The relationship between social support, personality and depression in the general population : Focusing on older people

Abstract: Today's wide variety of diseases and health problems areinfluenced in part by an aging population and by environmental andlifestyle changes. Depression is one of the most quickly growingdisorders, causing a huge decrease in quality of life. Depression alsoincreases with age. The expected increase in the number of olderpeople in the years to come might lead to an increasing problem ofincreased case loads for primary health care in the coming years asthe delivery of healthcare services shifts from clinical settings to thehome. People who lack social support are more likely to experiencepoorer quality of life, including depression. Personality is a robustpredictor of behaviour and essential life outcomes. The aim of thisthesis is to describe the relationship between social support,personality and depression in the general population, with a focus onolder people.This thesis used data from the Nord-Trondelag Health Study(HUNT), a large census population survey in Norway. Paper I (n=40,659), II (n= 35,832), and III (n=35,797) used data from HUNT3(2006-2008), and Paper IV (n=25,626) used data from both HUNT2(1995-1997) and HUNT3. Paper I, II, and III used cross-sectionaldesigns and paper IV used a longitudinal design. The age of thesample was 20−89, divided into three age-groups: 20−64 years(adults), 65−74 years (old), and 75−89 years (oldest old). Depressionwas measured with the Hospital Anxiety and Depression Scale(HADS in the HUNT2 and 3), personality was measured with a shortversion of the Eysenck Personality Questionnaire (EPQ in theHUNT3), and social support was examined with single questionsabout perceived support from friends (HUNT2 and 3).iiiThe main finding in Paper I was that self-rated perceived supportwas significantly associated with depression, even after controllingfor age and gender, emotional support (OR = 3.14), and tangiblesupport (OR = 2.93). The effects of emotional and tangible supportdiffer between genders. Interaction effects were found for age groupsas well as emotional and tangible support. Paper II showed arelationship between depression and both neuroticism andextraversion in a general population. Older people are more likely toscore low on extraversion (E) than younger people. Interactions wereobserved between neuroticism and age, neuroticism and gender, andextraversion with depression. The interaction terms indicates a highscore on neuroticism (N) is enhanced by introversion, older age, andbeing a male with depression. Paper III showed a significantassociation between levels of perceived social support, personality,sense of community in the neighbourhood, and civic participation.Women frequently reported higher levels of social support, andhigher scores on both extraversion and neuroticism than men, whilemen reported higher sense of community in the neighbourhood andlevels of civic participation than women. Paper IV showed that riskfactors had a greater effect on new cases than on recovery fromdepression. The greatest association with new cases of depressionwas found for male sex, the oldest age group, melancholics, thosewho lacked social support, those who never participated in socialactivities, those with decreasing community in the neighbourhood,those with poor health, and those who have gotten divorced. Thegreatest association with recovery from depression was found forfemale sex, sanguine temperament, those with social support, thosewho participated in social activities, those with increasingivcommunity in the neighbourhood, and those who have obtainedbetter health.The findings show that both social support and personality arerisk factors for developing depression. Nurses should put extra effortinto how they care for patients with low extraversion, highneuroticism and, low social support in order to help these patientsavoid depression. Nurses have to "see the patient" and "care about",and respect patient’s values, preferences and expressed needs.