Relationships Between Perceived Social Support, Depressive Symptoms, and Suicidal Ideation in Older Adulthood: Variations Based on Biological Sex and Partnership Type

Perceived social support is consistently associated with better physical and mental health outcomes in older adulthood. In this dissertation I examined the associations between the number and combination of sources of perceived social support (i.e., spouse/partner, child, family, and friend support) and depressive symptoms and suicidal ideation, in a nationally-representative sample of older adults living in the United States. Further, I examined if the association between perceived spousal/partner support and depressive symptoms and suicidal ideation differ by partnership type (i.e., same-sex or different -sex) or participant sex. I examined these relationships with data from the 2020 wave of the Health and Retirement Study (HRS) utilizing a novel multilevel modeling approach termed multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) that allowed the effects of each unique combination of sources of perceived social support to be examined in a single, parsimonious model. In general, the effects of different sources of perceived social support on both depressive symptoms and suicidal ideation were additive, indicating that more sources of perceived social support were associated with fewer depressive symptoms and a lower likelihood of suicidal ideation, for both males and females. For depressive symptoms in particular, perceived spousal/partner support was associated with the lowest predicted depressive symptom scores for both males and females, regardless of other individual sources or combinations of sources of perceived support. Further, the association between perceived spousal/partner support and depressive symptoms was significant regardless of relationship type (same- or different-sex/sex unknown). Consistent with prior evidence, female participants reported significantly more depressive symptoms and suicidal ideation compared to male participants. However, I found females who reported perceiving significant support from their partner/spouse, child(ren), and friends had similar predicted depressive symptoms and likelihood of endorsing suicidal ideation compared to the average male participant. Indicating that significant perceived social support from enough sources may buffer older females’ increased risk of depression and suicidal ideation. Findings related to the moderating effect based on relationship type are limited by same-sex partners sample size, but supplement extant evidence that perceived partner/spousal support can be a significant protective factor for same-sex older adults, who are at increased risk of depression and suicidal ideation as compared to heterosexual older adults. Overall, findings indicate that strengthening perceived social support from as many sources as possible (e.g., partner, friends, children, other family) may be a useful focus of interventions aimed at reducing risk of depressive symptoms and suicidal ideation for all older adults, and such an intervention is particularly important for older females. Further research is needed to test causality of the relationship between perceived social support and mental health and explore how cultural understandings of perceived social support affect this relationship.