Journal of Affective Disorders 290 (2021) 89–92

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Journal of Affective Disorders

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Aging anxiety, loneliness, and depressive symptoms among middle-aged

adults: The moderating role of ageism
Yoav S. Bergman a, *, Dikla Segel-Karpas b
a
Faculty of Social Work, Ashkelon Academic College, 12 Ben-Tzvi St., Ashkelon 78211, Israel
b
Department of Gerontology, University of Haifa, 199 Abba Khoushy Ave., Haifa 3498838, Israel

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Aging anxiety, or fears and concerns regarding one’s future aging, have been shown to take a toll on
Ageism older adults’ health and well-being, including loneliness and depressive symptoms. However, little is known
Aging anxiety about the possible consequences that aging anxiety holds for middle-aged adults. The current study examines the
Depressive symptoms
relationship between aging anxiety and both loneliness and depressive symptoms in a sample of middle-aged
Loneliness
adults. It further examines whether ageism, or negative attitudes toward older adults, which have been associ­
Middle-aged adults
ated with increased aging anxiety, loneliness, and depressive symptoms, moderates the connections between
these variables. It was hypothesized that for those with higher ageist perceptions, the psychological toll of aging
anxiety will be greater.
Methods: A convenience sample of 1038 participants (age range = 50-67, M=58.16, SD=5.22) was collected
using online questionnaires assessing aging anxiety, ageism, loneliness, and depressive symptoms.
Results: Aging anxiety was positively associated with loneliness and depressive symptoms. Furthermore, ageism
moderated these relationships, such that they were stronger for those with a higher level of ageism.
Limitations: A cross-sectional design; an internet survey consisting of a non-clinical, healthy cohort.
Conclusions: The results point to the clinical importance of addressing aging anxiety and negative attitudes in
middle-aged adults with regard to loneliness and depression. The study provides clinicians with additional in­
formation regarding the formation and psychological consequences of aging anxiety with regard to how in­
dividuals perceive older adults and the aging process.

1. Introduction
Aging anxiety, or fears and concerns regarding the aging process,
have been associated with various negative psychological outcomes,
which include apprehensions regarding the future, loneliness, and
depressive symptoms (Ayalon, 2018; Bergman et al., 2018). Interest­
ingly, the majority of research concerning aging anxiety has focused
primarily on younger and/or older adults, and the psychological con­
sequences of aging anxiety among middle-aged adults are relatively
understudied. This relative scarcity of research is interesting, since ac­
cording to Lynch (2000), aging anxiety tends to decline throughout the
life-cycle, with the notable exception of individuals aged 50-64. Lynch
(2000) suggests that while older adults’ decline in aging anxiety may be
the consequence of their gradual adaptation to age-related limitations,
the higher rates of aging anxiety in middle adulthood may be the result
of their experience of age-related changes, that may bring on heightened
anxiety about aging and the future. In this regard, empirical evidence
points to the importance of this concept among middle-aged adults, as
well as to its negative psychological consequences. For example, aging
anxiety has been associated with increased dying and death anxiety, as
well as with a feeling that life is nearing its end, among middle-aged
adults (Bergman et al., 2018). Moreover, perceived losses attributed to
one’s age were associated with depressive symptoms in middle- and
late-adulthood (Dutt et al., 2018).
From a theoretical standpoint, these findings may be in line with
Terror Management Theory (TMT; see Martens et al., 2004). According
to TMT, the understanding that human life is not infinite may result in
high levels of distress, which might greatly inhibit the individual’s
ability for daily functioning. Accordingly, As individuals in their fifties
and sixties are already experiencing various physical aspects of aging,
these experiences may bring on anxieties and apprehensions about the
future, which, in turn, contribute to a sense of limited future time

* Corresponding author.
E-mail address: yoav.s.bergman@gmail.com (Y.S. Bergman).

https://doi.org/10.1016/j.jad.2021.04.077
Received 18 September 2020; Received in revised form 29 December 2020; Accepted 25 April 2021
Available online 4 May 2021
0165-0327/© 2021 Elsevier B.V. All rights reserved.
Y.S. Bergman and D. Segel-Karpas
perspective, loneliness, and depressive symptoms (see also Bergman and
Segel-Karpas, 2018). Moreover, experiencing aging anxiety may hinder
the ability to benefit from one’s social interactions, making it more
difficult to enjoy close and satisfying relationships, thereby contributing
to subsequent loneliness and distress (see Spitzer et al., 2019). However,
to the best of our knowledge, the connections between aging anxiety and
both loneliness and depressive symptoms have not been previously
examined among middle-aged adults. Accordingly, the current study
aims to examine these connections among this age-group, and it is hy­
pothesized (H1) that high aging anxiety will be associated with
increased loneliness and depressive symptoms.
An additional aim of the current study is to examine how negative
attitudes toward older adults, or ageism, may affect the connection be­
tween aging anxiety and loneliness/depressive symptoms. According to
Levy’s Stereotype Embodiment Theory (Levy, 2009), individuals may
internalize ageist experiences throughout their lives, and as they age,
such internalizations gradually become self-definitions through which
they perceive themselves and define their self-image (Levy, 2009).
Accordingly, research has demonstrated that ageism is associated with
several negative psychological consequences for older adults. For
example, ageism was found to be high in middle-aged adults in com­
parison with other age groups (Bodner et al., 2012). Moreover, ageism
among middle-aged adults was associated with increased feelings that
life is nearing its end, as well as with aging, dying, and death anxieties
(Bergman et al., 2018). Ageism has also been associated, theoretically
and empirically, with elevated levels of loneliness (see Shiovitz-Ezra
et al., 2018). As ageism may contribute to individuals’ fear of their
“future aging selves”, it may contribute to the negative psychological
consequences of aging anxiety. In other words, those who fear their own
aging, and perceive older adults negatively, may be more vulnerable to
the consequences of their own aging anxiety. Accordingly, it is hy­
pothesized (H2) that the connections between aging anxiety and both
loneliness and depressive symptoms will be more pronounced among
middle-aged adults who display high levels of ageism (see supplemen­
tary Fig. S1 for the study model).
2. Methods
2.1. Participants and procedure
Data were obtained from 1038 participants (age range=50-67,
M=58.16, SD=5.22), of which 449 (43.3%) were male. The vast ma­
jority of participants reported that they were in a relationship (n=877,
84.5%), and that their economic status (n= 928, 89.4%) and health
status (n=943, 90.8%) were at least “pretty good”. Information was
collected using an online survey using Qualtrics, which was advertised
by research assistants through snowball sampling. The study was
distributed using various social media (e.g., Facebook, Whatsapp).
Following informed consent, subjects were provided with a link to a
designated website which contained the study questionnaires, and no
personal information was required or provided. Unless otherwise spec­
ified, scales were back-translated into Hebrew by two bilingual psy­
chologists. The study was approved by the IRB of the first author’s
former university.
2.2. Measures
Aging anxiety was assessed by the Hebrew version of the 6-item
shortened Kafer Aging Anxiety Scale (see Bergman et al., 2018), which
is rated on a scale ranging from 1 (“strongly disagree”) to 5 (“strongly
agree”). The scale demonstrated high internal consistency (.85; Bergman
et al., 2018), and in the current study, Cronbach’s alpha was .84 (for
descriptive information and correlation matrix of the study variables,
see supplementary Table S1).
Ageism was assessed by the 18-item Hebrew version of the Fraboni
Scale of Ageism (see Bergman et al., 2018), which assesses various
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Journal of Affective Disorders 290 (2021) 89–92
stereotypes aimed at older adults (e.g., “many old people just live in the
past”) on a scale ranging from 1 (“strongly disagree”) to 6 (“strongly
agree”). This scale was proved to be reliable in previous studies (.86;
Bodner et al., 2015), and in the current study, Cronbach’s alpha was .82.
Loneliness was examined by the short scale suggested by Hughes
et al. (2004). Three items assessing various components of the loneliness
experience (e.g., lack of companionship), rated on a scale of 1 (“hardly
ever or never”) to 3 (“often”). The scale has demonstrated high reliability
(.87; Palgi et al., 2020), and Cronbach’s alpha in the current study was
.78.
Depressive symptoms were examined by a 10-item short version of
the Center for Epidemiologic Studies Depression Scale (Andersen et al.,
1994). Individuals state whether they had experienced certain emotions
(e.g., “I was bothered by things that usually don’t bother me”) in the past
month on a scale ranging from 0 (“rarely or none of the time”) to 3 (“most
or all of the time”), and a sum is calculated. This scale has demonstrated
high reliability in Israeli cohorts (.83; Bergman and Segel-Karpas, 2020),
and Cronbach’s alpha in the current study was .82.
Subjects also provided information regarding age, gender, relation­
ship status (not in a relationship / in a relationship), and self-rated
economic and health status measured by two single items ranging
from 1 (“not good at all”) to 5 (“very good”).
3. Data analysis
Data were analyzed using the SPSS 24 software, and significant in­
teractions were probed using Model 1 of the PROCESS 3.4 macro for
SPSS (Hayes, 2018). Initial correlations between the study variables
were calculated, and the hypotheses were examined by two identical
hierarchical regression, with loneliness and depressive symptoms as the
dependent variables (for regression details and coefficients, see sup­
plementary Table S2).
4. Results
Initial correlations indicated significant positive connections be­
tween aging anxiety and ageism, loneliness, and depressive symptoms
(.24 ≤ r ≤ .44, ps< .001). Ageism was also positively associated with
loneliness and depression (.27 ≤ r ≤ .33, ps< .001; see Table S1 in the
supplementary files for means, SDs, and correlation matrix for the study
variables). In line with the first hypothesis, main effects were found for
both aging anxiety (B= .07, SE= .02, β= .12, p< .001; B= 1.44, SE= .16,
β= .27, ps< .001) and ageism (B= .16, SE= .02, β= .20, p< .001; B=
1.49, SE= .21, β= .20, ps< .001) in connection with loneliness and
depressive symptoms, respectively. Moreover, in line with the second
hypothesis, a significant interaction of Aging anxiety × Ageism was
discovered for both loneliness (B= .05, SE= .01, β= .11, p< .001) and
depressive symptoms (B= .38, SE= .11, β= .09, p< .001). Probing these
interactions using PROCESS (Hayes, 2018) revealed that for loneliness,
the significant effect of aging anxiety was nullified among individuals
with low levels of ageism (B= .02, SE= .02, β= .03, p> .05), and
remained significant only for those with high levels of ageism (B= .13,
SE= .02, β= .23, p< .001; see Fig. 1). Regarding depressive symptoms,
the effect of aging anxiety remained significant across ageism levels, but
was significantly more pronounced among individuals with high levels
of ageism (B= 1.98, SE= .20, β= .35, p< .001) in comparison with those
reporting low ageism levels (B= 1.09, SE= .19, β= .19, p< .001; see
Fig. 2). It should be mentioned that the results remained unaltered when
we excluded individuals over the age of 65.
5. Discussion
In line with the first hypothesis, aging anxiety was associated with
increased loneliness and depressive symptoms among middle-aged
adults. This finding emphasizes the relevance of aging anxiety in this
age-group, and expands current knowledge by demonstrating that it is
Y.S. Bergman and D. Segel-Karpas
Fig. 1. The two-way interaction between aging anxiety and ageism in pre­
dicting loneliness.
Fig. 2. The two-way interaction between aging anxiety and ageism in pre­
dicting depressive symptoms.
connected not only to specific anxieties regarding the end of life, as
reported in a different sample of middle-aged adults (Bergman et al.,
2018), but also to more general feelings of psychological distress and
loneliness. While loneliness has been found to be associated with
depressive symptoms (Bergman and Segel-Karpas, 2018), the current
work examines how aging anxiety and ageism may play an interactive
role for both loneliness and depressive symptoms separately. Moreover,
the second hypothesis was corroborated, as aging anxiety was associated
with loneliness only for individuals with high levels of ageism, and the
aging anxiety-depressive symptoms connection was more pronounced
among this group in comparison with individuals with low ageism
levels. These findings provide additional strength to Stereotype
Embodiment Theory (Levy, 2009), by demonstrating that the negative
psychological consequences of the internalization of ageist attitudes can
be demonstrated not only among older adults, but also among adults
who have begun to experience the physical aging process. This finding
may be useful for healthcare professionals who are dealing with adults
in their fifties and sixties, as our findings indicate that one’s
self-perception as an older adult may contribute to his/her concerns
about aging and subsequent psychological health. Consequently, it may
be important for clinicians to take into account not only individuals’
attitudes toward the aging process vis-à-vis their feelings of loneliness
and depression, but also the extent to which they perceive themselves,
and their future aging selves, in a positive or negative light.
6. Limitations
Several limitations should be noted. First, the cross-sectional nature
of the current study precludes the ability to establish causal connections
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Journal of Affective Disorders 290 (2021) 89–92
between the study variables. Although the study model is in line with
existing theory, it is possible that ageism precedes aging anxiety, thereby
leading to loneliness/depression, and this should be examined using
longitudinal designs. Second, our study was an internet survey,
comprised of non-clinical, healthy, community-dwelling adults, and it is
important to examine the study model among additional samples (e.g.,
clinical populations; individuals reporting cognitive decline). In this
regard, it is important to take into consideration additional factors, such
as objective measures of physical health, social support and social se­
curity, which may contribute information to the study model. Moreover,
we did not assess personality characteristics or cultural variables, which
have been associated with aging anxiety (e.g., Bergman et al., 2013;
Harris and Dollinger, 2003), and these factors should also be considered
in the future. Nevertheless, despite these limitations, our study dem­
onstrates how the combination of aging anxiety and negative attitudes
toward older adults contribute, together and separately, to increased
loneliness and depressive symptoms among a relatively understudied
age-group, which has already begun to experience the aging process.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial or not-for-profit sectors. No funding
was given or received for this research and/or preparation of the
manuscript.
Authors’ statement
Both authors took part in the design of the study and analyzed the
data. Y. Bergman contributed the methodological parts, and D. Segel-
Karpas provided the literature research. All authors contributed to and
have approved the final manuscript.
Declaration of Competing Interest
We wish to draw the attention of the Editor to the following facts
which may be considered as potential conflicts of interest and to sig­
nificant financial contributions to this work.
We wish to confirm that there are no known conflicts of interest
associated with this publication and there has been no significant
financial support for this work that could have influenced its outcome.
We confirm that the manuscript has been read and approved by all
named authors and that there are no other persons who satisfied the
criteria for authorship but are not listed. We further confirm that the
order of authors listed in the manuscript has been approved by all of us.
We confirm that we have given due consideration to the protection of
intellectual property associated with this work and that there are no
impediments to publication, including the timing of publication, with
respect to intellectual property. In so doing we confirm that we have
followed the regulations of our institutions concerning intellectual
property.
We further confirm that any aspect of the work covered in this
manuscript that has involved either experimental animals or human
patients has been conducted with the ethical approval of all relevant
bodies and that such approvals are acknowledged within the
manuscript.
We understand that the Corresponding Author is the sole contact for
the Editorial process (including Editorial Manager and direct commu­
nications with the office). He is responsible for communicating with the
other authors about progress, submissions of revisions and final
approval of proofs. We confirm that we have provided a current, correct
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Y.S. Bergman and D. Segel-Karpas
Acknowledgement
None.
Supplementary materials
Supplementary material associated with this article can be found, in
the online version, at doi:10.1016/j.jad.2021.04.077.
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