People with depression face significantly greater social and health-related challenges

A new study has found that individuals with depression tend to have substantially higher health-related social needs compared to their non-depressed peers. They also exhibited higher frailty index scores. The research was published in the Journal of Affective Disorders.

Health-related social needs refer to non-medical factors that significantly influence health outcomes, such as access to food, housing, transportation, utilities, and social support. These needs fall under the broader concept of social determinants of health. When unmet, health-related social needs can contribute to chronic disease, hospitalizations, and poor overall health.

Healthcare providers and systems are increasingly screening for these needs to address barriers to care and improve health equity. Addressing them often requires collaboration among medical professionals, community organizations, and social services.

Another important indicator of vulnerability to adverse health outcomes is the frailty index. Frailty is a condition marked by diminished physiological capacity and an increased susceptibility to harmful outcomes such as frequent falls, fractures, disability, impaired mobility, feelings of isolation, confusion, and an elevated risk of both dementia and depression.

Study author Ruoyu Gou and his colleagues hypothesized that individuals with high levels of health-related social needs are at an increased risk of depression. They also hypothesized that this relationship may be mediated by frailty.

The authors analyzed data from the National Health and Nutrition Examination Survey, a large, ongoing survey designed to collect nationally representative data on the U.S. population. This analysis included non-institutionalized U.S. adults from ten survey cycles conducted between 2003 and 2023. Data from 22,024 participants were included, with an average age of approximately 46 years.

The researchers assessed health-related social needs across eight specific components: employment status, household income relative to the poverty line, food security, education level, healthcare access, health insurance coverage, housing status, and marital status. Depression symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and frailty was measured using a frailty index based on 36 items related to the accumulation of health deficits. This index incorporated self-reported health status, vital signs, and laboratory tests.

Results showed that individuals with depression had higher health-related social needs than their non-depressed peers. More specifically, the odds of depression were 1.5 to 2 times higher in participants with moderate levels of unmet social needs compared to those with no unmet needs. The odds were nearly 9 to 12 times higher among individuals with the greatest number of unmet needs.

Depressed individuals also had higher frailty index scores compared to non-depressed participants. Further statistical analysis revealed that frailty accounted for approximately 45% of the association between health-related social needs and depression, indicating that frailty partially mediated the relationship.

“Over a period of 20 years in the United States, HRSN [health-related social needs] levels have been associated with an increased risk of depression. This may occur through the induction of frailty in participants,” the study authors concluded.

The study sheds light on the links between health-related social needs and depression. However, it should be noted that the design of this study does not allow any causal inferences to be derived from the results.

The paper, “Association of Health Related Social Needs (HRSN) with depression in NHANES (2003− 2023): mediating effects of frailty,” was authored by Ruoyu Gou, Hongting Cao, Danni Dou, Zhengyang Huo, and Guanghua Li.