Title

Marriage and other important social relationships as predictors of accessing mental health services and on mental health outcomes among older adults with depression

Date of Award

2005

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Social Sciences

Advisor(s)

Christine L. Himes

Keywords

Marriage, Social relationships, Mental health services, Older adults, Depression

Subject Categories

Medicine and Health | Social and Behavioral Sciences | Sociology

Abstract

Objective . Older adults access mental health services at lower rates than younger adults. The effects of marriage and other important social relationships on older adults' accessing mental health services are largely unknown. The purpose of this study was to use an expanded Behavioral Model and social integration theory to examine the effect marriage and other important social relationships have on accessing mental health care by elders with depression. Once study participants entered into mental health care, this study focused on the effect marriage and other social relationships had on the depression outcomes of older adults who participated in mental health treatment. Methods . Study subjects for this research were 1002 depressed older adults age 65 and above who participated in the PRISM-E study, a randomized mental health services trial. Predisposing, enabling and evaluated needs components were entered into a stepwise multivariate logistic regression model to determine the effect marriage and other social relationships had on accessing mental health services. Analysis of variance models were estimated to examine the effect of marriage and other social relationships on depression outcomes at six months compared to baseline scores, using the Center for Epidemiological Studies for Depression (CES-D). Results . Marriage did not have any effect on older adults' accessing mental health treatment, nor did having close relatives. Having close friends or participating in one or more social/recreation groups had a significant, direct effect on accessing mental health services by older adults controlling for evaluated needs. The structural indicators of social relationships had no effect on the depression outcomes of older adults. Men in the treatment group experienced a greater reduction in their CES-D score compared to women. Conclusion . Marriage, a structural indicator of social integration, had no effect on accessing mental health services or on the severity of depression scores among older adults with depression. Use of the Behavioral Model in conjunction with social integration theory is discussed. Implications for future directions in mental health services research are presented.

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