Social connectedness, depression symptoms, and health service utilization: a longitudinal study of Veterans Health Administration patients
Our study explored whether aspects of veterans’ social connectedness (social support, interpersonal conflict, loneliness, social norms, number of confidants) are associated with change in their depression symptoms and health services utilization over 1 year.
We conducted a prospective, longitudinal study of 262 military veterans who obtained primary care and other services at a Veterans Health Administration (VHA) facility and screened positive for depression. Participants completed surveys at baseline and 12-month follow-up. We measured social connectedness variables using the NIH Toolbox Adult Social Relationship Scales. We used the Patient Health Questionnaire to assess depression symptoms and suicidal ideation and administrative medical record data for health services utilization. We calculated change scores to model outcomes over time using multivariable regressions.
We found that higher levels of baseline loneliness were associated with decreased depression severity over 1 year (B = − 1.55, 95% CI [− 2.53, − .56], p < .01). We found a similar association for suicidal ideation. In contrast, higher baseline number of confidants was associated with increased depression (B = .55, 95% CI [.18, .92], p < .01). Higher levels of emotional support were associated with decreased mental health visits (B = − 3.88, 95% CI [− 6.80, − .96], p < .01). No significant associations were found between social connectedness variables and primary care visits.
Emotional support may play an important role in reducing mental health treatment utilization among VHA-using veterans. Additional investigation as to how and why loneliness and number of confidants might be paradoxically associated with depression symptoms remains necessary.
KeywordsMajor depression Suicide Veterans Social support Health services
We would like to acknowledge Jason T. Newsom, Ph.D., who provided feedback on the ideas within this manuscript.
This project was funded by a VA Health Services Research and Development Career Development Award (Teo; CDA 14-428). Dr. Chen completed this work under the auspices of a Trans-NIH-funded K12 award in Emergency Care Research (5K12HL133115). This material is the result of work supported with resources and the use of facilities at the VA Portland Health Care System, Portland, OR. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Institutes of Health, or the United States government. On behalf of all authors, the corresponding author states that there are no conflicts of interest.
- 4.Perlman D, Peplau LA (1982) Theoretical approaches to loneliness. Loneliness: a sourcebook of current theory, research and therapy. Wiley, Hoboken, NJ, pp 123–134Google Scholar
- 6.American Psychological Association (2010) 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 [press release]. American Psychological Association, USAGoogle Scholar
- 14.Office of Mental Health and Suicide Prevention (2016) Suicide among veterans and other Americans, 2001–2014. US Department of Veterans Affairs, Washington, DCGoogle Scholar