Functional impairment, illness burden, and depressive symptoms in older adults: does type of social relationship matter?

In the United States, approximately 13% of the adult population is diagnosed with major depressive disorder in their lifetime (Hasin et al. 2005). Of particular concern, older adults may be at greater risk for depression than other age groups due to developmental, role expectation, and health-related changes (Teachman 2006). Declining physical health is often a primary trigger for depression (Yang 2006), and epidemiological data suggests that 75% of adults 65 and older have at least one, and almost 50% have two or more, chronic illnesses (National Center for Chronic Disease Prevention and Health Promotion 2000). The association between chronic medical conditions and depressive symptoms may be tempered, or exacerbated, by the degree and quality of an individual’s interpersonal relationships. The Interpersonal Theory of Depression proposes that difficulties in interpersonal relationships, perhaps due to recent changes in a major interpersonal role resulting from illness, are a robust contributing factor to the onset and maintenance of depressive symptoms (Davidson et al. 2004;Weissman 2010). Having a large, active social network and the receipt of emotional support may provide a buffer against health-related stressors (Penninx et al. 1998;Yang 2006), whereas loneliness, isolation, or negative social exchanges may exacerbate the effect of poor health on emotional functioning (Cacioppo et al. 2006). In the current study, we investigated the role of three types of social support as potential buffers of the association between illness, impairment and depressive symptoms, including: instrumental support (i.e., assistance with tasks of daily living); perceived support (i.e., subjective quality of and satisfaction with one’s social network); and, social interaction (i.e., the actual extent and availability of one’s social network) (George et al. 1989;Landerman et al. 1989). Of these, perceived social support is often more predictive of depressive symptoms than the objective forms of support (Antonucci et al. 1997). Not all interpersonal relationships are positive or helpful in nature. Concerns over close relationships, and negative social exchanges, are associated with elevated depressive symptoms (Krause et al. 1989). Importantly, dysfunctional familial relationships may impact well-being more than conflicts in peripheral relationships (Abbey et al. 1985), as they threaten enduring commitments. In the context of health dysfunction, family members may become critical, disapproving or rejecting of the health behaviors and decisions of an older adult (Seaburn et al. 2005), which may result in further functional decline, maladaptive health behaviors, increased negative affect, and depression (Bressi et al. 2007;Shields et al. 1992). As such, in the current study, we examined the role of family criticism, or the extent to which an individual perceives the receipt of critical comments from family members (Shields et al. 1994), as a potential exacerbating factor that might strengthen the association between illness or impairment and depressive symptoms. It is not clear from previous research, however, what type of social support, or negative social interaction, is most salient for illness versus impairment, if any differences exist. We hypothesized that both illness burden and functional impairment would be independently associated with greater levels of depressive symptoms. Further, we examined the potential independent and combined moderating effects of family criticism and social support, hypothesizing that family criticism would exacerbate the association between illness/impairment and depressive symptoms, whereas social support variables would buffer this relationship.