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Prognostic significance of social network, social support and loneliness for course of major depressive disorder in adulthood and old age

Published online by Cambridge University Press:  10 February 2017

R. H. S. van den Brink*
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
N. Schutter
Department of Geriatric Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
D. J. C. Hanssen
Department of Psychiatry, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
B. M. Elzinga
Section Clinical Psychology, Leiden University, Leiden, The Netherlands
I. M. Rabeling-Keus
School of Psychology and Artificial Intelligence, Radboud University Nijmegen, Nijmegen, The Netherlands
M. L. Stek
Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Old Age Psychiatry, GGZinGeest, Amsterdam, The Netherlands
H. C. Comijs
Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Old Age Psychiatry, GGZinGeest, Amsterdam, The Netherlands
B. W. J. H. Penninx
Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
R. C. Oude Voshaar
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
*Address for correspondence: Dr R. H. S. van den Brink, University Medical Center Groningen, P.O. Box 30.001, CC73, 9700 RB Groningen, The Netherlands. (Email:



Poor recovery from depressive disorder has been shown to be related to low perceived social support and loneliness, but not to social network size or frequency of social interactions. Some studies suggest that the significance of social relationships for depression course may be greater in younger than in older patients, and may differ between men and women. None of the studies examined to what extent the different aspects of social relationships have unique or overlapping predictive values for depression course. It is the aim of the present study to examine the differential predictive values of social network characteristics, social support and loneliness for the course of depressive disorder, and to test whether these predictive associations are modified by gender or age.


Two naturalistic cohort studies with the same design and overlapping instruments were combined to obtain a study sample of 1474 patients with a major depressive disorder, of whom 1181 (80.1%) could be studied over a 2-year period. Social relational variables were assessed at baseline. Two aspects of depression course were studied: remission at 2-year follow-up and change in depression severity over the follow-up period. By means of logistic regression and random coefficient analysis, the individual and combined predictive values of the different social relational variables for depression course were studied, controlling for potential confounders and checking for effect modification by age (below 60 v. 60 years or older) and gender.


Multiple aspects of the social network, social support and loneliness were related to depression course, independent of potential confounders – including depression severity – but when combined, their predictive values were found to overlap to a large extent. Only the social network characteristic of living in a larger household, the social support characteristic of few negative experiences with the support from a partner or close friend, and limited feelings of loneliness proved to have unique predictive value for a favourable course of depression. Little evidence was found for effect modification by gender or age.


If depressed persons experience difficulties in their social relationships, this may impede their recovery. Special attention for interpersonal problems, social isolation and feelings of loneliness seems warranted in depression treatment and relapse prevention. It will be of great interest to test whether social relational interventions can contribute to better recovery and relapse prevention of depressive disorder.

Original Articles
Copyright © Cambridge University Press 2017 

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