How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources

This study examines the process whereby functional disability amplifies depressive symptoms through decreasing perceived social support and psychological resources. The study analyzed two waves of panel data (1986 to 1992) of a large sample of older adults from the National Institutes of Aging Established Populations for Epidemiologic Studies of the Elderly. The results of longitudinal change models and path analyses show that the perceived availability of a confidant, satisfaction with support, sense of control, and self-esteem mediate the effects of disability on increments in depressive symptoms in late life. Psychological resources play a dominant role in mediating the effects of functional impairment. Scales of sense of control and self-esteem account for 53 percent of the total effect of baseline disability and 43 percent of the total effect of changes in disability on changes in the CES-D depression scale. Self-esteem appears to be the strongest mediator.     

HOMELESSNESS AND AFFILIATION

Sociological theory portrays affiliation as an important source of personal power. Accordingly, some students of homelessness suggest that the extreme poverty and powerlessness of homeless individuals can be traced to a lack of social ties. Using data from a quota sample of 150 homeless persons in Birmingham, Alabama, this study examines (1) whether the homeless are disaffiliated and (2) the relationship between affiliation and power-related life experiences (personal efficacy). A 26-item scale measures affiliation; subscales assess expressive ties, instrumental supports, and acquaintances. Personal efficacy outcomes studied are depressive symptoms, anomie, mastery, physical and mental health, service knowledge, environmental satisfaction, and monthly income. Evidence suggests that many homeless persons have a network of confidants, friends, relatives, and acquaintances. However, these networks differ from those described in past research on general populations. Additionally, multiple regression results assign networks, at best, only modest effects on personal efficacy among the homeless.     

The stress process and the social distribution of depression

Mental health generally and depression in particular have been repeatedly shown to vary in relation to gender, socioeconomic status, marital status, and age. These status differences may be linked to mental health because they tend to define important differences in stress exposure and in the availability of coping resources. This paper examines the capacity of the stress-process model to account for the social distribution of depression. We employ mediation analyses using data from a 1990-1991 survey of Toronto community residents. In general, we found hypothesized risk factors to vary across these statuses with depressive symptoms and disorder and the distribution of protective factors to vary inversely. Results indicate that the model as expressed in our analyses accounts for a substantial minority of observed depression differences across individuals and for a considerable portion of reliably observed variation across social statuses. Our findings with respect to major depressive disorder parallel those for depressive symptomatology. Most compelling is the nearly total explanation of the socioeconomic status association with depressive symptoms and the substantial contribution toward explaining the socioeconomic status-disorder relationship when stress process mediators are accounted for.     

Abuse, support, and depression among homeless and runaway adolescents

This study examines the effectiveness of social support networks on psychological well-being among 602 homeless and runaway adolescents. The respondents were interviewed in shelters, drop-in centers, and on the streets in cities of four Midwestern states (Missouri, Iowa, Nebraska, and Kansas). The path model was used to test the direct effect of family abuse and precocious independence on adolescent depressive symptoms and indirect effects through social support networks. Results indicate that although abusive family origins contribute directly to depressive symptoms there are indirect effects of family abuse and early independence through social support networks. Family abuse and early independence drive homeless adolescents to rely on peers for social support. While support from friends on the street reduces depression, association with deviant peers increases depression.     

The life stress paradigm and psychological distress.

The paper focuses on two forces (stressors and resources) in the life stress process as they affect psychological distress. Utilizing three waves of panel data from a representative community sample in upstate New York, six causal models of the life stress process are tested with indicators of two types of stressors (social and physiological) and two types of resources (social and psychological). Both deterring and coping models are tested. Analysis shows that: (1) stressors and resources in the social environment have a direct impact on depressive symptoms, (2) social resources mediate the effects of social stressors on psychological distress, and (3) psychological resources indirectly affect distress by enhancing social resources. The critical role played by the social environment in the life stress process involving psychological distress is substantiated. The implications of these and other findings are discussed.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.     

LIFE CHANCES AND CHOICES:

A Weberian lifestyles approach is employed to examine differences in quality of life among the homeless. Using a systematic random sample of 161 homeless people in a mid-sized, Southern metropolitan area, the study focuses on the impact of life chances and social choices on aspects of quality of life in this severely challenged population. Regression results show that a number of life chance and social choice variables affect general and domain-specific well-being. While chances and choices both contribute to these aspects of quality of life, there is only modest evidence of a mediating effect. With the exception of depressive symptoms, life chances appear to play a more important role in quality of life differences than life choices. The specific life chance and choice factors influencing aspects of quality of life vary with each separate well-being outcome. The implications of these findings for general sociology and homeless social policy are explored.     

Psychosocial correlates and depression in Vietnamese adolescents

This paper reports findings on depression in a sample of 38 Vietnamese adolescents. Hierarchical regression analysis was conducted to examine the empirical use of psychosocial variables and stressful life event measures in predicting depression. Self-esteem (Esteem) and SLEs scales were entered in blocks and explained for 68 percent of the total variance in depression (CES-D scale). Esteem accounts for 30 percent of the overall variance. The SLE block contributes another 39 percent above and beyond in the prediction of depression. Death, PTSD, and Peer stress scales were significant predictors (p<.01). The mean CES-D depression score was 16.32 (SD=10.95). A cutoff score of 16 was used to classify those adolescents who were depressed from those who were not depressed (Radloff, 1977).     

Differentiating the Social Service Needs of Homeless Sexual Minority Youths from those of Non-homeless Sexual Minority Youths

While homeless youths and sexual minority youths are at greater risk for negative life experiences, and homeless sexual minority youths are at greater risk than homeless heterosexual youths, little is known about the differential risks for homeless sexual minority youths compared to non-homeless sexual minority youths. Using a sample of 187 sexual minority youths from a community-based social service agency in Denver, Colorado, the findings of this study suggest that homeless sexual minority youths are at greater risk for victimization, mental health issues, substance abuse, and illegal or dangerous activities than their non-homeless counterparts. Implications for social work practice and social service provision are discussed.     

The Connections of Mental Health Problems,Violent Life Experiences,and the Social Milieu of the “Stroll” with the HIV Risk Behaviors of Female Street Sex Workers

Abstract

This paper examines the connections of mental health, victimization, and sexual risk behaviors among a sample of 278 street-based female sex workers in Miami. Using targeted sampling strategies, drug-using sex workers were recruited into an HIV prevention research program. Data were collected by trained interviewers, and focused on drug use and sexual risk for HIV, childhood abuse, recent victimization, and mental health. More than half of the participants reported histories of physical (51.1%) or sexual (53.1%) abuse as children, 37.4% were classified with moderate or severe anxiety symptoms, and 52.9% had symptoms of moderate or severe depression. Logistic regression analyses demonstrated significant associations between mental health issues and engagement in recent unprotected vaginal and oral sex. The program development and policy implications of these findings are discussed.     

A longitudinal study of the role and significance of mattering to others for depressive symptoms.

This paper addresses the hypothesis that the experience of mattering to others is inversely related to depressive symptomatology. We also assess the extent to which mattering overlaps or is redundant with other measures of personal and social resources. Based on multivariate analyses of two waves of data from a large urban community sample (n = 1,300), we identify three important findings. First, women experience substantially higher levels of mattering than do men. Therefore, if men and women had equal levels of mattering, women would report even higher depression scores relative to men. Second, it is clear that mattering and sub-dimensions of social support are substantially more confounded among men than among women. Finally, analyses confirm that mattering is conditionally predictive of depression by gender. Specifically, variations in mattering are predictive of depression for women, but not for men. This relationship is confirmed both cross-sectionally and over time.     

Cross-Cultural Perspectives on Illness and Wellness: Implications for Depression1

The purpose of this research is to determine the relationships among race, socioeconomic status (SES) and depressive symptomatology. Contrary to the findings of over 20 years ofpsychiatric epidemiology, two research teams have recently reported that Blacks, primarily those oflow SES, are significantly more depressed than Whites occupying the same status. Using the same epidemiologic field survey data as one of these research groups (Whites = 1,648; Blacks = 450), the issues of race, SES, and depression are reopened for examination. Depressive symptomatology was measured by the Florida Health Study Depression Scale. The findings indicated that, in general, Blacks had significantly higher levels of depressive symptomatology than Whites. However, these differences were eliminated once SES, a composite of occupational status, education, and household income, was statistically controlled. Race, in other words, was not found to be an independent predictor of depression. The author concludes that poverty is hazardous to one's psychological well-being and that race, by itself, is merely a proxy for socioeconomic status. In addition, methodological issues associated with the conceptualization and opera~ tionalization of socioeconomic status and mental health constructs such as depression are explored.     

Social Support as a Predictor of Psychological and Physical Well-Being and Lifestyle in Lesbian,Gay, and Bisexual Adults Aged 50 and Over

Aging lesbian, gay, and bisexual (LGB) adults often differ from their heterosexual counterparts in their social network. This study examined a sample of 220 LGB adults over 50-years-old; most were White, well-educated, and employed. Social networks were used to predict physical and psychological well-being and lifestyle/risk. Respondents had on average 2.5 members in their social network; 56 percent had at least one close friend. Support from friends rather than family predicted higher mental quality of life and lower depression, anxiety, and internalized homophobia. Study participants functioned within normal ranges of most psychological measures. However, they had serious health risks due to alcohol consumption and obesity (inwomen). Findings add further evidence of the importance of friends in providing social support among LGB adults.     

Predictors of employment among sheltered homeless women

The effect of homelessness on the psychological and physical health of women is damaging and long lasting. Understanding of the personal factors that enable homeless women to secure employment and re-enter mainstream society is of utmost importance. A sample of homeless women residing in a US Midwestern nonprofit treatment and transitional living shelter for homeless women and their children were surveyed regarding the extent to which life satisfaction, social self-efficacy, and hopeful thinking predicted women's expected capabilities to obtain employment above and beyond social support provisions, while controlling for participants' age, ethnicity, and education level. Findings failed to reveal that social psychological (i.e., life satisfaction and social self-efficacy) and intrapersonal (i.e., hope) variables predicted homeless women's job procurement self-efficacy above and beyond perceived social support. The social support provision of social integration and younger age significantly predicted women's self-efficacy to secure employment. Implications of results for social justice initiatives and interventions are discussed.     

Perceived discrimination and depression among Mexican-origin adults in California

We contend that perceived discrimination has an independent effect on depression outcomes among adults of Mexican origin. Using a sample of 3,012 Mexican-origin respondents in Fresno, California in 1995/96 (ages 18-59) we investigate the direct and moderating connections between perceived discrimination, acculturative stress, and mental health (CES-D). We also investigate the social patterning of perceived discrimination. While more highly acculturated immigrant respondents were more likely to experience discrimination than their less acculturated counterparts, more highly acculturated U.S. born respondents were less likely to experience discrimination. Discrimination was directly related to depression, but this effect was moderated through nativity/country of residence, English-language acculturation, sex, and country of education variables. Moderate levels of legal status acculturative stress were especially depressive for native-born U.S. residents.     

Mental health around and after the menopause

The menopause is a time in a woman's life when it is recognized that biological and social changes can impact upon mental wellbeing. Several studies have investigated the relationship between menopause and psychological symptoms, especially depression, with mixed results. In part, this is due to a considerable overlap between depressive symptoms and those due to declining estrogen levels, causing challenges in assessment. However it appears that vulnerable women are at a higher risk of succumbing to depression during menopausal transition. Antidepressants remain the mainstay of treating depressive symptoms, with little conclusive evidence for hormone replacement therapy. Memory problems during menopause are a common complaint, but there is no demonstrated link to subsequent dementia. This paper also reviews considerations of diagnosis and treatment of postmenopausal depression.     

The process of coping with domestic violence in adult survivors of childhood sexual abuse

Research suggests that the use of disengaged or avoidant strategies to cope with interpersonal violence contributes to the development of depressive symptoms and other psychological difficulties. Survivors of childhood sexual abuse (CSA) who are exposed to subsequent episodes of abuse may be more likely to rely on disengaged coping strategies, placing them at elevated risk of psychological symptomatology. In this study, we explored the interrelationships between coping, depression, and self-esteem in an ethnically diverse sample of domestic violence survivors (N = 219) with and without a history of CSA. As predicted, CSA survivors (n = 86) reported significantly greater use of disengaged coping strategies (wishful thinking, self-criticism, and social withdrawal) than non-CSA survivors (n = 133). As hypothesized, both a CSA history and the use of disengaged coping significantly predicted higher levels of depression and lower self- esteem. Clinical implications of the findings are discussed.     

Homeless mothers and depression: misdirected policy.

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services.     

Cross-cultural perspectives on illness and wellness: Implications for depression

The purpose of this research is to determine the relationships among race, socioeconomic status (SES) and depressive symptomatology. Contrary to the findings of over 20 years of psychiatric epidemiology, two research teams have recently reported that Blacks, primarily those of low SES, are significantly more depressed than Whites occupying the same status. Using the same epidemiologic field survey data as one of these research groups (Whites=1,648; Blacks=450), the issues of race, SES, and depression are reopened for examination. Depressive symptomatology was measured by the Florida Health Study Depression Scale. The findings indicated that, in general, Blacks had significantly higher levels of depressive symptomatology than Whites. However, these differences were eliminated once SES, a composite of occupational status, education, and household income, was statistically controlled. Race, in other words, was not found to be an independent predictor of depression. The author concludes that poverty is hazardous to one's psychological well-being and that race, by itself, is merely a proxy for socioeconomic status. In addition, methodological issues associated with the conceptualization and operationalization of socioeconomic status and mental health constructs such as depression are explored.Paper presented at the Conference on Multicultural Perspectives on Mental Illness, May 1994, St. John's University.     

Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing

As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg–Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N?=?126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including “equal access to services,” “enhancing economic stability,” “providing safe and affordable housing with trauma-informed services,” and “training service social workers to deliver well-informed linkages and services” are discussed.