Undergraduate Research Journal for the Human Sciences

This study examined the correlation between social intimacy and depression of residents in long-term care facilities for the elderly. It was hypothesized that a negative correlation would exist between the two variables. Twenty-three participants aged 65 and older were selected from two nursing facilities in northeastern Indiana using convenience sampling. They were asked to complete two surveys, the Miller Social Intimacy Scale (MSIS) and the Geriatric Depression Scale (GDS). A Pearson r correlation coefficient was used to analyze the data. No significant correlation was found between the two variables. Certain limitations to the study suggest further need for research on this population.

Social Intimacy and Depression in Long-term Care Facility Residents

A popular misconception abounds in our society: the belief that depression is a natural consequence of old age. Related to this falsity is the disdain people have toward nursing homes and other long-term care facilities for the elderly population. Nursing homes have gained a bad reputation: client abuse, client neglect, poor nutrition, and uneducated help. This list is the exception, rather than the norm, to characteristics of nursing home facilities. Even so, nursing homes are often associated with helplessness, isolation, sickness, and death (Hillier & Barrow, 2007; Kart & Kinney, 2001). The general assumption is that aging, and more specifically living in a nursing home, inevitably leads to depression. This is far from the truth, as past research on geriatrics has indicated (Alexpolous, 2005; Kinsella & Phillips, 2005; Lawton, 1995).

Quadagno (2005) offers several definitions of old age. Chronological age involves classifying individuals based on a numerical range. Those 65 and older generally fall under the categorization of “elderly,” an age marker used by the government for the purposes of allotting Social Security funds. Functional age refers to the ability (or lack thereof) to perform activities of daily living, such as bathing, dressing, and cleaning. Self-perception is yet another way in which a person may be defined as elderly, reflecting the idea that one is only as old as one feels. Physiological age is concerned with chronic diseases and other impediments of the aging process. Social age relates to the particular social roles that one possesses, including relational (e.g., grandparent), economic (e.g., retiree), and political (e.g., AARP member).

There are also many ways to define intimacy. Bullard-Poe, Powell, and Mulligan (1994) examined the importance of intimacy to men living in a long-term care facility. The results showed that social intimacy was ranked first in importance and sexual-physical intimacy ranked last in importance. However, intimacy is more than just sexual and physical. Another study examined how social intimacy affects the participant’s response to stress. Miller & Lefcourt (1983) found that participants who currently lacked intimacy were pre-disposed to experience emotional disturbances. Gaia (2002) examined emotional intimacy in interpersonal relationships by reviewing previous studies on this variable and synthesizing its various conceptualizations.

Another component of intimacy is sociality. Krahn (1996) operationalized social intimacy as personal self-disclosure. Krahn (1996) discovered females had higher levels of intimacy in their same gendered relationships as compared to men. A difference was not found between different age groups. Social intimacy was experienced throughout all age groups; however, as one ages, social intimacy may decrease because of decline in mobility, widowhood, as well as living arrangements, such as long-term care facilities. These factors can lead to fluctuations in emotional well-being, including increased risk of clinical depression. Clinical depression is a symptomatic diagnosis, focused on labeling individuals who meet certain predetermined criteria. These criteria include depressed mood, loss of interest in pleasurable activities, loss of appetite, sleep disturbances, and feelings of worthlessness (American Psychiatric Association, 2000).

Ross and Mirowsky (1989) analyzed social patterns of depression. They concluded that consistently higher levels of income and education, being male, and being married were associated with consistently lower levels of depression. The authors examined these phenomena as a result of the social perceptions of controlling one’s own life and the sense of having a supportive and understanding person to talk to in times of trouble.

Mirowsky and Ross (1992) viewed the relationship between age and depression. The authors examined age from five different points of view: maturity, decline, life-stage, survival, and historical trend. They concluded that depression is the lowest among middle aged, higher among younger and older adults, and the highest among the oldest adults. The authors say that aging in itself is not depressing. The rise in rates of depression among the elderly can be accounted for by such things as retirement, widowhood, economic hardship, physical degeneration, and the loss of personal control. Lawton (1995) explored the relationship between positive and negative events and emotional well-being for depressed and non-depressed residents of a nursing home and congregate housing care facility. He found that the most significant depressants were health-related. Positive events were more frequent than negative events in the non-depressed participants.

Alexopoulos (2005) scrutinized depression from a medical point of view. The author said that depression mainly affects those with chronic mental illness and cognitive impairment. Alexopoulos compared different causes of depression as well as the diagnosis, prevention, and management of depression in elderly. The author concluded that the available treatments were as effective for the treatment of depression in the elderly as they were in younger individuals, but late-life depression is often under-recognized and under-treated.

Lasser, Siegel, Dukoff, and Sunderland (1998) found that geriatric depression affects as much as one-third of the older population. They say that the mismatch between high prevalence of depression and its under-treatment is the result of attitudes toward depression as a “normal” response to aging and loss. However, depression is not a normal consequence of aging. Loss of independence, characteristic of those in nursing homes, is more a cause of depression than the aging process. Rates of depression among nursing home residents are three to five times higher than the rates among the elderly not residing in an extended care facility (Minicuci, Maggi, Pavan, Enzi, & Crepaldi, 2002). Amount of social engagement is a major factor in rates of depression among nursing home residents (Gilbart & Hirdes, 2000).

The Geriatric Depression Scale (Yesavage, 1982; see also Kurlowicz, 1999) and the Miller Social Intimacy Scale (1982) were used in this study. A prior quasi-experimental study between the two measures found support for a negative correlation between social intimacy and depression (Appenzeller, 1998). It was hypothesized that a negative linear correlation exists between geriatric depression and social intimacy in senior citizens residing in long term-care facilities.

Method

Thirty participants were selected from a 65 and older population residing in three long-term care facilities in northeastern Indiana. Participants were chosen using convenience sampling, based on the discretion of the residential director and/or social worker. The sample included 4 males and 19 females. The average age of the male participants was 76.75 and the average age of the female participants was 70.86.

The social intimacy of the participants was assessed using the Miller Social Intimacy Scale (MSIS), which consists of 17 questions scored on a 10-point Likert scale (Miller & Lefcourt, 1982) (see Appendix A). This scale parallels the Marlowe-Crowne (1960) Need for Approval Scale, with items modified to relate to social intimacy. The reliability of the MSIS is .96 over a two-month period. The validity of this scale is .84 over the same period.

Depression was measured using the Geriatric Depression Scale (GDS), which consists of 30 “yes” or “no” questions (Yesavage, 1982; see also Kurlowicz, 1999) (Appendix B). Originally developed by Yesavage (1982), life satisfaction, withdrawal, and general depressive affect are the three components investigated by the GDS. It differs from standard depression scales in that it has less emphasis on somatic pathologies because deteriorating health is natural in the aging process. The reliability of the GDS is .92 and the validity of the GDS is .89.

Facility directors and social workers were informed of our intent and granted us permission to conduct research at their sites. They compiled a list of names of residents willing to participate. Participants unable to read or comprehend the survey items and participants who lacked the fine motor skills necessary to select their answers in writing were disqualified from the study. Consent forms were distributed with the assurance of individual confidentiality and with a statement of the study’s purpose (Appendix C).

Employing a within-subjects design, the MSIS and the GDS were administered to the participants immediately following the signing of the consent forms. In addition to the survey items, demographic information was requested, including age, gender, and duration of residence in the nursing home. Two variations in survey distribution were used to counterbalance the possible confounding variable of survey order. The Geriatric Depression Scale was administered first to one-half of the participants, followed by the Miller Social Intimacy Scale. The remaining participants received the Miller Social Intimacy Scale first and concluded with the Geriatric Depression Scale. The data were collected and organized for analysis.

A Pearson r correlation coefficient was used to analyze the data. An alpha level of .05 with 21 degrees of freedom was used. Scores for the MSIS were compared with scores from the GDS. The obtained r was 0.188. When the obtained r was compared to the critical r value (r = 0.413), the null hypothesis was retained (Figure 1). No significant correlation was found between social intimacy and depression. The mean score on the MSIS was 110.52 with a range of 32-140 and a standard deviation of 27.77. The mean score on the GDS was 6.07 with a range of 5-16 and a standard deviation of 4.75.

Discussion

No significant correlation was found between geriatric depression and social intimacy. This study obtained data through convenience sampling in order to avoid using participants who did not have the mental capacity to complete the surveys. Even though these findings cannot be generalized to the national elderly population, this research has implications for residents, their families, facility directors, and future studies conducted in this area.

The results of this study might lead one to think that geriatric depression is not as prevalent in nursing homes as most people assume. This finding is in accordance with Hillier and Barrow (2007) and Kart and Kinney (2001). The recent decline in cases of depression may be a result of residential staff working to counteract the historical trend of nursing home depression. Evidence of this movement was found in the two long-term care facilities included in this study. Each facility had an extensive activities list, encouraging interaction with staff and other residents.

The sample did not include any participants who were labeled “severely depressed” as determined by the Geriatric Depression Scale (GDS), nor did it assess many participants with low social intimacy, according to the Miller Social Intimacy Scale (MSIS). Because the sample included 23 participants, it may not have been large enough to yield statistically significant results if those two variables are in fact significantly related. Generalization to the larger population is also an issue since lack of ethnic and religious diversity was obvious. All participants were Caucasian and resided in “Christian” long-term care facilities.

As with most research, several issues associated with the administration of the surveys had to be addressed. One survey set was discarded because the participant completed the scales incorrectly. One potential participant declined to complete the surveys due to self-proclaimed lack of relevance. GDS items on which participants either did not answer or answered both “yes” and “no” were assigned a value of 0.5. This was done on six surveys. Unanswered items on the MSIS were assigned a mean value based on that participant’s responses to the rest of the items on the survey. This was done on ten surveys. An additional limitation was the researchers’ presence while participants completed the surveys, which could have altered the mood of the participants.

Future research on the elderly population should broaden its scope to include facilities of various religious affiliations in both urban and rural settings. Facilities with independent, assisted-living, and dependent living would also offer a more diversified population. A larger sample than the one obtained in this study would be beneficial to prospective studies.

As the elderly population continues to grow and as the baby boom generation approaches old age, long-term care will become more prevalent and of increasing importance to society. The baby boom generation is healthier and more active than its predecessors and will demand high-quality care in facilities that offer services and programs which allow for more interpersonal contact and, therefore, social intimacy. This high level of social intimacy will likely coincide with a low level of geriatric depression and an improvement in overall mental health (Alexopoulos, 2005).

References

Alexopoulos, G. S. (2005). Depression in the elderly. The Lancet, 365(9475), 1961-1970.

American Psychiatric Association. (2000). Practice guideline for the treatment of patients with major depressive disorder (revision) (4th ed.). Washington, DC.

Appenzeller, M. M. (1998). Relationship between social intimacy and depression in the elderly. (Doctoral dissertation, Walden University, 1998). Dissertation Abstracts

International, 58, 4518. Abstract retrieved February 4, 2007, from PsycINFO database.

Bullard-Poe, L., Powell, C., & Mulligan, T. (1994). The importance of intimacy to men living in nursing homes. Archives of Sexual Behavior, 23(2), 231-236.

Crowne, D. P., & Marlowe, D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology, 24(4), 349-354.

Gaia, A. C. (2002). Understanding emotional intimacy: A review of conceptualization, assessment and the role of gender. International Social Science Review, 77(3), 151-171.

Gilbart, E. E., & Hirdes, J. P. (2000). Stress, social engagement & psychological well-being in institutional settings: Evidence based on the Minimum Data Set 2.0. Canadian Journal on Aging, 19(Suppl. 2), 50-66.

Hillier, S. M., & Barrow, G. M. (2007). Aging, the individual, and society (8th ed.). Belmont, CA: Thomson Wadsworth.

Kart, C. S., & Kinney, J. M. (2001). The realities of aging: An introduction to gerontology (6th ed.). Needham Heights, MA: Allyn & Bacon.

Kinsella, K., & Phillips, D. R. (2005, March). Successful aging. In H. Cox (Ed.), Annual Editions: Aging. Dubuque, IA: McGraw-Hill.

Krahn, E. E. (1996). Intimacy between friends: Age and gender similarities and differences. (Doctoral dissertation, University of Saskatchewan, 1996). Dissertation Abstracts International, 56, 6463. Abstract retrieved February 4, 2007, from PsycINFO database.

Kurlowicz, L. (1999, May). Geriatric Depression Scale (GDS). Try this: Best practices in nursing care to older adults, 4. Retrieved February 13, 2007, from www.hartfordign.org.

Lasser, R., Siegel, E., Dukoff, R., & Sunderland, T. (1998). Diagnosis and treatment of geriatric depression. CNS Drugs, 1, 17-30.

Lawton, M. P. (1995). Relationship of events and affect in the daily life of an elderly population. Psychology and Aging, 10(3), 469-477.

Miller, R. S., & Lefcourt, H. M. (1982). The assessment of social intimacy. Journal of Personality Assessment, 46(5), 514-518.

Miller, R. S., & Lefcourt, H. M. (1983). Social intimacy: An important moderator of stressful life events. American Journal of Community Psychology, 11(2), 127-139.

Minicuci, N., Maggi, S., Pavan, M., Enzi, G., & Crepaldi, G. (2002). Prevalence rates & correlates of depressive symptoms in older individuals: The Veneto study. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57A(3), M155-M161.

Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33, 187-205.

Quadagno, J. (2005). Aging and the life course: An introduction to social gerontology (3rd ed.). New York: McGraw-Hill.

Ross, C. E., & Mirowsky, J. (1989). Explaining the social patterns of depression: Control and problem-solving or support and talking. Journal of Health and Social Behavior, 30(2), 206-219.

Yesavage, J. A. (1982). Development and validation of a Geriatric Depression Screening Scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49.

Appendix A

Appendix B

Please circle either “yes” or “no” in response to the following questions.

12. Do you prefer to stay at home, rather than going out and doing new things? Yes No

Appendix C

I have been asked to participate in a research project investigating relationship dynamics and mood assessment.

This project is under the direction of Stephanie Baehrens, Emily Horne, and Amanda Van Rosendale, undergraduate students at Huntington University and fulfills a requirement for a course in the psychology major taught by Wayne Priest, Ph. D.

I understand that there are no known risks associated with participating in this project and that I will be asked to complete surveys on relationship dynamics and mood.

I understand that the information gathered from me during this project will not be reported to anyone outside the project in any manner that might personally identify me. A report of combined and generalized results involving multiple participants will be prepared. This information will be presented in a scholarly public forum, and will be available to participants upon request.

My signature indicates that I understand and voluntarily agree to the conditions of participation described above and that I may withdraw from the study at any time without prejudice.

Social Intimacy and Depression in Long-Term Care Facility Residents