Senior Men, Social Capital, and Social Policy Opportunities

Mitigating a Potential Mental Health Crisis among Aging Male “Baby Boomers”

Peter Kellett MN RN Ph.D. Student (Demography) 1

Peter Kellett MN, RN, Ph.D. Student (Demography), Instructor (Nursing), Faculty of Health Sciences, University of Lethbridge, , Alberta, Canada.

Susan McDaniel Ph.D. , FRSC, Director of the Prentice Institute for Global Population & Economy, Canada Research Chair in Global Population & Life Course, Prentice Research Chair, & Professor of Sociology, University of Lethbridge, Alberta, Canada.

Bradley Hagen Ph.D. (Nursing), RN , R.Psych, Associate Professor & Coordinator of Health Sciences Graduate Program, Faculty of Health Sciences, University of Lethbridge, Alberta, Canada.

Olu Awosoga Ph.D. (Statistics), Assistant Professor, Faculty of Health Sciences, University of Lethbridge, Alberta, Canada.

Cheryl Currie Ph.D., Assistant Professor (Public Health), AIHS Translational Health Chair in Aboriginal Health & Wellness, Faculty of Health Sciences, University of Lethbridge, Alberta, Canada.

Authors

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Shifting Socio-demographic LandscapeAging Population

3(Statistics Canada, 2012a)

>65 years 2009 – 14% 2036 – 23-25% 2061 – 24-28%

Increasing Divorce Rates & Decreased Investment in Traditional Marriage

4

(Milan, 2013)

Transnational Trend of Living Alone

5Note. Figure created based on data supplied by Jamieson & Simpson (2013), p. 34

Men > Women

Men, Social Capital, & Mental Illness

• Social Support networks are a documented mediator of mental health outcomes (Conrad, 2010; Keating,2009).

• Systematic review (n=14) individual social capital: inverse relationship between cognitive social capital & common mental disorders (De Silva, 2005)

• Men’s social support is generally inferior to women’s (Conrad, 2010)

• Female family members, wives, partners main source of emotional support for men (Conrad, 2010)

• Retirement or job loss may significantly reduce men’s social capital (Oliffe et al., 2010,2013)

• Older men may be more affected by a lack of informal social capital (Muckenhuber et al., 2013)

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Depression in Men

• Annual prevalence of major depression in Canadian men: 2.9 – 4% (Blackmore, et al., 2007; Patten, et al., 2006; Simpson, et al., 2012)

• Statistics suggest that women experience depression approximately twice as much as men.

• Surveys frequently use WMH-CIDI or CIDI-SF-MD (Kessler et al., 1998)

– Diagnostic tools for major depression (90% cut-point)– Do not capture all masculine presentations of depression– Many current estimates of depression in men may

underestimate the prevalence of depression in men (Oliffe & Philips, 2008)

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Masculinities & Suicide • Paradox - despite lower reported rates of

depression, men consistently have significantly higher rates of completed suicide (worldwide)– Western Societies: female-to-male ratio at least

1:2– WHO reports 1:3.5 (based on 58 countries)– U.S. Has highest ratio at 1:6

• Men tend to use more dramatic & lethal methods (e.g. hanging, firearms etc.)

• Profoundly linked to the performance of masculinities

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Suicide and Older Men

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Note. Data from Statistics Canada (2012b), CANSIM Table 102-0551

PurposeTo examine the impact of living alone on the availability of social support, the prevalence of depression, and the prevalence of suicidal ideation among older Canadian men

Research Questions1. Do senior men exhibit higher rates of suicidal ideation and

depression?2. Does living alone contribute to higher risk for decreased

social support, depression, and suicidal ideation in senior men?

3. Does education level influence the prevalence of depression and suicide in senior men?

Sample2010 Canadian Community Health Survey (CCHS) (n=62 909)

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Findings2010 Annual Prevalence of Depression Men: 4.1% (approximately 302 000)Women: 6.4%

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Age Cohort Frequency Proportion of Men with Major Depression

Teenagers: 12-19 28 400 3.4%

Young Adults: 20 -44

155 000 5.2%

Mid-age Adults (“Boomers”): 45-64

106 300 4.4%

Older Adults: 65+ 11 700 1.1%

Suicidal Ideation (Past 12 months)When men were asked if they had seriously considered suicide in the past 12 months

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Answer Percent per Age Cohort

Young Adults20-44

Mid-age Adults45-64

Older Adults65+

Yes 1.9% 2.1% .9%

No 5.3% 6.9% 3.4%

Not Applicable

89.2% 86.8% 85%

Not Stated 3.6% 4.2% 10.8%

Depressed men, over 65 years-old had a significantly higher odds of suicidal ideation OR=14.9 (95% CI:13.3, 16.6)

The Impact of Living Alone• More unattached older men (65+), who lived alone, experienced

major depression than older men living with a spouse or partner (χ2 (1, N=7791560)=85.4, p<.001), OR= 1.2 (95% CI: 1.1, 1.2)

• More unattached Men 65+, who lived alone, reported suicidal ideation in the past 12 months when compared to those, who lived with a spouse or partner, χ2 (1, N=137437) = 1824.4, p<.001, OR=2.4 (95% CI: 2.3, 2.5)

• However, residing with others does not always result in less depression for unattached older men, since both unattached older men who lived alone, and older men who lived with a spouse/partner, were significantly more likely to be classified as not depressed (Bonferroni corrected z-test of column proportions).

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Medical Outcomes Study (MOS) Social Support Scores by Living Arrangement for Men Older than 65 years

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Living Arrangement

Tangible Social Support- MOS subscale index

(0-16)

M (SD)

Affection MOS subscale index

(0-12)

M (SD)

Positive Social Interaction MOS subscale index

(0-16)

M (SD)

Emotional and Informational Support MOS

subscale index(0-32)

M (SD)

Unattached Individual Living Alone

10.6 (5.0) 8.0 (3.7) 10.5 (5.0) 21.6 (9.1)

Unattached Individual Living with Others

13.2 (2.7) 8.7 (2.7) 12.5 (3.4) 23.5 (7.5)

Living with Spouse/Partner

14.6 (2.4) 11.2 (1.7) 14.5 (2.6) 28.0 (6.1)

Kruskal-WallisTest Statistic

Χ2 (2, N=646 339) = 107 241.9, p<.001

Χ2 (2, N=650 099) = 149 527, p<.001

Χ2 (2, N=646 892) = 107 547.7, p<.001

Χ2 (2, N=632 184) = 75 198.4, p<.001

(Sherbourne & Stewart, 1991)

All post hoc pairwise Mann-Whitney U comparisons indicated significant differences between all living arrangements for each subscale (p<.001)

Effect of Education Level on Major Depression and Suicidal Ideation in the Past 12 months among Men

65 years +

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Education Level Living Arrangement

DepressionOR (95% CI)

Suicidal IdeationOR (95% CI)

Secondary School or Less

Unattached Living Alone

1.46 (1.37, 1.53) .35 (.30, .40)

Living with Spouse Partner

.988 (.987, .990) 1.05 (1.05, 1.06)

Some Post-secondary to Post-secondary Graduation

Unattached Living Alone

.922 (.884, .962) 3.80 (3.63, 3.98)

Living with Spouse Partner

1.002(1.001, 1.003)

.84 (.83, .84)

Social Policy OpportunitiesNational/Provincial Level– Governments must target social policy investment to facilitate the

development and maintenance of social support networks beyond the traditional nuclear/biological family

• Broaden the legal definition of family• Consider the use of tax mechanisms (deductions) to encourage

collaborative and informal caregiving relationships between individuals that are not biologically related or formally partnered

• Invest in social programming that provides resources to support informal caregivers and informal social support networks

– Particularly target investment for seniors that may be informal caregivers for other seniors

– Invest in programming that provides seniors resources for managing mental health issues

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Social Policy OpportunitiesLocal/Community Level

• Promote new housing/living options that encourages collaborative living between individuals that live alone

• Create programs to facilitate intergenerational connection/exchange between biologically/formally unrelated individuals

• Create social spaces to build social capital among “solo” older men, or men who have lost social networks due to retirement (Actual/Virtual)– e.g. Men Sheds, virtual communities

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peter.kellett@uleth.ca

Gender and Population Studies (GAPS) in Health

www.gapsinhealth.com

@GAPSinHealth

Contact Information

ReferencesBlackmore, E. R., Stansfeld, S. A., Weller, I., Munce, S., Zagorski, B. M., & Stewart, D. E. (2007). Major

depressive episodes and work stress: results from a national population survey. American Journal of Public Health, 97(11), 2088-2093. doi: http://dx.doi.org/10.2105/AJPH.2006.104406

Cleary, A. (2012). Suicidal action, emotional expression, and the performance of masculinities. Social Science & Medicine, 74, 498-505.

Connell, R. W. (2005). Masculinities (2nd ed.). Berkley, CA: University of California Press.Conrad, D. (2010). Social capital and men's mental health. In D. Conrad & A. White (Eds.), Promoting

men's mental health (1st ed.). Oxford, UK: Radcliffe Publishing Ltd.Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well-being: a theory

of gender and health. Social Science & Medicine, 50(10), 1385-1401. Demey, D., Berrington, A., Evandrou, M., & Falkingham, J. (2013). Pathways into living alone in mid-life:

Diversity and policy implications. Advances in Life Course Research, 18(3), 161-174. doi: http://dx.doi.org/10.1016/j.alcr.2013.02.001

De Silva, M. J., McKenzie, K., Harpham, T., & Huttly, S. R. A. (2005). Social capital and mental illness: a systematic review. Journal of Epidemiology & Community Health, 59(8), 619-627.

Evans, J., Frank, B., Oliffe, J. L., & Gregory, D. (2011). Health, Illness, Men and Masculinities (HIMM): a theoretical framework for understanding men and their health. [Article]. Journal of Men's Health, 8(1), 7-15. doi: 10.1016/j.jomh.2010.09.227

Gunnell, D., Middleton, N., Whitley, E., Dorling, D., & Frankel, S. (2003). Why are suicide rates rising in young men but falling in the elderly?—a time-series analysis of trends in England and Wales 1950–1998. Social Science & Medicine, 57(4), 595-611. doi: http://dx.doi.org/10.1016/S0277-9536(02)00408-2

19

Gunnell, D., Middleton, N., Whitley, E., Dorling, D., & Frankel, S. (2003). Why are suicide rates rising in young men but falling in the elderly?—a time-series analysis of trends in England and Wales 1950–1998. Social Science & Medicine, 57(4), 595-611. doi: http://dx.doi.org/10.1016/S0277-9536(02)00408-2

Jamieson, L., & Simpson, R. (2013). Living alone: Globalization, identity, and belonging. Basingstoke, UK: Palgrave Macmillan.

Keating, D. P. (2009). Social interactions in human development: Pathways to health and capabilities. In P. A. Hall & M. Lamont (Eds.), Successful Societies: How institutions and culture affect health (pp. 53-81). Cambridge, NY: Cambridge University Press.

Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H.-U. (1998). The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7(4), 171-185. doi: 10.1002/mpr.47

Milan, A. (2013). Marital status: Overview, 2011. Ottawa,ON: Statistics Canada.Muckenhuber, J., Stronegger, W. J., & Freidl, W. (2013). Social capital affects the health of older people

more strongly than that of younger people. [10.1017/S0144686X12000219]. Ageing & Society, 33(05), 853-870.

Oliffe, J., Ogrodniczuk, J. S., & Han, C. (2010). Suicide from the perspectives of older men who experience depression. [doi: 10.1016/j.jomh.2010.09.025]. Journal of Men's Health, 7(3), 289.

Oliffe, J. L., & Phillips, M. J. (2008). Men, depression and masculinities: A review and recommendations. Journal of Men's Health, 5(3), 194-202.

Oliffe, J. L., Rasmussen, B., Bottorff, J. L., Kelly, M. T., Galdas, P. M., Phinney, A., et al. (2013). Masculinities, Work, and Retirement Among Older Men Who Experience Depression. Qualitative Health Research, 23(12), 1626-1637. doi: 10.1177/1049732313509408

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Payne, S., Swami, V., & Stanistreet, D. L. (2008). The social construction of gender and its influence on suicide: a review of the literature. Journal of Men's Health, 5(1), 23-35.

Patten, S. B., Wang, J. L., Williams, J. V. A., Currie, S., Beck, C. A., Maxwell, C. J., et al. (2006). Descriptive epidemiology of major depression in Canada. Canadian Journal of Psychiatry, 51(2), 84-90.

Pompili, M., Vichi, M., Qin, P., Innamorati, M., De Leo, D., & Girardi, P. (2013). Does the level of education influence completed suicide? A nationwide register study. Journal of Affective Disorders, 147(1-3), 437-440. doi: 10.1016/j.jad.2012.08.046

Schmutte, T., O'Connell, M., Weiland, M., Lawless, S., & Davidson, L. (2009). Stemming the Tide of Suicide in Older White Men: A Call to Action. American Journal of Men's Health, 3(3), 189-200. doi: 10.1177/1557988308316555

Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science & Medicine, 32(6), 705-714. doi: http://dx.doi.org/10.1016/0277-9536(91)90150-B

Simpson, K. R. S., Meadows, G. N., Frances, A. J., & Patten, S. B. (2012). Is Mental Health in the Canadian Population Changing Over Time? [Article]. Canadian Journal of Psychiatry, 57(5), 324-331.

Statistics Canada. (2010). Population projections for canada, provinces and territories (pp. 248). Ottawa: Statistics Canada.

Statistics Canada. (2011). Canadian community health survey (CCHS) annual component: User guide 2010 and 2009-2010 microdata files (pp. 97). Ottawa, ON.: Statistics Canada.

Statistics Canada. (2012a). Generations in Canada. Ottawa, ON: Statistics Canada.Statistics Canada. (2012b). Suicides and suicide rate, by sex and by age group Retrieved November 7th, 2013, from

http://www.statcan.gc.ca/tables-tableaux/sum-som

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