Formal and informal sources of social support and their differential associations with intervention outcomes for depressive and anxiety symptoms among older adults

Background: Previous studies have highlighted social support as an important protective factor for depression and anxiety. Yet, little is known about how different dimensions of social support would be differentially associated with the prognosis of intervention outcomes. Objective: We examined the influences of different sources of emotional support and the quantity of emotional and instrumental support pre-intervention on the prognosis of depressive and anxiety symptoms among older adults. Methods: Data were prospectively collected from 4002 adults aged ≥60 years from a collaborative stepped-care intervention programme for depressive symptoms in Hong Kong. Source of emotional support and quantity of emotional and instrumental support were assessed pre-intervention. Depressive and anxiety symptoms were assessed using Patient Health Questionnaire–9-item (PHQ-9) and Generalized Anxiety Disorder–7-item (GAD-7) pre- and post-intervention. Linear mixed models were used to examine the prognostic effects of social support on mental health symptoms, adjusting for loneliness, living status, and sociodemographics. Results: Preference for formal support was associated with greater reductions in depressive symptoms (b = −0.52, CI = −1.05–0.01), whereas preferences for informal family and community support was associated with greater reductions in anxiety symptoms (b = −0.51, CI = −0.94 to −0.07; b = −0.46, CI = −0.91 to −0.0004, respectively). More instrumental support pre-intervention was associated with a greater magnitude of increase in both depressive and anxiety symptoms. Conclusions: Determining the preferences and availability of various dimensions of social support pre-intervention may provide insights into the potential prognosis of mental health outcomes, and thereby guide clinical decisions in treatment selection. Future studies can further elucidate the mechanisms underlying these associations.