The Role of Social Isolation and Chronic Pain in Depression Among Older Adults

Background: Depression among older adults is central to quality of life, with implications for morbidity and mortality outcomes in this population. Chronic pain which affects more than 50% of older adults is strongly associated with depressive symptoms (Fitzcharles et al., 2010). Social isolation, also a common concern for older adults, may in fact intensify the association between chronic pain and depression. The present study explores the relationship between chronic pain and social isolation on self-reported depression within a sample of community-dwelling older adults.

Methods: This study was a partnership with a large, community-based not-for-profit organization that provides a range of housing options for seniors in a larger, midwestern metropolitan area. The present analysis includes survey data collected from 1,113 older adults (60 years of age and older) residing in 27 independent, subsidized housing communities for low-income seniors (i.e., HUD Section 202 properties). A series of self-report physical and mental health measures were collected with the assistance of organization staff. These included the following single-item measures employed in the current analysis: feeling down, depressed or hopeless (yes/no), experience chronic pain (yes/no), feeling socially isolated from other people (never/sometimes or more often). Multilevel modeling was employed for the analysis due to the clustering of residents in multiple affordable housing communities and predictive margins were estimated to better explicate the interaction between chronic pain and social isolation. All analyses were completed in Stata/MP 16.0.

Results: Controlling for a range of sociodemographic variables, the final model found that the relationship between chronic pain and depression is moderated by perceived social isolation. Specifically, the predicted probability of depression among those who report neither chronic pain nor social isolation is 0.083 (95% CI: 0.051, 0.115) and increases to 0.192 (95% CI: 0.132, 0.252) for individuals reporting chronic pain but do not feel socially isolated. This interaction was statistically significant (p<0.001). The predicted probability of depression for those who report feeling socially isolated but did not have chronic pain was 0.391 (95% CI: 0.289, 0.493) and 0.443 for those with chronic pain (95% CI: 0.345, 0.541), although there was not a statistically significant difference between these two groups (p=0.38).

Conclusion and Implications: Both chronic pain and social isolation are associated with feelings of depression, yet these variables interact to worsen the probability of depression. In this study, the absence of social isolation significantly buffered the impact of pain on depression. Future research should examine the qualities of social support and social cohesion that most effectively buffer the impact of chronic pain for older adults. Such research might inform interventions that enhance social support structures and functions to reduce the impact of chronic pain on quality of life for older adults. While chronic pain can be difficult to manage, future research should explore the ways in which efforts to decrease social isolation can benefit all older adults, but especially individuals who experience chronic pain.