‘WE HAVE known for a long time that being socially isolated is bad for your mental health. Some of the most cruel and enduring punishments are about social isolation – banishment, exile and solitary confinement. So we know this instinctively, and it’s been used throughout history. But I was interested in finding from a more scientific approach what aspects of the social world were important for recovery from depression.
My PhD was part of the ‘diamond’ study based at the department of General Practice at the University of Melbourne. ‘Diamond’ is a longitudinal study of 789 people who have all seen a GP and had depressive symptoms. We interviewed them and got them to fill out questionnaires over a number of years. We’re up to the eight-year mark now. My PhD looked at the first two years.
First, I tried to get an understanding of how we should look at social connectedness or social relationships. I found that we could best look at social relationships as falling into three domains. First is the availability of people in your life that you have an enduring relationship or strong attachment to. Then there is the level of social integration – which is the number of people you see and the number of times you see them — and, finally, how you feel about your social relationships.
‘Some people are very satisfied with just one or two people in their lives and some people can be dissatisified with having a multitude of people. It’s a very personal thing.’
Whether you believe the qualities of your relationships are adequate is not the same as having social integration. Some people are very satisfied with just one or two people in their lives and some people can be dissatisfied with having a multitude of people. It’s a very personal thing.
Then we looked at which parts of the social relationships were really important for the progress or the course of depression. We found that when we put them all together it was only the perception of social connectedness that was important. So people who were unsatisfied with their level of social relationships were significantly more likely to have depression one to two years later.
That in itself has been shown to some degree in past studies. Where my research went further was that we looked at whether the relationship between being unhappy about your social relationships was still important when you took into account a lot of other factors. These could include the person’s personality, whether they had suffered from chronic physical illness, experienced child abuse and domestic violence, or smoked or drank. These could change your perception of social connectedness and be risk factors for depression. We did some quite sophisticated analysis of whether social relationships still predicted depression, even when all the other things were taken into account, and we found that they did.
‘We found that when we put them all together it was only the perception of social connectedness that was important. So people who were unsatisfied with their level of social relationships were significantly more likely to have depression one to two years later.’
This is important for understanding what sort of interventions we might develop and what sort of treatments might be good. An intervention aimed at increasing your networks is unlikely to have an effect on your later depression unless your perceptions of the quality of those relationships also improved.
After my PhD I was awarded a National Health and Medical Research Council (NHMRC) Early Career Research Fellowship. My findings have been used to develop a clinical prediction tool, which is when you have a series of questions that we can use to estimate a person’s risk of having persistent depression.
I’m working with other investigators on a randomised controlled trial using this tool to estimate people’s risk of depression in primary care and to put them into different treatment groups accordingly. People will get more or less intensive treatment based on their risk for persistent depression.
We will compare patients who get these interventions against patients who just get usual care, and we’ll see whether triaging people using a clinical prediction tool results in a better overall outcome for patients and whether it’s cost-effective.
GPs could use this prediction tool in their daily practice to help them make decisions on management and which patients should get more resources and more intensive treatment, and which patients are likely to recover spontaneously and don’t require much intervention, if any.
This study is about helping to identify the right treatment for the right person – a one-size-fits-all approach is not optimal. Depression is treated a lot in general practice and the best way to identify and manage it is an ongoing issue in general practice. It has really big implications for the patients and for the cost of mental health services.’
Sandra Davidson’s PhD was titled : ‘Social connectedness and its association with depression outcome among primary care patients’.
* My PhD is an irregular series in which The Citizen speaks with recent Melbourne University PhD graduates.