Social infrastructure, social support, and loneliness in older people with depressive symptoms

Background

Loneliness and depression are major public health concerns in ageing populations. Community-based psychosocial interventions are established responses, but modifiable neighbourhood conditions associated with their outcomes remain poorly understood. We examined whether neighbourhood social infrastructure was associated with changes in loneliness and depressive symptoms after intervention, and whether social support mediated these associations.

Methods

We analysed data from 3537 older adults enrolled in a community-based psychosocial intervention. Social infrastructure was measured using GIS for the availability and proximity of community facilities and public open spaces within 500m/1000m residential buffers. Social support, loneliness (UCLA-3) and depressive symptoms (PHQ-9) were assessed before and after intervention. Latent change score models estimated total, direct, and indirect effects among these variables.

Results

Greater distance to community facilities was associated with lower social support (β = −0.050, P < 0.001); this pathway accounted for 15.8% of the association with changes in loneliness (P = 0.006) and 9.5% with depressive symptom change (P = 0.014). Higher availability of public open space within 500 m was associated with higher social support (β = 0.070, P < 0.001); the pathway accounted for 16.7% of the association with loneliness change (P = 0.004) and 15.0% with depressive symptom change (P = 0.023). Availability of community facilities and proximity to open space showed no statistically significant mediating effects via social support.

Conclusions

Community facilities and public open spaces were associated with both outcomes through social support, but via distinct spatial mechanisms. Mental health programmes should consider linking older participants to these urban facilities to enhance intervention effectiveness. Age-friendly planning should prioritise walkable service access, along with near-home open-space provision, to support healthy ageing.

Key messages

• Social infrastructure was associated with loneliness and depression changes following psychosocial intervention, mediated by social support gains, in older people.

• Community facilities operated through proximity and open spaces through density, pointing to differentiated policy strategies to complement mental health programmes.