The Gerontologist
Vol. 48, No. 3, 300–310

Copyright 2008 by The Gerontological Society of America

More Than Just a Communication Medium:
What Older Adults Say About Television and
Depression
Giang T. Nguyen, MD, MPH, MSCE,1,2,3,4 Marsha N. Wittink, MD, MBE,1
Genevra F. Murray, PhDc,5 and Frances K. Barg, PhD, MEd1,4,5
Purpose: Older adults watch more television than
younger people do. Television’s role in mental health
has been described in the general population, but
less is known about how older adults think of television in the context of depression. Design and
Methods: Using a semistructured interview created to
help clinicians understand how older adults conceptualize depression diagnosis and treatment, we
conducted a qualitative study of 102 patients aged
65 years or older. We recruited them from primary
care offices and interviewed them in their homes.
During our analysis, we found that many respondents
offered spontaneous thoughts about the relationship
between television and depression. We extracted all
television-related content from the interview transcripts and identified themes by using grounded
theory. Results: Participants cited television as
a way to identify depression in themselves or others
The Spectrum I and II studies were supported by Grants MH6221001, MH62210-01S1, and MH67077 from the National Institute of Mental
Health (NIMH). Dr. Nguyen was supported by a Pfizer Fellowship in
Health Literacy/Clear Health Communication, an American Cancer
Society Cancer Control Career Development Award (CCCDA-05-16101), and an institutional training grant from the Bureau of Health
Professions (D55-HP-05164-01). Dr. Wittink was supported by a career
development award from NIMH (5K23MH073658-02).
We thank Jerene Good, Julia Switzer, Britt Dahlberg, and Grace Kim
Lee for data management, statistical support, and editorial assistance.
Special thanks to the patients who generously gave their time to share
their experiences with the Spectrum Study Team. Finally, we thank
Joseph Gallo, Marjorie Bowman, and the anonymous reviewers of this
journal, whose insightful recommendations helped to shape the final
version of this manuscript.
Address correspondence to Giang T. Nguyen, MD, MPH, MSCE,
Department of Family Medicine and Community Health, The University
of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA
19104. E-mail: nguyeng@uphs.upenn.edu
1
Department of Family Medicine and Community Health, University
of Pennsylvania, Philadelphia.
2
Leonard Davis Institute of Health Economics University of
Pennsylvania, Philadelphia.
3
EPIC Center of Excellence in Cancer Communication Research,
University of Pennsylvania, Philadelphia.
4
Center for Public Health Initiatives, University of Pennsylvania,
Philadelphia.
5
Department of Anthropology, University of Pennsylvania,
Philadelphia.

300

(either through overuse or lack of interest) or as a way
to cope with depressive symptoms. Some felt that
television could be harmful, particularly when content
was high in negativity. A substantial number of
participants discussed more than one of these themes,
and a few mentioned all three. Married people were
more likely to discuss television’s role in identifying
depression. Participants with low education more
often mentioned that television could be helpful,
whereas those with a history of depression treatment
were more likely to discuss television’s potential
harm. Implications: Researchers should conduct further studies to help them better understand the
relationship among depression, television viewing,
and individual viewpoints concerning television’s role
in geriatric depression. An exploration of these issues
may yield new approaches to help clinicians address
depression in late life.
Key Words: Aged, Depression, Media,
Mental health, Primary health care, Television

Television viewing is ubiquitous in contemporary
American society. For older adults in particular,
television is a central aspect of everyday life. Older
adults watch more television than college students
do (Mundorf & Brownell, 1990), and older seniors
watch more than younger seniors do (Grajczyk &
Zollner, 1998). An estimated 89% of older adults
watch television daily, with 64% of these watching
over 3 hours daily (Schreiber & Boyd, 1980). As
adults grow older, they are less likely to continue
such activities as going to the theater, traveling, and
attending spectator sports, but watching the television remains important (Strain, Grabusic, Searle, &
Dunn, 2002). Indeed, watching television occupies
most of the leisure time for adults aged 70 to 105
years (Horgas, Wilms, & Baltes, 1998). From a health
care perspective, television usually is thought of as
The Gerontologist

a communication medium and an information
source (Connell & Crawford, 1988). However,
television plays other roles in depression as well.
Depression is common in late life and is often associated with disability and poor quality of life (Unutzer,
Bruce, & NIMH Affective Disorders Workgroup,
2002). Although depressive symptoms may affect 15%
of community-dwelling elderly patients (Mulsant &
Ganguli, 1999), depression may present differently
among older adults than among younger adults
(Lebowitz et al., 1997). For example, it may appear
more frequently in elderly persons as agitation,
hypochondriasis, or dementia syndrome of depression
(Moore & Jefferson, 2004), and it may often appear
without complaints of sadness (Gallo & Rabins,
1999).
Much of the literature on mental health and
television has focused on children (Kirkcaldy, Siefen,
Urkin, & Merrick, 2006; Singer, Slovak, Frierson, &
York, 1998) and college students (Anderson, Collins,
Schmitt, & Jacobvitz, 1996). For example, maternal
depression has been associated with increased television viewing among children (Burdette, Whitaker,
Kahn, & Harvey-Berino, 2003). Among adults aged
25 to 33 years, the CARDIA Study identified a link
between heavy television viewing and depression
(Sidney et al., 1996). Although viewing itself may be
increased with depression, ability to concentrate
while watching television may decrease, perhaps as
a result of ‘‘mind wandering’’ (Watts & Sharrock,
1985). Among adults, TV viewing can serve as a
means of escape from depressive moods or as a
calming device for anxiety. However, the nature of
the effect seems dependent on the type of program
viewed. For example, television viewing can help
depressed moods when content is positive, but
watching the news can exacerbate depressed moods
(Potts & Sanchez, 1994).
Mood management theory suggests that people
experiencing stress use television to block anxious
thoughts and to replace dysphoric moods. For
example, in one study of adult voters (mean age 45
years), participants were asked to estimate typical
daily television viewing for each day of the week.
Investigators found that women with more stressful
life events in the past year (using the Life Events
Inventory) were more likely to exhibit addiction-like
behavior (measured by the TV Addiction Scale). A
related study cited in the same article found that
stressful family life events were associated with
increased comedy and decreased news in the viewing
diet (as recorded in viewing diaries). Furthermore,
stressed women watched more game and variety programming as well as more overall television. Stressed
men watched more action and violent programming
(Anderson, Collins, Schmitt, & Jacobvitz, 1996).
At the same time, television has been described as
a vehicle for patient education; for example, cancer
patients experience less anxiety if they watch an educational video prior to the initiation of chemotherVol. 48, No. 3, 2008

301

apy or radiotherapy (Thomas, Daly, Perryman, &
Stockton, 2000). Moreover, television can be used to
disseminate public health messages about depression
and to influence attitudes about depression and its
treatment (Paykel, Hart, & Priest, 1998). Television
is an important medium for the delivery of direct-toconsumer advertising for antidepressants; pharmaceutical companies rationalize direct-to-consumer
advertising for this purpose on the grounds that it
provides important patient education (Frosch,
Krueger, Hornik, Cronholm, & Barg, 2007). Finally,
television has been used for telepsychiatric care, with
improved follow-up noted among depressed or schizophrenic patients receiving counseling via interactive
television (Zaylor, 1999).
Among elderly individuals, previous studies have
looked at how older adults respond to various
portrayals of older people on television. The idea of
downward comparison suggests that seeing others
who are worse off may give viewers a comparative
feeling of being better off. For example, one study
found that older persons who were lonely showed
greater interest in viewing negative rather than positive portrayals (vice versa for participants who were
not lonely). In addition, lonely older people felt
better after viewing negative portrayals than after
viewing positive portrayals (Mares & Cantor, 1992).
The role of television in geriatric depression has
not been described extensively in the medical literature. A recent Ovid Medline search for the key
words television/TV, depression/depressed, and
aged/aging/elderly yielded 52 articles, and a review
of the titles and abstracts produced only 9 articles that
truly addressed television use among older adults in
the context of depression. Among these articles, some
studies simply included television use among potential predictors of depression (Chen et al., 2005; Kivela,
1995; Kleinke, 1988; Koenig et al., 1997; Stessman
et al., 1996). The remaining articles dealt with television in the context of seeing or hearing problems
among elderly persons (Lopez-Torres Hidalgo et al.,
1995), television as a vehicle for public health
messages (Kerkhof, Visser, Diekstra, & Hirschhorn,
1991; Thomas, Deary, Kaminski, Stockton, & De
Zueew, 1999), and television as a part of daily life for
retirees (Jackson, Kart, Wagner, & Rowe, 1985).
In this article, we discuss themes expressed by
older adults related to television viewing in the context of talking about geriatric depression (the Spectrum study). Although approximately half of the
participants were depressed according to a self-rating
and a physician rating, all were told that the interview would address aging and mental health.
Our report differs from other work on geriatric
depression and television because it seeks to provide
an understanding of the relationship between
television and depression from the perspective of
older adults. Unlike purely quantitative research,
our design incorporated methods based in grounded
theory so that the ‘‘emic,’’ or insider, perspective

could be recognized. Rather than imposing the investigators’ notions of depression and television viewing
upon the participants, we allowed participants to
share their own views of how to define this
relationship.
Methods
We used open-ended interview data from the
Spectrum study, a mixed-methods study designed to
help researchers understand the sociocultural experience of depression among older adults. This study
and two quantitative predecessors have been described in other published work (Barg et al., 2006;
Bogner et al., 2004; Gallo et al., 2005; Wittink,
Barg, & Gallo, 2006). At the end of this article, we
have supplied an appendix describing sampling and
procedural issues in detail. Briefly, we used transcripts of interviews with 102 adults aged 65 years or
older, whom we recruited from primary care offices.
The interviews were designed to elicit participants’
explanatory model for depression, including where
they thought depression came from, their perception
of depression symptoms, their ideas about treatment,
and their notions about the seriousness of depression
(Wittink, Barg, & Gallo, 2006). We obtained signed
consent to record prior to the initiation of the
interviews.
Television was mentioned in some of the openended questions (details provided in the appendix).
However, we purposely did not ask directly about
television use or any other specific activity, preferring instead to see what prominent features of
participants’ social lives would emerge on their own.
When participants brought up activities that were
important to them (such as television), we asked
follow-up questions to elicit further detail.

grounded theory methodology of Glaser and Strauss
(Glaser & Strauss, 1967), this strategy involves taking
one piece of data (e.g., discussion about television)
and comparing it with all others that may be similar
or different in order to develop conceptualizations of
the possible relations among various pieces of data.
Once we identified themes, we organized them into
larger categories when common features were
present. Finally, we reviewed individual coded text
units again to confirm the accuracy of coding.
Participant Characteristics
In addition to the qualitative (textual) data, we
also recorded the following personal characteristics:
age, gender, ethnicity, marital status, living arrangement (alone or with others), education, physician
rating or self-rating of depression, and depression
treatment history (counseling, mental health referral,
antidepressant prescription). Furthermore, we assessed symptoms of depression, anxiety, and hopelessness by using the Center for Epidemiologic
Studies–Depression (CES-D) scale (Radloff, 1977),
the Beck Anxiety Inventory (Steer, Willman, Kay, &
Beck, 1994), and the Beck Hopelessness Scale (Beck,
Brown, Berchick, Stewart, & Steer, 1990). We
measured cognition by using several tests: the MiniMental State Examination (Folstein, Folstein, &
McHugh, 1975), the FAS verbal fluency score
(Troyer, 2000), and the Hopkins Verbal Learning
Test (Hogervorst et al., 2002). We assessed functioning status with the Medical Outcomes Study 36-item
Short-Form Health Survey (Ware & Sherbourne,
1992). To minimize effects on interview responses, we
administered these formal instruments after the openended interviews.
Quantitative Comparisons

Identification of Text Related to Television
We managed the transcript data by using QSR N6
qualitative analysis software. We used the textsearch function in N6 to identify all instances in
which the following words or their plurals were
mentioned: TV, television, program, and show. We
excluded text if the mentions were limited to side
comments with no subsequent discussion by study
respondents or if the context did not pertain to
television (e.g., mention of a drug-rehabilitation
‘‘program’’).
Constant Comparative Method
We assigned codes to the text that were derived
through an iterative process with multiple transcript reviewers. We used the constant comparative
method, moving iteratively between codes and text to
derive themes related to depression and television
(Boeije, 2002). Originally developed for use in the
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We used t tests and chi-square tests to compare
participants who discussed television or specific
television-related themes with participants who did
not (with regard to sociodemographics and measures
of physical, cognitive, and psychological status).
Although this research was formative rather than
hypothesis testing, we chose to use these statistical
tests to help identify relationships that potentially
may be evaluated further in future research, and to
serve as aids to inference and interpretation. For
example, knowing some of the characteristics of
individuals who endorse the theme that television
viewing is therapeutic for depression may help us to
design interventions targeting this subset of patients.
We used a significance level of a = 0.05. Finally, we
performed cross-tabulations to identify instances in
which multiple themes were described within the
same interview, allowing us to evaluate the breadth
of viewpoints about television and depression on the
individual level.
The Gerontologist

Table 1. Sample Characteristics
All
Participants (n ¼ 102)

Discussed
TV (n ¼ 65)

Did not
Discuss TV (n ¼ 37)

Sociodemographic characteristics
Age in years: M (SD)
Women: %
African American: %
Education less than high school: %
Married or with partner: %
Live alone: %

78.3 (6.5)
74
46
37
44
38

77.8 (6.8)
71
45
40
48
32

79.2 (5.8)
78
49
32
38
49

Psychological status
Self-identifies as ever depressed: %
CES-D score: M (SD)
BAI score: M (SD)
BHS score: M (SD)

52
9.5 (3.7)
6.2 (6.3)
4.1 (3.3)

59
9.1 (7.0)
6.6 (6.6)
3.8 (3.0)

41
10.1 (9.2)
5.5 (5.7)
4.6 (3.8)

Cognitive status
MMSE score: M (SD)
FAS score: M (SD)
HVLT score: M (SD)

26.3 (3.9)
26.9 (12.0)
17.8 (8.0)

26.2 (4.3)
27.4 (12.3)
17.9 (8.5)

26.6 (3.2)
26.2 (11.6)
17.5 (7.2)

Physical health, SF-36: M (SD)
Physical function score
Role physical score
Role emotional score

55.3 (30.9)
62.8 (40.4)
84.0 (33.4)

57.3 (30.1)
65.4 (39.9)
83.6 (33.9)

51.8 (32.2)
58.1 (41.3)
84.7 (33.0)

48
38
12
28

52
43
12
31

39
28
11
22

Characteristic

Primary care physician ratings at index visit: %
Physician rates patient as depressed
Depression counseling in past 6 months
Mental health referral in past 6 months
Prescribed antidepressant in past 6 months

Note: Our t tests and chi-square tests revealed no statistically significant differences between respondents who discussed television and those who did not. CES-D = Center for Epidemiology and Statistics–Depression scale; BAI = Beck Anxiety Index;
BHS = Beck Hopelessness Scale; MMSE = Mini-Mental Status Examination ; FAS = a verbal fluency test; HVLT = Hopkins Verbal Learning Test; SF-36 = Medical Outcomes Study 36-item Short-Form Health Survey.

Results
Sample Characteristics
A total of 102 interviews were completed, in
which television was explicitly discussed by 65 participants (64%). Table 1 includes demographic characteristics of the full sample as well as those of
respondents who did or did not discuss television.
Interviews lasted approximately 3 hours and covered
participants’ perceptions about aging, depression,
and physical problems.

of 16 or higher are more suggestive of depression
(Heikkinen & Kauppinen, 2004), we emphasize that
psychometric measures and physician assessments
are used not to judge the truth of an individual’s
comments but to elaborate the dynamics of depression in any given older adult’s lifeworld; they are
used to highlight what different assessments, quantitative and qualitative, capture and miss with regard
to depression in older adults.
‘‘That’s How I Knew’’

Themes That Emerged Related to Television
The participants described television within
a number of broad categories: (a) ‘‘That’s how I
knew’’ (television helps identify depression); (b) ‘‘I
turn the TV on . . . and I’m OK’’ (television is useful
in coping with depression); and (c) ‘‘Watch TV. . .
you will go crazy’’ (television can have a harmful
impact in depression). To provide context for the
quotations presented in this article, we indicate
CES-D scores and the presence or absence of selfrated and physician-rated depression after them (e.g.,
CES-D = 21; self, þ, MD, –). Although CES-D scores
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303

There were 21 participants who mentioned the
idea that television was a tool for identifying depression, either from observing a loved one or from introspection about one’s own viewing behavior. For
example, increased television viewing, particularly to
the exclusion of other activities, was a frequently
mentioned characteristic of depression. One 77-yearold widowed White woman highlighted just such an
exclusive engagement with television as ‘‘how she
knew’’ her friend was depressed:
[She] would come home from work, flop on her bed
and watch TV. Just never cooked—get food on her

way home from work. She never cooked. She had
a lovely townhouse in [name]. She didn’t take care
of her house. She didn’t cook. She didn’t entertain at
all. That’s the way I saw her as—that’s how I knew
she was depressed. (CES-D = 22; self, þ, MD, þ)

For this woman, it was her ability to contrast her
friend’s current, exclusive television watching to
a prior, more active lifestyle that made her certain
the problem was depression. Although for this respondent the television viewing was a marker of
depression in others, for a number of participants
this activity was an important component of their
own personal experience of depression. For one 69year-old divorced African American woman, this
amounted to a reduction of engagement (‘‘no
interest’’; ‘‘no energy’’), in which viewing the television remained as the sole interest and activity in
her life: ‘‘sometime I don’t feel like doing anything,
just looking at TV’’ [(CES-D = 41; self, –, MD, þ).
Another respondent, a 68-year-old married White
man, described the same sort of exclusive television
viewing as indicative of depression but with the key
addition of immobility and inertia as also linked to
his experience of television and depression. When he
was asked a question about how he thought
depression affected his health, he gave this answer:
‘‘I remember, it was kind of strange, I—I would get
up in the morning and—this was after I had
retired—and I went to get dressed and I would go
downstairs and sit in front of the TV set. And the
shades would be drawn in the room from the night
before and it would be sun shining outside and I
would say to myself, ‘Sunshine usually helps my
disposition.’ But I couldn’t get the energy to get up
and raise that shade and I’d sit there and watch
TV.’’ (CES-D = 28; self, þ, MD, þ)

Respondents also noted that their personal
reactions to television changed during depressive
episodes. In some cases, this was characterized as
a shift to surface engagement with television viewing
marked by a failure to fully engage, as was the case
with one 75-year-old married African American
woman: ‘‘Well it got so I’d look at TV, I was just
looking, looking through the TV’’ (CES-D = 5; self,
þ, MD, þ). Respondents linked this kind of shift with
a state of drifting or distraction enabled by the
presence of the television. This was the case with
a 77-year-old married White woman who found that,
while depressed,
. . . you get to the end of the story on the TV and
you say ‘Now what was that about?’ because I think
while the story’s going on your mind is going a mile
a minute. (CES-D = 12; self, þ, MD, –)

into racing thoughts, with the actual images and
stories pictured on television passing over her,
leaving no lasting impression whatsoever. But its
valence was negative: you watch ‘‘that stupid
television’’ and ‘‘half the time you don’t even know
what’s going on.’’ Meanwhile, one 80-year-old
married White woman used her awareness of her
reaction to television to treat her depression in a
wider sense:
I found myself jutting my jaw out when I, something
suspenseful was on the television. I thought ‘I gotta
cut that out.’ So that helped; it helped me over the
hump. (CES-D = 2; self, þ, MD, –)

This woman’s bouts of depression had resulted in
significant tooth problems, the result of holding too
much ‘‘tension’’ in her mouth. In this case, by working on her localized, embodied response to television
while she was depressed—the holding of physical
tension in place of emotional tension—she was able
to use this insight in concert with pharmaceutical
treatment (use of valium) to ‘‘get over the hump’’ of
depression.
Finally, some respondents commented that
a decrease in desire to watch television could also
be a signal of depression. In the words of a 75-yearold married White female, ‘‘[During times of
depression] television didn’t interest me’’ (CES-D =
9; self, þ, MD, þ). In most cases, respondents linked
this reduction in desire with a greater compulsion to
turn within oneself and cease engaging with the
larger world. For example, when describing depressed people, the same respondent said this:
[They don’t] care about their appearance, don’t
want to talk, really don’t want any kind of
company, the television irritates them, the telephone
upsets them, seems like no matter how much you try
to help them they don’t want your help.

Even more powerfully, a 69-year-old widowed
African American woman said this:
[During depression] you just want to be in—no
lights on, no TV, don’t want to listen to nothing;
you want to close yourself off there for awhile.
(CES-D = 6; self, þ, MD, þ)

As she pointed out so vividly, refusal of television
viewing could be part of the larger process of closing
off and moving inward during depressive episodes.
‘‘I Turn the TV on . . . and I’m OK’’

Clearly, for this woman, television engagement
while she was depressed was marked by a plunge
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The most frequently mentioned theme (n = 37)
was the concept that viewing television can help in
coping with depression. For example, a number of
participants with a reported history of depression
spontaneously offered television viewing as a method
The Gerontologist

for handling depression. When asked questions such
as, ‘‘What are you doing now for your depression?’’
several respondents listed television viewing as one
of the activities that they found helpful for dealing
with depression. For example, a 73-year-old married
White woman said: ‘‘I read, I work puzzles, I
watch TV, some good movie that’s romantic’’ (CESD = 0; self, þ, MD, þ). Others combined television
viewing with other activities they found helpful. For
instance, a 79-year-old married African American
woman said, ‘‘I like to sew in my hand and I get
it and sit in front of the television’’ (CES-D = 13;
self, þ, MD, þ). Some respondents, such as this
83-year-old widowed African American man, even
suggested television viewing among the sorts of
activities they might advise a depressed friend to
engage in:
You should go out and mingle with people and read
a book, look at TV or go to the movies or try to sit
down and meditate and relax. (CES-D = 1; self, –,
MD, –)

By using the phrase ‘‘you take television,’’ this
respondent almost appeared to equate television
with a treatment, as one might speak when referring
to ‘‘taking a medication.’’ Another respondent
echoed the notion that television viewing can cause
new emotional experiences:
Instead of paying attention to yourself, you can
watch an entertaining show on TV and laugh at
different things. . .. Redd Foxx, Lucy and all that
stuff and sometimes I’ll be laughing, tears coming—
and I feel so good for doing that, you know? . . . I
turn the TV on, and then I get a laugh and turn
round and I’m OK. (CES-D = 22; self, þ, MD, –)

For another respondent, a 69-year-old widowed
African American woman, television viewing was
equated with the uplifting power of music:

Although respondents who listed television as
a helpful activity did not always elaborate as to why
television was helpful, those who did (or who were
probed further by the interviewer to explain)
discussed television viewing as a way to occupy the
mind. A 73-year-old widowed White man responded
to the question ‘‘What are you doing now for your
depression?’’ in the following way: ‘‘A lot of times I
might turn on the television and watch something.’’
When questioned further about how TV might help
him he said, ‘‘I try to find something to occupy my
mind; I’ll say it in that manner’’ (CES-D = 38; self, þ,
MD, þ). Another respondent, a 77-year-old White
woman, elaborated on this notion of television
occupying the mind:

Yeah, I use music or, you know, the television.
That’s why I keep that television; it goes on in the
morning and goes off at night. And the one in my
bedroom is on now. So when I go upstairs and want
to do something, I can get television. You’d be
surprised how them things delight you. (CES-D =
18; self, –, MD, –)

For this respondent, television (like music) could
‘‘delight’’ or entertain. In addition, she seemed to
suggest that keeping the television on all day might
be helpful in some way. For example, another
respondent (an 81-year-old widowed African American woman) noted the importance of waking up to
the television being on:
[I like having] the TV looking at me when I wake up
and I feel better, get up and wipe my face and I’m
100% better. (CES-D = 22; self, þ, MD, –)

You get absorbed in what’s going on in the TV and
you forget your own problems. . . . If I start feeling
like that I either go lay down and take a nap or
watch TV and get my mind off of what’s going on.
(CES-D = 12; self, þ, MD, –)

Many of the respondents, such as this 71-year-old
married African American woman, talked about
how viewing the television allowed them to forget
their problems: ‘‘I watch TV and I forget all
about those things’’ (CES-D = 14; self, –, MD, þ).
They seemed to suggest that, because television
can be so engaging, one stops focusing on oneself.
One respondent, a 71-year-old widowed White
woman, felt that TV allowed her to have emotions
that she otherwise would not experience while
depressed:
[Y]ou forget everything and you watch television
and you get happy, you get hungry, you get—you
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get many emotions when you take television and
usually I take the news and have many emotions so I
forget my problems. (CES-D = 32; self, þ, MD, þ)

305

For these respondents the notion of having the
television waiting for them upstairs or in the
morning when they wake up provided a comfort—
something to look forward to or help them start
the day.
‘‘Watch TV. . . You Will Go Crazy’’
Although more respondents stated that television
viewing could help depression, a number of
respondents spoke about its potential harms with
respect to depression (n = 10). In particular, some
respondents felt depression could be made worse by
the ‘‘negativity’’ on television. For example, an
89-year-old divorced African American woman
stated this quite simply: ‘‘Watch TV—Jerry Springer
show—you will go crazy’’ (CES-D=17; self, –, MD,þ).

For her, TV was immediately equated with one type of
programming: a talk show.
Another respondent, an 89-year-old White man,
generalized about negative types of television programming that can exacerbate depression: ‘‘Depression can be worsened by watching stuff on TV
that’s negative – there is so much stuff on that tube
today that’s negative’’ (CES-D = 22; self, –, MD, þ).
Other respondents were more specific about the
types of programming that could be detrimental. For
example, a 75-year-old married White woman said
the following while deciding how she would classify
television:
You know, it’s so hard. . . because it’s what you’re
watching on TV and if you’re watching Joan of
Arcadia that’s great but if you’re watching the
Republican Convention it’s not. I think for the most
part [it depends on] what you see on television—the
things that lift you up and the things that let you
down—like the state of world today and Iraq and
all those soldiers and all those Iraqi people being
killed. (CES-D = 43; self, þ, MD, þ)

Another participant, a 73-year-old White woman,
noted that although she might turn to the radio,
newspaper, or television to lift her spirits, sometimes
the news would make her feel worse: ‘‘the news can
be almost as depressing [as one’s own moods while
depressed]’’ (CES-D = 0; self, þ, MD, þ).
Furthermore, some respondents found that certain
types of television programming were negative not
only because of their negative content but because
they might serve as a reminder of their own
struggles. A 77-year-old married White woman said
the following about watching the news on television:
‘‘And then you know what comes along, all that stuff
on TV about the priests, the abuse and all and
that really—I had that in my life with my father’’
(CES-D = 12; self, þ, MD, –). This woman often had
extended depressive episodes in which she did not
want to leave the house for weeks at a time. She
felt rather disconnected and even enjoyed the
interactions she would have with the occasional
telemarketer.
Respondent Characteristics and Themes
We found no statistically significant differences
between the 65 respondents who talked about
television and the 37 who did not (see Table 1),
though there was a higher percentage of people who
self-identified as depressed who discussed television
than there was of those who did not self-identify as
depressed (72% vs 55%; p , .10). We did identify
several significant differences between those mentioning specific themes and those who did not.
‘‘That’s How I Knew’’.—Respondents who were
married or partnered were more likely than un306

married people to mention television’s role in
identifying depression (31% vs 12% mentioned this
theme; p , .05).
‘‘I Turn the TV on . . . and I’m OK’’.—Participants
with lower education were more likely to mention
that television was a way of coping with depression
than were those who had graduated high school
(50% vs 28%; p , .05). Although the information
was not quite statistically significant, we also found
that participants who had been counseled for
depression in the past 6 months were somewhat
more likely to discuss this theme than those who had
not (47% vs 30%; p , .10), and those who had
received antidepressant prescriptions in the past 6
months also were slightly more likely to discuss this
theme (51% vs 32% among those not receiving
prescriptions; p , .10).
‘‘Watch TV . . . You Will Go Crazy’’.—People
who had received counseling or antidepressants in
the past 6 months were more likely than those who
had not to mention that television could be harmful
for depression. Among those counseled for depression, 18% mentioned this theme (as opposed to
5% among those who had not received counseling;
p , .05). Similarly, among respondents who had
been prescribed antidepressants in the past 6 months,
25% discussed this theme (compared with 4%
among those without such prescriptions; p , .01).
In addition, though it is not statistically significant
(p , .10), participants who self-identified as depressed were more likely to mention this theme
(15%) than those who did not self-identify as
depressed (4%).
Concurrent Themes.—A number of participants
mentioned more than one theme during the course of
their interviews. The idea that television both can be
helpful (‘‘I turn the TV on . . . and I’m OK’’) and
harmful (‘‘Watch TV . . . you will go crazy’’) was
described by six participants (9% of those who
discussed television). Eight people (12%) mentioned
that television viewing could be helpful for coping
with depression as well as identifying depression
(‘‘That’s how I knew’’). Six people concurrently
discussed ‘‘That’s how I knew’’ and the theme of
television viewing as something harmful in depression. Four individuals (6%) mentioned all three
themes.

Discussion
Older adults in this study spoke at length about
television despite its not being a main focus of the
interview, suggesting the high degree of salience that
the relationship between television viewing and
depression holds for older adults.
The Gerontologist

Our participants’ characterization of television
viewing as a way to forget one’s problems is
consistent with previous findings that suggest that
television viewing is used for mood elevation. Studies
using functional MRI during television viewing have
determined that humorous television programming
can activate regions of the insular cortex and
amygdala (Moran, Wig, Adams, Janata, & Kelley,
2004). Moreover, research in the pediatric literature
suggests that television viewing can actually have
analgesic effects for children receiving venipuncture
(Bellieni et al., 2006). It is possible, in light of our
findings, that television viewing can also help to
reduce the emotional pain caused by depression in
elderly persons, and further study in this area is
warranted.
We found that behavioral patterns related to
television viewing are used as diagnostic clues by
older people interacting with depressed loved ones,
and they also are used by patients themselves to
gauge their own state of mind. Respondents
recognized tremendous increases in television viewing or great declines in interest in television during
depression. Although this phenomenon has not been
emphasized in descriptions of geriatric depression, it
is plausible in light of the observation that other
behaviors can manifest themselves on either extreme
during depression (e.g., anorexia or hyperphagia,
and insomnia or hypersomnia; Moore & Jefferson,
2004).
This study has a number of limitations. The
semistructured interview was not specifically
designed to elicit many details about television’s
relationship with depression, so the number of
comments identified may represent the views of
only those respondents who had the strongest
feelings about the topic. However, by limiting the
number of questions asking directly about television,
we also provided more opportunity for respondents
to speak from their own perspectives, and it is likely
that themes identified in this fashion had the highest
salience for this population. Although television was
mentioned briefly by our interviewers, the overwhelming majority of comments about television
were not made in the context of these portions of the
interviews. It is, therefore, unlikely that participant
remarks were highly influenced by the interviewers.
We used significance testing to point us in new
directions for future quantitative testing. For example, we found that married patients (as opposed
to unmarried ones) were more likely to describe
television in the context of identifying depressed
patients. It might simply be the case that individuals
who are married to depressed persons may have
more opportunities to recognize changes in television-viewing habits that occur in conjunction with
worsening depression. Furthermore, participants
with lower education were more likely to mention
television’s potential therapeutic role in depression.
This may be a function of the observation that indiVol. 48, No. 3, 2008

307

viduals with lower education may watch more television than more highly educated persons (Kubey &
Csikszentmihalyi, 1990) and may therefore think of
it more positively. We noted that patients who have
received depression counseling or prescriptions were
more likely to mention that television viewing can be
harmful, suggesting that older patients undergoing
conventional treatment may be getting necessary
care and therefore are less likely to look to other
sources (such as television) to treat their symptoms.
Alternatively, these patients’ more intensive exposure to the treatment process may lead them to hold
a more negative opinion of modalities outside of this
therapeutic paradigm.
Because television is such a ubiquitous component of the lives of older adults, it is highly germane
in their worldviews about depression. For older
adults, particularly those with depression, television
is so much more than just an information source.
People learn about depression in an explicit manner
from the programming content, but it appears
that they also learn implicitly about depression
through their own familiarity with the televisual
experience.
In this study, we expanded on existing expert
theories by exploring the emic viewpoints of older
adults’ lived experiences regarding television and
depression. To our knowledge, no other published
studies have addressed older adults’ perspectives on
television and depression in late life. Previous studies
used expert-derived (or etic) categories. Our study
goes beyond this measure by gathering the experiences of daily life of older adults in order to
understand the sociocultural context of depression;
this provided us with a more textured and nuanced
description of the different dimensions of the
relationship between television and depression
among older adults.
Although our findings are too preliminary to
justify broad changes in the standard of care for
depressed older adults, this study does have implications for clinical practice. Providers caring for
older adults should recognize cues from patients
(such as spontaneous remarks about television) and
consider asking further questions regarding depressive symptoms, particularly if patients report
changes in their quantity of television viewing.
Patient’s responses to such follow-up questions could
be used to guide potential initiation or alterations in
therapy.
Additional qualitative work, with interviews
focusing specifically on this issue, would be of value.
Future quantitative studies should track television
viewing in older adults and assess correlations
between viewing and measures of depressive symptoms. In the present study, we have broadened the
realm of questions and the range of ways in which
scientists and clinicians can view depression in late
life, and new questions arise. For example, do beliefs
about television as depression treatment, social

support, and information source vary by ethnicity,
functional capacity, level of depression, or experience with television earlier in life? Do depressed
older patients make decisions about their television
programming in a different way than do nondepressed (or younger) patients? If a patient states
that television viewing helps her depression, is this
also the case when her depression level is evaluated
longitudinally by use of traditional depression
scales? For patients who feel that television viewing
can be both helpful and harmful for depression,
what circumstances influence this characterization?
How does all of this relate to long-term outcomes
and adherence to clinically proven depression
treatment regimens? Guided by the findings of this
study, larger quantitative studies to elucidate the
relationships between depression, demographic characteristics, and beliefs about television in older
adult populations could help to identify methods
to address television viewing in a way that can
improve the diagnosis and treatment of depression in
late life.

References
Anderson, D. R., Collins, P. A., Schmitt, K. L., & Jacobvitz, R. S. (1996).
Stressful life events and television viewing. Communication Research,
23, 243–260.
Barg, F. K., Huss-Ashmore, R., Wittink, M. N., Murray, G. F., Bogner,
H. R., & Gallo, J. J. (2006). A mixed methods approach to understand
loneliness and depression in older adults. Journal of Gerontology: Social
Sciences, 61B, S329–S339.
Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L., & Steer, R. A. (1990).
Relationship between hopelessness and ultimate suicide: A replication
with psychiatric outpatients. American Journal of Psychiatry, 147,
190–195.
Bellieni, C. V., Cordelli, D. M., Raffaelli, M., Ricci, B., Morgese, G., &
Buonocore, G. (2006). Analgesic effect of watching TV during
venipuncture. Archives of Disease in Childhood, 91, 1015–1017.
Boeije, H. (2002). A purposeful approach to the constant comparative method
in the analysis of qualitative interviews. Quality and Quantity, 36, 391–
409.
Bogner, H. R., Wittink, M., Merz, J. F., Straton, J. B., Cronholm, P. F.,
Rabins, P. V., et al. (2004). Personal characteristics of older primary
care patients who provide a buccal swab for APOE testing and banking
of genetic material: The Spectrum study. Community Genetics, 7,
202–210.
Burdette, H. L., Whitaker, R. C., Kahn, R. S., & Harvey-Berino, J. (2003).
Association of maternal obesity and depressive symptoms with televisionviewing time in low-income preschool children. Archives of Pediatrics &
Adolescent Medicine, 157, 894–899.
Chen, R., Wei, L., Hu, Z., Qin, X., Copeland, J. R. M., & Hemingway, H.
(2005). Depression in older people in rural China. Archives of Internal
Medicine, 165, 2019–2025.
Connell, C. M., & Crawford, C. O. (1988). How people obtain their health
information—A survey in two Pennsylvania counties. Public Health
Reports, 103, 189–195.
DiGregorio, S. (2003). Analysis as cycling: Shifting between coding and
memoing in using qualitative software. Paper presented at the
conference on Strategies in Qualitative Research: Methodological Issues
and Practices Using QSR NVIVO and NUD*IST, Institute of Education,
London.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). ‘‘Mini-Mental
State’’: A practical method for grading the cognitive state of patients for
the clinician. Journal of Psychiatric Research, 12, 189–198.
Frosch, D. L., Krueger, P. M., Hornik, R. C., Cronholm, P. F., & Barg, F. K.
(2007). Creating demand for prescription drugs: A content analysis of
television direct-to-consumer advertising. Annals of Family Medicine, 5,
6–13.
Gallo, J. J., Bogner, H. R., Straton, J. B., Margo, K., Lesho, P., Rabins, P. V.,
et al. (2005). Patient characteristics associated with participation in

308

a practice-based study of depression in late life: The Spectrum study.
International Journal of Psychiatry in Medicine, 35, 41–57.
Gallo, J. J., & Rabins, P. V. (1999). Depression without sadness: Alternative
presentations of depression in late life. American Family Physician, 60,
820–826.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory:
Strategies for qualitative research. New York: Aldine.
Grajczyk, A., & Zollner, O. (1998). How older people watch television.
Telemetric data on the TV use in Germany in 1996. Journal of
Gerontology: Social Sciences, 44B, S176–S181.
Heikkinen, R. L., & Kauppinen, M. (2004). Depressive symptoms in late
life: A 10-year follow-up. Archives of Gerontology & Geriatrics, 38,
239–250.
Hogervorst, E., Combrinck, M., Lapuerta, P., Rue, J., Swales, K., & Budge,
M. (2002). The Hopkins Verbal Learning Test and screening for
dementia. Dementia and Geriatric Cognitive Disorders, 13, 13–20.
Horgas, A. L., Wilms, H. U., & Baltes, M. M. (1998). Daily life in very old
age: Everyday activities as expression of successful living. The
Gerontologist, 38, 556–568.
Jackson, J. B., Kart, C. S., Wagner, K. S., & Rowe, A. R. (1985). A survey of
retired dentists in the United States. Council on Dental Practice. Journal
of the American Dental Association, 110, 386–389.
Kerkhof, A. J., Visser, A. P., Diekstra, R. F., & Hirschhorn, P. M. (1991).
The prevention of suicide among older people in The Netherlands:
Interventions in community mental health care. Crisis: Journal of Crisis
Intervention & Suicide, 12, 59–72.
Kirkcaldy, B. D., Siefen, G. R., Urkin, J., & Merrick, J. (2006). Risk
factors for suicidal behavior in adolescents. Minerva Pediatrica, 58,
443–450.
Kivela, S. L. (1995). Long-term prognosis of major depression in old age: A
comparison with prognosis of dysthymic disorder. International
Psychogeriatrics, 7(Suppl.), 69–82.
Kleinke, C. L. (1988). The Depression Coping Questionnaire. Journal of
Clinical Psychology, 44, 516–526.
Koenig, H. G., Hays, J. C., George, L. K., Blazer, D. G., Larson, D. B., &
Landerman, L. R. (1997). Modeling the cross-sectional relationships
between religion, physical health, social support, and depressive
symptoms. American Journal of Geriatric Psychiatry, 5, 131–144.
Kubey, R. W., & Csikszentmihalyi, M. (1990). Television and the quality
of life: How viewing shapes everyday experience. Hillsdale, NJ:
Erlbaum.
Lebowitz, B. D., Pearson, J. L., Schneider, L. S., Reynolds, C. F., III,
Alexopoulos, G. S., Bruce, M. L., et al. (1997). Diagnosis and treatment
of depression in late life. Consensus statement update. Journal of the
American Medical Association, 278, 1186–1190.
Lopez-Torres Hidalgo, J., Requena Gallego, M., Fernandez Olano, C., Cerda
Diaz, R., Lopez Verdejo, M. A., & Marin Nieto, E. (1995). Visual and auditory difficulties expressed by the aged. Atencion Primaria, 16, 437–440.
Mares, M.-L., & Cantor, J. (1992). Elderly viewers’ responses to televised
portrayals of old age: Empathy and mood management versus social
comparison. Communication Research, 19, 459–478.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis
(2nd ed.). Walnut Creek: Sage.
Moore, D. P., & Jefferson, J. W. (2004). Handbook of medical psychiatry
(2nd ed.). Philadelphia: Elsevier Mosby.
Moran, J. M., Wig, G. S., Adams, R. B., Jr., Janata, P., & Kelley, W. M.
(2004). Neural correlates of humor detection and appreciation. Neuroimage, 21, 1055–1060.
Mulsant, B. H., & Ganguli, M. (1999). Epidemiology and diagnosis of
depression in late life. Journal of Clinical Psychiatry, 60(Suppl. 20), 9–15.
Mundorf, N., & Brownell, W. (1990). Media preferences of older and
younger adults. The Gerontologist, 30, 685–691.
Paykel, E. S., Hart, D., & Priest, R. G. (1998). Changes in public attitudes to
depression during the Defeat Depression Campaign. British Journal of
Psychiatry, 173, 519–522.
Potts, R., & Sanchez, D. (1994). Television viewing and depression—No
news is good news. Journal of Broadcasting and Electronic Media, 38,
79–90.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for
research in the general population. Applied Psychological Measurement,
1, 385–401.
Richards, L. (2002). Using N6 in qualitative research (Version N6).
Doncaster, Victoria, Australia: QSR International.
Schreiber, E. S., & Boyd, D. A. (1980). How the elderly perceive television
commercials. Journal of Communication, 30, 61–70.
Sidney, S., Sternfeld, B., Haskell, W. L., Jacobs, D. R., Jr., Chesney, M. A., &
Hulley, S. B. (1996). Television viewing and cardiovascular risk factors
in young adults: The CARDIA study. Annals of Epidemiology, 6,
154–159.
Singer, M. I., Slovak, K., Frierson, T., & York, P. (1998). Viewing
preferences, symptoms of psychological trauma, and violent behaviors

The Gerontologist

among children who watch television. Journal of the American
Academy of Child & Adolescent Psychiatry, 37, 1041–1048.
Steer, R. A., Willman, M., Kay, P. A. J., & Beck, A. T. (1994). Differentiating
elderly medical and psychiatric outpatients with the Beck Anxiety
Inventory. Assessment, 1, 345–351.
Stessman, J., Ginsberg, G., Klein, M., Hammerman-Rozenberg, R.,
Friedman, R., & Cohen, A. (1996). Determinants of loneliness in
Jerusalem’s 70-year-old population. Israel Journal of Medical Sciences,
32, 639–648.
Strain, L. A., Grabusic, C. C., Searle, M. S., & Dunn, N. J. (2002).
Continuing and ceasing leisure activities in later life: A longitudinal study.
The Gerontologist, 42, 217–223.
Thomas, R., Daly, M., Perryman, B., & Stockton, D. (2000). Forewarned is
forearmed—Benefits of preparatory information on video cassette for
patients receiving chemotherapy or radiotherapy—A randomised controlled trial. European Journal of Cancer, 36, 1536–1543.
Thomas, R., Deary, A., Kaminski, E., Stockton, D., & De Zueew, N. (1999).
Patients’ preferences for video cassette recorded information: Effect
of age, sex and ethnic group. European Journal of Cancer Care, 8,
83–86.
Troyer, A. K. (2000). Normative data for clustering and switching on verbal
fluency tasks. Journal of Clinical and Experimental Neuropsychology,
22, 370–378.
Unutzer, J., & Bruce, M. L., &NIMH Affective Disorders Workgroup.
(2002). The elderly. Mental Health Services Research, 4, 245–247.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-Items- Short-Form
Health Survey (SF-36). Medical Care, 30, 473–480.
Watts, F. N., & Sharrock, R. (1985). Description and measurement of
concentration problems in depressed patients. Psychological Medicine,
15, 317–326.
Wittink, M. N., Barg, F. K., & Gallo, J. J. (2006). Unwritten rules of talking
to doctors about depression: Integrating qualitative and quantitative
methods. Annals of Family Medicine, 4, 302–309.
Zaylor, C. (1999). Clinical outcomes in telepsychiatry. Journal of Telemedicine & Telecare, 5(Suppl. 1), S59–S60.
Received February 8, 2007
Accepted July 18, 2007
Decision Editor: William J. McAuley, PhD

Appendix: Supplement to the Methodology
Methodology Overview: The Spectrum Study
The Sociocultural Context of Depression, or
Spectrum II, study built upon survey data collected
for a concurrent set of linked studies, entitled the
Spectrum of Depression in Late Life, or Spectrum I,
study. Spectrum I was designed in order to describe
depression in late life that may not meet standard
criteria for major depressive disorder (Gallo et al.,
2005). After they were recruited from primary care
offices, 355 adults who were 65 years of age or older
completed a baseline in-home assessment for Spectrum I. We used standard measures to assess
depression, anxiety, hopelessness, daily functioning,
cognition, medical conditions, and personality.
Spectrum II was designed to give respondents an
opportunity to express their views about depression
and to integrate these views with results from the
fixed-answer questions in Spectrum I.
Study Sample
We identified participants for Spectrum II (n =
102) from the pool of participants in Spectrum I who
had agreed to be contacted and interviewed again.
We used a purposive sampling strategy to select
participants, based on demographics and test results
Vol. 48, No. 3, 2008

309

from Spectrum I. Purposive sampling (as opposed to
random sampling) is used frequently in qualitative
research to achieve a specific purpose such as maximum heterogeneity or maximum homogeneity on
a given attribute (Miles & Huberman, 1994). Rather
than using random sampling in which each member
of the population has an equal chance of being
‘‘chosen,’’ purposive sampling allows for the identification of a range of ideas, even if they come from
a small proportion of the entire group. Attributes or
criteria we used to guide sample selection included
presence or absence of family history of depression,
concordance and discordance between self-rating
and physician rating of depression, men with good
physical functioning, and those in the oldest age
group. The selection of these particular attributes came from ongoing review of the data. In
addition, we also purposively sampled to achieve
equal numbers of White and African American
participants.
Interview Process
Semistructured interviews were completed in each
participant’s home and were recorded with participant consent; the information was transcribed and
entered into QSR N6 software for coding and
analysis (DiGregorio, 2003; Richards, 2002). Interviewing participants in their homes took the
discussions out of a medical environment and into
the context of their everyday lives. Seven professional interviewers previously trained in conducting telephone and in-person interviews were chosen
for the study. Though the study design included no
gender preference for interviewers, all interviews
were all female. They underwent a 3-day training
designed and conducted by the anthropologists on
the study team before beginning interviews. Training
focused on the craft of in-depth, semistructured
interviewing, with an emphasis on the difference
between structured interviews for surveys and semistructured, ethnographic interviewing. The primary
aims of this training were to widen the notion of
‘‘data’’ to be elicited and recorded and develop deep
rapport with interviewees. Interviewers practiced on
one another and were taped and critiqued to hone
their skills before commencing interviews. Monthly
interviewer debriefings and review of transcripts
provided further oversight of the interview process.
At the completion of each interview, the interviewer dictated field notes containing her impressions of the conversation, descriptions of unusual
circumstances, or comments on the environment in
which the interview took place. The field notes
became part of the interview transcript.
Specific Mentions of Television in the Interviews
The a priori design of the study included
a ‘‘free-listing’’ exercise that mentioned television.

At the beginning of the interview, participants were
presented with a scenario and asked to list words
they would use to describe what is wrong with
a retired man who had stopped participating in all
of his usual activities (including watching his
favorite television shows). The first 64 respondents
participated in this free-listing exercise. The study
was designed such that, after about half of the
interviews were complete, the free-listing portion of
the interview would be replaced by a ‘‘pile-sorting’’
exercise whereby participants were asked to classify
a list of activities (generated by the comments in
the earlier interviews) as either helpful or not
helpful. Because there was a large number of

310

participants who mentioned television’s therapeutic
role in depression during the early interviews,
television watching was included in this list of
activities (which also included counseling, prayer,
medication, and 16 other activities mentioned by
the informants). Thus, 38 participants participated
in the pile-sorting task. (The percentage who
explicitly discussed television was the same regardless of whether participants were exposed to the
free-listing or the pile-sorting exercise, at 64% and
63%, respectively. Many of the comments
about the negative effects of television did,
however, occur in the context of the pile-sorting
activity.)

The Gerontologist