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

Alan R Teo,Marcia Valenstein,Hwajung Choi,James Coyne

doi:10.1371/journal.pone.0062396

Abstract

BackgroundSocial 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.MethodsThe 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.ResultsRisk 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.ConclusionsQuality of social relationships is a major risk factor for major depression. Depression interventions should consider targeting individuals with low quality of social relationships.

Highlights

Major depressive disorder (MDD) is an illness of major clinical and public health significance
Social relationships may influence mental health outcomes through multiple mechanisms including influence on health-related behaviors, engagement in social activities, transfer and exchange of social support, and access to material resources. [6,7] On an empirical level, social isolation and negative social interactions are associated with depression [8,9] and suicide
[10] Prospective community studies have found perceived marital dissatisfaction and negative marital quality at baseline are risk factors for an incident major depressive episode. [11,12] Meta-analyses have shown that interventions addressing social relationships, including couples therapy and peer support may be effective in reducing depressive symptoms. [13,14]

Summary

Introduction

Major depressive disorder (MDD) is an illness of major clinical and public health significance. [6,7] On an empirical level, social isolation and negative social interactions are associated with depression [8,9] and suicide. Differing dimensions of social relationships are often not examined within the same study, including questions regarding with whom, how often, and in what way do people interact with others. This prevents direct comparisons of the relative importance of specific features of social relationships on depression. 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

Methods

Results

Conclusion