Social Support and Depression Among Community Dwelling Older Adults

Although social support variables have long been associated with psychological well-being, and in particular, depressive symptoms, few studies have examined the causal association between social support and depressive symptoms. The present study examined two basic hypotheses: do levels of social support predict later depressive symptoms, or conversely, do depressive symptoms predict subsequent declines in social support? Depression is the most frequent cause of emotional suffering in older adults, and thus identifying contributors to depressive symptoms among older adults has important implications for developing treatment for depressive symptoms. Two hypotheses regarding the causal relation between the association between social support and depression were identified. Lewinsohn's social skills model of depression posits that social skills deficits lead to reduced social support, which in turn produces depression. In contrast, Coyne's interpersonal theory of depression (1976), proposed that depressed individuals interact with others in a manner that is aversive and lacking in social skills (Coyne, 1976), which serves to reduce social support. In the current study, the influence of three dimensions of social support on subsequent depressive symptoms was examined. In a modified test of the first hypothesis (low social support predicts depression), the present study examined the influence of the three dimensions of social support (i.e., emotional social support, instrumental support and size of social network), on subsequent depressive symptoms in a sample of older adults. The second hypothesis examined whether depressive symptoms negatively impacted subsequent levels of social support, that is, whether initial levels of baseline (time 1) depressive symptoms had a negative impact on indices of social support. It should be noted these were only partial test of Coyne and Lewinsohns's theories, as social skills was not measure in the current study. A longitudinal study design based on data obtained from the Duke EPESE was employed to examine the association between dimensions of social support and depressive symptoms over a six-year period in a sample of older adults (N=2100). The three dimensions of social support were identified based on a factor analysis of survey items included in the EPESE study. These social support measures tapped aspects of both the quality and quantity of social support. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). A test of the first hypothesis, that social support deficits would predict subsequent depressive symptoms among older adults was not supported. Inconsistent with Lewinsohn's theory, as quality of instrumental support increased, depression increased. Therefore, it appears that individuals with more difficulty are receiving more instrumental support from family and friends. In a test of the second hypothesis, based on Coyne's theory of depression, baseline (time 1) depressive symptoms were examined to see if they predicted any of the social support measures. Depressive symptoms measured at time 1 did not predict any of the social support measures assessed at time 2. However, there was a sex and depression interaction in the prediction of size of social networks. As depression decreased the size of social networks increased, but it increased more for men than women. Maintaining a large network of support may be more important to men than for women. However, in partial support of a Coyne's modified theory results showed that a change in depressive symptoms did predict a change in emotional social support such that as depression decreased emotional support increased. Similarly, a change in depressive symptoms predicted a change in social network support such that as depression decreased social network support increased. Thus, these results are consistent with the modified Coyne's theory that suggests that depressed individuals have aversive styles of functioning and therefore are more likely to lower both the quality and quantity of social support. In light of these findings, special attention should be paid to the status of social networks. Elderly individuals with fewer friends and family and less social may be at risk for developing depressive symptoms and further erosion of support networks. In addition, older adults, particularly those with depression, may benefit from interventions designed to maintain or even enhance social networks.