Life Stress, Social Supports and Psychological Well-Being of Older Adults in Mumbai, India

Background and Purpose: There is growing concern that rapid social, economic, and political change is eroding the status of older people and protective and supportive functions of traditional family structures in developing countries, with harshest effects on poorer sectors. This study draws on stress and coping theory to examine the association of life stressors, social support and psychological well-being among poor older adults in Mumbai, India. We hypothesize that: (1) life stress will be significantly related to depressive symptoms and (2) life stress will be significantly related to life satisfaction, even after adjusting for potential confounders and (3) social support will mediate these relationships. Methods: The study was set in a low-income complex in Central Mumbai. We used a two-stage random sampling strategy. We first selected 15% of the 32 buildings in the complex, each with 4 floors of 20 tenements. Of these 400 units, we selected 25% of households that included a resident aged 60 and over, yielding a final sample of 100. We conducted face-to-face interviews with a structured schedule. Per standard protocol, the instrument was translated from Hindi to English and back. In addition to information on the sample, we assessed two dependent measures—depressive symptoms (Geriatric Depression Scale-Hindi, α= .84) and life satisfaction (Satisfaction with Life Scale, α= .82), two independent measures--life stressors (Stress Life Events Scale; health problems and financial strain) and social support (sum of six indicators of quantity, quality, type, and reciprocity of support) and controls. Zero-order correlations of independent variables ranged from .00 to .46 and statistical power was .82.

Using hierarchical OLS, we regressed depressive symptoms on socio-demographic covariates in Step 1, added stressors in Step 2, then resources in Step 3. We repeated this process, regressing life satisfaction on the three sets of independent variables. We tested the mediating effects of social support on these associations using Baron and Kenny's (1986) criteria for mediation and a Sobel test for significance.

Results: Two thirds of participants were female, the same proportion as persons aged 60 – 70. Just over half were married and 85% identified as Hindu. Fifty-five percent had monthly incomes at or below 2000 INR (~$45.00USD). Women had significantly lower incomes, lower home ownership, lower likelihood of living with all children, and were less able to meet expenses. Four out of five participants lived with at least one adult child. Fully 80 % rated their health status as fair or poor. There was a strong, significant association of life stress and depressive symptoms and a significant, slightly weaker association of life stress and life satisfaction. Social support was a significant partial mediator of both relationships. Conclusions and Implications: Data supported the three hypotheses, viz., life stress was associated with depressive symptoms and life satisfaction and social support partially mediated these relationships. The findings underscore the need for policy, programming and practice efforts to focus on supplemental and /or alternative means of support to improve the mental health of poor older adults, particularly women, in urban India.