The Impact of Social Support on the Risk of Depression

Srijan Sen, PhD, is the director of the Frances and Kenneth Eisenberg and Family Depression Center and joins this episode of Michigan Minds to talk about recent data from the Intern Health Study, the impact of social support on depression risk and Mental Health Awareness Month. 

Sen is the Frances and Kenneth Eisenberg Professor of Depression and Neurosciences in the Michigan Medicine Department of Psychiatry, where his research focuses on the interactions between genes and the environment and their effect on stress, anxiety and depression. He also leads  the Intern Health Study, which studies physicians in their first year of post-medical school training using genomics, mobile technology and other tools to understand how stress leads to depression.

“My own personal research is trying to understand stress and how it gets under the skin and affects our risk for depression, anxiety and a whole host of other problems. A lot of my work has focused on the specific population of training doctors, residents.” 

Recent data from the Intern Health Study, which used advanced statistical methods to emulate a randomized clinical trial, found that the more hours a first-year resident worked each week, the more their risk of depression rose. 

“In the study that we did last year, we actually used a relatively new statistical technique where you can emulate or mimic a clinical trial through observational data like we have in the Intern Health Study. In doing that, we see what people’s depression would be like if you actually assigned them to work 30 hours, 40 hours, 60 hours, 100 hours in a week.”

Sen discusses the connection the study found between hours worked and depression, which has implications for residents, who tend to work long hours. The study found that those working 90 hours a week had about three times the depression increase as those working 40 to 50 hours a week.

“We saw the relationship between work hours and depression hold across the spectrum of hours, from 25 hours all the way up to 100 hours a week. So this indicates that in this population, work hours are an important driver, and probably the most important driver, of depression. And if we can reduce the work hours, we will likely reduce depression.”

Data from the Intern Health Study also demonstrated the importance of social support in buffering the risk of developing depression symptoms in general. The paper uses a measure of genetic risk—called a polygenic risk score—which is based on research on the specific genes linked to depression risk. The study included first-year doctors and recently widowed older adults, and found the greatest impact of social support in those with highest polygenic risk scores for depression.

“One of the big environmental factors that plays a role in depression is social support. Broadly, we know the importance of social connection in our day-to-day functioning. The Surgeon General’s Office just released a report about the epidemic of loneliness in our society and the importance of social connection—and that’s true in physicians and in our population,” he says. “In this study, people who lost social support overall, got more depressed. What we found was an interaction between the genetic risk, and here we used what’s called a polygenic risk score, adding up across the whole genome for your depression risk.”

As director of the Eisenberg Family Depression Center, Sen highlights the mission and work of the center, and highlights various educational resources including a Depression Toolkit and information regarding self-help and getting help. The center also provides resources about maintaining well-being and prioritizing mental health.  

“The Eisenberg Family Depression Center has been around at Michigan for over 20 years now, and the goal is to try to catalyze innovations and breakthroughs that really allow us to make major progress in fighting depression, and doing it in many different ways,” Sen says. 

Mental Health Awareness Month is recognized annually during May. Sen notes that it’s especially important this month to recognize and prioritize taking care of our mental well-being. He says that there are various factors that impact people’s health differently, including amount of sleep, eating healthy and exercising. Understanding which aspects of our daily lives help our mental well-being is one way to prioritize wellness.  

“I think the other major point is really to prioritize our mental health, not only in times of crisis, but also in times of relative calm,” he says. “That we can do so much to help ourselves and those around us by prioritizing broad things like we’ve talked about, like social connection and sleep and physical activity. And also figuring out what the most important of those factors are, or other factors are, for our mental health. And then making sure that we make time for that every day. It’s important for us individually, and for our friends and family, and we can do so much good by doing that.”

Sen comments on the feeling of aloneness, and why it can be beneficial to remind ourselves that others experience the same feelings. He also notes the value of reaching out to people who may be struggling, and the impact that can make.

“Particularly if you’re struggling: it’s hard to remember, but important to remember, how many others are struggling, too. And that you should really feel empowered to reach out for help from those around you and professional help, if needed. And there’s so many resources out there and so many people that care about all of us, that it’s hard to remember that in times of crisis. And the flip side of it is if you notice someone around you struggling, really do feel empowered to reach out and talk with them. And we don’t often know how much we help people by reaching out and having those conversations.”