Prepandemic Social Integration: Protection or Risk for Older Adults in the Time of COVID-19?

To examine the association between prepandemic social integration and posttraumatic stress disorder (PTSD) symptoms during the coronavirus disease 2019 (COVID-19) pandemic and test whether the association is mediated by social support received and social events missed during the pandemic. We also explored age, race, gender, and socioeconomic differences in the association.

We adopted a prospective design. Path analysis was conducted using data from the COVID-19 supplement (2020) and the 2019 wave of the National Health and Aging Trends Study (NHATS). The sample represents Medicare beneficiaries aged 70 years and older (N = 2,694). Social integration was measured using a six-item index. A standardized scale assessed PTSD symptoms. Both social support received and social events missed were single-item measures. The analysis controlled for sociodemographic characteristics, prepandemic physical and mental health, and coronavirus exposure during the pandemic.

Prepandemic social integration was positively associated with PTSD symptoms during the pandemic. The association was primarily mediated by social events missed-high levels of prepandemic social integration were associated with missing more social events during the pandemic resulting in more PTSD symptoms. Social support received was also a mediator-social integration was positively associated with social support received during the pandemic, with more received support associated with greater PTSD symptoms. Prepandemic social integration had no significant direct effect on PTSD symptoms. The direct, indirect, and total effects of social integration on PTSD symptoms did not significantly differ by age, race, gender, education, or poverty status.

Social integration may carry mental health risks in times of infectious disease outbreaks.