Social Support, Illness Burden, and Depressive Symptoms in Older Adults

1. Social Support, Illness Burden, and Depressive Symptoms in Older Adults Joshua P. Hatfield, B.S.1,Jameson K. Hirsch, Ph.D.1,2, & J.M. Lyness, M.D.2 Laboratory of Rural Psychological and Physical Health Department of Psychology, East Tennessee State University1 University of Rochester Medical Center, Rochester, NY2 • METHODS • Patients = Older adults recruited from private & hospital-based Internal and Family Medicine primary care clinics, and assessed via interview. • Participants completed the • Hamilton Rating Scale of Depression (Williams, 1988) • Duke Social Support Scale (DSSI; Landerman, George, Campbell, et al., 1989) • Mini Mental State Exam (MMSE; Folstein et al., 1975) • Cumulative Illness Rating Scale (CIRS; Linn et al., 1968) • Karnofsky Performance Status Scale (KPSS; Karnofsky and Burchenal, 1949) • SAMPLE • 745 primary care patients (63.4% Female) • Mean age 75.12 [SD=6.86] • Ethnicity: 92% White • Education Level: 14.11 years [SD = 4.1] • DISCUSSION • We found that high levels of Perceived Social Support were related to less depressive symptoms in the context of illness burden; a near-significant trend toward moderation existed for Social Interaction. • Our findings support the idea that both the quantity and perceived quality of social support buffer against depressive symptoms in older adults (Penninx et al, 1996; Travis et al., 2004; Uchino et al., 1996), and that these factors may be of specific value in the context of illness. • Depression is not an inevitable outcome of aging, and social relationships may contribute to risk or protection from depressive outcomes depending on their quality. • The perception and frequency of support may help attenuate the burden associated with illness such that the quality of life for older adults is improved. • Contrary to the hypothesis, instrumental support was not a significant moderator of the association between illness burden and depression, and this may be due to the use of the DSSI which does not test for directive versus nondirective forms of instrumental support (Walker, Zona, & Fisher, 2006). • ABSTRACT • Social relationships are an omnipresent part of life, and serve multiple functions across the lifespan (Uchino, Cacioppo, & Kiecolt-Glaser, 1996) – for older adults burdened by illness, interpersonal interactions may be an important contributor to psychological well-being. • Our findings suggest interpersonal interaction is a significant contributor to reduced depressive symptoms in the context of medical illness. • ANALYSES • Bivariate correlation analysis. • Multivariate, hierarchical linear regression, covarying age, gender, education, functional impairment, cognitive status. • Covariates & predictors entered on 1st step of model; interaction terms on 2nd step. • INTRODUCTION • For older adults in the United States, deteriorating health and depression constitute a growing cluster of public health concern (Baldwin, Chiu, & Katora, 2002; Kerse et al., 2008; Yang, 2006). • Although the relationship between illness and depression may be bi-directional, Gatz and Hurwicz (1990) suggest that depressive symptoms may be reactions to physical illness. • In comparison to members of other age groups, older adults may experience deteriorating health, increasing frailty, increased medical costs, and decreased social support and diminished social interactions (Choi & Kim, 2007) which, in turn, contribute to vulnerability for depressive symptoms and decreased psychological well-being (Choi & Kim, 2007; Schillerstrom, Royall, & Palmer, 2008). • Social support may mitigate some of the adverse effects of stress from illness (Plant & Sachs-Ericsson, 2004), and is related to improved treatment adherence (Gonzalez et al., 2004), better physical and mental health (Flannery & Wieman, 1989), and reduced morbidity and mortality (Uchino, Cacioppo, & Kiecolt-Glaser, 1996). • During times of physical or mental hardship, older adults may rely more heavily on the support of others than those in other age groups (Husanini, 1997), and their well-being may be particularly sensitive to changes in support from family and friends (Prince, Harwood, Blizard, Thomas, & Mann, 1997). • The subjective (i.e. perceived) experience of social support as well as the size of the social network have been shown to significantly predict depressive symptoms (George, Blazer, Hughes, & Fowler, 1989) • Frequency of social interactions, perceived satisfaction with social network, and instrumental support from others may play a critical role in both psychological and physical health, for older adults (Stice, Ragan, & Randall, 2004; Travis, Lyness et al., 2004). • RESULTS • Frequency of Depressive Symptoms: • 70 patients reported sub-clinical depressive symptoms (9%) • 60 mild depressive symptoms (8%) • 11 moderate to severe depressive symptoms (1%) (Reynolds & Kobak, 1995). • Perceived Social Support moderated the relationship between Illness Burden (CIRS) and Depressive Symptoms (HAMD), t = 2.200, p<.05, Un β = .06 (SE =.03). • Trend toward significance for Social Interaction as a moderator, t = -1.939, p = .053. • LIMITATIONS • Cross-sectional data precludes examination of causality. • Use of a well-educated and predominantly White sample could limit generalizability. • The relationship between illness burden and depression may be bi-directional. • IMPLICATIONS • Promotion of support networks, particularly meaningful community and intergenerational relationships, may be important for older adults with chronic medical problems. • Cognitive restructuring (altering the perceived quality of social support) may be useful to increase awareness or change perceptions of social support. • Behavioral interventions such as senior citizen community center programs may be used to bolster the number of supportive interactions for older adults. • HYPOTHESIS • We hypothesized that the subscales of social support (frequency of social interactions, instrumental support, and perceived satisfaction with social network) would moderate the association between illness burden and depressive symptoms.