The Impact of Social Relationships on Depressive Symptoms among Older Barbadian Women

Introduction

• Two models have been proposed to explain the relationship between social ties and mental health (Kawachi & Berkman, 2001)– Main effect model – Stress buffering model

• Social ties (Berkman & Glass, 2000) – positive effects on health behaviors and

psychological states or – by promoting access to a greater variety of

types of support

Introduction

• Stress process that leads to depression – Physical limitations (Yang & George, 2005)– Economy insecurity (Krause, 1987)

• Women report higher depression (Wethington, McLoed, Kessler, 1987)– Married women display similar or higher

prevalence of depression compare to single women (Bebbington, 1999)

Introduction

• By the year 2000, 6 Caribbean countries had already found more than 10 % of their populations over the age of 60 years

• By 2025, Barbados and Cuba are projected to be the first countries in the Caribbean with 25% of their population to be over age 60

• On a general note, not much is known of the lives of women over age 60 in the Caribbean

Specific Aims

1. Examine how social relationships acts as buffers in the presence of life stressors

2. Examine how social support affect older Barbadian women’s depressive symptomology across types of living conditions

Methods• Survey on Health and Well-Being of Elders

– Seven cities in Latin America and Caribbean Bridgetown, Barbados

– The national electoral registry, which is updated periodically, was used to calculate the sample

– Response rate 85%– Female = 924/ Male = 888

• Measurements– Abbreviated Geriatric Depression Scale – Self Reported Health

Methods

• MMSE score of <12 OR Pfeffer score of >6 (N = 867)

• Outcome variable: Geriatric Depression Scale– Cut-off point 6/7

• Independent variable: Functional social network

• Control variables: age, levels of education, ethnicity,

Table 1. Sample Characteristics of Barbadian Older Women

N (%) µ (sd)Age Group N = 924 72.9 (8.6) 60 to 69 years 309 (42.2) 70 to 79 years 320 (34.6) 80 and older 214 (23.1)Ethnic Background N = 924 White 49 (5.4) Black 738 (80.9) Mulatto 112 (12.3) Other 13 (1.4)Levels of Education N = 919 5.15 (3.2) None 21 (2.3) Primary 714 (77.7) Secondary 148 (16.1) Higher 36 (3.9)Born in Barbados N = 924 Yes 807 (87.3) No 117 (12.7)

Table 2. Characteristics of Social Network Structure of Older Barbadian Women

Marital Status N = 913 %

Single 236 25.8

Married or cohabiting 217 23.8

Widowed 316 34.6 Separated or divorced 144 15.8

Living arrangement N = 924

Alone 219 23.7

With someone 705 76.3

Living arrangement of children N = 910

Yes 858 94.3

No 43 4.7

Does not know 9 1

Table 3. Health Status

%

Self-rated health N = 924 Excellent 23 2.5 Very good to Good 398 43.0 Fair to Poor 499 54.0 Does not know 4 0.4Hypertension N = 923 Yes 496 53.7Type-2 Diabetes N = 920 Yes 218 23.7Cancer N = 922 Yes 32 3.5Chronic Lung Disease N = 922 Yes 43 4.7Heart Condition N = 923 Yes 106 11.5Cerebral Embolism N = 917 Yes 59 6.4Arthritis N = 923 Yes 533 57.7Fallen in the last 12 months N = 918 Yes 263 28.6

Table 4. Odds Ratios and 95% CI obtained from Logistic Regression Analysis for Depressive Symptoms by Social Network Structure and Characteristics

Independent Variable β SE OR (95%CI) p-value

Age -0.002 0.031 0.003 (0.939 – 1.061) 0.954

Race

Black 1.0 (ref)

Non-Black 0.366 0.767 0.77 (0.320 – 6.486) 0.227

Education -0.028 0.085 0.11 (0.823 – 1.148) 0.738

Marital Status

Married 1.0 (ref)

Single 1.482 1.632 1.6 (0.453 – 42.756) 0.201

Not Married 2.038 1.101 3.4 (0886 – 66.403) 0.064

Widowed 2.573 1.087 5.6 (1.556 – 110.455) 0.018

Living arrangement

Alone 1.0 (ref)

With someone -0.257 0.653 0.155 (0.215 – 2.780) .694

Conclusion

• Women less likely to be married but more likely to live with someone (i.e., children)

• Women appear to benefit from having some of their children living inside the home

• Social relationships have important buffering properties

• Public health implications: interventions that are family-focused

• Future research: Links to reciprocity between provider and recipients

Acknowledge

• Samatha Pittman, BS• Diana Arellego• Ayumi Irie, BS