Social networks and health among older adults in Lebanon: the mediating role of support and trust

The association of social networks and depression in community-dwelling older adults: a systematic review

BACKGROUND AND OBJECTIVE

Depression is a globally prevalent mental condition, particularly among older adults. Previous research has identified that social networks have a buffering effect on depression. Existing systematic reviews have either limited their research to specific geographic areas or provided evidence from over a decade ago. The vast body of recent literature particularly from the last decade emphasizes the need for a comprehensive review. This systematic review aims to analyze the association of structural aspects of social networks and depression in older adults.

METHODS

The electronic databases APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science were searched from date of data base inception until 11 July 2023. Studies were eligible for inclusion if they reported on community-dwelling older adults (defined as a mean age of at least 60 years old), had an acceptable definition for depression, referred to the term social network in the abstract, and were published in English. Quality was appraised using the Newcastle Ottawa Scale for cross-sectional and longitudinal studies. Outcome data were extracted independently from each study and analyzed by direction of the relationship, social network domain and cross-sectional or longitudinal study design.

RESULTS

In total, 127 studies were included. The study categorizes structural network aspects into seven domains and finds that larger and more diverse networks, along with closer social ties, help mitigate depression. The literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive. DISCUSSION AND IMPLICATIONS: Despite inconsistent findings, this review highlights the importance of quantifying complex social relations of older adults. Limitations of this review include publication and language bias as well as the exclusion of qualitative research. Further research should use longitudinal approaches to further investigate the reciprocal relationship between social networks and depression. Following this review, interventions should promote the integration of older adults in larger and more diverse social settings. Other: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704]. This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK .

Testing the Reciprocal Relationship Between Social Networks and Purpose in Life Among Older Adults: Application of a Random Intercept Cross-Lagged Panel Model

Objectives: The purpose of this study is to examine if there are longitudinal reciprocal effects between social network size and purpose in life among older adults. Methods: Using data from the National Health and Aging Trends Study, the sample included 1485 male and 2058 female adults 65 years and older. We first computed t-tests to assess gender differences in social network size and purpose in life. In order to examine the reciprocal effects between social network size and purpose in life over four time points (2017, 2018, 2019, and 2020), a RI-CLPM (Model 1) was computed. In addition to the main model, two multiple group RI-CLPM analyses (Model 2 and 3) were computed to test the moderated gender effect on the relationship with models estimating unconstrained and constrained cross-lagged parameters. Results: The results of the t-tests denoted significant gender differences in social network size and purpose in life. The results indicated that Model 1 fit the data well. The carry-over effects of social networks and purpose in life and spill-over effect from wave 3 purpose in life on wave 4 social networks were significant. There were no significant differences between the constrained and unconstrained models testing for moderated gender effects. Discussion: The findings of the study highlight the significant carry-over effect of purpose in life and social network size over four years and the positive spill-over effect from purpose in life on social network size at the subsequent wave, which only appeared at the last time point.

The relationship between social capital and health from a configuration perspective: an evidence from China

BACKGROUND

The debate on the relationship between social capital and health is still ongoing. To enhance previous research, this study uses data drawn from China to analyse the situations in which social capital is related to good health and the various configurations that result in good health outcomes.

METHODS

Using the data of China Family Panel Studies, the conditions of age, gender, marriage, education, income, structural social capital and cognitive social capital were included to analyse the sufficient and necessary conditions for achieving good general health and their different configurations using the fsQCA method.

RESULTS

None of the listed conditions were prerequisites for excellent general health in terms of either their presence or their absence. The sufficiency analysis found 11 configurations with an average of 3-4 conditions per configuration; in no configuration was the condition of social capital present alone. Structured social capital and cognitive social capital exhibited negative states in configurations 1 and 2, respectively. The most prevalent factor in all configurations was the condition of age.

CONCLUSIONS

The relationship between social capital and health is both positive and negative, with cognitive social capital playing a larger role in the positive relationship than structural social capital. Social capital is neither a necessary nor a sufficient condition for health, and it must be combined with a variety of other factors to promote health. A variety of methods can be used to promote an individual's health, as different populations require different approaches to good general health, and no single pathway applies to all populations. In the Chinese population, an individual's age is a significant determinant of their health status.

The moderating effect of emotion regulation in the association between social support and religiosity and psychological distress in adults

BACKGROUND

Lebanese adults face daily obstacles due to their numerous responsibilities and non-ending external pressures to the extent that Lebanon has been ranked second among highest negative experiences countries worldwide. A sparse number of international studies showed that positive social support, religiosity and cognitive reappraisal would decrease psychological distress, but none in Lebanon. This study aimed to evaluate the association between social support, religiosity and psychological distress among Lebanese adults, taking into consideration the moderating role of emotion regulation.

METHODS

387 adult participants enrolled in this cross-sectional study between May and July 2022. Participants were chosen from five different governorates in Lebanon, using the snowball sampling technique, and were asked to complete a structured questionnaire, which included the following scales: the Mature Religiosity Scale, the Emotional Regulation Scale, the Depression Anxiety Stress Scale, and the Multidimensional Scale of Perceived Social Support.

RESULTS

The interaction social support by cognitive reappraisal was significantly associated with psychological distress; at high levels of cognitive reappraisal and low levels of expressive suppression, higher social support (Beta = - 0.07; p = .007) was significantly associated with lower psychological distress. The same was found at high levels of cognitive reappraisal and moderate levels of expressive suppression (Beta = - 0.08; p = .021). Social support alone was not significantly associated with psychological distress in the model (Beta = 0.15; t = 1.04; p = .300; 95% CI - 0.14; 0.44).

CONCLUSION

This cross-sectional study has provided evidence that the adequate use of emotional regulation skills such as high level of cognitive reappraisal and low level of expressive suppression with presence of social support would remarkably decrease psychological distress. This result casts a new light on clinical approaches to tackle this association between the emotional regulation of a patient in interpersonal psychotherapy.

Linked lives and convoys of social relations

We consider linked lives through the Convoy Model of Social Relations to illustrate their complexity, consequences, and development across contexts. To illustrate how the Convoy Model lens provides a unique opportunity to examine the multidimensional and dynamic character of linked lives across time and space, we analyze twenty-three years of longitudinal data from the Social Relations Study (SRS). The SRS is a regionally representative Detroit-area sample (N=1,498) with three waves (1992; 2005; 2015) of data from community dwelling people age 13 to 93. We present three illustrative examples of linked lives: 1) the influence of earlier life social network characteristics (size and closeness) on later life health outcomes; 2) the influence of social position (race and education) on relationship quality with spouse/partner and child over time; and 3) the influence of transitioning from working to retirement on network structure (size and geographic proximity). Findings illustrate linked lives through multiple instances of social relationships and as influenced by various contexts. Further, the consequences of linked lives for mental health are consistent across the life course while influence on physical health is variable. The Convoy Model presents key concepts to situate the ways in which linked lives form and function at various levels and across multiple contexts to have far reaching effects on life outcomes.

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

Reduced social activities and networks, but not social support, are associated with cognitive decline among older chinese adults: A prospective study

BACKGROUND

Social relationships consist of distinct dimensions. The literature on the effect of specific social relationship subdomains on cognitive function is limited. This large-scale, prospective cohort study examined the associations of social relationships with cognitive decline and further explored which subdomains of social relationships were predictive of cognitive decline among elderly Chinese individuals.

METHODS

A total of 3314 older Chinese adults aged 65-110 years from the 2011-2012 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Cognitive decline was defined based on the Chinese version of the Mini-Mental State Examination (MMSE). Social relationships were divided into three subdomains: social activities, social networks, and social support. Linear and binary logistic regression analyses were conducted to assess the effect of social relationships and the social relationship subdomains on cognitive decline after adjusting for age, sex, education, residence, exercise, drinking, smoking, activities of daily living, chronic diseases, depression, and baseline cognitive function.

RESULTS

Seven hundred and sixty-eight participants (23.17%) developed greater cognitive decline during the 3-year follow-up. The social relationships score was negatively associated with cognitive decline. Binary adjusted odds ratios showed that after potential covariates were controlled, social relationships, activities, and networks significantly reduced the risk of cognitive decline. When all social relationships variables were entered simultaneously with all covariates, the effect of social activities and networks on the risk of greater cognitive decline remained significant. However, we did not observe a significant association between social support and the risk of greater cognitive decline.

CONCLUSION

Our findings suggest that social relationships and the subdomains of social activities and networks, but not social support, have a protective effect against greater cognitive decline in older adults. This implies that structural dimensions of social relationships might be more important than functional dimensions in preserving cognitive health among elderly Chinese individuals.

Knowledge and attitude towards Alzheimer's disease and related dementias in a low- to middle-income country: a cross-sectional survey among Lebanese middle-aged and older adults

BACKGROUND

Despite the growing burden of Alzheimer's disease and related dementias (ADRD) in low- to middle-income countries (LMICs) and prior findings of important gaps in research on ADRD knowledge, very few studies have assessed ADRD knowledge in these populations. This study evaluates the knowledge and attitudes towards ADRD among Lebanese middle-aged and older adults.

METHOD

Participants aged ≥ 40 (n = 215) attending primary care clinics at a large medical centre in Lebanon completed the Alzheimer's Disease Knowledge Scale (ADKS), an attitude scale, and the Duke University Religion Index.

RESULTS

ADRD knowledge accuracy was 61.5% (mean score = 18.6 out of 30 (SD = 3.05)). Items with the least correct answers were related to caregiving and risk factors (≤9% and ≤28%). Overall, participants had tolerant views concerning ADRD; the least positive views were regarding living with people with ADRD. Older age, lower educational attainment, and higher religiosity scores were associated with poorer knowledge and attitudes.

CONCLUSION

Results highlight the need for awareness and preventive efforts that address misconceptions about modifiable risk factors and living with ADRD, especially given that the burden of caregiving for older adults often falls on family members in Lebanon and other LMIC countries.

Problematic social media use and mental health (depression, anxiety, and insomnia) among Lebanese adults: Any mediating effect of stress?

PURPOSE

To examine the association between problematic social media use with depression, anxiety, insomnia, and stress in a sample of young Lebanese adults.

METHODS

This cross-sectional study was achieved between January and May 2019; 466 out of 600 adults completed the questionnaire.

RESULTS

Higher problematic social media use was significantly associated with higher depression, anxiety, and insomnia, but not stress. Stress mediated the relation between depression, anxiety, insomnia, and problematic social media use.

PRACTICAL IMPLICATIONS

This study showed that problematic social media use was associated with psychological disorders. Additional research is needed to identify and describe the potential causality between the use of social media and various mental health issues and the interplay between the social media network and other mental health factors.

The association mechanism between social network types and health-related behaviours among the elderly in rural Hubei Province, China

China's rural population ageing situation is extremely serious, and the social network has become a very important social and environmental factor to ensure the health. This study aims to explore the association mechanism between social network types and health-related behaviours among the elderly in rural Hubei Province, China. A cross-sectional cluster sample survey method was used to investigate elderly individuals aged 60 or older. The following three results were obtained: (1) the level of health-related behaviours differed significantly depending on their social network types. The rural elderly embedded in restricted and family restricted networks had lower levels of health-related behaviours than those in other networks, especially those in diverse networks; (2) Social network types were found to be significantly associated with health-related behaviours, the perceived quality of social relationships and social support and (3) Social network types not only had a direct effect on health-related behaviours (except for health-seeking behaviour), but also an indirect effect through the mediating effects of the perceived quality of social relationships and social support. Policy makers should formulate relevant measures to improve unfavourable social network types of the rural elderly, thus promoting their health.

Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0-18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0-15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = -0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = -0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults' social networks, and these moderating effects vary between rural and urban China.

Towards Positive Aging: Links between Forgiveness and Health

Forgiveness may serve as an essential positive resource to help individuals cope emotionally with stressful events, ultimately influencing health. Examination of how individuals forgive within the context of close relationships can provide useful information about positive aging. In this study, we examine how the severity of a recent transgression committed by a spouse/partner or other close social relationship is associated with self-reported physical health among older adults. We also examine how state forgiveness (i.e., in context of a specific event) can offset the potentially negative impact of transgressions on health and further compare the impact when the transgressor is a spouse/partner versus another close social relationship. Data are from the Detroit Community Survey, a cross-sectional survey of social relations, forgiveness, humility, and health in the Detroit Metropolitan Area. Respondents age 50 and older were selected for analysis (N=380). Structural equation models indicated that greater transgression severity was associated with worse self-rated health. Further, state forgiveness was found to play a significant moderating role. Among older adults who were more likely to forgive their transgressor, experiencing a more severe transgression was associated with worse health. In contrast, among older adults less likely to forgive, there was no association between transgression severity and self-rated health. Additionally, among older adults less likely to forgive, the transgressor being a close other social relationship was associated with worse health compared to when it was a spouse/partner. In contrast, when more likely to forgive there was no association between who the transgressor was and self-rated health. This study contributes to a better understanding of how interpersonal stress, specifically a recent transgression experienced within the context of close social relationships, can be harmful to older adults’ health. Findings highlight the importance of forgiveness as a resource that can help facilitate positive aging.

Social Interaction in Walking Groups and Affective Responses Among Japanese Older Adults

This study examined whether satisfaction with social interactions and the number of people interacted with during walking groups is associated with affective responses among older adults. Twenty-six older adults were asked to participate in five walking group sessions. The participants walked together for 40-50 min. In every session, the participants reported their affective responses to walking (positive engagement, tranquility, and negative affect), their level of satisfaction with the social interactions experienced, and the number of people interacted with during the walk. The available data were from 107 person-sessions. Multilevel models revealed that, although a higher number of people interacted with was not significantly associated with improvements in any affective responses, higher satisfaction with the interactions was significantly associated with improvements in positive engagement at both the within- and between-person levels. This study found that higher satisfaction with the interactions was associated with desirable affective responses among older adults.

Social Network Size and Subjective Well-Being: The Mediating Role of Future Time Perspective Among Community-Dwelling Retirees

An accumulating body of literature has confirmed the effect of social networks on the subjective well-being (SWB). However, the relevant mechanism for the relationship between them requires further exploration. This research examined the association between social network size and SWB and the mediating role of future time perspective (FTP) among Chinese retirees. We modeled the relationship between social network size, FTP, and SWB by two sub-studies. SWB was indicated by life satisfaction, positive affect, negative affect, and meaning in life. FTP comprised two dimensions: focusing on opportunity in future and focusing on limitation of time. Study 1 used the number of Spring Festival greeters, and Study 2 used the size of networks based on common actions (discussion, mutual helping, and social participation) as indicators of network size to examine the association and mediating effect among 1097 and 335 community-dwelling retirees, respectively. Both studies revealed that social network size was positively associated with SWB; FTP-opportunity but not FTP-limitation mediated above associations, when possible confounding variables were controlled for. Findings confirm relevance of social networks in the SWB of retirees, and provide a new insight into the role of FTP as an explanatory mechanism.

Typology of Social Network Structures and Late-Life Depression in Low- and Middle-Income Countries

Background:

Rapid social changes and youth migration ensures a continuous drain on the social networks of the elderly in Low- and Middle-Income Countries (LMICs).

Objective:

We reviewed available literature on the relationship between social network structures and depression among community dwelling older persons in LMICs with a view to identifying patterns that might provide information for designing preventive psychosocial interventions.

Methods:

We searched the MEDLINE database through Pubmed, extracted information on the typologies of social network structures in LMICs and identified dimensions with the strongest systematic association with late-life depression, by weight, using the inverse of variance method. All analyses were conducted using the Cochrane review manager version 5.3.

Results:

Fourteen community-based surveys drawn from 16 LMIC contexts met criteria for syntheses. They included a total of 37,917 mostly female (58.8%) participants with an average age of 73.2 years. Social network size, contact with network, diversity of network, co-residency with own child, having more friends than family in the network, and prestigious standing of persons in the social network were protective structures against late-life depression. Conversely, low network diversity contributed 44.2% of the weight of all social network structures that are predictive of late-life depression.

Conclusion:

Recommendations are made for the design of new measures of social network structures in LMICs that captures the key dimensions identified. Epidemiological studies using such tools will provide more precise information for planning and prioritization of scarce resources for the prevention of late-life depression in LMICs.

Social Network Types and Health among Older Adults in Rural China: The Mediating Role of Social Support

This study aimed to identify social network types among older adults in rural China, to explore the relationship between social network types and the health of the older adults, and further, to examine the mediating role of social support in this relationship. A cross-sectional survey method was employed to investigate the health of adults aged 60 or older in rural areas of Hubei Province from 5 September 2018 to 15 October 2018; 405 samples were obtained. First, using k-means clustering analysis, we found five robust network types: diverse, restricted, family, friends and a specific type—family-restricted. Second, the results of multiple linear regression analysis showed that social network types were significantly associated with depressive symptoms and self-rated health in older adults. Older people with diverse friend networks were significantly associated with lower levels of depressive symptoms, whereas those with restricted and family-restricted networks were significantly associated with higher levels of depressive symptoms and lower levels of self-rated health. Finally, the results of multiple linear regression analysis confirmed that social support partially mediated the association of the identified social network types with depressive symptoms and self-rated health. Enriching the social network relationships of older adults and providing them with more social support should be conducive to promoting their mental and physical health.

Cognitive Reserve Factors in a Developing Country: Education and Occupational Attainment Lower the Risk of Dementia in a Sample of Lebanese Older Adults

Background: Dementia secondary to neurodegenerative diseases is prevalent among older adults and leads to social, psychological and economic burden on patients, caregivers and the community as a whole. Cognitive reserve factors such as education, and mental stimulation among others were hypothesized to contribute to the resilience against age-related cognitive impairment. Educational attainment, occupation complexity, physical activity, and leisure activity are explored in the context of protecting the older adults' cognitive function. We investigated the cognitive reserve effect on dementia, cognitive decline and impairment, and global cognitive function.

Methods: This study is a secondary analysis of data from a cross-sectional, community-based cohort study that aimed at investigating factors associated with dementia and their prevalence. The sample was of 508 community based older adults in Lebanon, aged 65 years and above in addition to 502 informants designated by these older adults. Older adults and informants answered structured questionnaires administered by interviewers, as well as a physical assessment and a neurological examination. Older adults were diagnosed for dementia. Global cognitive function, depression, and cognitive decline were assessed.

Results: Older adults with dementia had lower levels of education, and attained lower occupational complexity. Factors such as high education, complex occupation attainment, and leisure activity, significantly predicted better global cognitive function. An older adult who attained high education levels or high complexity level occupation was 7.1 or 4.6 times more likely to have better global cognitive function than another who attained lower education or complexity level occupation respectively.

Conclusion: These results suggest that cognitive reserve factors ought to be taken into consideration clinically during the course of dementia diagnosis and when initiating community-based preventive strategies.

Quality of support in the social networks of older Filipino church members: an exploratory study

Purpose

The purpose of this paper is to explore the quality of social relationships of older Filipino church members by determining their perceptions of support and non-support in their social network.

Design/methodology/approach

A qualitative research approach with semi-structured interviews was utilized. A purposive sample of six Filipino older adults (ages 60-89) were invited and agreed to participate in the study.

Findings

The themes found in the study confirmed the types of support outlined in social convoy theory. Several unique nuances in the types of support and non-support between the interactions of older adult Filipinos with people very close to them, somewhat close to them, and merely acquainted with them were identified. The themes of support include instrumental support, emotional care, social connectedness, and companionship during engagement in activities. Themes characterising lack of support include disrespect and lack of understanding, constraining one’s actions, helplessness in responding to the other’s needs, non-dependability and non-reliability, difficulty in maintaining social connections, making it difficult to play a desired or expected role.

Research limitations/implications

The study’s limitations are the small sample size, the quality of support explored only through nominating two members of each level of closeness in the older adults’ social convoy, sample size adequacy to reach data saturation, and the lack of data on support reciprocity that may influence the respondents’ perceptions of support and non-support.

Practical implications

The findings of the paper point to possible interventions to improve social support for the older population. The road map for those interested in developing interventions should also put some emphasis on older adults’ needs in their continued societal engagement. Interventions may involve facilitating role transitions and providing social support systems attuned to the needs of the elderly.

Social implications

The authors speculate that this lack of support experienced by the older adults relates to the loss of societal roles, especially as this relates to their identity, meaning, and changes in social interactions within their communities. It is therefore important that interventions be planned to provide structures for older adults’ transitions in their re-engagement in society and into the work-force, thereby reducing this sense of role ambiguity and providing them with more positive identities in their communities.

Originality/value

The results suggest another form of support distinct from the emotional and instrumental support elaborated in previous work. This support is identified as companionship from within the social network that allows older adults to sustain engagement in meaningful activities. The study’s results further suggest a lack of clarity in societal roles, i.e. a sense of role ambiguity, which older adults may experience in the transitioning from adulthood to later adulthood.

Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country

OBJECTIVES

This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors.

DESIGN

Data were drawn from the Older Adult Component (n = 740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses.

RESULTS

Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89-3.79) to 1.42 (95% CI: 0.96-2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39-3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96-2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80-1.76).

CONCLUSIONS

The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings.

Social Network and Mental Health Among Older Adults in Rural Uttar Pradesh, India: A Cross-Sectional Study

The rapid growth of the older population in India draws attention to the factors that contribute to their changing health realities. However, there has hardly been any study in India that has looked at the effects of specific social networks with children, relatives, friends and confidant on depression among older adults. The objective of the study is to investigate the association between social network and depression among the rural elderly. The study population comprised over 630 older adults (aged 60 and above) from the rural areas of Varanasi, Uttar Pradesh. We adopted Berkman's theoretical model of the impact of social relations on depression among the elderly in the Indian context. Results of the Confirmatory Factor Analysis (CFA) demonstrated that the four specific social network types: children, relatives, friends and confidant were tenable. The results showed that a better social network with 'friends/neighbours' was protective against depression among the rural elderly. This clearly points to the need for more social network centres for older adults, so that they can interact with friends within the community or between communities and participate in group activities.

Social network types among older Korean adults: Associations with subjective health

With population aging now a global phenomenon, the health of older adults is becoming an increasingly important issue. Because the Korean population is aging at an unprecedented rate, preparing for public health problems associated with old age is particularly salient in this country. As the physical and mental health of older adults is related to their social relationships, investigating the social networks of older adults and their relationship to health status is important for establishing public health policies. The aims of this study were to identify social network types among older adults in South Korea and to examine the relationship of these social network types with self-rated health and depression. Data from the Korean Social Life, Health, and Aging Project were analyzed. Model-based clustering using finite normal mixture modeling was conducted to identify the social network types based on ten criterion variables of social relationships and activities: marital status, number of children, number of close relatives, number of friends, frequency of attendance at religious services, attendance at organized group meetings, in-degree centrality, out-degree centrality, closeness centrality, and betweenness centrality. Multivariate regression analysis was conducted to examine associations between the identified social network types and self-rated health and depression. The model-based clustering analysis revealed that social networks clustered into five types: diverse, family, congregant, congregant-restricted, and restricted. Diverse or family social network types were significantly associated with more favorable subjective mental health, whereas the restricted network type was significantly associated with poorer ratings of mental and physical health. In addition, our analysis identified unique social network types related to religious activities. In summary, we developed a comprehensive social network typology for older Korean adults.

Social networks and links to isolation and loneliness among elderly HCBS clients

OBJECTIVES

The purpose of this study was to explore the network types of HCBS clients based on the structural characteristics of their social networks. We also examined how the network types were associated with social isolation, relationship quality and loneliness.

METHOD

Forty personal interviews were carried out with HCBS clients to assess the structure of their social networks as indicated by frequency of contact with children, friends, family and participation in religious and community organizations. Hierarchical cluster analysis was conducted to identify network types.

RESULTS

Four network types were found including: family (n = 16), diverse (n = 8), restricted (n = 8) and religious (n = 7). Family members comprised almost half of participants' social networks, and friends comprised less than one-third. Clients embedded in family, diverse and religious networks had significantly more positive relationships than clients embedded in restricted networks. Clients embedded in restricted networks had significantly higher social isolation scores and were lonelier than clients in diverse and family networks.

DISCUSSION

The findings suggest that HCBS clients' isolation and loneliness are linked to the types of social networks in which they are embedded. The findings also suggest that clients embedded in restricted networks are at high risk for negative outcomes.