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Why Is Social Isolation Among Older Adults Associated with Depressive Symptoms? The Mediating Role of Out-of-Home Physical Activity

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Abstract

Background

Social networks are known to be a key factor associated with late-life depression. However, there is limited knowledge about the pathways linking social isolation to mental health. It has been proposed that health-related behaviors such as physical activity represent one pathway. This study examines the way out-of-home physical activity mediates between social isolation and depressive symptoms in older adults.

Methods

A subsample of 334 older adults from the ActiFE Ulm study, Germany, was randomly selected. Older adults (M = 72.6 years; 60.8% male) were interviewed at baseline and 3 years later. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Social isolation was measured using the Lubben Social Network Scale (LSNS-6). Physical activity was measured by an accelerometer (activPAL) over 1 week. To identify out-of-home physical activity, a contemporary physical activity diary classified out-of-home physical activity.

Results

A cross-lagged structural equation model supported an indirect effect (β = .014, 95% CI .002 to .039) which means that being socially isolated was associated with lower levels of out-of-home physical activity, and this predicted more depressive symptoms after 3 years. However, no direct relationship was observed between social isolation from friends and neighbors at the baseline and depressive symptoms 3 years later.

Conclusions

Utilizing a longitudinal study design and accounting for reverse causality, this study extends prior work linking social isolation to depression by showing that a variety of neighbor and friendship ties are linked to fewer depressive symptoms by providing occasions for out-of-home physical activity.

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Acknowledgements

The ActiFE Ulm study group consists of further members: T. Becker: Department of Psychiatry and Psychotherapy II, Ulm University—B. Böhm, Department of Internal Medicine I—Division of Endocrinology, University of Ulm Medical Center and LKC School of Medicine, Imperial College London and Nanyang Technological University, Singapore—K. Scharffetter-Kochanek: Department of Dermatology and Allergic Diseases, Ulm University—J. Stingl: Institute of Pharmacology of Natural Products & Clinical Pharmacology and BfARM (Federal Institute for Drugs and Medical Devices)—W. Koenig: Department of Internal Medicine II-Cardiology, University of Ulm Medical Center and German Heart Centre, Technical University Munich and DZHK (German Centre for Cardiovascular Research) Munich—M. Riepe, Division of Gerontopsychiatry, Department of Psychiatry and Psychotherapy II, Ulm University—R. Peter, Institute of the History, Philosophy and Ethics of Medicine, Ulm University—H. Geiger, Department of Molecular Medicine, Ulm University—A. Ludolph, C. v. Arnim, Department of Neurology, Ulm University—D. Rothenbacher, G. Nagel, G. Weinmayr: Institute of Epidemiology and Medical Biometry, Ulm University—J. Klenk: Institute of Epidemiology and Medical Biometry, Ulm University and Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart—K. Rapp: Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart—M. D. Denkinger, D. Dallmeier: Agaplesion Bethesda Clinic, Ulm—J. M. Steinacker, R. Laszlo: Division of Sports and Rehabilitation, Department of Internal Medicine II-Cardiology, Ulm University Medical Center.

Funding

This work was supported by a grant from the Ministry of Science, Research and Arts, state of Baden-Wuerttemberg, Germany, as part of the Geriatric Competence Center, Ulm University.

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Authors and Affiliations

  1. Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany

    Florian Herbolsheimer & Richard Peter

  2. Institute of Psychology, Heidelberg University, Hauptstraße 47-51, Heidelberg, 69117, Germany

    Nadine Ungar

Authors
  1. Florian Herbolsheimer
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Contributions

Florian Herbolsheimer substantially contributed to acquisition of data, did the data analysis, and wrote the article.

Nadine Ungar contributed to analysis and interpretation of data, revised the article critically for important intellectual content, and revised the manuscript.

Richard Peter contributed to study conception and design, contributed to acquisition of data, revised the article critically for important intellectual content, and revised the manuscript.

Corresponding author

Correspondence to Florian Herbolsheimer.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of Ulm University for the baseline (312/08) and the follow-up assessment (50/12).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Electronic Supplementary Material

Electronic Supplementary Material 1

. Structural equation model with standardized parameter estimates and covariances between the different variables and confounders. Notes. *p < .05, **p < .01, ***p < .001; Age in years; Multimorbidity was assessed using the Functional Comorbidity Index; T0 = baseline (2009/2010); T1 = follow-up (2012/2013); Inter-measurement interval = 3.3 years; The ovals represent latent variables, and the rectangles depict manifest variables; dashed lines are statistically non-significant relationships; arrows represent hypothesized direction of effects Model fit indices: χ2 (364) = 727.1, CFI = .892, and TLI = .879, RMSEA = .054; Calculations are based on the imputed sample (N = 344) (PPTX 52 kb)

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Herbolsheimer, F., Ungar, N. & Peter, R. Why Is Social Isolation Among Older Adults Associated with Depressive Symptoms? The Mediating Role of Out-of-Home Physical Activity. Int.J. Behav. Med. 25, 649–657 (2018). https://doi.org/10.1007/s12529-018-9752-x

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