The role of social relationships in persistent or recurrent depression among primary care patients

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The problem

Approximately a third of primary care patients with depression experience persistent or recurrent symptoms. The risk of chronic depression is significantly increased among patients with low social connectedness. However, it is unknown if this association is due to a causal effect of social connectedness on mood or a spurious by-product of shared variance with factors like social disadvantage, trauma or personality. Identifying the role of social connectedness in depression can help identify patients at risk and inform appropriate treatment. This study aimed to empirically identify social connectedness’s latent factors and determine if they independently predict 12 month depression status when relevant clinical, social and psychological factors are considered.

The approach

This was a secondary analysis of survey data from an observational, longitudinal cohort study: Diagnosis, Management & Outcomes of Depression in Primary Care (diamond). We recruited 789 patients (71% female) from 30 Australian primary care clinics. Exclusion criteria included: inability to read English, terminal illness, not residing in the community. A total of 655 participants completed surveys at 12 months. The main outcome measure was probable depression (>10 on the PHQ-9) at 12 months.


Confirmatory factor analysis supported a three dimension structure of social connectedness: perceptions; integration and availability of attachments. Multivariate regression analysis found that the perception that one’s relationships were satisfactory, that support would be available if needed and, most importantly, that they had someone to confide in predicted 12 month depression status (OR: 0.90; 95%CI 0.84-0.97; p<0.01) independently of social integration, availability of attachments, baseline depression severity, self-rated health, neuroticism, health care use, alcohol abuse, childhood abuse, intimate partner violence and social disadvantage.


Patients who believe their relationships are inadequate are at risk of persistent or recurrent depression. Building on the confiding nature of the doctor-patient relationship and exploring opportunities for improving relationship quality among at risk patients should be regularly incorporated into depression treatment.


  • Sandra Davidson, University of Liverpool, Liverpool, Australia
  • Christopher Dowrick
  • Jane Gunn, University of Liverpool, Liverpool, Australia