Social support and protection from depression

Here in the woods we elves are very attentive to how we support each other. Of course, sharing a passion for the use of evidence does give us a starting point for making connections and helping our fellow elves. But, in all that we do we think about the social support we are giving to each other and how it may help prevent depression. A depressed elf is a very, very sad sight. However, is what we are doing actually worth it? By offering social support to each other, are we helping to protect against depression?

Depression is a major phenomenon across the globe, being a significant contributor to the global burden of disease. Anything we can do to protect people from getting depression and/or helping them to recover more quickly from it will be hugely beneficial to families and societies.

Social support, a broad term encompassing a range of help through having connections with others, is one potential means of helping. There remain, though, many complex questions and gaps in the evidence concerning how this might best work. This systematic review by Gariepy et al. was designed to help us better understand this picture and to help us think about the importance of social support in protecting people from depression.

How important is social support in preventing depression?

Methods

The authors of this paper were interested in the evidence concerning social support and depression. Specifically, they conducted a systematic literature review to summarise existing knowledge on social support and protection from depression. They were also concerned to examine the nature of social support as a potential protective factor across the life course by examining the evidence for three age groups, namely young people, adults and older adults.

Systematic reviews, as discussed on our Elf pages many times, are a structured approach to pulling together, synthesising and analysing all the current evidence on a topic. Their strengths are in being comprehensive, structured and transparent in terms of how the review is conducted, which, amongst other things, allows others to replicate the review if necessary to verify findings. Gariepy and colleagues are very clear about how they undertook the review.

Findings

The authors examined 100 studies and found that overall the evidence supports the view that good social support is a protective factor against depression. The nature of the support varies across the age groups, as we’d probably expect. For young people parental support was most importantly associated with protection from depression. For adults and older adults, spousal support was most salient as a protective factor. Other sources of support were important for each age group.

There were other interesting detailed findings in the paper examining, for example, gender differences in the age groups (e.g. parental support seemed particularly important for girls, and spousal support was more significant in older men than women). Social support from friends was not consistently associated with protection from depression amongst young people. Reciprocity (giving and receiving support) in spousal relations was associated with protection from depression. Emotional support (such as having someone to confide in) was, in adults, more consistently seen as a protective factor than instrumental support (e.g. having someone to help with housework). There was no evidence of a strong protective factor from family for older adults. It seems that, in later life, friends may become more important social support than family (beyond spouses) in terms of potential protection against depression.

In adults, spousal support was found to have the greatest protective effect against depression.

Strengths and limitations

All of these results need interpreting, and here some of the weaknesses in the review become important to consider. An issue is that most studies were cross-sectional, meaning they only collected data from participants at one point in time, which means we can’t examine cause and effect between variables nor changes over time. We can’t be sure that the protective factors discussed above work in the way we might presume or are sustained over time.

Another notable issue was the range of ways in which social support was conceptualized and measured, with close on 100 different measures of social support used across the studies. Such diversity makes it harder to compare and combine the results of different studies. There were similar challenges with how depression was measured across the studies.

There were a lot of important differences between the studies – we need to be cautious in combining the results.

What does this mean for social care policy and practice?

Although there were methodological challenges inherent in the review it does provide some very thought provoking evidence, but, as it wasn’t the purpose of the authors, the paper gives little direct insights for social care policy or practice. There is remains the challenge, then, to be imaginative about how social care policy makers and practitioners might use this evidence.

An initial step ought to be at least to ensure that nothing is done to undermine existing good social relationships and networks. There is a Think Family policy in government (see Cabinet Office Report 2008 and Social Care Institute for Excellence Guide) whose intention was to encourage policy makers and those directly concerned with organizing and delivering services to think more deeply about the nature of family relations and the impact of their work on these. Perhaps we also need a more general Think Relationally policy to encourage these same people to think about everyone’s social support can be supported and enhanced.

At least it is good to know that the attention we give to social support for each other is not wasted.

How would you interpret and use the findings of this review? What do you think the implications are for social care policy, practice and research?