1. Introduction
The paradigm for health is shifting along with the increment of human life expectancy through advances in medicine [
1]. For the health policy makers of today, it will be a key task to pay attention to the social aspects of health and to avoid factors that hinder personal and social health. In this regard, one of the emerging issues is that the number of older adults living alone is increasing exponentially with the aging society [
2]. It is thought to be related to new social problems including deaths due to loneliness and social isolation of the older adults living alone [
3]. Accordingly, the policy to protect against social isolation by developing an older adults’ community has become a global trend in recent years [
4,
5,
6]. Most of these older adults’ communities are based on geographic proximity [
4,
5]. However, the natural development and maintenance of interpersonal relationships are not only shaped by simple geographic proximity, but are also affected by various interpersonal factors as individual characteristics, schema, and attitudes toward interpersonal relationships, and shared lifestyles and interests [
7,
8,
9]. Hence, it is important to identify factors that affect the interpersonal relationships for a successful older adults’ community.
The interpersonal schema is considered as a decisive factor that fundamentally affects both the initiation and maintenance of interpersonal relationships among many other factors influencing interpersonal relationships [
7]. The interpersonal circumplex model (IPC) describes the interpersonal behaviors based on two orthogonal fundamental domains: Dominance (or agency, control) and Warmth (or communion, affiliation) [
10,
11]. The model hypothesizes that interpersonal schema and behavior represent the interaction between domination/submission and friendliness/hostility. The individual differences in interpersonal relationships are classified into eight sectors (or octants) under these two axes. The octants with high relevance are adjacent to each other, are located at an angle of 90° if they are unrelated, and are located at an angle of 180° if they exhibit opposite characteristics (
Figure 1). Accordingly, the more right means the more intimate and pro-social the attitude, and the more left, the more hostile and colder the attitude in the
Figure 1. The higher means the more dominant and leading attitude in interpersonal relationships, and the downward the more submissive and non-assertive attitude toward others likewise. When the model is simply divided into quadrants, the upper right represents an intimate and proactive attitude with others, the lower right represents an intimate and obedient attitude, the upper left represents a cold, hostile, and assertive attitude towards others, and the lower left represents hostile, but non-assertive, and submissive [
10,
11].
The advantage of the IPC model is that it is not only directly related to the conceptualization and evaluation of personality disorders [
12], but is also consistent with personality classification according to the five-factor theory, enabling a broad interpretation of the interpersonal behaviors of healthy and clinical population [
13,
14]. Researchers tried to place traits derived from different personality theories on the IPC topology. For instance, the extraversion of the five-factor theory is not exactly an interpersonal trait, but still it is located on the upper right section of the IPC model, related to a relatively friendly but intrusive attitude toward others [
15,
16]. On the other hand, agreeableness is related to the attitude of being pro-social and trusting others and is located on the lower right section of the IPC model [
15,
16]. Evidence also suggested that the IPC model is associated with a variety of pathological characteristics. Chronic depression, more severe forms of social anxiety, and Schizoid personality disorder are primarily associated to the lower left area of the IPC model [
17,
18,
19]. Personality traits such as pathological narcissism, psychopathy, and Machiavellianism have also occupied their own positions on the IPC topology, respectively [
20].
Considering that the importance of interpersonal relationships is constantly being emphasized in the mental health of older adults, literature focusing on interpersonal relationships of and evaluation tools specific to the older adults based on IPC is insufficient despite the high utility of the model. Moreover, various scales used to assess interpersonal schema based on IPC have been developed and used for clinical and research applications to date, but these scales are still limited by their self-reported features using paper and pencil [
11,
21]. In addition to the general disadvantages of self-reporting assessment tools, such as the impact of social desirability and problems caused by individuals not really understanding themselves well [
22], the paper-delivered tests raise realistic concerns especially in the older adults, including the high illiteracy rate of the older adult population compared to younger adults, which may interfere with the response of the older adults to questions [
23,
24]. Further, the paper and pencil-based self-reported tests are associated with inherent limitations, as personalization is difficult because the item content is limited to general situations and interpersonal relationships [
22]. An objective measure that has greater ecological valid than paper and pencil-based self-reported tests would be needed to evaluate the interpersonal schema in older adults.
Self-Defining Memory (SDM) is a part of autobiographical memory, but is a more specific, vivid, emotionally intense memory, suggesting that self-discovery enables self-understanding, and contributes to a sense of identity [
25]. Exploring SDM would be helpful not only to increase the ecological validity based on individual experience, but also to utilize the strengths of the IPC model in the assessment of interpersonal schema, because it reflects the continuing interests and unresolved conflicts of individuals, and contains a core belief (schema) of oneself and the world [
26]. In particular, SDM for interpersonal events is formed by experiences and behaviors in individual relationships to date, which can again influence future interpersonal behaviors [
27,
28]. It is considered as appropriate for the evaluation of interpersonal relationships and serves as an important predictor of individual behavior in future relationships. Many researchers have developed several types of interview and performance evaluation tools to assess autobiographical memories [
29,
30]. However, most of the measurements have been developed for the purpose of identifying disease-specific impairment of autobiographical memory, with limited validity for evaluation of the extent and degree of impairment such as the accuracy and specificity of memory, and impossible to evaluate core beliefs or relationship schema quantitatively [
29,
31].
We aimed to develop a structured interview for evaluating the Interpersonal schema based on Autobiographical Memory (IAM) of older adults living alone as part of a study of expanding social network for the older adults living alone. In particular, we tried to develop an interview suitable for the evaluation of interpersonal schemas, while not being too broad in the content of the reported SDM. To this end, we standardized the word cues to those of life events involving interpersonal relationships that elders living alone often report. In addition, in order to systematically measure the interpersonal schema according to the two dimensions of Dominance and Warmth based on the IPC, we developed scoring rules according to the typical interpersonal schema and behaviors of each axis based on previous studies [
21].
Accordingly, we aimed to identify the coordinates of the reported SDMs on the IPC topology, and to test whether the indexes developed in this study agree with the Dominance and Warmth dimensions by examining the concurrent validity with well-established tests developed based on the IPC model. More specific, the Dominance index score was hypothesized to be related to the indicators corresponding to the top and bottom of the IPC model, and the Warmth index score was thought to be related to the indicators corresponding to the left and right side. We also wanted to exploratively identify the relationship between the frequency of SDM reports related to interpersonal relationships and conflicts and the IPC model.
4. Discussion
In this study, a structured interview was developed to evaluate the Interpersonal schema based on Autobiographical Memory (IAM) of older adults living alone as part of a study of expanding social network for the older adults living alone, and the reliability and validity of the ratings were examined. It was organized based on a search of autobiographical memories, overcoming the limitations of the self-report scale, and provided personalized evaluation using events that are important to individuals. In addition, a word list that frequently reported self-defining memories related to interpersonal relationships was provided for the older adults living alone in Korea, so that the interview evaluated their interpersonal schemas more efficiently.
First, to confirm the reliability of the interview, inter-rater reliability of IAM and item-total correlation of Dm and Wm indexes were identified. The substantial reliability of all indexes suggested that the agreement between the raters of indexes for the interpersonal schema based on the interview was sufficiently reliable. In addition, the item-total correlation of the two indexes was also significantly high. Therefore, the scoring method provided by the structured interview tool developed in this study represents a stable method for the evaluation of interpersonal schema based on the exploration of personal self-defining memories.
Next, in order to examine the validity of the structured interview, the correlation between the sub-indexes of the interview was determined, and the relationship with the KIIP-SC sub-scale was analyzed. The relationship frequency (RF), a level of reporting on the content of interpersonal relation in important self-defining memories, did not show any significant correlation with other indexes, except the conflict frequency (CF) reporting interpersonal conflicts. Since there was no significant association with any of the subscales of KIIP-SC, which collects responses to difficulties in interpersonal relationships, the RF was considered insufficient to identify problematic or maladaptive interpersonal schemas. However, the reported interpersonal SDM’s frequency is suggested to be important in identifying individuals’ self-image related to interpersonal relationships [
40,
41]. It is thought that the predictive validity of this index could be examined through further research, rather than immediate discarding. RF can also be used as a way to evaluate the validity of the entire interview. In other words, indexes obtained through interviews with an RF value of 0 should be considered unreliable.
CF showed a significant negative correlation with the mean value of the Warmth index (Wm), which measures the point on the scale of behaviors from intimate and compassionate to cold and indifferent in interpersonal behavior. It showed a significant positive correlation with the mean value of the Dominance index (Dm), which measures the point on the continuous line from the dominant behavior to the submissive behavior in interpersonal relationships. In other words, individuals who report more memories of conflicts related to interpersonal relationships, whether or not they are involved in the conflict, are expected to be more likely to exhibit relatively cold behavior and were indifferent in interpersonal relationships as well as behaviors controlling or dominating others.
Correlation between the subscales of IAM, BFI-A, and KIIP-SC was confirmed to analyze the concurrent validity. The CF score showed a significant negative correlation with BFI-A and positive correlation with the DE, FG, and NO subscales of KIIP-SC, suggesting this index might be closely related with relatively maladaptive interpersonal schemas and behaviors. The older adults who recalled conflict situations more frequently among other memories are expected to be relatively hostile or cynical to others since CF is related to the DE and FG subscales of KIIP-SC, which are located on the hostile side of the Warmth axis of the IPC model. On the other hand, it seems difficult for them to show appropriate behavior even when they want to be friendly to others. Older adults who represent high CF likely to have difficulty in expressing pro-social behaviors such as intimacy, altruism, and empathy in interpersonal situations, while also being excessively intrusive with others’ behavior.
This study revealed that frequent memories of conflict could not serve as lessons for satisfactory interpersonal relationships, at least in the older adults, and suggested that CF is a useful index associated with dysfunctional interpersonal schemas. It is known that SDM for interpersonal conflict reflects the interpersonal self-image that individuals have for themselves, and also serves as a manual for coping in relationships with others, whether it is positive or negative [
26,
41]. For instance, researches examining the memory of patients with Borderline personality disorder (BPD) have discovered that patients frequently recall SDM for failed trust by family members or romantic partners [
49], and that they recall negative social information much better [
50,
51]. These characteristics of memories seem to eventually serve as a manual for violent and unstable interpersonal behaviors of BPD patients. Further research is needed on whether CF can discriminate personality disorders, still it was revealed that this index has a high sensitivity to a vindictive and hostile schema to others (
Table A1).
The Dm score, measured in autobiographical memory selected as important to oneself, showed a negative correlation with BFI-A and significant positive correlation with the NO subscale of KIIP-SC, which measures issues related to excessive involvement with others. Thus, individuals exhibiting more proactive and dominant behavior in interpersonal relationships based on autobiographical memories more frequently experienced problems involving interference with and engaging in actions with others, which was consistent with the location of NO subscale on a high level of Dominance axis in the IPC model [
47,
52]. Moreover, it was found that those who scored high in the Dm index exhibited a low level of agreeableness. Agreeableness is a personality trait that represents social adaptability and communal attributes toward others, and includes qualities such as altruism, affection, trust, consideration, and humility. Although agreeableness and dominance were derived from independent theoretical concepts of personality and interpersonal schema, respectively, several researchers have explored their relevance [
15,
53]. Agreeableness is known as located in relatively friendly and submissive direction (i.e., lower right section in
Figure 1) on the IPC model [
15], which is consistent with the negative correlation between Dm index and Agreeableness revealed as results of this study.
The results suggest that older adults who scored high in the Dm index could behave dysfunctional as being overly interfering with others rather than trusting others or acting altruistically, even though they have a compassionate interest in others and want to behave pro-socially, considering the NO subscale has both high Dominance and Warmth values in the IPC model. This kind of behavior might be problematic when they want reciprocal social relationships. Previous studies have shown that highly dominant people prefer relationships in a harsher, hierarchical way, and frequently use coercion, intimidation, and power to gain high social status [
54,
55]. However, these behaviors are likely to cause different outcomes than their intentions. From our findings, it can be speculated that interventions related to social skills and pro-social behavior will be useful for older adults with high scores on the Dm index.
The Wm score showed a significant negative correlation with the DE and FG, rep-resenting challenges related to socially distant and cold, or excessively shy and evasive attitudes, respectively. This negative correlation suggests that the Wm index is highly valid for the assessment of behavior in the Warmth axis since the DE and FG is a parameter located at the bottom of the Warmth axis in the IIP model (i.e., left side of
Figure 1). The results also suggest that older adults who score low on this index may be aloof, avoidant, and even hostile toward others. This kind of attitude might be an important factor to cause older adults’ maladjustment in communities. In fact, Machiavellianism, one of the Dark Triad personalities that can seriously harm social relationships, sits in a submissive–hostile position in the IPC model [
20]. Individuals with high levels of Machiavellianism easily manipulate others for their own interests, and basically have cynical and distrustful interpersonal schemas [
20,
56]. In addition, social workers might need to carefully monitor the mental health of older adults who score high in Wm in community. A lot of studies have focused on the vulnerability in mental health of individuals with submissive–hostile interpersonal schemas. Although clinical level depression was excluded in this study, researchers have shown that submissive–hostility is common in chronically depressed patients [
17], and is associated with more severe social anxiety [
19].
Contrary to our hypothesis, however, the Dm score did not show a significant correlation with the PA subscale of KIIP-SC, which is used to measure challenges related to controlling and manipulating others and located at the highest level on the Dominance axis. Moreover, no negative correlation was observed between the Dm score and the HI, the nonassertive subscale of KIIP-SC, located at the bottom of the Dominance axis. the Wm score did not show significant correlation with the LM subscale of KIIP-SC, which measures issues related to excessive responsibility for the needs of others, and placed at the highest sides on the Warmth axis of the IPC model. The results can be explained as due to the primary focus of KIIP-SC are on problematic behaviors and schemas reviled in interpersonal relationships. It is necessary to understand the terms of interaction with the individual environment whether or not an individual’s main behavioral patterns in interpersonal relationships caused problems [
57,
58]. Thus, the older adults living alone who increasingly reported the dominant and leading behaviors based on a high Dm score showed intimacy with others, but likely manifested frequent issues related to invasive and excessive interference behavior, rather than challenges related to intentional control and manipulation of others [
44,
47]. Likewise, individuals who show high Wm scores could behave pro-social and friendly at an appropriate level, so that might not be related to significant interpersonal problems.
Lastly, the indexes developed in this study did not show high sensitivity to maladaptive interpersonal schema, but specificity was found to be very high (
Table A1). It could serve as an advantage of IAM, considering that this interview was not a diagnostic test tool, but aimed to promote healthy interpersonal relationships by identifying the interpersonal schema of older adults who do not report specific problems with interpersonal relationships.
The study limitations are as follows. First, the study participants were limited to the older adults living alone in small and medium-sized towns, and therefore do not represent a large city or rural area. It is possible that the characteristics of the residential area were reflected in the interpersonal behaviors and schemas reported by participants. This limitation was addressed by recruiting participants according to the demographic characteristics of the older adults living alone in Wonju city, and determining the schematic of SDM and interpersonal relations according to actual interpersonal relationship patterns of the older adults living alone. Second, although well-established tests were used to examine the concurrent validity of the structured interview developed in this study, still further studies are needed to determine whether the interpersonal schematic indexes can predict the real-world interpersonal behavior of the older adults living alone. Finally, the interviewers and the raters of the interview were separated, and the raters only read the written verbatim for scoring, since this study was conducted as a part of a research project providing emotional support for the older adults living alone. As a result, it is possible that the reliability of the evaluation is somewhat questionable because nonverbal communication clues such as facial expressions, intonation, and gestures were not considered [
59]. The inter-rater reliability may be enhanced by providing structured manuals and formal training to enable implementation and scoring, and direct evaluation of the interviewer’s method.