Bidirectional changes in depressive symptoms and social functioning in older adults attending psychological therapy services.

Background: Impairments in the ability to carry out social activities commonly co-occur alongside depression. Improving social functioning is often overlooked in treatment. This is despite the high value placed by patients on social functioning and the potential for interventions focused on social functioning to have additional benefits in reducing depressive symptoms. In older adults the relationship between depressive symptoms and social functioning during treatment is poorly understood.

Methods: We analysed data across the first four treatment sessions of 3260 older adults receiving psychological therapy for depression at eight NHS Talking Therapies for anxiety and depression services in England. Random-intercept cross-lagged panel models were estimated, modelling bi-directional change between depressive symptoms, and impairments in (a) social leisure activities, and (b) close relationships, controlling for gender and diagnosis.

Results: Over treatment sessions, depressive symptoms and impairments in social functioning decreased. A bi-directional relationship was observed whereby depressive symptoms were associated with future impairments in social functioning and vice versa. Changes in depressive symptoms appeared to have a greater association with future social functioning, compared to the reverse.

Limitations: Patients lived in Greater London and findings may not translate to other settings. We included older adults that attended at least four treatment sessions, and had no missing data at the first assessment, potentially biasing the sample and results.

Conclusions: Older adults receiving psychological therapy experience reductions in depressive symptoms and impairment in social functioning early in treatment. Treating core depressive symptoms and impairments in social functioning may benefit one another, and improve outcomes.