(WITHDRAWN) Impact of Social Relationships on Mental Health Among Low-Income Older Indian Women: Results from the World Health Organizationâ₀™s (WHO) Study on Global Ageing and Adult Health (SAGE)

Background: In India, gender is a risk factor for depression. Yet, few studies have explored depression among low-income older Indian women. Our study is guided by feminist standpoint theory and informed by our qualitative synthesis (Bhattacharya et al., 2019) that documented Indian women’s perceived causes of depression as rooted in social/contextual factors. We examined whether marital status and perceived interpersonal difficulty were associated with depressive symptoms using a nationally representative sample of 1,082 midlife/older women (aged 50–100) who were married or widowed from the lowest income quintiles of the Indian arm of the Study on global AGEing and adult health (SAGE).

Methods: SAGE used a multistage, stratified sample design, with household clusters sampled to reflect age, sex, level of wealth/local economic development, and urban/rural status. Measures were standardized and well-validated. Our outcomes were two tiered, that is presence of at least once cardinal (low mood or anhedonia) symptom (dichotomous) and total number of depressive symptoms among those with at least one cardinal symptom (continuous). We hypothesized that being married (compared to widowed) and higher interpersonal difficulty (measured by quality of relationships and conflict) would be positively associated with the presence and total number of depressive symptoms among low-income older Indian women. We used logistic and linear regression analyses and controlled for key demographic (age, education, urban/rural) and health factors (chronic diseases, self-rated health).

Findings: In our sample, 56 percent were married and 18 per cent reported at least one cardinal symptom of depression. Women with at least one cardinal symptom reported a mean total number of 8.7 symptoms (of maximum 13). In fully adjusted models, being married was not associated with reporting at least one cardinal symptom or overall total number of depressive symptoms. Difficulty with relationships was positively associated with reporting at least one cardinal depressive symptom [OR= 1.424, 95% CI 1.194, .697; p = .000] but not with overall total number of depressive symptoms. Conflict was not associated with reporting at least one cardinal symptom but was positively associated with overall total number of depressive symptoms [β= .447, p= .01].

Implications: The study highlights the high prevalence of clinically significant depressive symptoms (i.e., 18% with mean 8.7 symptoms) among older Indian women. Our findings related to marital status do not support our hypothesis. Results support the idea that relationships are central to women’s mental health and well-being in India; however additional research is needed to deepen our understanding as to how interpersonal relationship dynamics and cultural factors contribute to depression among older women. As gerontological social work gains prominence in India, researchers and clinicians should collaborate to develop/implement gender-sensitive interventions that consider the multi-faceted role of familial and social relationships in prevention and treating depression among elders.