ANN ARBOR—The reasonable hope or strong certainty that social support will be available has a more beneficial effect on the mental and physical health of the elderly under economic stress than actually receiving help, according to a national study from the University of Michigan School of Public Health. Indeed, the actual provision of support, even when it is absolutely required, can backlash sometimes and increase stress and depression.

The U-M findings are based on interviews with 947 persons aged 65 or older (average age was 74) from across the country. The study, authored by Neal M. Krause, professor of health behavior and health education at the U-M School of Public Health and research scientist, U-M Institute of Gerontology, appears in the November 1997 issue of the Journal of Gerontology: Psychological Sciences.

The 50- to 80-minute interviews were conducted by Louis Harris and Associates in 1992-93. The elderly were queried about their anticipation that informal support—emotional, informational or tangible (help with daily tasks, and so on)—would be available if they needed it in the future and how much informal social support they had actually received in the past year.

They also reported on which major economic stressors they had encountered in the past year, how much social support they had actually received, how often they felt “sad, blue or depressed,” and how often they had somatic symptoms of stress such as difficulties sleeping, eating and “getting going.”

The major economic stressors included having difficulty paying phone or utility bills, a loss of 20 percent or more of one’s income, a problem with Social Security or retirement benefits, failing to qualify for money to pay for medical, food or housing expenses, and having been unable to pay for a major purchase.

Sixteen percent of those in the study had encountered one of the economic stressors in the past year while 5 percent had encountered more than one.

The effects of anticipated support on the elderly under economic stress:

The economically stressed elderly who believed that no one would come to their aid in the future (in the bottom quartile of anticipated support scores) had the greatest number of depressive symptoms.

“Those who thought they would get a little assistance were considerably less depressed (in the second and third quartiles), and the effects of financial difficulties were offset completely among those who had the highest anticipated support scores (in the fourth quartile),” Krause said. “In fact, the highest level of anticipated support reduced the noxious effects of economic stress on depression scores by approximately 77 percent.”

The pattern was similar for the effect of anticipated support on somatic symptoms—sleeping, eating, and getting going. “Here again, the highest level of anticipated support reduced the effect of economic difficulties on somatic symptoms by 79 percent,” he said.

The effects of received support on those with economic stressors:

In contrast to anticipated support, receiving assistance was not beneficial to mental health. Krause found that symptoms of depression were significantly greater among those who actually received assistance from their support network compared with those who got no assistance.

“Indeed, depression scores were actually 15 times higher among those who received assistance compared to those who did not,” Krause said.

Despite the increased depression scores among those who received assistance, Krause also discovered that, paradoxically, “the more assistance elders had received from others in the past, the more likely they were to believe that their social network would help out in the future, if need be. So, although the direct effect of received support is negative, these effects are offset somewhat by providing future hope.”

How can family and friends minimize the negative effects of providing assistance to older people? “Don’t be too ready to help too much. Send a message to them that you have faith in their ability to cope,” Krause suggested. “Let older people tell you what they need and when they need it. Say to them, ‘I’ll be very happy to help you out. Just tell me when you need it.’ That way they can anticipate support and feel hopeful while they try to solve the problem on their own.”