Today's wide variety of diseases and health problems are
influenced in part by an aging population and by environmental and
lifestyle changes. Depression is one of the most quickly growing
disorders, causing a huge decrease in quality of life. Depression also
increases with age. The expected increase in the number of older
people in the years to come might lead to an increasing problem of
increased case loads for primary health care in the coming years as
the delivery of healthcare services shifts from clinical settings to the
home. People who lack social support are more likely to experience
poorer quality of life, including depression. Personality is a robust
predictor of behaviour and essential life outcomes. The aim of this
thesis is to describe the relationship between social support,
personality and depression in the general population, with a focus on
older people.
This thesis used data from the Nord-Trondelag Health Study
(HUNT), a large census population survey in Norway. Paper I (n=
40,659), II (n= 35,832), and III (n=35,797) used data from HUNT3
(2006-2008), and Paper IV (n=25,626) used data from both HUNT2
(1995-1997) and HUNT3. Paper I, II, and III used cross-sectional
designs and paper IV used a longitudinal design. The age of the
sample was 20−89, divided into three age-groups: 20−64 years
(adults), 65−74 years (old), and 75−89 years (oldest old). Depression
was measured with the Hospital Anxiety and Depression Scale
(HADS in the HUNT2 and 3), personality was measured with a short
version of the Eysenck Personality Questionnaire (EPQ in the
HUNT3), and social support was examined with single questions
about perceived support from friends (HUNT2 and 3).
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The main finding in Paper I was that self-rated perceived support
was significantly associated with depression, even after controlling
for age and gender, emotional support (OR = 3.14), and tangible
support (OR = 2.93). The effects of emotional and tangible support
differ between genders. Interaction effects were found for age groups
as well as emotional and tangible support. Paper II showed a
relationship between depression and both neuroticism and
extraversion in a general population. Older people are more likely to
score low on extraversion (E) than younger people. Interactions were
observed between neuroticism and age, neuroticism and gender, and
extraversion with depression. The interaction terms indicates a high
score on neuroticism (N) is enhanced by introversion, older age, and
being a male with depression. Paper III showed a significant
association between levels of perceived social support, personality,
sense of community in the neighbourhood, and civic participation.
Women frequently reported higher levels of social support, and
higher scores on both extraversion and neuroticism than men, while
men reported higher sense of community in the neighbourhood and
levels of civic participation than women. Paper IV showed that risk
factors had a greater effect on new cases than on recovery from
depression. The greatest association with new cases of depression
was found for male sex, the oldest age group, melancholics, those
who lacked social support, those who never participated in social
activities, those with decreasing community in the neighbourhood,
those with poor health, and those who have gotten divorced. The
greatest association with recovery from depression was found for
female sex, sanguine temperament, those with social support, those
who participated in social activities, those with increasing
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community in the neighbourhood, and those who have obtained
better health.
The findings show that both social support and personality are
risk factors for developing depression. Nurses should put extra effort
into how they care for patients with low extraversion, high
neuroticism and, low social support in order to help these patients
avoid depression. Nurses have to "see the patient" and "care about",
and respect patient’s values, preferences and expressed needs.