Social connections, particularly interactions with friends, neighbors, and the wider community, are important predictors of mental health in older adults. General practitioners are well placed to screen for social isolation and encourage patients to remain socially active as part of healthy aging and prevention of depression..

This scenario is familiar. The disease develops after the patient retires and gradually withdraws from social life. Former friends have had jobs, moved, passed away, developed physical limitations, or taken on caregiving responsibilities. Last month, the patient was invited to a birthday gathering, but declined because he was “not feeling well.” With gentle questioning, the patient described a persistent feeling of fatigue and lack of desire to participate. Patients no longer enjoy the activities they once cherished and appear despondent.

This presentation is becoming increasingly common. In Australia, 15% of adults aged 55 and over report have depression or anxiety This is not surprising. According to the RACGP Health of the Nation 2025 report: 71% of GP Currently, mental health is cited as the main reason patients report symptoms.

At the same time, 11% of Australians aged 65 and over reported: socially isolated According to the Australian Institute of Health and Welfare, this will happen in 2023. Loneliness is even more common, with one in three Australians reporting feeling moderately or severely lonely. Social Connections in Australia 2023 Report. It is important to challenge common assumptions. Loneliness doesn’t just affect people who live alone. Around 40% of people who live alone feel lonely, as do 30% of people who live with others.

While loneliness and depressive symptoms affect each otherAn important clinical question remains: which types of social interactions are most protective against depression later in life?

Social connections and mental health

At UNSW Sydney’s Center for Healthy Brain and Aging (CHeBA), we focus on understanding how we can protect and promote brain health and mental health as we age.

Our recent research British Journal of Psychiatryanalyzed data from the Elderly Australian Twin Study, which followed 570 twins longitudinally for 6 years.

We investigated patterns of social interaction and associations with mental and cognitive health outcomes among older Australians. Utilizing a twin design, we also investigated heritability and genetic correlates associated with social connectedness using ICE FALCON (Inference of Causation from Examination of Familial Confounding). This is a new technique that allows us to examine shared genetic influences between predictors and outcomes such as social isolation and depression.

We identified three main types of social interactions.

• with friends, neighbors, and community.
• family and childcare. and
• In religious organizations and other caregiving.

Some older Australians participate in more than one type of social interaction, while others primarily participate in only one type of interaction.

Notably, the heritability of social ties is weak, suggesting that these behaviors are determined by the environment and may remain modifiable even in later life.

After adjusting for known risk factors for depression in older adults, including a history of depression, neuroticism, physical activity, chronic pain, hypertension, diabetes, body mass index, smoking, and alcohol use, we found that regular interactions with friends, neighbors, and family members were associated with decreased symptoms of depression over time.

The main strength of this longitudinal study lies in its rigorous methodology, which includes detailed cognitive assessments, physical examinations, blood tests, and comprehensive biopsychosocial questionnaires. Limitations include a highly educated sample with primarily European ancestry, which may limit generalizability to more diverse populations.

How do social connections support our health?

So why are social connections important? People with strong social relationships have a 50% higher chance of survival than those who are socially isolated. Conversely, social isolation is associated with an increased risk of: Cardiovascular disease, poor mental health Consequences and functional decline.

The magnitude of the risk of loneliness has been compared to smoking. 15 cigarettes a day.

One explanatory framework is “stress buffering hypothesis‘. Social support may reduce the physiological and psychological effects of chronic stress by providing emotional validation, practical assistance, and a sense of belonging. Our findings suggest that peer-based community ties, as well as family and caregiving roles, may be particularly protective.

Social support is very important for older people. Our previous research compared emotional support with instrumental or practical support in approximately 24,000 older adults around the world. In particular, we found that emotional support – having someone to talk to, confide in, and feel understood – was most strongly associated. fewer depressive symptoms.

Policy implications

There are some things we need to do as a society to increase social connections.

• Age-friendly environmental spaces such as malls, parks, and senior centers encourage socialization.
• Awareness campaign about social connectedness and its impact on health.
• Correct or compensate for modifiable factors such as hearing loss and provide mobility assistance to people with disabilities.
• Volunteer programs: Encourage people to volunteer to help seniors with transportation and social activities. Encourage older people to volunteer to stay socially active.

Clinical impact

General practitioners are in a unique position to identify and address social isolation and loneliness, especially as they may be the only health professionals regularly seen by older people who have experienced psychological distress.

Simple, focused questions can spark meaningful conversations.

• When was the last time you contacted a close friend?
• Is there someone I can talk to when I come up with something?
• How often do you see friends and neighbors?
• Are you involved in any community or group activities?

Share a bonus clinical tip. As a clinical psychologist, I often ask this question: What activities did you enjoy before? Are there people or activities you might be able to reconnect with?”

This helps patients identify personally meaningful pathways back to social engagement.

conclusion

Social connection is not a luxury. It is a powerful and modifiable factor in determining mental health later in life. Social connections not only provide a buffer against depression, but also reduce the risk of dementia and death.

By regularly testing for loneliness and social isolation, and helping patients rebuild or strengthen social connections, GPs can offer patients something that isn’t bottled up and has deep therapeutic value: human connection.

Dr Suraj Samtani is a clinical psychologist at Sunrise Psychology Group and a postdoctoral fellow at the Center for Healthy Brain Aging (CHeBA) at UNSW Sydney..

The statements and opinions expressed in this article reflect the views of the author and do not necessarily represent the official policy of the AMA. M.J.A. or Insight+ Unless otherwise stated.

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