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

Older people in sub-Saharan Africa are increasingly facing challenges of reduced support from adult children and taking on new roles caring for orphans and vulnerable children. How these changes affect the health of older people themselves is largely unknown. We use data from the 2002-2003 World Health Surveys for 15 countries in sub-Saharan Africa to examine whether Africans over the age of 50 years who live alone or in skipped-generation households are at an increased risk for depressive symptoms compared to those living in households with at least one working-age adult. Using meta-regression, we also examine whether heterogeneity across countries in the prevalence of depressive symptoms or the association between living arrangements and depressive symptoms is explained by country-level factors, including HIV/AIDS prevalence and national income. We find evidence that a sizable proportion of older adults suffer from depressive symptoms (mean prevalence=11.9%). Controlling for individual covariates, the prevalence of depressive symptoms was 2.3% higher among older adults living alone compared to individuals living with at least one working-age adult (95% CI: 0.2%, 4.4%). In the meta-regression, HIV/AIDS prevalence did not explain heterogeneity across countries in the relationship between living arrangements and depressive symptoms, however we find some evidence of a positive association between depressive symptom prevalence and severity of a country's HIV/AIDS epidemic. The increased prevalence of depressive symptoms associated with solitary living is important to consider in policies to improve the health and well being of older Africans.