Social Activity and Improvement in Depressive Symptoms in Older People: A Prospective Community Cohort Study

doi:10.1097/JGP.0b013e3181a88441

The American Journal of Geriatric Psychiatry

Volume 17, Issue 8, August 2009, Pages 688-696

https://doi.org/10.1097/JGP.0b013e3181a88441 Get rights and content

Objective:

To investigate: i) the association between level of social activity and late-life depressive symptoms and ii) the association between level of social activity and improvement in depressive symptoms over a 2-year period among people scoring above case level.

Design:

A secondary analysis of data from a prospective community-based study.

Setting:

Montpellier district, France.

Participants:

Community residents aged 65 and older (N = 1,849), 85.4% of whom were reassessed after a 2-year interval.

Measurements:

Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale at baseline and follow-up, and the standard 16 + cutoff was applied to define case-level symptomatology. The primary independent variable assessed at baseline was three levels of social activity defined from a 33-point scale. Other covariates included age, gender, marital status, education, alcohol consumption, chronic illness, cognitive impairment, disability, life events, and antidepressant use at baseline and follow-up.

Results:

In the sample at baseline (N = 1,849), higher social activity was negatively associated with case-level depressive symptomatology after adjustment for potential confounders (odds ratio across three groups 0.7, 95% confidence interval 0.6–0.8). In a prospective analysis of participants above case level at baseline (N = 463), high-social activity at baseline was the only variable associated with improvement in depressive symptoms and remained significant after adjustment for all other factors (odds ratio=1.6; 95% confidence interval = 1.2–2.2).

Conclusions:

In a large community sample, higher social activity was associated with a lower risk of late-life depressive symptoms at baseline and, in those with case-level baseline symptoms, was the principal factor predicting improvement over 2-year follow-up.

Section snippets

The Study Sample

Participants at baseline were community residents aged 65 years and older recruited by random selection from the 15 electoral rolls of the Montpellier district between March 1999 and February 2001 as part of the Esprit Study of late-life psychiatric disorder.¹⁶ A personal letter was sent to potential participants describing the study and inviting them to participate The spouse/partner was also invited to participate in the study if he or she met eligibility criteria (i.e., age and residence).

Sample Characteristics

The analyzed baseline sample consisted of 1,849 participants. Descriptive data for independent variables are summarized in the first column of Table 1. The mean age of the sample was 73.2 years; 57.8% were women; 66.0% were married, 34.0% were living alone; 25.0% had low education, 29.6% medium low, 21.8% medium high, and 23.6% high. Using the 15/16 cutoff for the CESD, 30.5% of the sample had case level symptoms. At least one chronic illness was reported by 60.7% and at least one life event

CONCLUSIONS

In a prospective study of a community population aged 65 and older, higher levels of social activity were associated negatively with late-life depressive symptoms at baseline and positively with an improvement in symptoms over a 2-year period in people with case level symptoms at baseline.

The study has particular strengths. First, the data were derived from a well-characterized sample with a large sample size and the follow-up rate was high, even in the group with case-level depressive

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Participants were recruited from the New Integrated Suburban Seniority Investigation Project, an ongoing prospective cohort study. A total of 525 older adults with depressive symptoms were included. The validated 15-item Geriatric Depression Scale was used to assess depressive symptoms. A self-report questionnaire was used to measure social activities (social-related, learning, and personal). LTC needs was defined according to Japan's Long-term Care Insurance System. A competing risk model and a Laplace regression model were used to estimate the hazard ratios of LTC needs incidence and the 25th percentile difference in LTC-needs-free survival time and their 95% confidence intervals.
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Depressive symptoms have a strong effect on appetite decline in older adults. There is also an association between social activity and decreased depressive symptoms, but the mechanism between appetite and social activity with respect to depressive symptoms is unclear. This cross-sectional study examined the direct and indirect effects of social activity on appetite, via depressive symptoms. A total of 259 community-dwelling older adults (mean age 75.1 ± 5.3 years; 55% female) completed the Council on Nutrition Appetite Questionnaire (CNAQ) and the 15-item version of the Geriatric Depression Scale (GDS). We used a cutoff score of 6 on the GDS-15 to determine whether participants displayed depressive symptoms. Social activity was assessed based on the number of activities participated in at least 1–3 times per month. The types of social activity consisted of local community, hobby, sports, citizen, industry, religion, volunteer, and others. Other assessed factors included age, sex, education, financial status, living situation, and comorbidities. To examine the relationships among social activity, depressive symptoms, and appetite, structural equation modeling (SEM) was used, adjusting for variables associated with depressive symptoms or appetite in multivariate analyses. SEM revealed that participation in more types of social activity had a significant indirect effect on higher appetite score via less having depressive symptoms (β = 0.04, p = 0.018). Our findings suggest that active participation in social activities may have a positive effect on good appetite via not having depressive symptoms among older adults. Further longitudinal or intervention studies are needed to confirm our findings.
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This study examined the effects of a facilitated 10-week Socially Supportive Activities Program (SSAP) designed to improve mood in a geriatric institutional setting. A sample of 68 Taiwanese elders in long-term care facilities with depressive symptoms were randomly assigned to either an experimental group (N = 35) or a control group (N = 33). Outcomes were measured before the intervention, week 1, and at week 12, one-week post intervention. In the experimental group, pre-post measurement results demonstrated significant reductions in depressive symptoms, measured by Geriatric Depression Scale, and significantly higher levels of self-transcendence, measured by the Self-Transcendence Scale. An additional post-intervention measure of mood was collected with the Apparent Emotional Rating Scale. The AERS also demonstrated a significantly higher score (better mood) in the experimental group than in the control group. This study supports the use of a structured, facilitated, well-designed social activities program like the SSAP, to enhance and improve mood in elders who live in long-term care facilities.
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Some studies have reported that participation in community activities was more likely to reduce health decline (Choi, Park, Cho, Chun, & Park, 2016; Dodge et al., 2008; Isaac, Stewart, Artero, Ancelin, & Ritchie, 2009; McGue & Christensen, 2007; Shah, Lin, Yu, & McMahon, 2017) and was associated with decreased risk of disability and mortality (Agahi, Lennartsson, Kareholt, & Shaw, 2013; Ashida, Kondo, & Kondo, 2016; Han, Tavares, Evans, Saczynski, & Burr, 2017; James, Boyle, Buchman, & Bennett, 2011; Pynnonen, Tormakangas, Heikkinen, Rantanen, & Lyyra, 2012). Participation in community activity among elderly people may be associated not only with sociodemographic factors and their own health (Aoki et al., 1996; Choi et al., 2016; Dodge et al., 2008; Isaac et al., 2009; McGue & Christensen, 2007; Shah et al., 2017), but also their partners’ health conditions. Because stroke and dementia have been identified as major causes of functional disability in the elderly (Cabinet Office, 2016; Vos et al., 2012), these patients may therefore experience some issues with activities of daily living (ADL) and require assistance.
This cross-sectional study aimed to determine association between partners’ functional disability and community activity in an elderly Japanese population.
A baseline survey was conducted between December 1 st and December 15th, 2006 and included 6600 participants from whom we collected data regarding their participation in community activity and functional disability among their partners. We defined functional disability as receiving certification for long-term care insurance in Japan, and frequent community activity as engaging in community activity more than once a month. Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for frequent community activity based on functional disability among partners. We also conducted additional analyses using three types of community activities (neighborhood associations; sports, exercise, or a hobby; and volunteering for nonprofit organizations) as outcomes.
Multivariate adjusted analysis showed that the OR (95% CI) for frequent community activity was 0.70 (0.54–0.89, P < 0.01) among those whose partners had functional disabilities, compared with those whose partners did not have functional disabilities. This finding remained true even for different types of community activities such as neighborhood activities, sports, exercises, hobbies, and volunteering for nonprofit organizations.
In this cross-sectional study of an elderly Japanese population, participants whose partners had functional disabilities were less likely to participate in community activity. We conclude that enhancement of support systems is important to promote participation in community activity, not only for patients with disability but their partners as well.
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: The ESPRIT Project was financed by the Regional Government of Languedoc-Roussillon (France) and an unconditional grant from Novartis (France). RS is supported by NIHR Biomedical Research Centre for Mental Health, The South London and Maudsley NHS Foundation Trust & The Institute of Psychiatry, King's College London.

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Regular Research ArticlesSocial Activity and Improvement in Depressive Symptoms in Older People: A Prospective Community Cohort Study

Objective:

Design:

Setting:

Participants:

Measurements:

Results:

Conclusions:

Section snippets

The Study Sample

Sample Characteristics

CONCLUSIONS

Am J Geriatr Psychiatry

Psychosomatics

Am J of Geriatr Psychiatry

Am J Prev Med

J Psychiatr Res

J Affect Disord

Diagnosis and treatment of depression in late life

JAMA

Prevalence of depressive illness in the elderly community

J R Coll Gen Pract

Effects of induced mood on self-reported life events and perceived and received social support

J Pers Soc Psychol