Depression and social support in late life: A clear but not obvious relationship

In this issue of Aging & Mental Health, four articles confirm the intuitive. Social factors, specifically social support, are important buffers to the stressors of late life that can lead to depression. Social support may also independently protect older adults from the risk of depression (Cappeliez, O’Rourke, & Chaudhury, 2005; Jang, Kim, & Chriboga, 2005; McCrae et al., 2005; Pirjo & Heikkinen, 2005; VanDerHorst & McLaren, 2005). A fifth article encourages social intervention to correct the impaired social support experienced by elders in the community through social care practitioners (McCrae et al., 2005). To most readers of our journal, the findings will be informative but not surprising. Yet investigators in the past as well as the present have either explicitly challenged or implicitly ignored this critical association of social risk and protective factors with late life depression. As the field of gerontology was emerging, a hypothesis was expounded by social scientists. Cumming and Henry (1961) suggested that the natural transition to be expected of older adults would be from social engagement to disengagement. Society and the elderly would mutually agree to ‘disengage’ from one another in late life. The older person would not only accept but actually welcome society’s decreased involvement. This withdrawal was believed to have both developmental as well as adaptive qualities. The elder would become increasingly preoccupied with the self and decrease emotional investment in persons and objects in the environment. The image of the elder happily being placed on an iceberg and cut loose from the tribe to float into oblivion emerges. George Maddox (1964) challenged this received wisdom. He believed that activity, not disengagement, was the secret to successful aging. A physically and socially active lifestyle was the most adaptable means for achieving life satisfaction in the later years. Empirical studies over the past 20 years have proved Maddox correct. Older adults are healthier and they live longer when they are socially engaged (Blazer, 1982). Social isolation and impaired social support have also been found to be associated with both moderate and severe depressive symptoms in the elderly (Bruce, 2002; Chi & Chou, 2001; George et al., 1989). Social scientists are now convinced that social engagement and support are critical for the physical and mental health of older adults. Now the challenge to the social engagement/social support argument comes implicitly from a different source. Biological psychiatry is in the ascendance, especially in the USA, and therefore social factors (either as risks or protective factors) have faded to the background. For example, in a recent edited textbook on late life depression (Roose & Sackeim, 2004; for which this writer contributed a chapter on epidemiology) social support was only mentioned as a ‘moderator’ of treatment response to antidepressant therapies. Even the psychotherapies that are most widely studied in North America for combination with antidepressant therapy focus on changing the individual, not the social environment—therapies such as cognitive-behavioral therapies (Reynolds et al., 1999). We cannot ignore the findings from biological psychiatry. The empirical evidence is mounting that many older adults are biologically vulnerable to the onset of depression (Alexopoulos et al., 2000; Krishnan, 2002). Even so, epidemiological studies document that depression is less frequent among the elderly until one reaches the oldest old (Blazer, 2002a). If one ‘connects the dots’, it would appear that older adults are more biologically vulnerable to depression, yet psychological and social factors are more protective in late life compared to mid-life