Understanding the protective effect of social support on depression symptomatology from a longitudinal network perspective

Gen Li; Yifan Li; Agnes Iok Fong Lam; Weiming Tang; Soraya Seedat; Corrado Barbui; Davide Papola; Catherine Panter-Brick; Judith van der Waerden; Richard Bryant; Ellenor Mittendorfer-Rutz; Katalin Gémes; Fredrick D Purba; Hari Setyowibowo; Irene Pinucci; Christina Palantza; Ceren Acarturk; Gülşah Kurt; Lorenzo Tarsitani; Naser Morina; Sebastian Burchert; Martina Patanè; Soledad Quero; Daniel Campos; Anja C Huizink; Daniela C Fuhr; Tobias Spiller; Marit Sijbrandij; Brian J Hall

doi:10.1136/bmjment-2023-300802

Understanding the protective effect of social support on depression symptomatology from a longitudinal network perspective

BMJ Ment Health. 2023 Nov 29;26(1):e300802. doi: 10.1136/bmjment-2023-300802.

Authors

Gen Li¹, Yifan Li¹, Agnes Iok Fong Lam^{2

3}, Weiming Tang^{1

4}, Soraya Seedat⁵, Corrado Barbui⁶, Davide Papola⁷, Catherine Panter-Brick⁸, Judith van der Waerden⁹, Richard Bryant¹⁰, Ellenor Mittendorfer-Rutz¹¹, Katalin Gémes¹¹, Fredrick D Purba¹², Hari Setyowibowo¹², Irene Pinucci¹³, Christina Palantza¹³, Ceren Acarturk¹⁴, Gülşah Kurt¹⁵, Lorenzo Tarsitani¹³, Naser Morina¹⁶, Sebastian Burchert¹⁷, Martina Patanè¹⁸, Soledad Quero^{19

20}, Daniel Campos^{21

22}, Anja C Huizink¹⁸, Daniela C Fuhr²³, Tobias Spiller²⁴, Marit Sijbrandij¹⁸, Brian J Hall²⁵

Affiliations

¹ Center for Global Health Equity, New York University Shanghai, Shanghai, China.
² Centre for Macau Studies, University of Macau, Macau, China.
³ Department of Communications, University of Macau, Macao, China.
⁴ University of North Carolina Project-China, Guangzhou, China.
⁵ SAMRC Genomics of Brain Disorders Research Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, UK.
⁷ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
⁸ Department of Anthropology, Yale University, New Haven, Connecticut, USA.
⁹ Institut Pierre Louis d'Épidémiologie et de Santé Publique (iPLesp), Sorbonne Université and INSERM, Paris, Île-de- France, France.
¹⁰ School of Psychology, UNSW, Sydney, New South Wales, Australia.
¹¹ Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
¹² Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia.
¹³ Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
¹⁴ Department of Psychology, Koc University, Istanbul, Turkey.
¹⁵ School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹⁶ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
¹⁷ Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
¹⁸ Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
¹⁹ Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Castellón, Spain.
²⁰ CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain.
²¹ Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain.
²² Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
²³ Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
²⁴ Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
²⁵ Center for Global Health Equity, New York University Shanghai, Shanghai, China bjh9622@nyu.edu.

Abstract

Background: Higher social support protects people from developing mental disorders. Limited evidence is available on the mechanism through which social support plays this protective role.

Objective: To investigate the stress-buffering process of social support on depressive symptoms using a novel longitudinal dynamic symptom network approach.

Methods: A total of 4242 adult participants who completed the first two waves (from May to October 2020) of the International Covid Mental Health Survey were included in the study. Cross-lagged panel network modelling was used to estimate a longitudinal network of self-reported social support, loneliness and depressive symptoms. Standardised regression coefficients from regularised cross-lagged regressions were estimated as edge weights of the network.

Findings: The results support a unidirectional protective effect of social support on key depressive symptoms, partly mediated through loneliness: A higher number of close confidants and accessible practical help was associated with decreased anhedonia (weight=-0.033) and negative self-appraisal symptoms (weight=-0.038). Support from others was also negatively associated with loneliness, which in turn associated with decreased depressed mood (weight=0.086) and negative self-appraisal (weight=0.077). We identified a greater number of direct relationships from social support to depressive symptoms among men compared with women. Also, the edge weights from social support to depression were generally stronger in the men's network.

Conclusions: Reductions in negative self-appraisal might function as a bridge between social support and other depressive symptoms, and, thus, it may have amplified the protective effect of social support. Men appear to benefit more from social support than women.

Clinical implications: Building community-based support networks to deliver practical support, and loneliness reduction components are critical for depression prevention interventions after stressful experiences.

Keywords: COVID-19; adult psychiatry; depression & mood disorders.

MeSH terms

Adult
Depression* / prevention & control
Female
Humans
Loneliness / psychology
Male
Mental Disorders*
Social Networking
Social Support