Regular Research Article| Volume 29, ISSUE 8, P843-852, August 2021

Perceived Social Support and Interpersonal Functioning as Predictors of Treatment Response Among Depressed Older Adults

Published:December 21, 2020DOI:


      • What is the primary question addressed by this study? Do components of social isolation including marital status, percieved social support and interpersonal problems predict change in depression severity over the course of a brief adherence intervention for older adults?
      • What is the main finding of this study? Our analyses showed that being married and reporting greater social support and less interpersonal problems predicted greater treatment benefits over time.
      • What is the meaning of the finding? Social variables may reduce older adults' vulnerability to depression and enhance their ability to benefit from treatment.



      Social isolation is highly common in late life and is associated with devastating mental health and physical outcomes. This study investigated whether components of social isolation (marital status, perceived social support, and interpersonal problems) predict change in depression severity over the course of a brief adherence intervention delivered in a primary care setting.


      A sample of 189 older adults with major depressive disorder were randomized to either an adherence intervention, “Treatment Initiation Program,” or treatment as usual. Marital status, perceived social support and interpersonal problems were assessed at baseline. A mixed-effects regression was used to test whether these factors predicted the change trajectory in depression severity over 24 weeks.


      Being married (F(2,176) = 6.60; p = 0.001), reporting higher perceived social support (F(2,177) = 4.70; p = 0.01), and fewer interpersonal problems (F(2, 176) = 4.34; p = 0.01) predicted lower depression severity on average over the course of 24 weeks.


      Social variables such as living in partnership, perceiving others as supportive, and reporting few interpersonal problems may reduce older adults’ vulnerability to depression and enhance their ability to benefit from treatment. These findings can guide development of interventions that will target these social factors early in treatment to increase efficacy.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Geriatric Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Golden J
        • Conroy RM
        • Bruce I
        • et al.
        Loneliness, social support networks, mood and wellbeing in community-dwelling elderly.
        Int J Geriatr Psychiatry. 2009; 24: 694-700
        • Cornwell B
        • Laumann EO
        • Schumm LP
        The social connectedness of older adults: a national profile.
        Am Sociol Rev. 2008; 73: 185-203
        • Nicholson NR
        A review of social isolation: an important but underassessed condition in older adults.
        J Prim Prev. 2012; 33: 137-152
        • Perissinotto CM
        • Cenzer IS
        • Covinsky KE
        Loneliness in older persons: a predictor of functional decline and death.
        Arch Intern Med. 2012; 172: 1078-1083
        • National Academies of Sciences Engineering & Medicine
        Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System.
        The National Academies Press, 2020
        • Luo Y
        • Hawkley LC
        • Waite LJ
        • et al.
        Loneliness, health, and mortality in old age: a national longitudinal study.
        Soc Sci Med. 2012; 74: 907-914
        • Evans IE
        • Llewellyn DJ
        • Matthews FE
        • et al.
        Social isolation, cognitive reserve, and cognition in older people with depression and anxiety.
        Aging Ment Health. 2019; 23: 1691-1700
      1. National Academies of Sciences Engineering and Medicine. (2020). Social isolation and loneliness in older adults: opportunities for the health care system. Retrieved from Washington, DC.

        • Peters A
        • Liefbroer AC
        Beyond marital status: partner history and well-being in old age.
        J Marriage Fam. 1997; 59: 687-699
        • Vanderhorst RK
        • McLaren S
        Social relationships as predictors of depression and suicidal ideation in older adults.
        Aging Ment Health. 2005; : 517-525
        • Law RW
        • Sbarra DA
        The effects of church attendance and marital status on the longitudinal trajectories of depressed mood among older adults.
        J Aging Health. 2009; 21: 803-823
        • Meyers BS
        • Sirey JA
        • Bruce M
        • et al.
        Predictors of early recovery from major depression among persons admitted to community-based clinics: an observational study.
        Arch Gen Psychiatry. 2002; 59: 729-735
        • Solomonov N
        • Bress JN
        • Sirey JA
        • et al.
        Engagement in socially and interpersonally rewarding activities as a predictor of outcome in “Engage” behavioral activation therapy for late-life depression.
        Am J Geriatr Psychiatry. 2019; 27: 571-578
        • Solomonov N
        • Lee J
        • Banerjee S
        Modifiable predictors of nonresponse to psychotherapies for late-life depression with executive dysfunction: a machine learning approach.
        Mol Psychiatry. 2020;
        • Gülaçtı F
        The effect of perceived social support on subjective well-being.
        Proc Soc Behav Sci. 2010; 2: 3844-3849
        • Cornwell EY
        • Waite LJ
        Social disconnectedness, perceived isolation, and health among older adults.
        J Health Soc Behav. 2009; 50: 31-48
        • Schwarzbach M
        • Luppa M
        • Forstmeier S
        • et al.
        Social relations and depression in late life - a systematic review.
        Int J Geriatr Psychiatry. 2014; 29: 1-21
        • Cacioppo JT
        • Hughes ME
        • Waite LJ
        • et al.
        Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses.
        Psychol Aging. 2006; 21: 140-151
        • Cacioppo JT
        • Hawkley LC
        • Thisted RA
        Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study.
        Psychol Aging. 2010; 25: 453-463
        • Hallgren M
        • Lundin A
        • Tee FY
        • et al.
        Somebody to lean on: social relationships predict post-treatment depression severity in adults.
        Psychiatry Res. 2017; 249: 261-267
        • Oxman TE
        • Hull JG
        Social support and treatment response in older depressed primary care patients.
        J Gerontol B Psychol Sci Soc Sci. 2001; 56: P35-P45
        • Hames JL
        • Hagan CR
        • Joiner TE
        Interpersonal processes in depression.
        Annu Rev Clin Psychol. 2013; 9: 355-377
        • Lewis G
        • Kounali DZ
        • Button KS
        • et al.
        Variation in the recall of socially rewarding information and depressive symptom severity: a prospective cohort study.
        Acta Psychiatr Scand. 2017; 135: 489-498
        • Burholt V
        • Scharf T
        Poor health and loneliness in later life: the role of depressive symptoms, social resources, and rural environments.
        J Gerontol B Psychol Sci Soc Sci. 2013; 49: 311-324
        • Bagby RM
        • Quilty LC
        • Segal ZV
        • et al.
        Personality and differential treatment response in major depression: a randomized controlled trial comparing cognitive-behavioural therapy and pharmacotherapy.
        Can J Psychiatry. 2008; 53: 361-370
        • Quilty LC
        • Mainland BJ
        • McBride C
        • et al.
        Interpersonal problems and impacts: further evidence for the role of interpersonal functioning in treatment outcome in major depressive disorder.
        J Affect Disord. 2013; 150: 393-400
        • Kushner SC
        • Quilty LC
        • Uliaszek AA
        • et al.
        Therapeutic alliance mediates the association between personality and treatment outcome in patients with major depressive disorder.
        J Affect Disord. 2016; 201: 137-144
        • Sirey JA
        • Banerjee S
        • Marino P
        • et al.
        Adherence to depression treatment in primary care: a randomized clinical trial.
        JAMA Psychiatry. 2017; 74: 1129-1135
      2. Sirey JS, Woods A, Solomonov N. Treatment adequacy and adherence as predictors of depression response in primary care, Am J Geriatr Psychiatry 2020;28(11):1164–1171.

        • Koenig HG
        • Westlund RE
        • George LK
        • et al.
        Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals.
        Psychosomatics. 1993; 34: 61-69
        • George LK
        • Blazer DG
        • Hughes DC
        • et al.
        Social support and the outcome of major depression.
        Br J Psychiatry. 1989; 154: 478-485
        • Horowitz LM
        • Rosenberg SE
        • Baer BA
        • et al.
        Inventory of interpersonal problems: psychometric properties and clinical applications.
        J Consult Clin Psychol. 1988; 56: 885-892
        • Scarpa A
        • Luscher KA
        • Smalley KJ
        • et al.
        Screening for personality disorders in a nonclinical population.
        J Personal Disord. 1999; 13: 345-360
        • Folstein ME
        A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 198
        • Hamilton M
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • Trajković G
        • Starčević V
        • Latas M
        • et al.
        Reliability of the Hamilton Rating Scale for Depression: a meta-analysis over a period of 49 years.
        Psychiatry Res. 2011; 189: 1-9
        • Svarstad BL
        • Chewning BA
        • Sleath BL,
        • et al.
        The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence.
        Patient Educ Couns. 1999; 37: 113-124
        • Rickles NM
        • Svarstad BL
        Relationships between multiple self-reported nonadherence measures and pharmacy records.
        Res Social Adm Pharm. 2007; 3 (doi:S1551-7411(06)00118-5 [pii] 10.1016/j.sapharm.2006.11.001): 363-377
        • Brook OH
        • van Hout HP
        • Stalman WA
        • et al.
        Nontricyclic antidepressants: predictors of nonadherence.
        J Clin Psychopharmacol. 2006; 26: 643-647
        • R Core Team
        R: A Language and Environment for Statistical Computing.
        2017 (Vienna, Austria)
        • Waite LJ
        Does marriage matter?.
        Demography. 1995; 32: 483-507
        • Ross CE
        Reconceptualizing marital status as a continuum of social attachment.
        J Marriage Fam. 1995; 57: 129-140
        • Wallsten SM
        • Tweed DL
        • Blazer DG
        • et al.
        Disability and depressive symptoms in the elderly: the effects of instrumental support and its subjective appraisal.
        Int J Aging Hum Dev. 1999; 48: 145-159
        • Kunik ME
        • Mulsant BH
        • Rifai AH
        • et al.
        Diagnostic rate of comorbid personality disorder in elderly psychiatric inpatients.
        Am J Psychiatry. 1994; 151: 603-605
        • Molinari V
        • Marmion J
        Relationship between affective disorders and Axis II diagnoses in geropsychiatric patients.
        J Geriatr Psychiatry Neurol. 1995; 8: 61-64
        • Morse JQ
        • Lynch TR
        A preliminary investigation of self-reported personality disorders in late life: prevalence, predictors of depressive severity, and clinical correlates.
        Aging Ment Health. 2004; 8: 307-315