Depression, Smoking, and Ego-Centric Social Network Characteristics in Ohio Appalachian Women

Abstract

Depression is a serious, costly, and debilitating disorder that is understudied in rural women. Studies show that depression is associated with low social integration and support, but few studies investigate the relationship between depression and social network characteristics. This study examined the associations among women from three Ohio Appalachian counties enrolled in a health study, which aimed to collect information for a future social network smoking cessation intervention. An address-based sampling method was used to randomly select and recruit 404 women. A cross-sectional survey and interview were used to collect information about demographic, psychosocial, behavioral factors, and ego-centric social network characteristics, which are variables derived from an individual (ego) and her first degree contacts (alters). The CES-D scale assessed depressive symptoms. A multivariable logistic regression analysis described the association between these factors and participants with depression (defined as CES-D≥16). Higher network density, or greater number of relationships among alters divided by the total amount of alters, reduced the risk for depression (OR = 0.84, 95% confidence interval [CI] 0.73-0.95). Additionally, women with a high percentage of smoking alters were at greater risk for depression (OR = 1.19, 95% CI 1.02-1.39). Other factors associated with risk for depression included perceived stress score (OR = 1.34, 95% CI 1.24-1.45), loneliness score (OR = 1.37, 95% CI 1.05-1.80), and days with poor physical health (OR = 1.06, 95% CI 1.02-1.11). Findings suggest that psychosocial factors and social networks should be considered when addressing depression in clinical practice.

Keywords: Appalachia; Depression; mental health; social network characteristics.

Figure 1

This figure depicts the social network of one chosen participant in the study. The white circle denotes the ego, a smoker in this example. The black circles denote smoking alters, and the grey circles denote nonsmoking alters. See Table 1 for example calculations of social network constructs.