A study by the Instituto de Saúde Pública da Universidade do Porto (ISPUP) analysed the relationship between social isolation and the existence of depression in a sample of people aged 60 years or older from the city of Porto and concluded that those who live alone are not necessarily those at a greater risk of developing depression. In fact, the occurrence of depression is more frequent in older adults who lack social support and are not involved in leisure activities, regardless of whether they live alone or accompanied.
The aim of the research, developed in 2017 as part of the HARMED project and published in the journal Health and Social Care in the Community, was to understand which indicators of social isolation were associated with a higher propensity for depression in a sample of people aged 60 or older, living in the city of Porto.
As clarifies Ana Henriques, first author of the study entitled A multidimensional perspective of the relation between social isolation and depression among Portuguese older adults, developed under the Epidemiology Research Unit (EPIUnit) of ISPUP, “most published studies define social isolation in a unidimensional way, considering only if people live alone and if they have contact with relatives and/or friends. However, more recent articles have shown that one cannot look at isolation based only on these indicators. There are other components, in addition to these, that help us to get a more complete picture of what social isolation is, namely, involvement in leisure activities and the social support received.”
“Bearing in mind that social isolation should be approached in a multidimensional way, we sought in this study to understand how the objective and subjective indicators of isolation intertwine and contribute to the development of depression in the sample studied. This is, in fact, one of the main innovations of this article”, she adds.
More than 600 individuals from the city of Porto were evaluated
To conduct the study, researchers assessed 643 individuals aged 60 years or more who were residents in the city of Porto and participants in the EPIPorto cohort, a longitudinal ISPUP study that has followed a sample of residents of the city of Porto since 1999, in order to assess their health determinants.
Participants were asked about their marital status, their housing situation (whether they lived alone or accompanied), and whether they performed leisure activities, such as taking care of grandchildren, spending time with their family, participating in religious activities, travelling or volunteering. In addition to these objective indicators, the survey also included indicators of a subjective nature. In this case, the elderly were asked about their perception of the social support they received from relatives, friends and/or spouses.
In general, it was found that 27.4% of older adults analysed suffered from depression. This prevalence was more pronounced in women, who, when considered alone, had a 30% prevalence of the illness.
Research has shown that living alone should not be seen as the main isolating factor associated with depression. In fact, it was found that individuals who live alone, but have a high level of social support and are involved in several leisure activities, are not more likely to develop depression when compared to those who live with a partner.
The highest propensity for depression occurs among older adults who live alone but who simultaneously accumulate the disadvantages of having low social support and little involvement in leisure activities.
Compensatory measures are crucial
As it turned out, “older people living alone are not necessarily those who are more susceptible to depression, and therefore looking at this variable alone as the only indicator of loneliness or isolation may give us an incomplete picture. All the variables of social support and of the practice of leisure activities play, as we have seen, an important role”, says Ana Henriques.
The researcher also highlights the importance of the cumulative issue, since the elderly living alone, without social support and without activities show worse mental health. Thus, social support and leisure variables are crucial in compensating the housing situation of older people and may help to prevent isolation and depression.
Useful information for depression prevention
This study could help healthcare professionals to identify early on older people at risk of depression, the research authors believe.
“Rather than taking a remedial approach, health professionals could act earlier by identifying older adults who lack leisure activities or good social networks, thus helping to prevent social isolation and depression in this population,” they say.
Researchers Makram Talih, Sílvia Fraga and Henrique Barros, from ISPUP, also signed the research, which also had the collaboration of Isabel Dias, from the Institute of Sociology of the University of Porto, Maria Pastor-Valero, from the Miguel Hernández University of Elche, and Alicia Matijasevich, from the University of São Paulo.
About the HARMED project
HARMED – Socio-economic and health determinants of elder abuse is a project resulting from the collaboration between the Instituto de Sociologia da Universidade do Porto and ISPUP, which sought to measure the impact of socio-economic crisis, violence, and social issues on the elderly. For this assessment, data from the EPIPorto cohort were used.
Additional information about the project and its results are available here.