Does social support buffer functional decline in elderly patients with unipolar depression?

Objective: This study tested whether social support protects against functi onal decline, either generally or selectively, in the most severely depress ed elderly patients undergoing treatment for major depressive disorder. Method: In a prospective cohort study design, 113 patients with incident an d prevalent unipolar depression were followed for 12 months while they were undergoing naturalistic treatment. Outcome measures included performance o n basic and instrumental activities of daily living; predictor variables in cluded Hamilton Depression Rating Scale scores and four domains of informal social support. The analysis employed multivariable ordinary least squares regression models. Results: Improved scores on instrumental activities of daily living and sta ble scores on basic activities of daily living characterized the subjects. In adjusted analyses, instrumental social support provided marginal protect ion against worsening performance on instrumental activities of daily livin g, which were primarily a function of baseline depression severity. Large s ocial networks, more frequent social interaction, and the perceived adequac y of social support played a modest buffering role against declines in perf ormance on basic activities of daily living among the most depressed elderl y patients. Conclusions: instrumental support was generally protective against worsenin g performance on instrumental abilities of daily living among elderly patie nts with recurrent unipolar depression. Subjective and structural dimension s of social support protected the most severely depressed elderly patients against the loss of basic maintenance abilities.