Social Interaction and Depression, Research Paper Example

Abstract

Social isolation effects individuals differently, but the consensus is in most cases the effects or negative and potentially fatal. Studies show this is especially true in regards to the elderly. Researchers have established a wide range of metrics and measurements within the sociological and psychological analysis of social isolation and its effects that attempt to better understand how this issue contributes to increased morbidity in older adults. In the following report the value of perceived isolation in relation to real isolation is shown to have more effect on the actually health of respondents. Meanwhile, medical professional fail to make the connection between social isolation and the direct cause of increased morbidity rates. All of this suggests that there are still mysteries to the mind body connection that have yet to be realized.

Chapter 1

Introduction to the Problem

Social interaction and depression among senior adults is a major concern when it comes to the health and wellbeing of the senior citizen population of all communities worldwide.  In one’s adult years getting out and socializing can be very difficult, especially if they have isolated themselves by moving to a new community, working online or even retiring.  There are numerous documented benefits to being social and active that are unnoticed on the surface but can significantly contribute to someone’s health.

One of the major benefits of being social can be found in the fact that people who are able to maintain friendship, especially very close personal friendships are statistically proven to live longer than those who don’t. Some of the specific benefits of social interaction for older adults are less chance for rheumatoid arthritis, reduced risk of cancer, reduced risk of osteoporosis, or reduced chance of having cardiovascular problems.  Being socially active can result in having lower blood pressure, reduced risk of mental health issues.  On the other hand socially isolation can result in high blood pressure, dementia, feeling depressed or lonely and also being less physically active.

Statement of the Problem

The purpose of this study is to analyze the relationship between the duration and frequency of social interactions and depression among senior adults.

Research question/Hypothesis

• Do social disconnectedness and health reflect the impact of loneliness? Or do social disconnectedness and feelings of loneliness diminish health separately?
• How do the effects of social isolation in older adults manifest themselves physically?
• What significance does duration of isolation have on symptoms of this condition?

Rationale

Individuals in their older years have more invested in their personal relationships. Likewise, it is often the case that an older person who has lived many years with a companion is more likely to grow morbidly depressed when that person dies, ultimately making them more likely to face mortality in the short time following as well. Ironically, it is also found that individuals over 50 have a high rate of loneliness when they aren’t married, researchers note that, “The primary predictor of loneliness in those older than 50 is not being married, according to a 2010 study by Laurie Theeke of the West Virginia University School of Nursing (Jones & Sell, 2010).” This is a significant fact because it means that all elderly, single or attached are finding themselves left isolated in their later years. Social relationships are proving to be of significantly more value than was previously more value many give credit. Reports show that elderly women are also largely at risk of this threat of isolation as, “last year, 41 percent of American women older than 65 were widowed, compared with 13 percent of men, census data show (Jones & Sell, 2010).” It is scientifically proven that this level of abandonment between older people leads to isolation. Isolation in elderly people can have serious health consequences, raising the risks of an earlier-than-expected death and the loss of physical functioning (Graham, 2012). This can most likely be attributed to factors far beyond emotional support or attachment. The authors note that, “A couple with health limitations can live independently by relying on each other; when one dies, the other may be ill-prepared for new responsibilities and stresses (Jones & Sell, 2010).” Responsibilities and stress of living independently after relying on the support of others can have a dramatic effect on one’s personal identity, but also their quality of life. If someone has spent the majority of their life equating their perception of self according to their personal relationships and then they become isolated from those relationships for whatever reason, it can have a dramatic effect on how they understand their sense of self-worth and value in the world. Likewise, couples provide support for one another in the form of emotional therapy, medical assistance3

In her New York Times article “The High Price of Loneliness, Judith Graham notes that “Lonely older adults also were 45 percent more likely to die than seniors who felt meaningfully connected with others, even after results were adjusted for factors like depression, socioeconomic status and existing health conditions (Graham, 2012).” This shows that the statistics measuring the influence social isolation has on health conditions is dramatic when the values are assessed in relation to the socially integrated. The author goes on to note that social factors are essential to the natural health of all individuals but critical to the health well-being and longevity of the elderly (Graham, 2012).” This dramatic effect social isolation has on physical health manifest itself in specific ways, Graham points to a recent study published by Psychology and aging that gives insight into a report done by Anthony Ong of Cornell. The study found that older people had higher incidents of high blood pressure due to the stress of living alone. All of these factors point to the rationality of tackling the issue head-on. Too often the concerns and issues effecting senior citizens and their respective communities are overlooked. This report takes an in-depth look at how social isolation is effecting the elderly in a far more severe way than it does for their younger counter parts.

Delimitations

From summer 2005 to spring 2006, NSHAP interviewed 3,005 individuals, age 57 to 85. The study group is composed of men and women between the summer of 2005 to spring 2006.  The study group is made up of NSHAP conducted interviews. There was a weighted response rate of 75.5 %.  The majority of data used in the study comes from the National Social Life, Health, and Aging Project (NSHAP) was evaluated for its merit in regards the proposed concerns. This group represents a national pool of older adults that reside within a community.

Definitions

ANTIDEPRESSANT: An antidepressant is a psychiatric medication. It’s most commonly prescribed to treat personality or mood disorders. Some of the common disorders for which anti-depressants are prescribed include, social anxiety disorder, major depression, and dysthymia.

BLOOD PRESSURE:  This is often referred to as (BP) or arterial blood pressure because it is the major vital sign that pressure is being exerted from circulating blood along the blood vessel walls.

CHRONIC ILLNESSES: A chronic condition is a long lasting disease or health condition.

DEPRESSIVE DISORDER: A set of symptoms or syndrome  that reflects  grief or sadness.

EMOTIONAL ISOLATION: A state of isolation where one feels emotionally separated from their community despite having a functioning social group.

GENERAL ANXIETY DISORDER:  (GAD) is characterized by having numerous concerns that interfere with daily life. This disorder is a form of social anxiety.

LONELINESS: A universally excepted definition of loneliness is the incongruence between one’s ideal and their perceived social relationships.

PSYCHOTHERAPY:  is a common term to define  psychological therapeutic interaction or treatment contracted between a trained professional and a client, patient, family, couple, or group.

SOCIAL ANXIETY DISORDER:  This is an excessive fear of embarrassment that can come from intrusive social interactions  t and have debilitating effects on personal and professional relationships.

Chapter 2

Literature Review Topic

In contemporary study of social isolation, there are currently a wide range of indicators that suggest social isolation poses a significant health risk. The result of social isolation according to Cornwell can manifest itself in the form of feelings of depression and loneliness. He argues that the multiple forms of isolation are rarely studied which just puts social isolation of the elderly in an epistemology that rarely gets the needed attention it deserves. Having a small social network, living alone, or infrequently involving in social activities can lead to the feelings of isolation and potential health risks that result from it. Cornwell states that, “However, multiple forms of isolation are rarely studied together, making it difficult to determine which aspects of isolation are most deleterious for health (Cornwell, 2009).” The author evaluates data from population-based reports issued by the National Social Life, Health and Aging Project. In the report multiple indicators break social isolation into measurable scales to evaluate social disconnectedness. The specific indicators measured against one another are social disconnectedness which entails, “small social network, infrequent participation in social activities) and perceived isolation (e.g., loneliness, perceived lack of social support) (Cornwell, 2009).”  In examining the relationship between social disconnectedness and perceived isolation Cornwell notes there is a significant need for researchers to reconsider the effects perceived isolation has on mental health. Perceived isolation and social disconnectedness can also significantly affect the duration of which one actually endures depressive symptoms (2009).

Many of the same health risks that are associated with obesity and smoking cigarettes have been likened to the influence of social isolation. Despite this connection, researchers and medical professionals have not identified a distinct correlation between the effects of isolation and smoking on one’s health. One major problem with studying social isolation factors is that most contemporary literature and data on the subject solely focuses on one or two specific measures of social isolation research. House notes this is largely due to data limitations imposed on the researcher. House also notes though that if the studies are evaluated for their true worth collectively, data shows that there are a number of indicators of social isolation that result in decreased health. These factors are identified as living alone, have little participation in social activities, having a perceived lack of social support or feelings of loneliness (House, 2001). It is when these aspects, or indicators, of social isolation   are isolated themselves and evaluated individually that it becomes difficult to distinguish the real causation of the unwanted results. For example, what significance does duration of isolation play on its influence on morbidity  when these factors of social isolation are evaluated individually, it becomes difficult to identify the “active ingredient” in social isolation that leads to its deleterious effects on health (House 2001).” The second issue is disciplinary differences and methodologies of study aren’t congruent in regards to social isolation health and the psychological research that focuses predominantly on the core characteristics of isolation, such as the subjective aspects of social integration verses isolation, but Cacioppo and Hawkley argues that     there is a significant importance that should be applied to the study of feelings of loneliness and perceived isolation. They also note that it is a common failure among depression epistemologists to not identify the connections between social inactivity, social disconnectedness and depression. This is a significant discrepancy, as studies show  them as the most common forms of isolation.

Two forms of isolation are considered, social disconnectedness, which involves limited social relationships and perceived isolation, which is defined as “loneliness and a perceived lack of social support (Cornwell & Waite, 2009). Social isolation is linked to the cause of worse quality health across all age groups, but older adults are identified as the group that is most affected by the issue. In many cases the elderly report morbidity rates that are much higher than those of their younger contemporaries.  The health risks posed by social isolation may be particularly severe for older adults in ways that would not be so if they were younger.

Social isolation is a central issue in a wide range of health research publications. Indicators of isolation are diverse and widely both across and within disciplines. Numerous sociologists who have studied   family living arrangements focus their qualitative data on the negative influence health  has on living alone. In their acclaimed article on the Psychology of the elderly, researchers and psychologists Jones and Sell note that, “Psychological and emotional losses change older Americans’ lives. How they navigate a cascade of challenges — particularly social isolation, death of a spouse and depression — can determine the course of their final decades (Jones & Sell, 2010).” These life transitions, such as the death of a loved one or the loss of a job, are predominantly seen as the core cause for isolation which leads to the final decades of depression.  Researchers go on to note that the reason the elderly are so vulnerable to the effects of social isolation is that they have declining resources. They say, “depressed people may grow withdrawn, isolating themselves further. Meanwhile, to make matters worse, many older adults lose their spouses, partners and friends, who were sources of companionship, stability and support (Jones & Sell, 2010).” In a 2006 study published by the New England Journal, it was found that older Americans have an increased mortality rate after the death of a spouse (Jones & Sell, 2010).Furthermore, in a retirement study published by the National Institute on Aging found 19 percent of people 85 or older report having depressive symptoms. Psychotherapy has been shown to improve these conditions as well as antidepressants.

Many researchers have assessed isolation as a measurement metric.  These authors have broken down the central isolation factors Gierveld and Hagestad note that emotional loneliness is the state of not having an attachment figure, while they distinguish social loneliness as diminished or no integration or companionship. Gierveld and Hagestad identify isolation as “integration’s opposite and they recognize loneliness as the counter to “embeddedness” (2006). The two main forms of social isolation these authors managed to value overall, in their sociological and psychological studies of the discipline are perceived isolation and social disconnectedness. Social disconnectedness, they identified as limited contact with other people. Perceived isolation, on the other hand is more subjective and has to do with how someone views their social situation and social resources. Perceived isolation can be characterized by feelings of loneliness.

Lakey and Cassady found that one’s perception of isolation does not always correlate to their level of actual isolation. There are many conditions that distinguish the difference between social disconnectedness, and perceived isolation. In this concept one might perceive their life as being social when they are really isolated. The best example is an individual who only interacts with others through social networks online.  While in the basic sense of the term, the individual is socially interacting with members of his social. The authors note, Loneliness is weakly connected with social network size and frequency of interaction with others. This is due to the fact that In fact, the degree to which one perceives himself as isolated is informed by personality and other individual-level characteristics, such as neuroticism and cognitive schemas (Lakey and Cassady 1990).” The core argument of the authors is that in order to truly assess loneliness duration, one must first identify which acts count as social situation and which do not.

There are numerous influences that effect feelings of isolation, one being gender, especially since women tend have the pattern of outliving their partners, also neighborhood deterioration and many others. Authors are clear to point out that, “When examining gender as a risk factor it becomes apparent in the literature that many studies point to women as being more at risk for loneliness and isolation than men (Kivett 1979) (British Columbia Ministry of Health, 2004).”  Also the ability to drive or access control of a vehicle is a vital factor influencing how isolated one will be from the ability to meet and network with others.  Elder individuals are also less likely “Increasing evidence supports the idea that out-of-home activity levels affect health status, well-being and survival in old age (British Columbia Ministry of Health, 2004).” These statistics further make transportation and the securing of transportation an essential part of  the independence process and a tool to alleviate feelings of isolation in older adults (British Columbia Ministry of Health, 2004). In regards to neighborhood deterioration as a factor leading to social isolation and loneliness, it was found that, “Krause (1993) found that neighborhood deterioration promotes distrust of others and that older adults who are distrustful of others tend to be more socially isolated ( British Columbia Ministry of Health, 2004).”

Literature identifies a wide range of factors that incite social isolation disorders or anxieties associated with loneliness. One significantly influential factor is economic status, the authors note that, “Other possible determinants of loneliness were presented in the literature. Among others, one’s economic status and self-esteem have been found to have a relationship with loneliness (Children’s, Women’s and Seniors Health Branch, (British Columbia Ministry of Health, 2004).” This means regardless of one’s economic status, ad any given time loneliness plays a contributing role in how one perceives their economic status. For example, an individual who abruptly becomes wealthy, only to find he is no longer welcome within his previous social group could be socially isolated and lonely among their peers.

While researchers note that older adults have a much more complicated time adapting to new found isolation, they also point out that there really is a double edged sword in regards to the effects of retirement on older people. Some may delve into a pit of despair, especially if their new retirement. Older adults deal with a number of challenges, which younger adults don’t have to face. In addition as authors point out, “There are also some differences between seniors living in urban and rural environments (British Columbia Ministry of Health, 2004).”When an elder person’s life course shifts, retirement can lead to a complete loss of social roles. and health problems may limit participation in social activities.

Chapter 3

Methodology

Between summers 2005 to spring 2006, NSHAP conducted interviews of exactly 3,005 older people, between the age of 57 and 85. This resulted in a weighted response rate of 75.5 %. The methodology utilized in the study mentioned, incorporated data provided by the National Social Life, Health, and Aging Project (NSHAP) was evaluated for its merit in regards the proposed concerns. This group represents a national pool of older adults that reside within a community.  The sample of data provided by the NSHAP was specifically chosen for its diversity of locations involved and the data was screened by the Social Research for Health and Retirement Study (HRS).  The best form of evaluating these respondents was seen as being through the act of questioning, as authors note “Loneliness is subjective and is measured using questions that seek perceptions of relationships, social activity, and feelings about social activity (Children’s, Women’s and Seniors Health Branch, British Columbia Ministry of Health, 2004).”  Many of these questions are best to be done as a self assessment. As previous research has shown, a respondent mentioning their perspective has more metrics of data available within the information given than one might expect.  Another metric in this study that can be measured subjectively is social isolation. As the British Colombia ministry of Health notes, “Social isolation is objective and can be measured using observations of an individual’s social interactions and network (British Columbia Ministry of Health, 2004).”

Subjects

The subjects of this study are elderly men and women between the age of 57 to 85 who were assessed for their bouts with isolation and depression. From summer 2005 to spring 2006, NSHAP data was retrieved for this study. In this study the subjects were interviewed during home interviews.  The respondents completed questionnaires with an 84% return rate of the exams.  All of the questions while related to health and psychology were self reported. Over 2,910 respondents had valid data. This was a nationally represented survey with respondent specifically recruited based on providing a diversity of socioeconomic, physical, gender, and racial impact. The subjects were questioned on emotional aspects of isolation and loneliness, specifically their frequency of certain feelings was assessed over a given period. The subjects were given questionnaires through the mail and allowed to respond in their own time. People will never respond unless there is some kind of reward in it for them, such as monetary compensation for time spent, free incentives, like gifts, or some form of rebate, or tax right off. These benefits used as incentives contribute to the 84% response rate of the study.

Variables

Dependent variables in this study included measures of physical and mental health evaluated by the candidates self-rated measures of their mental health as well as their physical. In addition to this respondents were evaluated according to indicators of common depressive symptoms. Self-rated physical health was as the question “Would you say your health is poor, fair, good, very good, or excellent?”Research documenting the use of this question has found that it does not necessarily effectively evaluate one’s actual health, but the results are predictive of one’s mortality probability. Self-rated health measures are largely seen as an efficient qualitative metric due to the fact that is measure both the physical self perception in regards to health condition as well as the psychological and this is largely based on the fact that medical professionals have reported very narrow margin of errors when it comes to self rated prognosis verses a real prognosis from a doctor. In layman’s terms, people genuinely tend to know when they are physically below their average health level.

The second question these respondents were asked was in regards to their emotional health, on the same 5 tier rating scale between excellent, poor and good (Cornwell and Waite (2009).” Questions regarding physical health were also self-rated. For these cases subjects were asked “How would you define your emotional mental health?” They were given the same 5 tier rating option. Is it excellent, very good, good, fair, or poor?” This measure has not been validated against clinical assessments of mental health disorders.

Instruments

The main instruments used in the study mentioned was the incorporation of interview questions for self rated physical and mental health. Both self-rated physical health and self-rated mental health are coded so that higher values indicate better health. Finally, we perform analyses predicting depressive symptomatology using a shortened 11-item version of the Center for Epidemiological Studies Depression Scale to assess the presence of depressive symptoms.  Respondents were asked to indicate how often they experienced a number of feelings during the past week, including (1) “I did not have the appetite to eat”; (2) “I felt sad or lonely”; (3) “I felt that all things required too much effort”; (4) “I had insomnia”; (5) “I felt joy or was excited”;; (7) “People were unfriendly”; (8) “I had a pleasant life”; (9) “I was down”; (10) “I think people didn’t like me ”; and (11) “I could not get ‘going.’” Responses ranged from “rarely or none of the time” to “some of the time,” “occasionally,” and “most of the time.”

Research Design

As interview candidate results come in, their data will be measured in relation to one another as well as in relation to traditional studies carried out in the field. The research design is constructed as one-on-one interview process, followed up by a questionnaire form that all of the respondents are free to fill out in their own leisure and then bring back to the research team. Previous studies using this research design found that their questionnaires had an 85% response rate out of over 3,000 potential candidates.  This is in large part due to respondent’s engagement and interpersonal interactions that were appreciated and sparked further interest during the initial interview process that carried over into the questionnaire portion of the study.

Statistical Design

The main statistic utilized throughout the study is the metric measurement between actual isolation and perceived isolation. The chart below shows that on a weighted average, perceived isolation is significantly more influential on mental health of respondents than actual social isolation. As previously stated this is in large part due to the fact that perception is largely based on personality traits that are vulnerable to the effects of depressive mood of social anxiety triggers. While social anxiety disorder, social isolation and depression are all aspects of these studies that can easily occur in most individuals following a significant crisis, there is still a specific type of outlook on one’s personal life and social resources that must be attained before one can perceive their way into depression.

Conclusion

In sum, data shows social isolation can have the same effects as smoking nearly 14 packs of cigarettes a day, or enduring severe alcoholism. The physical effects of social isolation can result in everything from high blood pressure and stress, to death.  Its long been a common understanding among medical professionals that stress can be detrimental to one’s health but the notion that there would be such a significant difference between dealing with that stress with a companion verses handling by one’s self is very telling about the nature of social isolation. The aspect of this issue that is most telling has to do with the level of information the medical industry has pertaining to the problem. While doctors are aware the problem is equal to that of smoking and alcoholism in its morbidity rates, they fail to find the distinct connection on the physical level. This suggests there are mysteries to the mind and body connection on which even the contemporary medical profession lacks knowledge. Finally, data shows that those who perceive isolation as a core part of their identity ultimately have more health risks than those who don’t perceive their conditions as socially isolated. The core finding of this research deals with the power and reach of the mind and demonstrates how it many mysteries can be used to save lives.

References

Casserly, M. (2010, September 24). Friends with health benefits. Retrieved from http://www.forbes.com/2010/08/24/health-relationships-longevity-forbes-woman-well-being-social-isolation_2.html

Children’s, Women’s and Seniors Health Branch, British Columbia Ministry of Health. (2004). Social isolation among seniors: an emerging issue. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2004/Social_Isolation_Among_Seniors.pdf

Cornwell , E. and Waite (2009). Social disconnectedness, perceived isolation, and health among older adults. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756979/

Gierveld J. and Hagestad G. (2006). Perspectives on the Integration of Older Men and Women. Research on Aging. 28:627–37.

Graham, J. (2012). The high price of loneliness. The New York Times, Retrieved from http://newoldage.blogs.nytimes.com/2012/06/18/the-high-price-of-loneliness/

House, J. S. (2001). Social isolation kills, but how and why?.Psychosom Med, 63(2), 273-4.

Jones, A., & Sell, S. (2010). Most senior citizens learn to adapt to the loss of a partner. The Washington Post, Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2010/08/09/AR2010080904176.html?sid=ST2010080905283

The Geriatric Mental Health Foundation. (2004). A guide to mental wellness in older age: Recognizing and overcoming depression. Retrieved from http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

The Geriatric Mental Health Foundation. (2009). Anxiety and older adults. Retrieved fromhttp://www.gmhfonline.org/gmhf/consumer/factsheets/anxietybrochure.pdf