• Vol. 43 No. 12, 576–587
  • 15 December 2014

Association of Socioeconomic Status (SES) and Social Support with Depressive Symptoms among the Elderly in Singapore

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ABSTRACT

Introduction: Depression in the elderly is a major public health issue. Socioeconomic status (SES) and social support are strong risk factors for depression. This study aimed to investigate the influence of SES and social support in elderly depression, and the modifying effect of social support on the relationship between SES and depression.

Materials and Methods: A community-based survey was conducted on residents ≥60 years old. Depressive symptoms were determined with scores ≥5 using the 15-item Geriatric Depression Scale (GDS). Multivariable logistic regression was performed to determine the odds ratio (OR) of depressive symptoms with respect to SES and social support, and interaction terms between the two variables.

Results: Of 2447 responses analysed, 188 (7.8%) respondents had depressive symptoms. Living in 2-room housing, living alone/with a domestic helper, infrequent leisure time with children/grandchildren or being childless, and feeling socially isolated were independently associated with depressive symptoms. Relative to residents living with spouse and children in 4-/5-room housing, the highest ORs for depressive symptoms were those living with spouse and children in 2-room (OR: 3.06, P <0.05), followed by living with children only in 3-room (OR: 2.98, P <0.05), and living alone/ with a domestic helper in 4-/5-room (OR: 2.73, P <0.05). Living with spouse only appears to buffer against depressive symptoms across socioeconomic classes, although the effect was not statistically significant.

Conclusion: Low social support and low SES significantly increased the odds of depressive symptoms. The moderating effect of social support on depression was however not consistent across SES groups. Specific interventions need to target different SES groups to better help older adults at risk of developing depression.


Depression in the elderly is a major public health issue. Associated morbidities such as higher risk of impairment in physical, mental and social functioning can be substantial, with the most serious complication being suicide. In the elderly, depression can often be undiagnosed and untreated because it may be related to various factors commonly associated with aging, such as comorbid diseases, loss of independence and function, and bereavement. In Singapore, population-based surveys have found that about 6% of community-dwelling older adults have depression, while 13% of them have depressive symptoms. Depression is also the second leading cause of disability.

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