Using the Social Determinants of Health as a Framework to Examine and Address Predictors of Depression in Later Life
Depression in later life is an important public health concern. Comprehensive assessments incorporating all key areas of the social determinants of health (SDOH) framework can assist in developing effective interventions to ensure mental health for the increasing older adult population. This study uses the SDOH model for identifying, evaluating, and addressing risk factors that contribute to depression in older adults. Secondary data analysis of the Health and Retirement Study was used to conduct a hierarchical multiple regression analysis to examine predictors of depression in later life. The SDOH key areas were used as a framework for the regression model. The main findings showed predictors of depression were health and social support, emphasizing the importance of aging in place. Implications for practice include the provision of services within the home, neighborhood, and community to maintain older adults within the least restrictive environments where they can maximize healthy living and continue to maintain connections with their social support networks.
KeywordsOlder adults Neighborhood Aging in place Depression Social determinants of health
First author wishes to acknowledge Meredith Hanson, DSW, who offered valuable guidance and insight for this project.
Compliance with Ethical Standards
Conflict of Interest
Bronwyn Cross-Denny declares that she has no conflict of interest. Michael A. Robinson declares that he has no conflict of interest.
Human participants were not utilized in this study by any of the authors as it was a secondary data analysis. Informed consent was obtained by the Health and Retirement Study from all individual participants included in the study.
This article does not contain any studies with human participants performed by any of the authors. The study is based upon secondary data analysis of the Health and Retirement Study and permission was received to use the data.
This study did not receive any funding.
- Bloch, G., Etches, V., Gardner, C., Pellizzari, R., Rachlis, M., Scott, F., & Tamari, I. (2008). Why poverty makes us sick: physician backgrounder. Ontario Medical Review, 75(5), 32–37.Google Scholar
- Brown, S. C., Mason, C. A., Spokane, A. R., Cruza-Guet, M. C., Lopez, B., & Szapocznik, J. (2009). The relationship of neighborhood climate to perceived social support and mental health in older Hispanic immigrants in Miami, Florida. Journal of Aging and Health, 21(3), 431–459. doi: 10.1177/0898264308328976.CrossRefGoogle Scholar
- Caskie, G. I. L., Sutton, M. C., & Margrett, J. A. (2010). The relation of hypertension to changes in ADL/IADL limitations of Mexican American older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65B(3), 296–305. doi: 10.1093/geronb/gbq001.CrossRefGoogle Scholar
- Castañeda-Sceppa, C., Price, L. L., Noel, S. E., Bassett Midle, J., Falcon, L. M., & Tucker, K. L. (2010). Physical function and health status in aging Puerto Rican adults: the Boston Puerto Rican health study. Journal of Aging and Health, 22(5), 653–672. doi: 10.1177/0898264310366738.CrossRefGoogle Scholar
- Chapman, A. R. (2010). The social determinants of health, health equity, and human rights. Health & Human Rights: An International Journal, 12(2), 17–30.Google Scholar
- Clarke, P., Fisher, G., House, J., Smith, J., & Weir, D. (2008). Psychosocial and lifestyle questionnaires 2006–2010: Documentation report core section leave-behind. Retrieved from Ann Arbor.Google Scholar
- Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of heatlh. Final report of the commission on social determinants of health. Geneva: World Health Organization.Google Scholar
- Dozeman, E., van Marwijk, H. W. J., van Schaik, D. J. F., Stek, M. L., van der Horst, H. E., Beekman, A. T. F., & van Hout, H. P. (2010). High incidence of clinically relevant depressive symptoms in vulnerable persons of 75 years or older living in the community. Aging & Mental Health, 14(7), 828–833. doi: 10.1080/13607861003781817.CrossRefGoogle Scholar
- Federal Interagency Forum on Aging-Related Statistics. (2012). Older Americans 2012: Key indicators of well-being. Retrieved from www.agingstats.gov.
- Greenfield, E. A., Scharlach, A. E., Lehning, A. J., Davitt, J. K., & Graham, C. L. (2013). A tale of two community initiatives for promoting aging in place: similarities and differences in the national implementation of NORC programs and villages. The Gerontologist, 53(6), 928–938. doi: 10.1093/geront/gnt035.CrossRefGoogle Scholar
- Kales, H. C., Mellow, A. M., & Neugroschi, J. A. (2006). Race and depression: does race affect the diagnosis and treatment of late-life depression? Geriatrics, 61(5), 18–21.Google Scholar
- Kane, R. L., & Kane, R. A. (Eds.). (2000). Assessing older adults: Measures, meaning, and practical applications. New York: Oxford University Press, Inc.Google Scholar
- Kaplan, D. B., Andersen, T. C., Lehning, A. J., & Perry, T. E. (2015). Aging in place vs. Relocation for older adults with neurocognitive disorder: Applications of wiseman’s behavioral model. Journal of Gerontological Social Work, 1–18. doi: 10.1080/01634372.2015.1052175
- Koh, H. K., Oppenheimer, S. C., Massin-Short, S. B., Emmons, K. M., Geller, A. C., & Viswanath, K. (2010). Translating research evidence into practice to reduce health disparities: a social determinants approach. American Journal of Public Health, 100(S1), S72–S80. doi: 10.2105/ajph.2009.167353.CrossRefGoogle Scholar
- Kondo, N., Sembajwe, G., Kawachi, I., van Dam, R. M., Subramanian, S. V., & Yamagata, Z. (2009). Income inequality, mortality, and self rated health: Meta-analysis of multilevel studies. BMJ, 339. doi: 10.1136/bmj.b4471.
- Lawn, S. (2008). ‘The needs of strangers’: understanding social determinants of mental illness. Social Alternatives, 27(4), 36–41.Google Scholar
- Marmot, M., & Wilkinson, R. G. (2006). Social determinants of health (2nd ed.). New York: Oxford University Press.Google Scholar
- Martens, M. P., Parker, J. C., Smarr, K. L., Hewett, J. E., Ge, B., Slaughter, J. R., & Walker, S. E. (2006). Development of a shortened center for epidemiological studies depression scale for assessment of depression in rheumatoid arthritis. Rehabilitation Psychology, 51(2), 135–139. doi: 10.1037/0090-55220.127.116.11.CrossRefGoogle Scholar
- Mental Health America. (2016). Depression in older adults: More facts. Retrieved from http://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts.
- Mertler, C. A., & Vannatta, R. A. (2013). Advanced and multivariate statistical methods: practical application and interpretation (5th ed.). Glendale: Pyrczak Publishing.Google Scholar
- National Association of Social Workers. (2001). Cultural competence in the social work profession social work speaks: NASW policy statements. Washington, DC: NASW Press.Google Scholar
- National Institute on Aging. (2007). Growing older in America: The Health and Retirement Study. Retrieved from Bethesda, MD: http://hrsonline.isr.umich.edu/.
- Neufeld, N. (2009). Increasing equity through medicine: an interview with Dr. Gary Bloch. University of Toronto Medical Journal, 86(2), 43–46.Google Scholar
- Newman, A. B., Bayles, C. M., Milas, C. N., McTigue, K., Williams, K., Robare, J. F., . . . Kuller, L. H. (2010). The 10 keys to healthy aging: Findings from an innovative prevention program in the community. Journal of Aging and Health, 22(5), 547–566. doi: 10.1177/0898264310363772
- Parra, D. C., Gomez, L. F., Sarmiento, O. L., Buchner, D., Brownson, R., Schimd, T., . . . Lobelo, F. (2010). Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogotá, Colombia. Social Science & Medicine, 70(7), 1070–1076. doi: 10.1016/j.socscimed.2009.12.024.
- Patient Protection and Affordable Care Act of 2010. (2010). Pub. L. No. 111–148, 124 Stat. 1025.Google Scholar
- Seplaki, C. L., Agree, E. M., Weiss, C. O., Szanton, S. L., Bandeen-Roche, K., & Fried, L. P. (2014). Assistive devices in context: Cross-sectional association between challenges in the home environment and use of assistive devices for mobility. The Gerontologist, 54(4), 651–660.CrossRefGoogle Scholar
- Stansfeld, S.A. (2006). Social support and social cohesion. In M. Marmot & R. G. Wilkinson (Eds.), Social determinants of health (pp. 148–171). New York, NY: Oxford.Google Scholar
- Steffick, D. E. (2000). Documentation of affective functioning measures in the Health and Retirement Study. Retrieved from Ann Arbor, MI: Survey Research Center, University of Michigan.Google Scholar
- Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Boston: Pearson Education.Google Scholar
- U.S. Department of Health and Human Services. (2005). Nutrition and your health: Dietary guidelines for Americans. Washington, D.C.: U.S. Government Printing Office.Google Scholar
- U.S. Department of Health and Human Services - Substance Abuse and Mental Health Services Administration. (2012). Results from the 2012 national survey on drug use and health: Mental health findings. Retrieved from http://archive.samhsa.gov/.
- Wen, M., Hawkley, L. C., & Cacioppo, J. T. (2006). Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: an analysis of older adults in cook county, Illinois. Social Science & Medicine, 63(10), 2575–2590. doi: 10.1016/j.socscimed.2006.06.025.CrossRefGoogle Scholar
- Wiles, J. L., Allen, R. E. S., Palmer, A. J., Hayman, K. J., Keeling, S., & Kerse, N. (2009). Older people and their social spaces: a study of well-being and attachment to place in Aotearoa New Zealand. Social Science & Medicine, 68(4), 664–671. doi: 10.1016/j.socscimed.2008.11.030.CrossRefGoogle Scholar
- Wilkinson, R., & Pickett, K. (2009). The spirit level: Why greater equality makes societies stronger. New York: Bloomsbury Press.Google Scholar
- World Health Organization. (1946). Constitution of the World Health Organization: Principles: Retrieved from http://www.who.int/about/mission/en/.
- World Health Organization. (2007). Global age-friendly cities: A guide. Retrieved from http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf
- World Health Organization. (2016a). Depression fact sheet: Retrieved from http://www.who.int/mediacentre/factsheets/fs369/en/.
- World Health Organization. (2016b). Mental health and older adults fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs381/en/.