Longitudinal Relationships Among Social, Mental, and Physical Factors in Later Life

Background

Previous literature has documented the inter-relationships among physical health, mental health, and social factors. More specifically, older adults are more likely to experience mental health problems because they are at a high risk for deterioration in physical functioning with age; further, those with greater levels of mental health problems showed poorer physical health status. Support from neighbors and monitoring individuals in community increase community safety and prevent escalation of problems by reporting and facilitating tangible assistance. As a result, social cohesion acted as a protective factor against poor health for those who lived in neighborhoods characterized by low to moderate disorder.

Studies also reported close association of social factors and mental health. Mair and colleagues (2010) reported that neighborhood social supports such as social cohesion, reciprocal exchange, and social ties were associated with lower levels of depressive symptoms in women. In addition, social factors including social cohesion acted as a buffer against the adverse effects of being single and low income on the well-being of older. However, limited studies evaluated a reciprocal relation among functional limitations, mental health, and social cohesion over time. Therefore, this study investigated the longitudinal relationships among physical health, mental health problems, and social cohesion over time.

Methods

We used data from the 8 waves of the National Health and Aging Trends Study that collected between 2011 and 2018. Study sample included older adults dwelling in community and residential care facilities at round 1. After removing proxy respondents at round 1, deceased cases, and dropped cases through round 2 and round 8, the final sample size was 2,774 in the present study. This study focused on understanding the longitudinal relationships among social cohesion, functional disabilities (activities of daily livings) and mental health measured with the Patient Health Questionnaire-4 , which is a brief instrument for depression and anxiety. Time-invariant (age, gender, race, education) covariates were included into the final model and controlled at wave 1. We used an autoregressive cross-lagged model to test a reciprocal relation among functional limitations, mental health, and social cohesion over time.

Results

The model fit for the autoregressive cross-lagged model was good (χ² = 1609.33, p<.001; CFI = .952; RMSEA = .05; and SRMR = .07). The results revealed that mental health and functional disability consistently influenced each other through 8waves. Social cohesion consistently influenced mental health status over 8 waves but influenced functional disability only two times. Mental health influenced social cohesion only two times. However, functional disability does not impact social cohesion.

Conclusions and Implications

As social, mental, and physical factors are closely associated, the relation of those factors need to be considered together. This longitudinal study identified the protective role of social cohesion for mental health in later life. This study also revealed the reciprocal relationship between mental and physical health. Therefore, social cohesion can change mental health problems, which may influence functional disability. Based on the study’s findings, a community-based program that increases social cohesion among older adults can be effective for their mental and physical.