Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands.
Department of Geriatric Psychiatry,Arkin Mental Health Care,Amsterdam,The Netherlands.
Epidemiol Psychiatr Sci. 2018 Jun;27(3):266-277. doi: 10.1017/S2045796017000014. Epub 2017 Feb 10.
Poor recovery from depressive disorder has been shown to be related to low perceived social support and loneliness, but not to social network size or frequency of social interactions. Some studies suggest that the significance of social relationships for depression course may be greater in younger than in older patients, and may differ between men and women. None of the studies examined to what extent the different aspects of social relationships have unique or overlapping predictive values for depression course. It is the aim of the present study to examine the differential predictive values of social network characteristics, social support and loneliness for the course of depressive disorder, and to test whether these predictive associations are modified by gender or age.
Two naturalistic cohort studies with the same design and overlapping instruments were combined to obtain a study sample of 1474 patients with a major depressive disorder, of whom 1181 (80.1%) could be studied over a 2-year period. Social relational variables were assessed at baseline. Two aspects of depression course were studied: remission at 2-year follow-up and change in depression severity over the follow-up period. By means of logistic regression and random coefficient analysis, the individual and combined predictive values of the different social relational variables for depression course were studied, controlling for potential confounders and checking for effect modification by age (below 60 v. 60 years or older) and gender.
Multiple aspects of the social network, social support and loneliness were related to depression course, independent of potential confounders - including depression severity - but when combined, their predictive values were found to overlap to a large extent. Only the social network characteristic of living in a larger household, the social support characteristic of few negative experiences with the support from a partner or close friend, and limited feelings of loneliness proved to have unique predictive value for a favourable course of depression. Little evidence was found for effect modification by gender or age.
If depressed persons experience difficulties in their social relationships, this may impede their recovery. Special attention for interpersonal problems, social isolation and feelings of loneliness seems warranted in depression treatment and relapse prevention. It will be of great interest to test whether social relational interventions can contribute to better recovery and relapse prevention of depressive disorder.
研究表明，抑郁障碍恢复不良与感知社会支持低和孤独感有关，但与社交网络规模或社交互动频率无关。一些研究表明，社交关系对年轻患者抑郁病程的意义可能大于老年患者，并且在男性和女性之间可能有所不同。没有研究探讨社交关系的不同方面对抑郁病程的预测价值是否具有独特性或重叠性。本研究旨在检查社交网络特征、社会支持和孤独感对抑郁障碍病程的预测价值，并检验这些预测关联是否因性别或年龄而有所改变。
将具有相同设计和重叠工具的两项自然队列研究合并，获得了 1474 名患有重度抑郁症的患者研究样本，其中 1181 名（80.1%）可在 2 年期间进行研究。在基线时评估社会关系变量。研究了两个方面的抑郁病程：2 年随访时的缓解和随访期间抑郁严重程度的变化。通过逻辑回归和随机系数分析，在控制潜在混杂因素的情况下，研究了不同社会关系变量对抑郁病程的个体和综合预测价值，并检查了年龄（<60 岁与≥60 岁）和性别对这些关联的影响。
社交网络、社会支持和孤独感的多个方面与抑郁病程有关，与潜在混杂因素（包括抑郁严重程度）无关，但当它们结合在一起时，发现它们的预测价值有很大程度的重叠。只有居住在较大家庭的社交网络特征、来自伴侣或亲密朋友的支持方面负面体验少的社会支持特征以及有限的孤独感，对抑郁的良好病程具有独特的预测价值。几乎没有证据表明性别或年龄存在调节作用。
如果抑郁患者在社交关系方面存在困难，这可能会阻碍他们的康复。在抑郁治疗和复发预防中，特别关注人际关系问题、社交孤立和孤独感是值得的。测试社交关系干预是否可以促进抑郁障碍的更好康复和复发预防将非常有趣。
