Benefit of Social Support Modest in Depressed Elderly

With the cresting of the “baby-boomer generation” and the aging of Americans in general, one can anticipate that millions of Americans will develop serious health problems over the coming years, and many will become very depressed about it. And those deteriorating, depressed people might have trouble carrying out activities of daily living that were once routine.

But wait! If such folks were given physical assistance and social support, would they be able to maintain their daily activities? The answer is a weak “maybe,” according to a study conducted by Judith Hays, Ph.D., of Duke University’s Center for the Study of Aging and Human Development, and colleagues. The study was published in the November American Journal of Psychiatry.

For one year Hays and her team followed 113 persons who were aged 60 years or older and were undergoing treatment for unipolar depression. About one-half of the subjects rated their overall health as fair or poor and had conditions such as heart trouble, cancer, or diabetes. All were assessed at the start of the study for depression severity; the amount of social support they were receiving, such as the size of their social network and the amount of social interaction they had; any instrumental support they were receiving, such as help with errands or transportation, or care during an illness; and their ability to perform various tasks of daily living, such as bathing, dressing, preparing meals, walking up and down stairs, and so forth. A year later the subjects were again assessed for their ability to perform various tasks of everyday life.

Hays and her coworkers then used their data to test three different hypotheses. The first hypothesis was that depression severity at the start of the study would predict a decline in ability to carry out various activities a year later. This hypothesis was strongly confirmed by their data.

The second hypothesis was that social support would mitigate severe depression’s ability to impair the subject’s capacity to carry out various tasks a year later. This hypothesis was not confirmed by their data. However, instrumental support was found to provide such a buffering effect.

The third hypothesis was that the ability of social support to counter a decline in capacity to conduct various activities would be strongest among subjects who were most depressed at the start of the study. This hypothesis was confirmed to some extent by their data.

“Instrumental support was generally protective against worsening performance on . . .abilities of daily living among elderly patients with. . .depression,” the researchers conclude in their study report. “Social support protected the most severely depressed elderly patients against the loss of basic maintenance abilities.”

The same issue of the American Journal of Psychiatry carried a letter by Sheldon Cohen, M.D., a psychiatrist in private practice in Atlanta. In this letter, Cohen argued that he and other older psychiatrists should play a greater role in the psychiatric treatment of the elderly. “I have suffered grievous bodily insults as my bones, joints, and muscles fall apart. . . .It helps me identify with those who are really impaired, either physically or mentally.”

Psychiatric News thus thought Cohen might be well suited to take a look at the study report by Hays and team and give an opinion of it. “Much data, very modest results,” he said. What the results really boil down to, he added, is that “if you are severely depressed, you’ll be slightly better off if you have family or friends with whom you can interact [and] if they are helpful in practical ways.”

This study was funded by the National Institute of Mental Health and the National Institute on Aging.

The report, “Does Social Support Buffer Functional Decline in Elderly Patients With Unipolar Depression?,” is posted on the journal’s Web site at www.ajp.psychiatryonline under the November issue. ▪

AM J PSYCHIATRY 2001 158 1850