People who engage in relationships in which they receive little or no emotional support have a much higher risk of developing depression, reports Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2012-2014) Alan Teo, MD, MS.
“As a psychiatrist, I’ve worked with a number of patients who were socially isolated, to differing degrees, but otherwise healthy,” Teo said. “So I decided to look closely at the impact of social ties on mental health. Because the World Health Organization rates depression as the number three contributor [it’s expected to become number one by 2020] to the burden of disease worldwide, I wanted to learn more about how it develops over the life course.”
A New Perspective on Depression
As a result, Teo’s work is one of the first nationally representative studies to follow a cohort over 10 years to understand the link between depression and social interaction. “We used data from the Midlife in the United States [MIDUS] survey,” Teo said. Results were drawn by examining 4,642 adults ages 25-75 at study baseline.
Participants were asked: How much does your spouse or partner really care about you? How much does he or she understand the way you feel about things? How much can you rely on him or her for help if you have a serious problem? And, how much can you open up to him or her if you need to talk about your worries? Additional questions included: How often does your spouse or partner make too many demands on you? How often does he or she criticize you? And, how often does he or she get on your nerves? The same list of questions was used to assess feelings about other family members and friends.
In the article “Social Relationships and Depression: Ten-Year Follow-Up from a Nationally Representative Study,” published online in May in PLOS ONE, Teo and his colleagues reported that respondents who felt unsupported by their spouses were at the highest risk of developing depression, followed by those who were let down by family members. Poor relationships with friends did not predict depression.
“Women with the lowest level of spousal emotional and social support had a 17 percent chance of becoming depressed. Women with the highest levels of spousal support were only 8 percent more likely to develop depression over a decade,” Teo explained.
“Men who received the lowest level of support from their wives had a 10 percent chance of becoming depressed. Those who had highly supportive wives only experienced a 4.6 percent chance of depression over 10 years,” Teo added.
The Surprising Benefit of Solitude
Other research has confirmed that women are more prone to depression than men and that unhappy spouses make each other miserable. “But I was surprised to find that people who were not in contact with family or friends had little or no increased risk of depression over the study period,” Teo said.
Not only did Teo’s results show that people fare worse in unsupportive relationships, the study also revealed that simply having a relationship with a spouse, family member or friend would not prevent depression, as other research has suggested.
Social isolation was assessed by asking if a study participant lived with a marital or romantic partner. The frequency of contact with family, friends and neighbors was also measured. Contact was defined as phone calls, letters, visits or email.
Feelings Do Matter
Teo’s findings underscore the critical role that emotional support plays in mental health, but it is also a reminder that it’s more important to have high-quality relationships than a high quantity of them.
“The other point I would like to emphasize, especially to other researchers, is that people’s subjective perceptions are the most important thing to measure when assessing depression and relationships,” Teo said. “Some scientists consider personal feelings soft data, but how people genuinely feel about the other people in their lives counts far more than looking at biomarkers to measure depression.”