Senior Men, Social Capital, and Social Policy Opportunities

1
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)
2
Authors

• 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.

3
Shifting Socio-demographic Landscape

• Aging Population

gt65 years 2009 14 2036 23-25
2061 24-28
(Statistics Canada, 2012a)
4

• Increasing Divorce Rates Decreased Investment
  in Traditional Marriage

(Milan, 2013)
5
Transnational Trend of Living Alone
Men gt Women
Note. Figure created based on data supplied by
Jamieson Simpson (2013), p. 34
6
Men, Social Capital, Mental Illness

• Social Support networks are a documented mediator
  of mental health outcomes (Conrad, 2010
  Keating,2009).
• Systematic review (n14) individual social
  capital inverse relationship between cognitive
  social capital common mental disorders (De
  Silva, 2005)
• Mens social support is generally inferior to
  womens (Conrad, 2010)
• Female family members, wives, partners main
  source of emotional support for men (Conrad,
  2010)
• Retirement or job loss may significantly reduce
  mens social capital (Oliffe et al., 2010,2013)
• Older men may be more affected by a lack of
  informal social capital (Muckenhuber et al.,
  2013)

7
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)

8
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
  12
• WHO reports 13.5 (based on 58 countries)
• U.S. Has highest ratio at 16
• 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
Note. Data from Statistics Canada (2012b),
CANSIM Table 102-0551
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• Purpose
• To 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 Questions
• Do senior men exhibit higher rates of suicidal
  ideation and depression?
• Does living alone contribute to higher risk for
  decreased social support, depression, and
  suicidal ideation in senior men?
• Does education level influence the prevalence of
  depression and suicide in senior men?
• Sample
• 2010 Canadian Community Health Survey (CCHS)
  (n62 909)

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Findings

• 2010 Annual Prevalence of Depression
• Men 4.1 (approximately 302 000)
• Women 6.4

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

Answer Percent per Age Cohort Percent per Age Cohort Percent per Age Cohort
Answer Young Adults 20-44 Mid-age Adults 45-64 Older Adults 65
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
OR14.9 (95 CI13.3, 16.6)
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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 (?2 (1,
  N7791560)85.4, plt.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, ?2 (1, N137437) 1824.4, plt.001,
  OR2.4 (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).

14
Medical Outcomes Study (MOS) Social Support
Scores by Living Arrangement for Men Older than
65 years
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-Wallis Test Statistic ?2 (2, N646 339) 107 241.9, plt.001 ?2 (2, N650 099) 149 527, plt.001 ?2 (2, N646 892) 107 547.7, plt.001 ?2 (2, N632 184) 75 198.4, plt.001
All post hoc pairwise Mann-Whitney U comparisons
indicated significant differences between all
living arrangements for each subscale (plt.001)
(Sherbourne Stewart, 1991)
15
Effect of Education Level on Major Depression and
Suicidal Ideation in the Past 12 months among Men
65 years
Education Level Living Arrangement Depression OR (95 CI) Suicidal Ideation OR (95 CI)
Secondary School or Less Unattached Living Alone 1.46 (1.37, 1.53) .35 (.30, .40)
Secondary School or Less 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)
Some Post-secondary to Post-secondary Graduation Living with Spouse Partner 1.002(1.001, 1.003) .84 (.83, .84)
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Social Policy Opportunities

• National/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 Opportunities

• Local/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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Contact Information
peter.kellett_at_uleth.ca Gender and Population
Studies (GAPS) in Health www.gapsinhealth.com _at_G
APSinHealth
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