Social Suffering Among Older Adults in Puerto Rico: The Association of Loneliness and Social Isolations with Mental Health Two Years after Hurricane Mariã¡

Background and Purpose

Social resource theory defines resources as any concrete or symbolic item that can be used as an object of interpersonal exchange. Examples are tangible items (money, information, goods/ services) and less tangible concepts (love/affection, sense of belonging, status). Social resources, particularly social isolation and loneliness are known to affect older adults’ mental health. These two types of resources are highly context-dependent and independently affect mental health outcomes. When Hurricane Mariá hit Puerto Rico in 2017, the island was aging and in deep demographic and economic decline due to massive labor out-migration of young adults. This study examines the association of loneliness and social isolation with the mental health of older adults in Puerto Rico two years after Mariá. We hypothesize: 1) poor mental health will remain problematic for a sizable proportion of older adults, and 2) loneliness, but not social isolation, will contribute to poor mental health.

Methods

We conducted face-to-face interviews with 154 community-dwelling adults aged 60+ in 10 of the island’s 78 municipalities. We recruited participants in their homes, senior centers, public spaces, and by word-of-mouth. Interviews lasted about one hour; 86% were in Spanish. Ages ranged from 60-97 (M = 73.77, SD = 8.67); 61.7% of participants were female, 65.6% were unmarried and 54.5% lived alone; half had completed high school and overall median income was $9,552. We translated and back-translated the data collection instrument using standard protocols and, when available, validated scales. We assessed social isolation with the Lubben Social Network Scale (LSNS-6; α = .74, M = 14.00, SD = 5.99, range = 0–30), loneliness with the brief UCLA Loneliness Scale (α = .81, M = 5.20, SD = 1.97, range 3-9), and mental health with the Self-Report Questionnaire (SRQ-20) (α = .88, M = 6.64, SD = 5.13, range 0-20). Higher scores indicate stronger networks, greater loneliness and more distress. Data met assumptions for linear regression, and we used hierarchical modeling to test the multivariate hypothesis.

Results

Using established clinical cutoffs, 34% of participants were at risk for social isolation (LSNS-6 <12), 42% were lonely (UCLA Loneliness Scale >5), and 42% screened positive for common mental disorder (SRQ-20 >7). Loneliness was positively associated with scores on the SRQ-20 (B = .966, SE = .209, p<.001); social isolation was not. Self-rated health (B = -2.139, SE = 0.767, p<0.01) and low resilient coping (B = -.370, SE = .138, p<0.01) were also associated with worse mental health.

Conclusions and Implications

This study supports previous findings that older adults experience heightened risks, including enduring mental distress, associated with natural disasters. Likewise, our finding that loneliness (but not social isolation) was associated with mental health adds to theoretical knowledge about the conditions under which specific types of social resources may be best indicated. Finally, we conclude that future research and the planning and deployment of short- and long-term social resources for older adults after natural disasters should consider the impact of existing and emergent structural problems in the local context on prolonged social suffering.