Greater Social Functioning Associated With Lower Depressive Symptomatology Among Black Belt African Americans Enrolled in the Southeastern Collaboration to Improve Blood Pressure Control Study

Abstract

Objective: In many populations, higher social functioning is associated with lower depressive symptomatology, which in turn is associated with improved cardiovascular health. This study aimed to establish an association between social functioning and depressive symptomatology, which has not yet been demonstrated in the African American Black Belt. This would be an important finding in a region with high cardiovascular morbidity.

Methods: This observational study used baseline data from 1,225 African American Black Belt residents with uncontrolled hypertension in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial. Three Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires-the emotional support, instrumental support, and social isolation questionnaires-and marital status assessed social functioning. The 8-item Patient Health Questionnaire assessed depressive symptomatology. Multivariable logistic regression models examined associations between social functioning and depressive symptomatology separately and then simultaneously. Data were collected from May 2017 to April 2021.

Results: Social functioning was higher than US-reported averages, and the prevalence of moderate to severe depressive symptomatology was low (20.8%) among primary care populations. In a separate model, lower emotional support, lower instrumental support, and increased social isolation were significantly associated with greater depressive symptomatology (odds ratio [OR] = 1.56, 95% CI, 1.20-2.02; OR = 1.33, 95% CI, 1.01-1.77; and OR = 2.39, 95% CI, 1.81-3.16, respectively). In a simultaneous model, only increased perceived social isolation remained significantly associated with greater depressive symptomatology (OR = 2.24, 95% CI, 1.67-3.00).

Conclusions: Greater social functioning is associated with lower depressive symptom burden in the Black Belt region. Future research into the directionality of this association could assist in the development of interventions to improve regional mental and cardiovascular health.

Trial Registration: ClinicalTrials.gov identifier: NCT02866669.

Conflict of interest statement

Potential conflicts of Interest:

Dr. Safford receives salary support for investigator-initiated research from Amgen, Inc. All other authors have no conflicts of interest to disclose.

© Copyright 2022 Physicians Postgraduate Press, Inc.

Figures

Figure 1.

Percent of Participants with Adequate (Black) and Inadequate (Gray) Health Literacy, Among High vs. Low PROMIS Social Functioninga Groups a. Raw scores from PROMIS 4a short item questionnaire translated to standardized t-scores. Score of 50 represents average for the United States general population. Those with score below 50 defined as low, participants with a score above 50 defined as high b. For Emotional and Instrumental Support, low levels indicate poor social functioning. For isolation, more indicates poor social functioning