The effects of social support, inclusion in social networks and alcohol consumption on depressive

338 Pages·2016·3.86 MB·English

by  Merin Philip

The effects of social support, inclusion in social networks
and alcohol consumption on depressive symptoms in the
adult urban population of the UK and of Central and
Eastern Europe.

Th e effects of social support, inclusion in social networks

and alcohol consumption on depressive symptoms in the
Margherita Franchi, ESRC PhD Student
Superivisors: Dr H. Pikhart, Dr J, Head, Dr S. Croezen, Prof. Michael Marmot

adult urban population of the UK and of Central and

Eastern Europe.
ii
Abstract

Background

Depression is the most common mental disorder and the leading cause of disability
worldwide. Three main risk factors for depression are inclusion in social networks, social
support and alcohol consumption. Although research has focused on the association
between each risk factor and depression, virtually no study has yet attempted to
investigate how they interact in affecting the risk of depression. This thesis aims to fill this
gap in our understanding of risk factors for depression.

Methods

The association between social support, inclusion in social networks, alcohol consumption
and depressive symptoms was investigated in three ways. First cross-sectionally, using data
from the Whitehall II and HAPIEE cohorts to compare the patterns of association observed
in the UK with those observed in Central and Eastern Europe. Then longitudinally, using
data from four phases of the Whitehall II cohort to assess the magnitude and duration of
the association. Finally, through growth curve models aimed at modelling patterns of
covariation between social support, inclusion in social networks, alcohol consumption and
depressive symptoms through time.

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Results

In all four countries odds of depressive symptoms were higher among individuals who did
not have or never saw their friends and relatives. In Central and Eastern Europe high odds
of depressive symptoms were found among both abstainers and heavy drinkers. In the UK,
negative social support, social isolation, daily drinking and abstention were predictive of
high odds of depressive symptoms for as long as nineteen years. Participants who suffered
from intense depressive symptoms, were socially isolated and received inadequate support
were more likely to engage in frequent drinking than their more socially connected
counterparts. This suggests that interventions aimed at improving social connections could
prove particularly effective in preventing depressive symptoms but also at containing
hazardous alcohol consumption.

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Acknowledgments

The realisation of this thesis was possible only thanks to the help and support of a
number of people to whom goes my deepest gratitude.
Firstly, I would like to thank the ESRC for funding the four years of this research project.
Secondly, my gratitude goes to Dr Hynek Pikhart, Professor Jenny Head and Dr Simone
Croezen for supervising the development of this work from the very beginning, patiently
advising and supporting me throughout the length of this project.

Thirdly, I would like to thank my parents for always supporting me during this adventure
and for proofreading the final draft of this thesis. Miss Sydney White and Mr Matthew
Nicks have kindly helped me with the formatting of this thesis and for this they have my
gratitude.

I thank Miss Ula Tymoszuk and Dr Peggie Huangfu for the long conversations about our
respective research and the advice they have provided over the years.
Last but not least, my gratitude goes to Miss Kasia Zbrowska and Mr Craig Sweetlove for
patiently supporting me, always compelling me to do better and not once losing faith in
me.

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Contents

Abstract ......................................................................................................... iii
1. Introduction ............................................................................................. 1
2. Background and Literature Review ......................................................... 15
Introduction ........................................................................................................................... 16
Depression ............................................................................................................................. 19
2.2.1 Historical context ........................................................................................................ 19
2.2.2 Symptoms and Diagnosis ............................................................................................ 20
2.2.3 Reporting and Treatment ............................................................................................ 23
2.2.4 Epidemiological Tools .................................................................................................. 26
2.2.5 Prevalence and Risk Factors ........................................................................................ 28
Inclusion in Social Networks and Social Support ................................................................... 30
2.3.1 Historical Context ........................................................................................................ 30
2.3.2 Modern Theory ........................................................................................................... 35
2.3.3 Social Capital ............................................................................................................... 38
2.3.4 Social Networks ........................................................................................................... 42
2.3.5 Social Support.............................................................................................................. 50
2.3.6 Gender differences ...................................................................................................... 54
2.3.7 Depressive symptoms, inclusion in social networks and social support..................... 56
Alcohol consumption ............................................................................................................. 58
2.4.1 Historical context ........................................................................................................ 58
2.4.2 Defining alcohol consumption .................................................................................... 60
2.4.3 Alcohol consumption and Depressive Symptoms ....................................................... 65
2.4.4 Gender differences ...................................................................................................... 71
2.4.5 Depressive symptoms and alcohol consumption........................................................ 74
Inclusion in Social Networks, Social Support, Alcohol Consumption and Depressive
Symptoms ......................................................................................................................................... 76
2.5.1 Introduction ................................................................................................................ 76
2.5.2 Social Capital and Alcohol Consumption ..................................................................... 78
2.5.3 Inclusion in Social Networks and Alcohol Consumption ............................................. 81
2.5.4 Alcohol Consumption and Inclusion in Social Networks ............................................. 84
2.5.5 Inclusion in Social Networks, Social Support, Alcohol Consumption and Depressive
Symptoms 87
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Evidence from the Whitehall II and HAPIEE cohort studies .................................................. 88
2.6.1 Introduction ................................................................................................................ 88
2.6.2 Whitehall II .................................................................................................................. 90
2.6.3 HAPIEE ......................................................................................................................... 93
Summary and gaps in the literature ...................................................................................... 94
3. Aims, Objectives and Hypotheses ........................................................... 99
Introduction and Research Aims ......................................................................................... 100
Objectives and Hypotheses ................................................................................................. 102
3.2.1 Introduction .............................................................................................................. 102
3.2.2 Cross-sectional Objectives and Hypotheses.............................................................. 103
3.2.3 Longitudinal Objectives and Hypotheses .................................................................. 104
3.2.4 Temporality and Association ..................................................................................... 105
4. Methods ............................................................................................... 107
Introduction ......................................................................................................................... 108
Study population and sample .............................................................................................. 109
4.2.1 Whitehall II ................................................................................................................ 109
4.2.2 HAPIEE ....................................................................................................................... 112
Measures of Depressive Symptoms .................................................................................... 114
4.3.1 Whitehall II: the General Health Questionnaire (GHQ) ............................................ 114
4.3.2 HAPIEE: the Centre for Epidemiological Studies Depression Scale (CES-D) .............. 114
4.3.3 Comparison of the two scales ................................................................................... 115
Measures of Inclusion in Social Networks and Social Support ............................................ 116
4.4.1 Whitehall II ................................................................................................................ 116
4.4.2 HAPIEE ....................................................................................................................... 118
Measures of alcohol consumption ...................................................................................... 119
4.5.1 Whitehall II ................................................................................................................ 119
4.5.2 HAPIEE ....................................................................................................................... 120
Covariates ............................................................................................................................ 122
4.6.1 Whitehall II ................................................................................................................ 122
4.6.2 HAPIEE ....................................................................................................................... 123
Ethics ................................................................................................................................... 124
5. International Comparison ..................................................................... 125
Introduction ......................................................................................................................... 126
Statistical Analysis ............................................................................................................... 128
Results ................................................................................................................................. 132
5.3.1 Comparison of the CESD and GHQ depression scales ............................................... 132
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5.3.2 Whitehall II descriptive statistics .............................................................................. 142
5.3.3 Whitehall II - Inclusion in Social Networks, Alcohol Consumption and Depressive
Symptoms 144
5.3.4 HAPIEE descriptive statistics ..................................................................................... 147
5.3.5 HAPIEE – Inclusion in Social Networks, Alcohol Consumption and Depressive
Symptoms 153
Inclusion in Social Networks, Alcohol Consumption and Depressive Symptoms – Differences
and Similarities between the Whitehall II and HAPIEE cohorts ...................................................... 160
Summary ............................................................................................................................. 164
6. Social support, Inclusion in Social Networks, Alcohol Consumption and
Depressive Symptoms in the Whitehall II cohort study. .............................. 166
Introduction ......................................................................................................................... 167
Statistical Analysis ............................................................................................................... 169
Descriptive analysis ............................................................................................................. 176
Social Support and Inclusion in Social Networks, Phase 1 .................................................. 181
Duration of the effects of social support, inclusion in social networks and alcohol
consumption on depressive symptoms .......................................................................................... 184
6.5.1 Social Support............................................................................................................ 184
6.5.2 Inclusion in Social Networks ...................................................................................... 189
6.5.3 Alcohol consumption ................................................................................................ 193
Confounders ........................................................................................................................ 197
Summary ............................................................................................................................. 204
7. Trajectories of change in Social Support, Inclusion in Social Networks,
Alcohol Consumption and Depressive Symptoms ........................................ 208
Introduction ......................................................................................................................... 209
Statistical Analysis ............................................................................................................... 211
7.2.1 Introduction to Latent Growth Curve Modelling (LGCM) ......................................... 211
7.2.2 Statistical Analysis ..................................................................................................... 215
7.2.3 Depressive Symptoms ............................................................................................... 218
7.2.4 Social Support and Inclusion in Social Networks ...................................................... 220
7.2.5 Alcohol Consumption ................................................................................................ 223
7.2.6 Social Support and Depressive Symptoms ................................................................ 225
7.2.7 Inclusion in Social Networks and Depressive Symptoms .......................................... 227
7.2.8 Alcohol Consumption and Depressive Symptoms .................................................... 229
7.2.9 Social support, Inclusion in Social Networks, Alcohol Consumption and Depressive
Symptoms 231
Results ................................................................................................................................. 234
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7.3.1 Depressive Symptoms ............................................................................................... 234
7.3.2 Social Support and Inclusion in Social Networks ...................................................... 236
7.3.3 Alcohol Consumption ................................................................................................ 239
7.3.4 Social Support and Depressive Symptoms ................................................................ 240
7.3.5 Inclusion in Social Networks and Depressive Symptoms .......................................... 242
7.3.6 Alcohol Consumption and Depressive Symptoms .................................................... 244
7.3.7 Social Support, Inclusion in Social Networks, Alcohol Consumption and Depressive
Symptoms 246
Summary ............................................................................................................................. 251
8. Discussion and Conclusion .............................Error! Bookmark not defined.
Introduction ......................................................................................................................... 256
8.1.1 Cross-sectional objectives and hypotheses .............................................................. 258
8.1.2 Longitudinal objectives and hypotheses ................................................................... 259
8.1.3 Temporality and Association ..................................................................................... 261
Summary of results.............................................................................................................. 262
8.2.1 International Comparison ......................................................................................... 262
8.2.2 Social Support, Inclusion in Social Networks, Alcohol Consumption and Depressive
Symptoms in the Whitehall II cohort .......................................................................................... 264
8.2.3 Trajectories of change in Social Support, Inclusion in Social Networks, Alcohol
Consumption and Depressive Symptoms ................................................................................... 267
Methodological Issues ......................................................................................................... 269
8.3.1 Methodological issues in the cohorts ....................................................................... 269
8.3.2 Issues in measurements ............................................................................................ 273
Comparison with the literature ........................................................................................... 277
8.4.1 Cultural variation ....................................................................................................... 278
8.4.2 Effects of inclusion in social networks on depressive symptoms ............................. 283
8.4.3 Effects of social support on depressive symptoms ................................................... 287
8.4.4 Effects of alcohol consumption on depressive symptoms ........................................ 290
8.4.5 Growth Curves ........................................................................................................... 293
Conclusion ........................................................................................................................... 299
9. References ............................................................................................ 300
10. Appendix .............................................................................................. 300

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Tables and Figures

Figure 2.3.1 ............................................................................................................................................ 37
Figure 2.3.2 ............................................................................................................................................ 45
Figure 2.4.1 ............................................................................................................................................ 63
Figure 2.4.2 ............................................................................................................................................ 67
Figure 4.2.1 .......................................................................................................................................... 111
Table 4.4.1 ........................................................................................................................................... 117
Table 4.5.1 ........................................................................................................................................... 121
Table 5.2.1 ........................................................................................................................................... 128
Table 5.2.2 ........................................................................................................................................... 129
Table 5.2.3 ........................................................................................................................................... 130
Table 5.2.4 ........................................................................................................................................... 130
Table 5.3.1 ........................................................................................................................................... 134
Table 5.3.2 ........................................................................................................................................... 135
Table 5.3.3 ........................................................................................................................................... 138
Table 5.3.4 ........................................................................................................................................... 139
Table 5.3.5 ........................................................................................................................................... 140
Table 5.3.6 ........................................................................................................................................... 143
Table 5.3.7 ........................................................................................................................................... 146
Table 5.3.8 ........................................................................................................................................... 150
Table 5.3.9 ........................................................................................................................................... 151
Table 5.3.10. ........................................................................................................................................ 152
Table 5.3.11 ......................................................................................................................................... 157
Table 5.3.12 ......................................................................................................................................... 158
Table 5.3.13 ......................................................................................................................................... 159
Figure 6.2.1 .......................................................................................................................................... 170
Table 6.2.1 ........................................................................................................................................... 171
Table 6.2.2 ........................................................................................................................................... 175
Table 6.3.1. .......................................................................................................................................... 178
Table 6.3.2 ........................................................................................................................................... 179
Table 6.3.3 ........................................................................................................................................... 180
Table 6.4.1 ........................................................................................................................................... 182
Table 6.4.2 ........................................................................................................................................... 183
Table 6.5.1 ........................................................................................................................................... 187
Table 6.5.2 ........................................................................................................................................... 188
Table 6.5.3 ........................................................................................................................................... 191
Table 6.5.4 ........................................................................................................................................... 192
Table 6.5.5 ........................................................................................................................................... 195
Table 6.5.6 ........................................................................................................................................... 196
Table 6.6.1 ........................................................................................................................................... 201
Table 6.6.2 ........................................................................................................................................... 202
Table 6.6.3 ........................................................................................................................................... 203
Table 7.2.1 ........................................................................................................................................... 215
Figure 7.2.1 .......................................................................................................................................... 219
Figure 7.2.2 .......................................................................................................................................... 221
Figure 7.2.3 .......................................................................................................................................... 222
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