Association of Social Relationships With Depressive Symptoms: Testing an Alternative to Social Support

Low social support and expressed emotion have been associated with depression, but no studies examined their relative contributions. A self-report questionnaire was developed to measure family emotional involvement and perceived criticism to assess the main components of family expressed emotion. Eighty-three family practice patients older than 40 years responded to a survey assessing depressive symptoms, social support, life events, and expressed emotion. Perceived criticism, intense emotional involvement, and negative life events were all independently associated with depressive symptoms. After controlling for expressed emotion, the association of low social support with depressive symptoms was no longer statistically significant. The results support the primacy of family interactions (with high perceived criticism and emotional involvement) over low social support in explaining the association between social relationships and depression.