68,
51–58.
Lawler-Row, K. A., Scott, C. A., Raines, R. L., Edlis-Matityahou,
M., & Moore, E. W. (2007). The varieties of forgiveness experi-
ence: Working toward a comprehensive definition of forgive-
ness. Journal of Religion & Health, 46, 233–248. doi:10.1016/j.
ijpsycho.2008.01.001
Lewis, J. S. (1996). Sense of coherence and the strengths perspective with
older persons. Journal of Gerontological Social Work, 26, 99–112.
Luppa, M., Sikorski, C., Luck, T., Weyerer, S., Villringer, A., Koenig, H.-
H., & Riedel-Heller, S. G. (2011). Epidemiology of depression in old
age: Results of the Leipzig longitudinal study of the aged (leila 75+).
Journal of Epidemiology and Community Health, 65, A127–A127.
doi:10.1136/jech.2011.142976e.14
McCullough, M. E. (2000). Forgiveness as human strength: Theory, meas-
urement, and links to well-being. Journal of Social and Clinical
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015
Psychology, 19, 43–55. doi:10.1521/jscp.2000.19.1.43
McFarland, M. J., Smith, C. A., Toussaint, L., & Thomas, P. A. (2012).
Forgiveness of others and health: Do race and neighborhood matter?
The Journals of Gerontology, Series B: Psychological Sciences and
Social Sciences, 67, 66–75.
Milfont, T. L., & Fischer, R. (2010). Testing measurement invariance
across groups: Applications in cross-cultural research. International
Journal of Psychological Research, 3, 111–130.
Nsamenang, S., Webb, J., Cukrowicz, K., & Hirsch, J. (2013). Depressive
symptoms and interpersonal needs as mediators of forgiveness and
suicidal behavior among rural primary care patients. Journal of
Affective Disorders, 149, 282–290.
Orth, U., Berking, M., Walker, N., Meier, L., & Znoj, H. (2008).
Forgiveness and psychological adjustment following interpersonal
transgressions: A  longitudinal analysis. Journal of Research in
Personality, 42, 365–385. doi:10.1016/j.jrp.2007.07.003
Phillips, W., & Ferguson, S. (2013). Self-compassion: A resource for posi-
tive aging. The Journals of Gerontology, Series B: Psychological
Sciences and Social Sciences, 68, 529–539.
Radloff, L. (1977). The CES-D scale: A  self-report depression scale
for research in the general population. Applied Psychological
Measurement, 1, 385–401.
Read, S., Aunola, K., Feldt, T., Leinonen, R., & Ruoppila, I. (2005). The
relationship between generalized resistance resources, sense of
coherence, and health among Finnish people aged 65–69. European
Psychologist, 10, 244–253. doi:10.1027/1016-9040.10.3.244
Ricciardi, E., Rota, G., Sani, L., Gentili, C., Gaglianese, A., Guazzelli,
M., & Pietrini, P. (2013). How the brain heals emotional wounds:
The functional neuroanatomy of forgiveness. Frontiers in Human
Neuroscience, 7, 839.
Rickwood, D., & Rylands, K. J. (2000). Predicting depression in a sample
of older women living in a retirement village. Australasian Journal
on Ageing, 19, 40–42. doi:10.1111/j.1741–6612.2000.tb00137.x
Saint Onge, J., Krueger, P., & Rogers, R. (2014). The relation-
ship between major depression and nonsuicide mortality for
U.S.  adults: The importance of health behaviors. The Journals
of Gerontology, Series B: Psychological Sciences and Social
Sciences, 69, 622–632.
Santor, D. A., & Zuroff, D. C. (1994). Depressive symptoms: Effects
of negative affectivity and failing to accept the past. Journal of
Personality Assessment, 63, 294–312.
Smalbrugge, M., Jongenelis, L., Pot, A. M., Eefsting, J. A., Ribbe, M.
W., & Beekman, A. T. (2006). Incidence and outcome of depressive
symptoms in nursing home patients in the Netherlands. The American
Journal of Geriatric Psychiatry, 14, 1069–1076. doi:10.1097/01.
JGP.0000224605.37317.88
Soenens, B., & Duriez, B. (2012). Does conservatism have a self-esteem
enhancing function? An examination of associations with contingent
self-worth and ill-being in late adults. Personality and Individual
Differences, 52, 728–732. doi:10.1016/j.paid.2011.12.037
Torges, C. M., Stewart, A. J., & Duncan, L. E. (2008). Achieving
ego integrity: Personality development in late midlife. Journal
 FORGIVENESS, EGO-INTEGRITY, AND DEPRESSIVE SYMPTOMS
of Research in Personality, 42, 1004–1019. doi:10.1016/j.
jrp.2008.02.006
Toussaint, L. L., & Webb, J. R. (2005). Theoretical and empirical connec-
tions between forgiveness, mental health, and well-being. In J. E. L.
Worthington (Ed.), Handbook of forgiveness (pp. 349–362). New
York, NY: Routledge.
Toussaint, L. L., Williams, D. R., Musick, M. A., & Everson, S. A.
(2001). Forgiveness and health: Age differences in a US prob-
ability sample. Journal of Adult Development, 8, 249–257.
doi:10.1023/A:1011394629736
Toussaint, L. L., Williams, D. R., Musick, M. A., & Everson-Rose,
S. A. (2008). Why forgiveness may protect against depression:
Hopelessness as an explanatory mechanism. Personality and Mental
Health, 2, 89–103. doi:10.1002/pmh.35
Van Hiel, A., & Vansteenkiste, M. (2009). Ambitions fulfilled? The effects
of intrinsic and extrinsic goal attainment on older adults’ ego-integ-
rity and death attitudes. International Journal of Aging & Human
Development, 68, 27–51.
Page 11 of 11
van’t Veer-Tazelaar, P. J., van Marwijk, H. W., Jansen, A. P., Rijmen, F., Kostense,
P. J., van Oppen, P., … Beekman, A. T. (2008). Depression in old age
(75+), the PIKO study. Journal of Affective Disorders, 106, 295–299.
Westerhof, G. J., Bohlmeijer, E. T., van Beljouw, I. M. J., & Margriet, A.
(2010). Improvement in personal meaning mediates the effects of a
life review: Intervention on depressive symptoms in a randomized con-
trolled trial. Gerontologist, 50, 541–549. doi:10.1093/geront/gnp168
Worthington, E. L. (2005). More questions about forgiveness: Research
agenda for 2005–2015. In E. L. Worthington, Jr. (Ed.), Handbook of
forgiveness (pp. 557–575). New York, NY: Routledge.
Wu, A. D., Li, Z., & Zumbo, B. D. (2007). Decoding the meaning of facto-
rial invariance and updating the practice of multi-group confirma-
tory factor analysis: A  demonstration with TIMSS data. Practical
Assessment Research & Evaluation, 12, 1–26.
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at University of New Orleans on May 30, 2015
Ysseldyk, R., Matheson, K., & Anisman, H. (2007). Rumination: Bridging
the gap between forgivingness, vengefulness, and psychologi-
cal health. Personality and Individual Differences, 42, 1573–1584.
doi:10.1016/j.paid.2006.10.032