Elsevier

Journal of Affective Disorders

Volume 175, 1 April 2015, Pages 53-65
Journal of Affective Disorders

Review
The association between social relationships and depression: A systematic review

https://doi.org/10.1016/j.jad.2014.12.049Get rights and content

Abstract

Background

Depression is one of the most prevalent mental disorders globally and has implications for various aspects of everyday-life. To date, studies assessing the association between social relationships and depression have provided conflicting results. The aim of this paper was to review the evidence on associations between social relationships and depression in the general population.

Methods

Studies investigating the association of social support, social networks, or social connectedness with depression were retrieved and summarized (searches using Pubmed, ScienceDirect, PsycNet were conducted in May 2014).

Results

Fifty-one studies were included in this review. The strongest and most consistent findings were significant protective effects of perceived emotional support, perceived instrumental support, and large, diverse social networks. Little evidence was found on whether social connectedness is related to depression, as was also the case for negative interactions.

Limitations

Due to the strict inclusion criteria relating to study quality and the availability of papers in the domain of interest, the review did not capture ā€˜gray literatureā€™ and qualitative studies.

Conclusion

Future research is warranted to account for potential bias introduced by the use of subjective measures as compared to objective measures of received support and actual networks. Due to the heterogeneity between available studies on the measure of social relationships, the inclusion of comparable measures across studies would allow for more valid comparisons. In addition, well-designed prospective studies will provide more insight into causality. Future research should address how social support and networks interact and together affect risks for depression. Social connectedness and negative interactions appear to be underutilized as measures in population-based studies.

Introduction

Depression is arguably one of the most prevalent and prominent mental disorders of our time, touching the lives of people across nations, ages, and social and cultural groups. The Global Burden of Disease Study 2010 has identified depressive disorders as the second leading cause of years lived with disability, designating it a as a major public-health priority (Ferrari et al., 2013). Besides depression being a serious and debilitating disorder in and of itself, it has various negative consequences for physical health (Prince et al., 2007). At worst, depression can lead to suicide (Ferrari et al., 2013), and 15% of those who are clinically depressed die by suicide (Verster et al., 2008). Further, the economic consequences of depression are substantial. The costs of mood disorders in Europe for the year 2010 has been estimated to be ā‚¬ PPP 113.4 billion (Gustavsson et al., 2011). Almost half of these costs is the result of productivity loss, implying the vast negative impact of depression on populations׳ economy and sustainability. Depression has been found to be associated with a wide range of factors such as female gender, somatic illness, and cognitive and functional impairments. Additionally, loss of close social contacts has been found to be an important predictor of depression, along with various other variables relating to social relationships (Djernes, 2006).

Social relationships have important implications for both physical and mental health. The state of one׳s social relationships can affect that person׳s overall health. Specifically, according to evidence from a recent review, good social relationships can prolong survival by 50% (Holt-Lundstad et al., 2010). A seven-decade follow-up study discovered that social relationships are better predictors of health than a range of biological and economic factors (Vaillant, 2008). Similarly, Holt-Lundstad et al. (2010) reported that having poor social relationships is potentially more harmful than excessive drinking and smoking, obesity, and lack of exercise.

Studies investigating social relationships generally pertain to three major domains: social support, social networks, and social connectedness (Ashida and Heaney, 2008, Barratt et al., 2006, Noone and Stephens, 2014, Ottmann et al., 2006, Stone, 2003). Social support has long been known to exert considerable influence on mental health and wellbeing (Thoits, 2011). The literature distinguishes between perceived and received (or enacted) social support. Perceived support is the subjective feeling of being supported by one׳s relationships, while received support refers to the actual support provided. The literature on social support further distinguishes between emotional support (e.g. someone being available to listen or offer sympathy during times of crisis or hardship, or someone available to give advice) and instrumental support (e.g. someone available to offer help with issues that require physical effort or financial aid). All these different forms of social support appear to have different implications for mental health (Nurullah, 2012). Support may also be provided to or received from different sources, such as spouse, children, relatives, friends, and co-workers. It has been demonstrated that the role and effect of social support on health and psychological well-being varies depending on the source of support (Li et al., 2014, Walen and Lachman, 2000). Finally, as an opposite measure of supportive behaviors, some studies also include negative interactions (strain), such as tension, criticism, or placing too strong demands on others (Schuster et al. 1990).

Social relationships can be more clearly distinguished in terms of their network structure (i.e. social networks) and network function (i.e. social support) (House, 1987). Thus, while the term social support relates to the functional content in social relationships, social networks is a concept that relates to the formal structure of social relationships, such as size, composition, contact frequency, boundedness, etc. (Prince et al., 1997). Studies on social networks have been characterized by investigating the web of social connections that surrounds an individual and this has been shown to have important associations with both physical and mental health (Smith and Christakis, 2008). Two distinct approaches exist for assessing social networks: egocentric and sociocentric approaches. Egocentric models include data from individuals about members in their network, whereas sociocentric models utilize not only the network information from each individual, but also information from the network members themselves. As a consequence, sociometric models often yield more novel insights, but also make much greater demands of data (Smith and Christakis, 2008). Another insightful way to examine social networks is to categorize them into network types, such as network composition (e.g. the level of diversity of family members, friends, and coworkers in a network) and other measures, such as social engagement. Network types thus tend to encompass a more comprehensive assessment of network properties and can be particularly informative (e.g. Litwin and Landau, 2000).

Finally, social connectedness refers to the degree to which a person experiences belongingness, attachment, relatedness, togetherness, or entrenchment in one׳s social relationships. Thus, it refers more to subjective feelings and attitudes towards oneself in relation to the social context, rather than specific social relationships (Townsend and McWhirter, 2005, Williams and Galliher, 2006). The literature also makes use of the term ā€˜social disconnectednessā€™ to refer to conditions of social isolation, such as living alone, physical separation from others, widowhood, etc. (Cornwell and Waite, 2009a, Cornwell and Waite, 2009b, Zavaleta et al., 2014).

A number of recent reviews have been published that address the influence of social relationships on populations׳ health status (Holt-Lundstad et al., 2010, Smith and Christakis, 2008; Tajvar et al., 2013; Uchino, 2006). However, the evidence in the literature concerning the influence of social relationships on mental illness, particularly for depression, is often conflicting or sparse (Nurullah, 2012). Moreover, many studies on social relationships employ non-probability or convenience sampling, which considerably limits the degree to which one can extrapolate findings and draw conclusions about the influence of global network and support properties in the general population (Smith and Christakis, 2008). Thus, this work focuses on population-based studies that investigate the association between social relationships (social support, social networks, and social connectedness) and depression.

Section snippets

Search strategy

The electronic databases of PsycInfo/PsycNet, PubMed/MedLine, and ScienceDirect were searched for studies measuring the association between social networks, social support, or social connectedness, and depression. Search words were customized for each database, and each search involved combining key word searches for a list of social relationships variables (ā€˜social supportā€™, ā€˜peer supportā€™, ā€˜emotional supportā€™, ā€˜social networksā€™, ā€˜social relationshipā€™, ā€˜social connectednessā€™, ā€˜belongingnessā€™)

Results

The review included 28 cross-sectional and 23 prospective studies. According to quality criteria set forth by the Effective Public Health Practice Project (Armijo-Olivo et al., 2012, Thomas et al., 2004), nine studies were rated as ā€˜low qualityā€™ (9/51=17.6%), 30 studies were rated as ā€˜moderate qualityā€™ (30/51=58.8%), and 12 studies were rated as ā€˜high qualityā€™ (12/51=23.6%). Of those rated as ā€˜lowā€™, seven were cross-sectional, and two were prospective studies. Of those rated as ā€˜moderateā€™, 21

Social support

There was a general consensus that perceived support is more important than received support, and there was also overwhelming evidence that the perceived emotional variant consistently played a protective role against depression across general populations. A considerable amount of good quality studies demonstrated a causal direction from perceived social support to depression through prospective analyses. Also, there was some indication that negative interactions are important risk factors for

Conclusion

This review provides some confirmation that perceived social support and larger, diverse social networks, in particular, play important protective roles against depression in the general population, including those with chronic somatic illness or disability. However, some challenges persist and must be addressed. First, studies are needed to address how people׳s perceptions of social support and networks, as compared to objective measures, affect the association between social relationships and

Role of funding source

None declared.

Conflict of interest

None of the authors have any interests to declare in relation to this submission.

Acknowledgments

The research leading to these results has received funding from the People Programme (Marie Curie Actions) of the European Union׳s Seventh Framework Programme FP7/2007ā€“2013 under REA Grant agreement no. 316795.

Ai Koyanagi׳s work was supported by the Miguel Servet contract by CIBERSAM, Grant agreement no. CP13/00150.

Stefano Tyrovolas׳ work was funded through a scholarship from the Foundation for Education and European Culture (IPEP).

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