Social Relationships and Depression: Ten-Year Follow-Up from a Nationally Representative Study

<div><p>Background</p><p>Social network characteristics have long been associated with mental health, but their longitudinal impact on depression is less known. We determined whether quality of social relationships and social isolation predicts the development of depression.</p><p>Methods</p><p>The sample consisted of a cohort of 4,642 American adults age 25–75 who completed surveys at baseline in 1995–1996 and at ten-year follow-up. Quality of relationships was assessed with non-overlapping scales of social support and social strain and a summary measure of relationship quality. Social isolation was measured by presence of a partner and reported frequency of social contact. The primary outcome was past year major depressive episode at ten-year follow-up. Multivariable logistic regression was conducted, adjusting for the presence of potential confounders.</p><p>Results</p><p>Risk of depression was significantly greater among those with baseline social strain (OR, 1.99; 95% CI, 1.47–2.70), lack of social support (OR, 1.79; 95% CI, 1.37–2.35), and poor overall relationship quality (OR 2.60; 95% CI, 1.84–3.69). Those with the lowest overall quality of social relationships had more than double the risk of depression (14.0%; 95% CI, 12.0–16.0; p<.001) than those with the highest quality (6.7%; 95% CI, 5.3–8.1; p<.001). Poor quality of relationship with spouse/partner and family each independently increased risk of depression. Social isolation did not predict future depression, nor did it moderate the effect of relationship quality.</p><p>Conclusions</p><p>Quality of social relationships is a major risk factor for major depression. Depression interventions should consider targeting individuals with low quality of social relationships.</p></div

Risk of major depressive episode at ten-year follow-up as a function of overall quality of social relationships, social support, and social strain.

a<p>Adjusted for the following variables at baseline: major depression, age, ethnicity, sex, household income, education level, generalized anxiety disorder, alcohol misuse, overall physical health, and overall mental health. Social strain, lack of social support, and overall poor quality in relationships were rated on a four-point scale and each was in a separate multivariable model. For analyses with participants with a spouse/partner, scales of social relationships quality are a composite of relationships with spouse/partner, family, and friends; for analyses of all participants, scales contain just the latter two relationships.</p

Predicted probability of depression.

<p>Impairment in quality of social relationships was rated on a four-point scale, with a higher score indicating <i>more impairment</i> in overall quality in relationships with spouse/partner, family, and friends. Data are weighted to adjust results to more closely match characteristics of the general U.S. population.</p

Baseline characteristics of the study sample (n = 4,642 unless otherwise noted).

a<p>Overall poor quality, social strain, and lack of social support were measured on a four-point scale, with a higher score indicating poorer quality, more strain, and less support, respectively.</p>b<p>Lack of social contact was measured on an eight-point scale for family and friends and a six-point scale for neighbors, with a higher score indicating more isolation.</p

Risk of major depressive episode at ten-year follow-up as a function of type of social relationship with overall poor quality at baseline.

a<p>Adjusted for the following variables at baseline: major depression, age, ethnicity, sex, household income, education level, generalized anxiety disorder, alcohol misuse, overall physical health, and overall mental health. Quality in relationships was rated on a four-point scale. Spouse/partner, family, and friends were included in the same multivariable model for analyses of participants with a spouse/partner and the just the latter two for analyses with all participants.</p

Results of Regression Analysis (Monetary Scores as Dependent Variable).

<p>Note:</p><p>* p<.05,</p><p>** p<.01.</p><p>Eleven participants were excluded in this analysis for failing to complete the questions.</p><p>Results of Regression Analysis (Monetary Scores as Dependent Variable).</p

The ratio of monetary score given by partner’s sex and attractiveness (** p<.01).

<p>The ratio of monetary score given by partner’s sex and attractiveness (** p<.01).</p

Trust Game Structure with the Most Extreme Cases.

<p>Trust Game Structure with the Most Extreme Cases.</p