Pre-pandemic Social Integration: Protection or Risk for Older Adults in the Time of COVID-19?

ABSTRACT

OBJECTIVES: To examine the association between pre-pandemic social integration and post-traumatic stress disorder (PTSD) symptoms during the COVID-19 pandemic and test whether the association is mediated by social support received and social events missed during the pandemic. We also explored age, race, gender, and socioeconomic differences in the association. METHODS: We adopted a prospective design. Path analysis was conducted using data from the COVID-19 supplement (2020) and the 2019 wave of the National Health and Aging Trends Study. The sample represents Medicare beneficiaries age 70+ (N = 2,694). Social integration was measured using a 6-item index. A 6-item standardized scale assessed PTSD symptoms. Both social support received and social events missed were single-item measures. The analysis controlled for sociodemographic characteristics, pre-pandemic physical and mental health, and coronavirus exposure during the pandemic. RESULTS: Pre-pandemic social integration was positively associated with PTSD symptoms during the pandemic. The association was primarily mediated by social events missed- high levels of social integration were associated with missing more social events during the pandemic resulting in more PTSD symptoms. Social support received was also a mediator-social integration was positively associated with social support received during the pandemic, with more received support associated with greater PTSD symptoms. Pre-pandemic social integration had no significant direct effect on PTSD symptoms. The direct, indirect, and total effects of social integration on PTSD symptoms did not significantly differ by age, race, gender, education or poverty status. DISCUSSION: Social integration may carry mental health risks in times of infectious disease outbreaks.