Measuring social environment factors of depressed inpatients: A cross-sectional study

Abstract The course and management of mental illness are both influenced by social contextual factors. Standardised questionnaires are required to monitor inpatients’ social environment and to design interventions. This study aims to describe the social environment of inpatients with depression using standardised instruments, and to analyse the instrument’s applicability. This cross-sectional study included depressed adult inpatients admitted to a German psychiatric hospital. We used three standardised questionnaires to evaluate social risk factors: the Lubben Social Network Scale (LSNS), the WHO Disability Assessment Schedule (WHODAS) and the Social Cohesion and Trust Scale (SCTS). The appropriateness of the questionnaires was assessed with a context-specific quality appraisal. Our study included 196 patients with depression having a mean age of 38.8 (SD = 13.7) years of whom 50% were female. A total of 164 (85%) of patients reported a family history of mental health problems, and 31 (38.8%) had experienced discrimination. Analyses of the LSNS and WHODAS showed that the prevalence of social isolation and disability was significantly higher among inpatients compared to the general population. The WHODAS scores were highest in patients aged 18-30, while social isolation was elevated but stable among different age groups (range 18.7- 19.4%). Both, the WHODAS and LSNS showed good clinical applicability, comparability, and test properties. A lack of validation in a young population of the LSNS was considered a weakness. The SCTS showed imperfections in its applicability and comparability. Depressed inpatients have a limited social network compared to the general population. We emphasise the importance of assessing the applicability of questionnaires representing social environment as the basis for developing interventions. We recommend systematic monitoring of social characteristics to identify potential targets of intervention and thereby facilitate the management of depression. Key messages • Hospitalised patients with depression have a decreased social functioning and a smaller social network compared to the general population. • Standardised social environment questionnaires should be consented and used to plan and enrich depression management.