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'Silver surfers' may have lower depression risk

11:00pm Monday 21st April 2014 content supplied byNHS Choices

"Silver surfers are happier than techno-foges [sic]: Internet use cuts elderly depression rates by 30 per cent," the Mail Online reports after the results of a US study have suggested that regular internet use may help combat feelings of isolation and depression in older adults.

In this study, 3,075 retired people were surveyed every two years between 2002 and 2008. Internet usage was assessed based on a "yes/no" response to the question: "Do you regularly use the world wide web, or the internet, for sending and receiving e-mail or for any other purpose?"

Depression symptoms were measured using a short version of the Center for Epidemiologic Studies (CES-D) scale. This scale looks at responses to eight "yes/no" questions about mood and defines a "depressed state" as a score of four or more out of eight.

The study found that internet users were less likely to have a "depressed state" than non-users, with internet use leading to a 33% reduction in the probability of being in a "depressed state". 

But it's important to note that this does not necessarily mean those who took part in the study had a medical diagnosis of depression. These findings cannot prove that internet use is the direct cause of any reduction in depression symptoms.

A randomised controlled trial of internet use would be required to better see whether - and how - internet use can reduce the risk of depression.

The internet, like any tool, can be a force for both good and bad. On the plus side, it does allow you to access up to seven years of Behind the Headlines articles.

 

Where did the story come from?

The study was carried out by researchers from Michigan State University, the University of Montevallo, Harvard University, and the Phoenix Centre for Advanced Legal and Economic Public Policy Studies in the US. The sources of funding for this study were not reported.

It was published in the peer-reviewed Journals of Gerontology, Series B: Psychological Sciences and Social Sciences.

The story was covered well by the Mail Online, although it should be noted that some of the quotes from the researchers were based on their personal opinions, rather than the results of the study.

 

What kind of research was this?

This study looked at data collected from repeated cross-sectional surveys completed by retired, non-working US citizens every two years between 2002 and 2008. The current study aimed to determine the influence of past depression symptoms and internet use on current depression symptoms.

This repeated analysis of data collected from cross-sectional surveys can suggest associations, but it can't prove that internet use was responsible for differences in depression symptoms. A randomised controlled trial of internet use would be required to better show whether - and how - internet use can reduce the risk of depression symptoms.

Importantly, this study did not obtain confirmed medical diagnoses of depression. Depression symptoms were only assessed using a short version of the Center for Epidemiologic Studies (CES-D) scale, which asks eight questions with "yes/no" responses.

Though this is a commonly used measure of depression in older adults, particularly in research studies such as this, the indication of a "depressed state" as used in this study - a score of four or more out of eight - does not necessarily mean a person has depression.

 

What did the research involve?

The researchers analysed information on 3,075 retired, non-working people collected as part of the Health and Retirement Study between 2002 and 2008. This study surveys people over the age of 50 every two years.

In this survey, depressive symptoms were measured using the short eight-item version of the Center for Epidemiologic Studies (CES-D) scale. The CES-D score on this shortened version is based on responses to eight "yes/no" questions assessing mood, with higher scores indicating more depression symptoms.

For the purposes of this study, participants were categorised as being in a "depressed state" if they had scores of four or more out of eight (the researchers note that the average score was 1.4 and approximately 12% of participants had a score of four or more).

Internet use was based on the answer to the question: "Do you regularly use the world wide web, or the internet, for sending and receiving e-mail or for any other purpose?"

The researchers looked at the effects of past "depressed state" and internet use on current "depressed state".

They adjusted their analyses for potential confounders, including:

  • age
  • gender
  • race
  • education
  • whether participants were married
  • physical activity
  • health conditions
  • household size
  • when the survey was completed

 

What were the basic results?

Over the course of the whole study, 14% of participants had a CES-D score of four or more on average. This was found to be relatively stable across time (13.5% in 2002; 12.9% in 2004; 14.4% in 2006; 15.4% in 2008). On average, 9.1% of internet users had a CES-D score of four or more compared with 16.1% of non-users.

About half (48.6%) of those categorised as being in a depressed state in one survey according to this criteria were also found to be in a depressed state in the preceding survey.

Internet use was also stable over the four surveys (28.9% in 2002; 30.4% in 2004; 30.0% in 2006; and 29.6% in 2008), with 85% of users in a current wave also being users in the preceding wave of surveys.

The researchers found that being in a depressed state is persistent, with people in a depressed state in a previous survey about 50% more likely to be in a depressed state in the current survey. Similarly, being in a depressed state in the first survey in 2002 greatly increased the probability of a later depressed state.

Internet users were found to be less likely to be in a depressed state than non-users, leading to a 33% reduction in the probability of a depressed state.

The researchers performed additional analysis to check that the reduction in the probability of a depressed state in internet users was not the result of differences between internet users and non-users.

To do this, they matched internet users and non-users based on demographic variables. In this analysis, internet use was found to reduce the probability of a depressed state by 48%.

They also performed some preliminary analysis of what could explain the reduction in the probability of depressed state in internet users. They found that using the internet reduced the probability of a depressed state the most in people living alone.

They used this result to hypothesise that internet use may improve isolation and loneliness. This hypothesis remains unproven, but is arguably plausible.

 

How did the researchers interpret the results?

The researchers concluded that, "For retired older adults in the United States, internet use was found to reduce the probability of a depressed state by about 33%. Number of people in the household partially mediates this relationship, with the reduction in depression largest for people living alone.

"This provides some evidence that the mechanism linking internet use to depression is the remediation of social isolation and loneliness. Encouraging older adults to use the internet may help decrease isolation and depression."

 

Conclusion

This US study analysed repeated cross-sectional surveys of retired older adults collected as part of the Health and Retirement Study between 2002 and 2008. The study found that depression symptoms were persistent, with people with a "depressed state" at one time point during the study more likely to have a "depressed state" at another time point.

It also found that internet users were less likely to have a "depressed state" than non-users, with internet use leading to a 33% reduction in the probability.

Preliminary analysis found that using the internet reduced the probability of a depressed state the most in people living alone. The researchers used this result to hypothesise that internet use may improve isolation and loneliness.

However, there are several important limitations of this study. Importantly, the study did not obtain confirmed medical diagnoses of depression. Depression symptoms were only assessed using a short version of the Center for Epidemiologic Studies (CES-D) scale, which asks eight questions with "yes/no" responses.

This is a commonly used measured of depression in older adults, particularly in research studies such as this. But the indication of a "depressed state" used in this study - a score of four or more out of eight - does not necessarily mean a person has depression. The CES-D scale is designed to assess a history of symptoms over the past two weeks, so a low score could be the result of a temporary lowering of mood rather than clinical depression.

It is also worth noting that internet usage was based on a "yes/no" response to the question: "Do you regularly use the world wide web, or the internet, for sending and receiving e-mail or for any other purpose?" There was no assessment of what the internet was used for, or how much time was spent on the internet.

The repeated analysis of data collected from cross-sectional surveys can suggest associations, but it can't prove that internet use was responsible for differences in depression symptoms.

There may be many other sociodemographic, psychological, health and lifestyle influences that are having an influence in the observed relationship which this study has not been able to account for.

A randomised controlled trial of internet use would be required to show whether - and how - internet use can reduce the risk of depression.

With these limitations in mind, there are many anecdotal reports from older adults about how internet use has made them feel more connected and less isolated.

If you know an older person who you think would benefit from using the internet, encouraging them to go their local library is probably the best first step towards becoming a "silver surfer".

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Summary

"Silver surfers are happier than techno-foges [sic]: Internet use cuts elderly depression rates by 30 per cent," the Mail Online reports after the results of a US study have suggested.

Links to Headlines

Silver surfers are happier than techno-foges: Internet use cuts elderly depression rates by 30 per cent. Mail Online, April 18 2014

Links to Science

Cotten SR, Ford G, Ford S, Hale TM. Internet Use and Depression Among Retired Older Adults in the United States: A Longitudinal Analysis. The Journals of Gerontology - Series B. Published online March 26 2014

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