Incident Depression in Relation to Contextual Isolation among Established Long-stay Residents of US Nursing Homes

Background: The U.S. Surgeon General recently put renewed focus on loneliness and isolation as fundamental determinants of health. Objective: To estimate the incidence of depression among established long-stay residents in relation to contextual isolation. Design: Retrospective cohort study. Setting: US nursing homes. Participants: 490,523 residents who lived in the same home for at least one year between 2010 and 2019. Measurements: Using data from the Minimum Data Set 3.0, we identified residents who were newly diagnosed with depression. We assessed contextual isolation for each resident with regard to 31 socially salient characteristics relative to their co-residents. Results: The incidence proportion of diagnosed depression from 3-12 months was 21.3% among residents not contextually isolated, 21.0% among residents contextually isolated on a single characteristic, and 22.2% among residents contextually isolated on multiple characteristics. After adjustment for several potential effect modifiers (gender, age group, race/ethnicity, use of translation services), the 3-12 month incidence proportion was 8% higher among residents experiencing contextual isolation on multiple characteristics (95% confidence interval 6% to 10%). Conclusion: Contextual isolation modestly increases the risk of newly diagnosed depression among long-stay residents after they have settled into the nursing home setting. Entry to a nursing home represents an opportunity to make new connections. Helping residents make novel connections may be particularly important for residents whose background or other socially salient characteristics leave them as outsiders to the mainstream of a given nursing home.