The Association Between Objective and Subjective Social Isolation, Depressive Symptoms, and Psychological Distress Among Older Adults

BACKGROUND/PURPOSE

Social isolation among older adults is associated with many negative health and well-being outcomes, including increased risk of mortality, poorer self-rated health, cognitive decline, depressive symptoms, and psychological distress.  However, only a few studies examine the combined effects of both objective isolation and subjective isolation on depressive symptoms and psychological distress. Furthermore, few studies compare the mental health effects of isolation from family versus isolation from friends. This study begins to address these gaps with the following research question: What are the combined and differential impacts of objective and subjective social isolation on depressive symptoms and psychological distress?

METHODS

This study uses the National Survey of American Life (NSAL), a nationally representative secondary dataset of African Americans, Black Caribbeans, and Whites. Data collection for the NSAL was conducted through a national multi-stage probability design between the years 2001-2003. The overall response rate was 72.3%. This study utilizes the older adult subsample (55 and up). Depressive symptoms were measured by the CES-D scale and psychological distress was measured by the Kessler-6. Objective isolation was operationalized into four categories based on frequency of contact with family members and friends: 1) isolated from both family and friends; 2) isolated from family members only; 3) isolated from friends only; 4) isolated from neither group. Subjective isolation was operationalized in a similar manner based on subjective closeness with family members and friends. Multivariate regression analyses was conducted with a range of covariates.

RESULTS

In regards to objective isolation, 5% (n=64) were isolated from both family members and friends, 7% (n=89) were isolated from family only, 12% (n=164) were isolated from friends only, and 76% (n=1090) were not isolated from either group. For subjective isolation, 1% (n=25) were isolated from both family and friends, 3% (n=42) were isolated from family only, 10% (n=128) were isolated from friends only, and 86% (n=1182) were not isolated from either group. Multivariate regression analyses found older adults who were subjectively isolated from both family and friends, and older adults subjectively isolated from friends only had significantly greater depressive symptoms in comparison to older adults who were not subjectively isolated from either group (p<.05 for both). Furthermore, older adults who were subjectively isolated from friends only had significantly higher psychological distress in comparison to older adults who were not subjectively isolated from family or friends (p<.05).

CONCLUSION/IMPLICATIONS

These findings illustrate the importance of assessing social isolation for mental health outcomes and that different types of social isolation may have a stronger association with specific health outcomes.  Subjective isolation from friends and family was related to higher depressive symptoms and psychological distress. Subjective family and friendship isolation could result from changing social roles, losses due to deaths, or emotional estrangement. Future research should continue to assess the impacts of both objective and subjective social isolation on mental health outcomes.  Clinicians working with older adults should assess the qualitative features of friend and family relationships when addressing depressive symptoms or psychological distress.