Longitudinal Examination of Stress and Depression in Older Adults Over a 2-Year Period: Moderation Effect of Varied Social Support Measures

Abstract

Depressive symptoms and stress exposure fluctuate over time in community-dwelling older adults, but they are frequently assessed using one-time retrospective self-report measures. Social support viewed as a multifaceted construct can play diverse moderating roles in this association although it is typically gauged through the measure of perceived social support. This study aims to explore the relationships between stress, social support, and depressive symptoms among older adults by utilizing the longitudinal data collected through a smartphone application and supplemented by annual face-to-face interviews conducted over a 2-year period. Using longitudinal multilevel analysis, we analyzed the data on PHQ-9, stress exposure, and four distinct measures of social support collected from 354 community-dwelling older adults in South Korea. The results demonstrated that 59% of the variability in depressive symptoms was attributable to differences between individuals. Stress exposure was a strong predictor (γ = 3.01⁣ ^∗∗∗ , 95% CI = 2.34-3.67). As expected, positive functional social support alleviated the effects of stress on depression (γ = -1.12⁣ ^∗∗ , 95% CI = -1.92 ~ -0.32) while negative functional social support (γ = 2.36⁣ ^∗∗∗ , 95% CI = 1.29-3.44) and negative structural social support (γ = 3.22⁣ ^∗ , 95% CI = 0.79-5.64) worsened the effects of stress on depression. A notable finding is that stress-amplifying effects from the negative functional and structural social support, in addition to well-known stress-buffering effects from positive functional social support, should be regarded as indispensable components in safeguarding the mental health of older adults. Considering the decline in social interactions and the lower probability of older adults establishing new social connections, it is essential to consider approaches that prevent a lack of functional and structural social support and foster a high-quality of functional and structural social support, particularly for those facing greater stressors, as a preventative method against depressive symptoms.

Keywords: depression; functional social support; older adults; stress; structural social support.

Figure 1

Longitudinal changes in individual depressive symptoms over 2 years and the average depressive symptom trajectories of the whole sample during the period (N = 354).

Figure 2

Moderation by positive and negative functional or structural social support on the association between stress and self-report depressive symptoms: (a) positive functional social support; (b) positive structural social support; (c) negative functional social support; (d) negative structural social support.