Measuring social environment factors of inpatients and outpatients with depression in Germany: a cross-sectional study

Social environment characteristics, including social relationships and cultural milieus, may influence the occurrence, course and management of depression. Effective questionnaires are needed to measure these factors and improve disease management.

We aimed to (1) evaluate the social environment, such as social isolation, social disability and social cohesion of depressed inpatients and outpatients, and (2) discuss the suitability of standardised questionnaires measuring it.

This cross-sectional study included adult patients with unipolar depression from a psychiatric hospital and general practitioner (GP) practices in Bavaria, Germany. Social isolation, disability and cohesion were measured using the Lubben Social Network Scale (LSNS), the WHO Disability Assessment Schedule (WHODAS) and the Social Cohesion and Trust Scale (SCTS), respectively. The suitability of these questionnaires was assessed with a context-specific quality appraisal.

Among 282 included patients (mean age 38.8 years, SD=13.3), 69.5% were inpatients and 30.5% were outpatients. Social isolation prevalence was 52.5%. Social disability was higher in our cohort than in the general population (p<0.001). LSNS and WHODAS showed no differences between inpatients and outpatients, and suggest good clinical suitability. The SCTS showed shortcomings in applicability and comparability.

People with depression, whether treated in psychiatric hospitals or in GP practices, reported more social isolation and social disability than the general population.

Researchers and clinicians should monitor social aspects as potential intervention targets to support patient management. Social environment questionnaires should be selected carefully, ideally guided by guidelines or medical associations, to enhance the understanding, comparability and implementation.