Content uploaded by Sandy Branson
Author content
All content in this area was uploaded by Sandy Branson on Apr 12, 2017
Content may be subject to copyright.
Journal of Mind and Medical Sciences
(85=6. C;;=. :<2,5.
Depression, loneliness, and pet aachment in
homebound older adult cat and dog owners
Sandy M. Branson
UTHealth School of Nursing;*7-:*6+:*7;87=<1<6,.-=
Lisa Boss
52;*+8;;=<1<6,.-=
Stanley Cron
;<*75.A,:87=<1<6,.-=
Dennis C. Turner
-.772;<=:7.:2.<,1
8558?<12;*7-*--2<287*5?8:4;*< 1F9;,185*:>*598.-=366;
#*:<8/<1. 726*5;;2;<.-E.:*9A86687;866=72<A.*5<186687;*7-<1. "<1.:
.7<*5*7-%8,2*5.*5<186687;
E2;$.;.*:,1:<2,5.2;+:8=01<<8A8=/8:/:..*7-89.7*,,.;;+A(*598%,185*:<1*;+..7*,,.9<.-/8:27,5=;287278=:7*58/ 27-*7- .-2,*5
%,2.7,.;+A*7*=<18:2B.-*-6272;<:*<8:8/(*598%,185*:8:68:.27/8:6*<28795.*;.,87<*,<*(*598%,185*:;<*D6.6+.:*< ;,185*:>*598.-=
$.,866.7-.-2<*<287
:*7;87%*7-A 8;;2;*:87%<*75.A*7-&=:7.:.772;.9:.;;287587.527.;;*7-9.<*F*,16.7<27
186.+8=7-85-.:*-=5<,*<*7--808?7.:; Journal of Mind and Medical Sciences(85;;:<2,5.
"#
>*25*+5.*< 1F9;,185*:>*598.-=366;>852;;
Depression, loneliness, and pet aachment in homebound older adult cat
and dog owners
Cover Page Footnote
).?8=5-524.<898;<1=68=;5A*,478?5.-0.:=,4..*70?18,87<:2+=<.-<8<1.,87,.9<=*5-.;207
8/<12;;<=-A*7-<1.?:2<2708/<1.6*7=;,:29<%1*:>*:2*6*< %*7*5AB.-<1.+28*;;*A;).*:.0:*<./=5<8
<1. .*5;87)1..5;%8,2.<A8/6.:2,*/8:<1.2:9*:<2,29*<287=7-270/8:<12;;<=-A?*;;=998:<.-+A<1.
'72>.:;2<A8/&.@*;.*5<1%,2.7,..7<.:%,18858/!=:;270;.*7$.;.*:,1?*:-/=7-;
E2;:.;.*:,1*:<2,5.2;*>*25*+5.278=:7*58/ 27-*7- .-2,*5%,2.7,.; 1F9;,185*:>*598.-=366;>852;;
J Mind Med Sci. 2017; 4(1): 38-48
doi: 10.22543/7674.41.P3848
Correspondence should be addressed to: Sandy Branson, UTHealth School of Nursing, Department of Nursing
Systems, 6901 Bertner Ave., Ste. 724, Houston TX 77030; email: sandra.m.branson@uth.tmc.edu
Research Article
Depression, loneliness, and pet attachment in
homebound older adult cat and dog owners
Sandy M. Branson1, Lisa Boss1, Stanley Cron1, Dennis C. Turner2
1UTHealth School of Nursing, Department of Nursing Systems, Houston, Texas
2Institute for Applied Ethology and Animal Psychology, Seestrasse 254. CH-8810 Horgen/ Switzerland
Keywords:
older adults, cat, depression, dog, loneliness, pet attachment
Abstract
Background: Companion animals may reduce depression and loneliness in socially
isolated homebound older adults. However, whether owning a cat or dog is more beneficial
in this population remains unknown.
Materials and Methods: Pet attachment and the levels of depressive symptoms and
loneliness were examined in 39 homebound older adults who exclusively owned a cat(s) or a
dog(s). Cat owners (n = 12) and dog owners (n=27) were assessed for depressive symptoms
(Geriatric Depression Scale-Short Form), loneliness (R-UCLA Loneliness Scale), and
attachment to pets (Likert scale).
Results: Cat owners reported significantly lower levels of depressive symptoms than
dog owners (t= 2.12; p = 0.04). There were no significant differences between cat owners
and dog owners in regards to levels of loneliness (t = -0.83; p = 0.41). Both cat owners and
dog owners reported a high level of attachment to pets (Median=10 of 10).
Conclusions: Although this study provides preliminary evidence that owning a cat to
which one is attached is associated with lower levels of depressive symptoms than owning a
dog to which one is attached in homebound older adults, the findings should be replicated
with longitudinal studies. Findings from such studies may assist homebound older adults in
selecting either a cat or dog as a companion pet.
Branson SM. et al.
39
Introduction
Multiple mental and physical comorbid health
conditions prevent homebound older adults from leaving
their homes (1). As such, homebound older adults are
socially isolated and at significant risk for loneliness and
depression (1, 2). While existing interventions promote
social integration and activities outside the home for
older adults, most homebound older adults are
functionally disabled, which limits their opportunity to
participate in activities outside the home. Although
human social support and companionship for socially
isolated older adults may be limited, companion pets
may reduce depression and loneliness by providing
nonhuman social support (3) and companionship (4) that
satisfies social needs (5). However, whether owning a
cat or dog is associated with less loneliness and
depression in this population remains unknown.
Depression and Pets
Depression is a serious mental illness associated
with physical and functional disability (6), increased
mortality (7) and formalized care placement (8). Major
depressive disorder is characterized by depressed mood
(feeling sad or empty), diminished interest or pleasure,
weight loss, sleep dysregulation, changes in appetite or
weight, psychomotor agitation or retardation, fatigue,
feelings of worthlessness or inappropriate guilt,
problems with concentration and/or thoughts of death
(9). Chronic medical conditions, multiple losses,
functional decline, and social isolation render
homebound older adults at risk for depression (10). As
such, approximately 13%-29% of homebound older
adults are diagnosed with depression (11, 12).
In a meta-analysis that included five studies, four of
which included dogs only, Souter and Miller concluded
that animal-assisted interventions were significantly
associated with reduced depressive symptoms with a
moderate level of effect (13). In a separate study,
researchers investigated the effects of cats on depression
and showed that the presence of a cat, as well as
interacting with a cat, reduced negative moods of
depression in a non-clinical, presumably healthy
population of adult cat owners but did not increase
“good moods” (14, 15, 16). To our knowledge, no
studies have compared homebound older adult cat
owners and dog owners in regards to depression, and
studies among older community-dwelling cat and dog
owners have reported mixed results.
In a secondary analysis of a study that examined
159 community-dwelling older womenin the United
States who were attached to their pets (17), dog owners
had significantly higher levels of depressed mood than
cat owners (18). Conversely, Enmarker, Helzén, Ekker,
and Berg investigated 12,093 rural-dwelling older adult
pet owners (men and women) in Norway who
participated in a population survey and found that cat
owners reported higher mean values of depression
symptoms than dog owners (19). In the Norway study,
older men who owned cats reported less depressive
symptoms than older women who owned cats, but this
same relationship was not found among dog owners.
Differences in study populations and study variables
make the U.S. and Norway studies difficult to compare.
The U.S. study included women with moderate to high
levels of pet attachment, whereas the Norway study
examined both genders and did not examine the impact
of pet attachment on depression outcomes. Disparate
findings between the two studies may suggest gender-
specific differences in depression outcomes among pet
owners, more specifically among cat owners. What
remains to be established is whether cat ownership or
dog ownership is associated with less depression in older
adults who are functionally disabled and unable to leave
Depression, Loneliness, Pet Attachment in Homebound Cat & Dog Owners
40
their homes and whether depression outcomes vary by
gender in this population.
Loneliness and Pets
Loneliness is characterized as an aversive
emotional state related to the perception of unfulfilled
intimate and social needs (20) that may emerge from a
lack of intimacy or companionship (21). Negative
implications of loneliness are extensive and are
associated with increased functional decline (22), an
increased number of physician visits (23), an increased
likelihood of formalized care placement (24), and a
greater risk for all-cause mortality (25). Owing to social
isolation and fewer emotional connections, homebound
older adults are at risk for loneliness (26, 27).
Peplau and Perlman suggested surrogate
relationships with pets may help older adults cope with
loneliness (20). Researchers investigatingolder adult
primary care patients found that pet owners reported less
loneliness than non-pet owners, and those living alone
without a pet had the greatest odds of reporting
loneliness (28). Gulick and Krause-Parello compared
levels of loneliness among older women who primarily
resided in senior living community settings or attended
senior community activities and found no statistically
significant differences in levels of loneliness between cat
owners and dog owners (18). However, whether owning
a cat or dog is associated with less loneliness in socially
isolated homebound older adults has not been explored.
Attachment to Pets
Companion pets provide compassion, pleasure, and
affection and respond with unconditional love (29).
People who are attached to their pets often consider their
pets significant family members (30). Affectional bonds
with pets are emotionally significant relationships
because pets are nonjudgmental members of social
networks that provide owners with feelings of being
cared for, beliefs that one is loved and valued, and the
sense of belonging to a reciprocal network (31, 32).
Although few studies have measured the impact of
pet attachment on loneliness and depression, Krause-
Parello found that the level of loneliness and the degree
of attachment to dogs and cats were significantly and
positively related in older women (17). The author
concluded that as loneliness increased for older women,
pet attachment also increased. In a secondary analysis of
the same study, pet attachment support mediated the
effects between loneliness and depressed mood. The
author concluded that support from a pet assisted older
community-dwelling women in coping with loneliness
and depressed mood (33). Thus, existing evidence
suggests the importance of evaluating pet attachment
when examining loneliness and depression in pet
owners.
Materials and Methods
The aim of the current cross-sectional study was to
compare differences in the levels of depressive
symptoms and loneliness and pet attachment between
homebound older adults who owned a cat(s) or dog(s).
Study Design
The current study was part of a larger cross-
sectional study (N=88) that compared homebound older
adult pet owners and non-pet owners (34). Because the
purpose of the current study was to determine whether a
cat or dog was more beneficial in terms of loneliness and
depression, the analysis of the current study included
participants who exclusively owned a dog(s) or cat(s)
but no other pets. Thirty-nine homebound older adult cat
owners (n=12) and dog owners (n=27) were compared
according to their levels of pet attachment, depressive
symptoms, and loneliness using self-report
questionnaires. Prior to data collection, the study was
approved by the university’s Committee for the
Protection of Human Subjects and granted exemption by
the university’s Animal Welfare Committee.
Branson SM. et al.
41
Sample and Setting
Homebound older adults who were enrolled in the
Meals on Wheels (MOW) Senior Nutrition Plan in a
rural county in the Southern United States were recruited
for voluntary participation in the parent study. MOW
recipients must be at least 60 years old and have a
functional disability that prevents them from leaving the
home (35). The inclusion and exclusion criteria for the
parent study were previously reported (34). Briefly, the
participants were MOW recipients who were able to
complete instruments in English, did not have a
neurodegenerative disease, and were not taking
hormones or corticosteroids.
Instruments
Depressive symptoms were measured using the
GDS Short Form, a 15-item instrument designed to
screen for depressive symptoms (e.g., somatic
complaints, cognitive complaints, motivation, future/past
orientation, self-image, loss, agitation, obsessive traits,
and mood) in older adults (36). The GDS Short Form
has been used extensively in healthy and cognitively
impaired community-dwelling older adults. Scores range
from 0 to 15, and higher scores indicate more depressive
symptoms (36, 37). GDS Short Form scores greater than
5 indicate an optimal cutoff for the detection of major
depression, with a sensitivity of 71.8% and specificity of
78.2% in older adults receiving home health care when
compared with the gold standard assessment with the
Structured Clinical Interview for the Diagnostic and
Statistical Manual of Mental Disorders-IV (38). The
GDS Short Form is a reliable instrument, as
demonstrated by a Cronbach’s alpha of .81 in the current
study.
Loneliness was measured with the R-UCLA, a
commonly used instrument measuring the frequency and
intensity of social isolation and dissatisfaction with
one’s social interactions (39). The questionnaire
comprises 10 positively worded items and 10 negatively
worded items. Scores range from 20 to 80, and higher
scores indicate higher levels of loneliness. The
instrument is considered reliable across various
populations (39), and in the current study, Cronbach’s
alpha was .89.
Attachment to companion pets was assessed by a 10-
point Likert scale, rather than one of the standard
multivariate pet attachment measures (e.g., the
Lexington Attachment to Pets Scale), because other
multivariate pet attachment scales have been criticized as
unreliable when comparing attachment levels between
dog owners and cat owners (40, 41). Participants were
asked to rate their attachment to their favorite cat or dog
from 0 to 10, with higher scores indicating a higher level
of attachment.
Data Collection
Participants were recruited via flyers delivered by
MOW volunteers with the daily home-delivered meal.
The flyer invited participants who met the inclusion
criteria to call the researchers directly and schedule an
appointment for informed consent and data collection.
The researchers met the participant at the participant’s
home, obtained informed consent, and subsequently
collected demographic and psychosocial data by self-
report from the participant. Participants were allowed to
have a spouse or other representative present during
consent and data collection and were allowed to re-
schedule data collection if necessary. A $10 incentive
was provided for participation.
Data Analysis
Descriptive statistics were computed for
demographic variables by group (cat ownership/dog
ownership). An exact version of the chi-squared (χ2) test
was used to account for the small sample size and
examine statistical differences between groups for
categorical demographic data. A t-test for independent
samples was conducted to test differences in outcomes
Depression, Loneliness, Pet Attachment in Homebound Cat & Dog Owners
42
between cat owners and dog owners. A multiple linear
regression model was used to compare depression by pet
type and gender and determine whether the difference by
pet type varies by gender using the interaction term (Pet
Type X Gender). Assumptions of the respective
statistical tests were met. Statistical analyses were
conducted using SAS 9.4 for Windows, and an alpha
level of ≤ 0.05 was considered significant.
Results
Characteristics of the Sample
The mean age of the total sample was 76 +/- 9
years, ranging from 62 to 95 years (72% female, 100%
white, 41% married, and 59% widowed, divorced or
single). As shown in Table 1, no statistically significant
differences were found between dog owners and cat
owners in age, gender, marital status, and education
level.
Depressive Symptoms, Loneliness, and Attachment
to Pets
Cat owners reported significantly fewer depressive
symptoms than dog owners (Table 2; t= 2.12; p = 0.04).
No significant difference was found between cat owners
and dog owners in loneliness (t = -0.83; p = 0.41) or
attachment to pets (t = -0.21, p = 0.84). Table 3 shows
descriptive statistics by gender for each type of pet
owned, with depression (GDS-SF scores) as the outcome
variable. Among cat owners, the men had a lower mean
depression score than the women. As noted in Table 4,
the multiple linear regression model indicated a
significant difference in depression score by pet type (p
= 0.04), but not by gender (p = 0.31). In addition, the
interaction term (Pet Type X Gender) was not
statistically significant (p = 0.26), which indicates the
difference in depression scores by the type of pet owned
did not vary significantly between men and women.
Table 1. Characteristics of cat and dog owners (N = 39).
Cat Owners
n=12 (22%)
M (SD)
n (%)
Dog Owners
n=27 (78%)
M (SD)
n (%)
t Value or
Chi-Square
Value
p value
Age (years)
77.67 (9.35)
74.63 (8.35)
- 1.01
0.32
Gender
1.55
0.26
Males
5 (42%)
6 (22%)
Females
7 (58%)
21 (78%)
Marital status
0.42
0.73
Married
4 (33%)
12 (44%)
Widowed, Divorced, Single
8 (67%)
15 (56%)
Education (years)
11.58 (2.02)
12.07 (2.13)
0.67
0.50
Note: SD = Standard deviation, M = Mean.
Branson SM. et al.
43
Table 2. Differences between cat and dog owners in depression and loneliness (N=39)
Cat Owners
N=12 (22%)
Dog Owners
N=27 (78%)
t Value
p value
Effect size
(Cohen’s d)
Depression
(GDS-SF)
3.33 (2.84)
5.72 (3.40)
2.12
0.04
0.76
Loneliness (R-
UCLA)
43.17 (9.86)
39.71 (12.87)
- 0.83
0.41
0.30
Pet Attachment
(Likert Scale)
9.38 (1.23)
9.24 (2.05)
-0.21
0.84
0.08
Note:GDS-SF = Geriatric Depression Scale Short Form, R-UCLA = Revised University of California
Los Angeles Loneliness Scale
Table 3. Descriptive statistics by gender for each type of pet owned with depression (GDS-SF
scores) as the outcome variable (N=39)
Pet Type
Gender
N
Mean
Std. Dev
Dog Owner
Female
21
5.69
3.36
Male
6
5.83
3.87
Cat Owner
Female
7
4.43
2.70
Male
5
1.80
2.49
Table 4. Results from multiple linear regression model that compares depression (GDS-SF) by pet
type (cat or dog owner) and gender (N=39)
Source
DF
Type III SS
Mean Square
F Value
Pr > F
Pet Type (Cat or Dog Owner)
1
50.33
50.33
4.77
0.04
Gender
1
11.09
11.09
1.05
0.31
Pet Type X Gender
1
13.79
13.79
1.31
0.26
Discussion
Despite our small sample of homebound older
adults, significant differences were found in the level of
depressive symptoms between cat and dog owners, with
cat owners reporting fewer depressive symptoms. Our
findings agree with those reported by Gulick and
Krause-Parello, who found the level of depressive
symptoms between attached cat owners and dog owners
were significantly different, with cat owners reporting
lower levels of depressed mood than dog owners (18).
Although the reasons for why older adults in both
studies who owned cats had lower depressive symptoms
Depression, Loneliness, Pet Attachment in Homebound Cat & Dog Owners
44
than those who owned dogs are not clear, one plausible
explanation is that cats are independent, which renders
them low maintenance, and thus provide great pleasure
and feelings of worthiness. For example, a cat does not
require training and exercise, factors that may make cat
ownership more emotionally satisfying and less
physically demanding than dog ownership for older
adults, especially for those who are disabled.
Alternatively, however, it is possible that older adults
with more depressive symptoms seek out dogs (who tend
to be naturally social), more so than cats (who tend to be
less social), to be more socially engaged and deal with
depressive symptoms.
Our finding that cat owners reported less depressive
symptoms than dog owners contradict findings from the
Norway population study, in which cat owners reported
higher levels of depression symptoms than dog owners
(19). However, both studies were similar in that men
who owned cats (but not dog owners) reported less
depressive symptoms than women who owned cats. Our
study lacked statistical significance that would indicate
that the difference in depression scores by the type of pet
varied between men and women; however, the lack of a
statistically significant difference in our study was due in
part to the small sample size, which reduced the power
of the interaction term. As such, future studies that
evaluate the impact of gender on depression outcomes
are needed, specifically among cat owners.
Although differences and similarities were found
between the Norway study and our study, comparing the
findings is difficult because participants in our study
were functionally disabled older adults who were mostly
women, whereas participants in the Norway study were
from the general population (functional limitations were
not reported) with similar representations of men and
women. Given inconsistent findings between the two
studies on depression outcomes between cat and dog
owners, further exploration is needed that investigates
differential emotional responses to pets that may vary
according to an older person’s gender, functional ability,
and living situation.
Pet attachment provides mutual pleasure and a
source of emotional support (42). Attachment figures
that provide attachment relationships are needed
throughout all phases of life; however, attachment
relationships may be limited for older adults owing to a
loss of family members and friends (43). The high level
of attachment to both cats and dogs in our study suggests
the importance of having a pet, regardless of the type of
pet, in an isolated and vulnerable homebound older adult
population. Additional studies are needed to compare
our findings with other homebound older adults. We
used a 0-10 visual analog scale to assess pet attachment
to minimize the potential pet species-specific bias on
existing scales (41). However, the reliability and validity
of using a visual analog scale needs to be further
explored.
Scores on the R-UCLA Loneliness Scale indicated
a moderate level of loneliness in both cat and dog
owners with no significant differences between the types
of pet owners. However, our study had a small sample,
which limited the likelihood of finding differences in
levels of loneliness. Weiss (described social loneliness
as a lack of social integration; owning cats and dogs may
not improve social integration for homebound older
adults but may decrease emotional loneliness by
improving attachment relationships (44). The R-UCLA
Loneliness Scale that was used in the current study is
considered a unidimensional measure of loneliness and
may have limited the capacity to assess the different
aspects of loneliness (45, 46). Another instrument, the
De Jong Gierveld Loneliness Scale, may have been a
Branson SM. et al.
45
more sensitive instrument to determine differences
between pet-attachment relationships of cat and dog
owners owing to the instrument’s multidimensional
design that measures both social and emotional
typologies of loneliness (47).
Our sample was small and comprised primarily
white women who lived in a rural setting; thus, the
findings may not be generalizable to other homebound
older adults who own cats or dogs. Because of our small
sample size, the probability of finding a difference in
depressive and loneliness symptoms between cat owners
and dog owners when one exists in the population (i.e.,
power) was small. A small sample increases the
probability of type II error, or not finding a difference in
depressive symptoms when one exists in the population.
Although the GDS Short Form is considered a screening
tool for depressive symptoms and not diagnostic of
depression, cat owners reported levels of depressive
symptoms that were below the recommended level to
detect major depression. In comparison, dog owners
reported levels of depressive symptoms equivalent to
major depression (38). However, the level of depressive
symptoms for dog owners was minimally above the
cutoff score of > 5 to detect major depression. Thus,
differences in depressive symptoms between cat and dog
owners should be interpreted with precaution. Owing to
the cross-sectional methodology, fewer depressive
symptoms reported by cat owners when compared with
dog owners may be unrelated to owning a pet and may
be related to other factors. Additionally, whether the
relationship between cat ownership and few depressive
symptoms is causal or whether pet owners with
depression seek out dogs to alleviate depressive
symptoms is unknown.
Considering that up to 29% of homebound older
adults have major depression (11) and that cat ownership
was associated with fewer depressive symptoms, our
results have potential implications for the choice of pet
and potential benefits of cat ownership in homebound
older adults. Given the high prevalence of depression in
homebound older adults and the association of
depression with poor physical and mental health, cat
ownership may be beneficial for homebound older adults
(6-8, 48, 49). Programs that match older cats with older
adults may need to be considered for potential mental
health benefits in homebound older adults (50, 51).
Conclusions
Although this study provides preliminary evidence
that owning a cat to which one is attached is associated
with fewer depressive symptoms than owning a dog to
which one is attached in homebound older adults, the
findings should be replicated with longitudinal studies.
Future studies need to establish whether owning a cat
decreases depression and, if so, how cats alleviate
depression in homebound older adults. Likewise, future
studies need to establish whether homebound older
adults with depression select dogs as pets and, if so,
determine whether dogs assist homebound older adults
in dealing with depression. Findings from such studies
may assist homebound older adults in selecting either a
cat or dog as a companion pet.
Acknowledgements
We would like to posthumously acknowledge Dr.
Duck-Hee Kang who contributed to the conceptual
design of this study and the writing of the final
manuscript. We are grateful to the Meals on Wheels
Society of America for their participation. Funding for
this study was supported by the University of Texas
Health Science Center School of Nursing's Dean
Research Award funds.
Depression, Loneliness, Pet Attachment in Homebound Cat & Dog Owners
46
References
1. Qiu WQ, Dean M, Liu T, George L, Gann M, Cohen
J, Bruce ML. Physical and mental health of
homebound older adults: An overlooked population.
J Am Geriatr Soc. 2010; 58(12), 2423–8.
2. Choi NG, Marti N, Bruce ML, Hegel MT, Wilson
NL, Wilson MA, Kunik ME. Six-month
postintervention depression and disability outcomes
of in-home telehealth problem-solving therapy for
depressed, low-income homebound older adults.
Depress Anxiety. 2014; 31(8): 653–61.
3. Friedmann E, Thomas SA. Pet ownership, social
support, and one-year survival after acute
myocardial infarction in the cardiac arrhythmia
suppression trial (CAST). Am J Cardiol. 1995;
76(18): 1213-1217.
4. McNichols J, Collis GM. Dogs as catalysts for social
interactions: robustness of the effect. Br J Psychol.
2000; 91(1): 61-70.
5. Archer J. Why do people love their pets? Evolution
and Human Behavior. 1997; 18: 237–259.
6. Lenze EJ, Rogers JC, Martire LM, Mulsant BH,
Rollman B, Dew MA, Schulz R, Reynolds CE. The
association of late-life depression and anxiety with
physical disability. Am J Geriatr Psychiatry. 2001,
9(2): 113-135.
7. Vilalta-Franch J, Planas-Pujol X, Lopez-Pousa S,
Llinas-Regla J, Merino-Aguado J, Garre-Olmo J.
Depression subtypes and 5-years risk of mortality in
aged 70 years: a population-based cohort study. Int J
Geriatr Psychiatry. 2012; 27(1): 67–75.
8. Harris Y. Depression is a risk factor for nursing
home admission among older individuals. J Am Med
Dir Assoc. 2007; 8(1): 14-20.
9. American Psychiatric Association. Diagnostic and
statistical manual of mental disorders: DSM-5. 2913;
Washington, DC: American Psychiatric Association.
10. U.S. Department of Health and Human Services.
Mental Health: A Report of the Surgeon General.
Rockville, MD: U.S. Department of Health and
Human Services, Substance Abuse and Mental
Health Services Administration, Center for Mental
Health Services, National Institutes of Health, 1999.
National Institute of Mental Health.
11. Levy MT. Psychiatric assessment of elderly patients
in the home: A survey of 176 cases. J Am Geriatr
Soc. 1985; 33(1): 9–12.
12. Choi NG, Teeters M, Perez L, Farar B, Thompson
D. Severity and correlates of depressive symptoms
among recipients of Meals on Wheels: Age, gender,
and racial/ethnic difference. Aging Ment Health.
2009; 14(2): 145-154.
13. Souter M, Miller M. Do animal-assisted activities
effectively treat depression? A meta-analysis.
Anthrozoös. 2007; 20(2): 167-180.
14. Rieger G, Turner DC. How depressive moods affect
the behaviour of singly living persons toward their
cats. Anthrozoös. 1999; 12(4): 224–233.
15. Turner DC, Rieger G. Singly living people and their
cats: a study of human mood and subsequent
behavior. Anthrozoös. 2001; 14(1): 38–46.
16. Turner DC, Rieger G, Gygax L. Spouses and cats
and their effects on human mood. Anthrozoös. 2003;
16(3): 213–228.
17. Krause-Parello CA. The mediating effect of pet
attachment support between loneliness and general
health in older females living in the community. J
Community Health Nurs. 2008: 25(1): 1-14.
18. Gulick EE, Krause-Parello CA. Factors related to
type of companion pet owned by older women. J
Branson SM. et al.
47
Psychosoc Nurs Ment Health Serv. 2012; 50(11):
30-37.
19. Enmarker I, Helzén O, Ekker K, Berg AT.
Depression in older cat and dog owners: the Nord-
Trøndelag Health Study (HUNT)–3. Aging Ment
Health. 2015; 19(4): 347-52.
20. Peplau LA, Perlman D. Perspectives on loneliness.
In Peplau, Letitia Anne; Perlman, Daniel, (Eds.),
Loneliness: A sourcebook of current theory,
research and therapy. 1982; New York: John Wiley
and Sons. ISBN: 978-0-471-08028-2.
21. Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L.
Loneliness and neuroendocrine, cardiovascular, and
inflammatory stress responses in middle-aged men
and women. Psychoneuroendocrinology. 2004;
29(5): 593-611.
22. Perissinotto CM, Stijacic C, Covinsky KE.
Loneliness in older persons: a predictor of functional
decline and death. Arch Intern Med. 2012; 172(14):
1078-1083.
23. Gerst-Emerson K, Jayawardhana J. Loneliness as a
public health issue: The impact of loneliness on
health care utilization among older adults. Am J
Public Health. 2015; 105(5): 1013-9.
24. Russell DW, Cutrona CE, de la Mora A, Wallace
RB. Loneliness and nursing home admission among
rural older adults. Psychol Aging. (1997). 12(4):
574–589.
25. Shiovitz-Ezra S, Ayalon L. Situational versus
chronic loneliness as risk factors for all-cause
mortality. Int Psychogeriatr. 2010; 22(3): 455–462.
26. Prince MJ, Harwood RH, Blizard RA, Thomas A,
Mann AH. Social support deficits, loneliness and life
events as risk factors for depression in old age: The
Gospel Oak Project VI. Psychol Med. 1997; 27(2):
323–332.
27. Perlman D. Loneliness: a life-span, family
perspective. In: Milardo RM (ed.) Families and
social networks. 1988; Beverly Hills: Sage, pp: 190–
220.
28. Stanley I, Conwell Y, Bowen C, Van Orden K. Pet
ownership may attenuate loneliness among older
adult primary care patients who live alone. Aging
Ment Health. 2014; 18(3): 394-399.
29. Walsh F. Human-Animal Bonds II: The Role of Pets
in Family Systems and Family Therapy, Fam
Process. 2009; 48(4): 481–499.
30. Cohen SP. Can pets function as family members?
West J Nurs Res. 2002; 24(6): 621–638.
31. Horowitz S. The human-animal bond: Health
implications across the lifespan. Alternative and
Complimentary Therapies 2008; 14(5): 251-256.
32. Collis GM, McNicholas J. A theoretical basis for
health benefits of pet ownership. In C.C. Wilson &
D. C. Turner (Eds.), Companion animals in human
health. 1998. Thousand Oaks, CA: Sage.
33. Krause-Parello CA. Pet ownership and older
women: The relationship among loneliness, pet
attachment support, human social support, and
depressed mood. Geriatr Nurs. 2012; 33(3): 194-
203.
34. Branson S, Boss L, Cron S, Kang D. Examining
differences between homebound elderly pet owners
and non-pet owners in depression, systemic
inflammation, and executive function. Anthrozoös.
2016; 29(2): 323-334.
35. Meals on Wheels Association of America (2015).
Retrieved May 15, 2016 from
http://www.mealsonwheelsamerica.org/
36. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V,
Adey MB, Leirer VO. Development and validation
of a geriatric depression screening scale: A
Depression, Loneliness, Pet Attachment in Homebound Cat & Dog Owners
48
preliminary report. J Psychiatr Res. 1983; 17(1), 37-
49.
37. Burke WJ, Roccaforte WH, Wengel SP. The short
form of the Geriatric Depression scale: a comparison
with the 30-item form. J Geriatr Psychiatry Neurol.
1991; 4(3): 173-180.
38. Marc L, Raue P, Bruce M. Screening performance of
the Geriatric Depression Scale (GDS-15) in a
diverse elderly home care population. Am J Geriatr
Psychiatry. 2008; 16(11): 914-921.
39. Russell D, Peplau LA, Cutrona C. The Revised
UCLA Loneliness Scale: Concurrent and
discriminant validity evidence. J Pers Soc Psychol.
1980; 39(3): 472-480.
40. Johnson T, Garrity T, Stallones L. Psychometric
evaluation of the Lexington Attachment to Pets
Scale (LAPS). Anthrozoös. 1992; 5(3): 160-75.
41. Zasloff RL. Measuring attachment to companion
animals: a dog is not a cat is not a bird. Applied
Animal Behaviour Science. 1996; 47: 43-48.
42. Wilson CC. A conceptual framework for human-
animal interaction research. In C. C. Wilson & D. C.
Turner (Eds.), Companion animals in human health
1998, pp. 61-89. Thousand Oaks, CA: Sage
Publications.
43. Bowlby, J. Attachment and loss. Vol. 1: Attachment
(2nd ed.). New York: Basic Books. 1982. Retrieved
from http://www.abebe.org.br/wp-content/uploads/John-
Bowlby-Attachment-Second-Edition-Attachment-and-
Loss-Series-Vol-1-1983.pdf
44. Weiss RS. Loneliness: The experience of emotional
and social isolation. 1973. Cambridge, MA: MIT
Press.
45. Hawkley LC, Browne MW, Cacioppo JT. How can I
connect with thee? Let me count the ways. Psychol
Sci. 2005; 16(10): 798-804.
46. Russell DW. UCLA Loneliness Scale (Version 3):
Reliability, validity, and factor structure. J Pers
Assess. 1996; 66(1): 20-40.
47. De Jong Gierveld J, Kamphuis F. The development
of a Rasch-type loneliness scale. Applied
Psychological Measurement 1985; 9: 289-99.
48. Doraiswamy PM, Khan ZM, Donahue RMJ, Richard
NE. The spectrum of quality-of-life impairments in
recurrent geriatric depression. J Gerontol A Biol Sci
Med Sci. 2002; 57(2): M134–7.
49. Turvey CL, Conwell Y, Jones MP, Phillips C,
Simonsick E, Pearson JL, Wallace R. Risk factors
for late life suicide: A prospective, community-
based study. Am J Geriatr Psychiatry.(2002; 10(4):
398–406.
50. Cats for Companionship. Animal Tales: Humane
Society of Bay County. Retrieved from (2016,
Summer). http://humanesocietybaycounty.org/wp-
content/uploads/2016/06/HSBC-Newsletter-Summer-
Color-6-19-16.pdf
51. C.A.T.S. (Companion Animals Touching Seniors).
(n.d.). Oakland County Michigan Animal Shelter
and Pet Adoption Center Programs and Services.
Retrieved from https://www.oakgov.com/
petadoption/Pages/Programs_Services.aspx
