The relationship of living arrangements and depressive symptoms among older adults in sub-Saharan Africa

Background: Older adults in sub-Saharan Africa are increasingly facing the twin challenges of reduced support from their adult children and taking on new roles caring for orphans and vulnerable children. How these changes affect the mental health of older adults is largely unknown. Methods: We use data from the 2002-2003 World Health Surveys for 15 countries in sub-Saharan Africa to examine whether older adults who may be lacking adequate support through living alone or in skipped-generation households are at an increased risk of depressive symptoms compared to those living with at least one working-age adult. Using meta-regression, we also examine whether heterogeneity across countries in the prevalence of depressive symptoms or in the association between living arrangements and depressive symptoms is associated with HIV/AIDS prevalence and national economic status. Results: The pooled prevalence of depressive symptoms among older adults was 9.2%. Older adults living alone had a 2.3% point higher predicted prevalence of depressive symptoms compared to individuals living with at least one working-age adult (95% confidence interval: 0.2%, 4.4%). None of the country characteristics examined explained heterogeneity across countries in the relationship between living arrangements and depressive symptoms. However, there was some evidence suggesting a positive association between depressive symptom prevalence and the severity of a country's HIV/AIDS epidemic. Conclusion: As depressive symptoms are known to be predictive of poor quality of life and increased mortality, it is important to address how health and social policies can be put in place to mitigate the potentially detrimental effects of solitary living on the mental health of older persons in sub-Saharan Africa.