Background
Loneliness among the elderly is a risk factor for poor health outcomes such as poor quality of life, reduced cognitive functions, depression, and functional disability [
1‐
3]. Loneliness has been identified in the literature as an offshoot of retirement, and retirement has the potential to interrupt social networks [
4] and reduce the feasibility of securing other jobs. Often in developing nations, including Nigeria, older adults who retired from work environments could have work-related chronic diseases. Also, they experience a lack of financial security or good welfare package and may face post-retirement challenges [
5], which may include loneliness, depressive, and anxiety symptoms.
In Nigeria, most people retire around the age of 60 or 65 years, and other people after 35 years in active service. However, many employees in the universities, private firms, and self-employed individuals retire beyond the age of 60 or 65 years. Furthermore, the proportion of older adults aged 65 years and above is increasing in Nigeria partly due to improving the standard of living and decline in the crude mortality rate (CMR). The Population Reference Bureau [
5] and the National Council on Ageing [
6] reported that older adults constitute about 3.1% or 5.9 million of the total population of 191 million. This figure represents an increase of 600,000 during the 5 years 2012–2017.
Nevertheless, many Nigerian older adults find it very difficult to adapt to life after retirement [
7] and experience mental health problems [
8,
9]. For instance, Gureje et al. [
8] reported that the lifetime and 12-month prevalence estimates of major depressive disorder among older adults in the Ibadan Study Ageing (ISA) were 26.2 and 7.1% respectively. Similarly, Ojagbemi, and Gureje [
9] reported a loneliness prevalence of 16.7% among older adults. Several reasons have been identified for post-retirement challenges experienced by the elderly in Nigeria. These include the rural-urban migration of family members that often leads to a higher likelihood of loneliness in older people, minimizes family or social networks [
10], and the breaking down of traditional family support systems for the elderly [
11]. Since retirement is a risk factor for loneliness in older adults [
4], many Nigerian retirees may be experiencing high levels of loneliness.
Loneliness has been conceptualized in literature. Loneliness has been defined as ‘a discrepancy between one’s desired and achieved levels of social relations’ [
12]. The discrepancy could exist in the quantity or the intimacy of the relationships [
13]. Also, loneliness refers to an upsetting feeling that is associated with the perception that one’s social needs are not fulfilled by the quantity or quality of one’s social networks [
14,
15].
Experience of loneliness is associated with poor health outcomes. Research evidence has established a link between loneliness and depressive symptoms [
16‐
18]. Additionally, the literature indicates that depressive symptoms are prevalent among older people with adverse health outcomes. For instance, depressive symptoms have been associated with reduced quality of life [
19], reduced activity levels, and higher mortality [
20]. Older adults experiencing perceived loneliness and depressive symptoms have poor general wellbeing [
21] and maybe prone to the risk of suicide [
22].
Also, lonely older adults may have a combined experience of depressive and anxiety symptoms [
23]. The co-occurrence of depressive and anxiety symptoms is known as anxious depression. Anxious depression refers to a major depressive disorder with high levels of anxiety symptoms based on symptom severity scales [
24,
25]. High anxiety levels in depression, according to Fava et al. [
26], refer to a ‘common subtype of depression that is associated with more impairment, suicidality and treatment resistance, both in younger and older adults’ [
27,
28]. However, there is a shortage of studies on the prevalence of perceived loneliness among older retirees in north-central Nigeria and the association of loneliness with depressive and anxiety symptoms in this group.
Hence, understanding the relationship between perceived loneliness, depression, anxiety, and anxious depression in a sample of retirees would provide valuable insight into the appropriate approaches of intervention for improving quality-of-life among older adults in Nigeria. Additionally, ascertaining association between loneliness and mental disorders in retirees could provide apt information on the form of mental disorder that is more independently and significantly associated with loneliness among retirees. Such information could prompt government agencies to formulate policies that seek to integrate retirees in mainstream developmental projects at the community, state and national levels, promote social support and opportunities for social interactions among older adults. This in turn could lower the risk of depression and anxiety disorders in retirees.
Therefore, the study aimed to investigate whether older retirees experience greater feelings of loneliness, the association between loneliness, depression or anxiety symptoms among Nigerian retirees. After that, we examined whether retirees with depression or anxiety experience greater feelings of loneliness than those without depression or anxiety. Finally, we examined whether retirees with anxious depression experience greater feelings of loneliness than those without anxious depression (non-anxious depression).
Discussion
Using data from a community-based cross-sectional survey of older retirees in Kogi State, North Central Nigeria, the current study aimed to examine the prevalence and associations between loneliness and depression, anxiety, anxious depression, and some demographic factors. In total, 21.8% of retirees reported that they were lonely. Also, more than half (52.0%) of the participants reported having depressive symptoms, while 27.7 and 20.5% reported having anxiety symptoms and anxious depression, respectively. The findings are consistent with prior research that reported prevalence of loneliness, depression, and anxiety among older adults [
1,
9,
10,
45‐
47]. The findings imply that Nigerian retirees experience higher levels of loneliness compared to those reported in previous Nigerian studies [
9,
10]. Thus, they are susceptible to depressive and anxiety symptoms and comorbid conditions. This is consistent with previous research that suggests loneliness always co-occur with depression. Although our findings show no significant difference in the loneliness experience of retirees with depression or anxiety and those without, nevertheless, a higher proportion of retirees with depressive or anxiety symptoms experienced loneliness compared to those without the conditions (details are in Table
4). This finding is consistent with prior studies [
47,
48].
Also, our findings indicated that male and female retirees differed significantly in their loneliness experiences. Female retirees had a higher mean loneliness score than their male counterparts. Although previous research has reported mixed results on the nexus between loneliness and gender [
49], however, the majority of the findings reported that women have higher levels of loneliness than men. Thus, our finding is consistent with the existing literature [
50,
51]. A higher prevalence of widowhood has been identified for higher levels of loneliness in women [
52]. Consequently, family members, community health workers, and social workers need to provide emotional support and psychosocial interventions for the widowed older adults, especially women, to alleviate their loneliness experience.
Our findings in the bivariate analysis showed that female gender, advanced age (≥ 75 years), having secondary and tertiary education were significantly associated with depression. The findings are consistent with previous studies that reported associations between age [
41,
50], low/poor education [
53], income [
54] and mental disorders such as depression, anxiety and loneliness [
41,
50,
53]. For instance, previous studies indicated that women are more likely to experience loneliness, depressive and anxiety symptoms compared to men due to the prevalence of widowhood in women [
50‐
52]. Thus, our findings indicate that psychosocial interventions to reduce mental disorders (i.e., loneliness, depression, anxiety and anxious depression) should specifically target the older women, the middle-old and oldest-old in Nigeria. Such interventions could include the provision of financial incentives, home or community-based regular mental health screening and integration of retirees especially older women middle-old and the oldest-old retirees in social or religious activities that promote their mental health.
One of the aims of this study was to identify independent association between loneliness and depression and anxiety among retirees. In the multivariable logistic regression model, the findings show that loneliness and anxious depression were significantly associated with depression in our sample. The finding coheres with previous studies that reported associations between loneliness, depression, and anxious depression [
1,
9,
16‐
18,
47,
55]. For instance, a systematic review [
56] reported association between a high level of loneliness and severe depressive symptoms. The results could suggest the collapse of family or social networks and the traditional family support systems for the elderly in Nigerian communities especially in the rural areas [
7]. It is therefore feasible that associations between perceived loneliness, depression and anxious depression among retirees could be due to ageism, truncation of social ties, migration of caregivers (i.e., younger family members) to urban centres in search of elusive job opportunities [
7]. Also, the harsh economic conditions in the country could make caring for the elderly by family members or relatives a huge financial burden. Hence, interventions based on social integration; mobilization of social resources to support the elderly; strengthening the fragile family and community support network for older women; and eradication of harmful widowhood practices targeted at older women that predispose to them severe levels of loneliness could significantly reduce mental disorders among the retirees [
57,
58]. Also, formal support that mitigates loneliness and that improves social contacts and increase activity levels [
55] among older adults should be provided via community health officers (CHOs) and community health extensions workers (CHEW). The intervention should be fully funded by the government and non-governmental organizations (NGOs).
Strengths and limitations
To the best of our knowledge, only two previous studies [
9,
10] have examined loneliness in older adults in Nigeria. Furthermore, only one study [
9] had examined the association between loneliness and major depressive order among older adults. None of these studies examined the association of loneliness with anxiety symptoms and anxious depression in retirees in Nigeria. Also, we measured loneliness, depression, anxiety, and anxious depression using well-validated scales. One of the limitations of this study is that we measured loneliness as a single variable (i.e., unidimensional). We did not examine loneliness as a bi-dimensional construct, as suggested in a previous study [
59].
Nonetheless, our study has provided valuable evidence on the prevalence of loneliness among Nigerian retirees and its association with depressive and anxiety symptoms. Future studies should examine loneliness as a bi-dimensional construct among Nigerian older adults to further facilitate interventions to reduce loneliness. We used convenience sampling; our study sample could be subjected to selection bias. Nevertheless, we believed this would not have much impact on the generalization of our findings. The retirees’ self-report of loneliness, depression, and anxiety may be undermined by recall bias-such as underreporting or overreporting. Nevertheless, we firmly believe that retirees’ recall of feelings of loneliness, depressive, and anxiety symptoms in the past year might be a significant event. Also, the use of ULS-8, DASS 21-D, and DASS 21-A as screening tools in identifying retirees with the primary outcomes may not be precise. Thus, many diagnoses may have been missed. This could be a limitation as several symptoms of depression and anxiety overlay, and the disorders are usually co-morbid [
54]. Therefore, future studies should make use of a clinical interview schedule based on the DSM-V criteria for assessing depressive, anxiety, and mood disorders. Also, this is a cross-sectional study; thus, the causal direction of the relationship between loneliness, depression, and anxiety could be argued to be reciprocal. Longitudinal studies are needed to provide insights into the causal relationship between loneliness and depressive and anxiety symptoms among older adults, including retirees in Nigeria.
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