Impact statement
This study provides community-based evidence derived from purposively selected rural and urban communities on severe depressive symptoms among older adults in southeastern Nigeria, revealing that over 60% of participants experience severe depressive symptoms, a prevalence higher than prior national estimates and global averages. While these findings should be interpreted with caution due to limited generalizability inherent in the sampling approach, they nonetheless underscore an urgent public health concern in the context of rapid population aging, limited integration of mental health into primary care and high psychosocial stressors. By examining key sociodemographic correlates in unadjusted, bivariate analyses, the study identifies advanced age, female gender, Christian religious affiliation, marital status and living with family as significant factors associated with severe depressive symptoms, while educational attainment showed no significant association. Importantly, marriage and co-residence with family, often considered protective, were linked to higher depressive symptom burden, highlighting the need to assess relationship quality, household dynamics and caregiving strain rather than structural arrangements alone. These insights provide actionable guidance for intervention: routine geriatric mental health screening in primary care, training community health workers for psychosocial support, engaging faith-based organizations to reduce stigma and developing family- and gender-sensitive programs that strengthen emotional support. By situating these findings within Nigeria’s sociocultural and economic context, the study contributes to a broader understanding of how social, demographic and cultural transitions influence mental health in aging populations in low-resource settings. Beyond Nigeria, the evidence informs global discussions on healthy aging and mental health equity, providing a foundation for culturally responsive policies and community-based interventions in similar low- and middle-income countries. Overall, this research offers timely, actionable insights to improve emotional well-being, social inclusion and quality of life among older adults while highlighting the need for further longitudinal and mixed-methods research to clarify causal pathways.
Introduction
Depression in later life remains a critical yet under-recognized public health challenge, particularly in low- and middle-income countries (LMICs) undergoing rapid demographic shifts. Globally, 10%–30% of older adults experience depression, resulting in functional impairment, reduced quality of life and higher healthcare utilization (World Health Organization [WHO], 2022; Jeong et al., Reference Jeong, Shin and Kim2023; United Nations, Department of Economic and Social Affairs [UN DESA], 2024). In many African settings, including Nigeria, the burden is likely underestimated due to stigma, limited diagnosis and poor integration of mental health services into primary care (Rajkumar, Reference Rajkumar2021; Ogunbode et al., Reference Ogunbode, Olusina and Adekunle2022). With Nigeria’s population aged 60 years and above projected to double by 2050, urgent, evidence-based interventions are required (United Nations Population Fund [UNFPA], 2024).
Existing Nigerian research on geriatric depression is largely hospital-based, geographically limited and insufficiently contextualized (Kareem et al., Reference Kareem, Uwemedimo and Ebong2024; Ugwu and Ene, Reference Ugwu and Ene2025). All cited sources have been verified as published or publicly accessible as of the time of submission. Community-level data, particularly from underserved regions such as southeastern Nigeria, remain scarce. Southeastern Nigeria is also characterized by a predominance of Igbo sociocultural structures, strong kinship systems and a largely Christian population, factors that may shape mental health experiences, help-seeking behavior and the interpretation of social support in later life. Furthermore, the influence of sociodemographic factors, such as age, gender, marital status, religion and living arrangements, on depression risk is poorly understood, and conventional protective factors like marriage or co-residence with family may operate differently within the Nigerian sociocultural and economic context (Akinrinmade and Ojo, Reference Akinrinmade and Ojo2022; Ekoh et al., Reference Ekoh, Uche and Nwankwo2023).
This study fills these critical gaps by assessing the prevalence and sociodemographic factors associated with severe depressive symptoms among community-dwelling adults aged 60 years and older in southeastern Nigeria, using culturally adapted tools to generate community-level evidence from diverse rural and urban settings. By generating robust community-level evidence, identifying key and counterintuitive associations and linking findings to actionable mental health strategies, the study provides a foundation for targeted interventions and policy reform. The results aim to inform context-sensitive programs that improve geriatric mental health, enhance quality of life and guide Nigeria, and similar LMICs, toward sustainable healthy aging initiatives (Federal Ministry of Health Nigeria, 2023; Prince et al., Reference Prince, Saxena and Wu2023; Surkan et al., Reference Surkan, Kane, Fischer and Salam2024).
Methods
Study design and setting
This study employed a community-based cross-sectional design conducted over a 14-month period, from June 2024 to August 2025. While this extended data collection period could introduce temporal or seasonal variability in depressive symptom reporting, the majority of communities were assessed within a narrow time window in each Local Government Area (LGA) and recruitment was balanced across rural and urban sites to minimize bias. Nonetheless, potential seasonal influences on mood and social activity should be considered when interpreting findings. Data were collected across 30 communities located in 15 LGAs within the five states of southeastern Nigeria: Abia, Anambra, Ebonyi, Enugu and Imo. Communities were purposively selected to ensure inclusion of both rural and urban settings. In each community, participants were selected using purposive sampling, supported by local health workers and community leaders to enhance feasibility and participation. Selection was guided by demographic data identifying high concentrations of retirees (Nigerian Union of Pensioners, 2024), population-level mental health trends from the Nigeria Demographic and Health Survey (National Population Commission [NPC] and ICF, 2019) and socioeconomic indicators characteristic of aging populations in low-resource environments. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure methodological rigor and reporting transparency (von Elm et al., Reference von Elm, Altman, Egger, Pocock, Gøtzsche and Vandenbroucke2008).
Participants and recruitment
Participants were older adults aged 60 years and above residing within the selected communities. Eligibility required adequate cognitive and physical functioning to independently engage with the study instrument, as well as the ability to communicate in English or any of Nigeria’s three major languages: Hausa, Igbo or Yoruba. Exclusion criteria included being younger than 60 years, having acute or severe cognitive impairments, being absent during data collection, possessing uncorrected sensory impairments that hindered communication or being unable to provide informed consent.
A multistage sampling strategy was used to enhance representativeness. Stage One: Each state served as a cluster, from which three LGAs were randomly selected via balloting, resulting in 15 LGAs. Stage Two: Two communities (one rural and one urban) were purposively selected from each LGA, yielding 30 study sites. Stage Three: In each community, 24 eligible participants were selected using purposive sampling, supported by local health workers and community leaders to ensure trust and participation, especially in rural areas. In total, 720 older adults were approached; 718 completed the survey and provided valid data. Two participants withdrew voluntarily without stating reasons.
Sample size determination and power calculation
Sample size estimation followed an adapted version of Cochran’s formula: [n = 45GD/P2], where G = prevalence of severe depressive symptoms (75.6%) (Ugwu and Ene, Reference Ugwu and Ene2025), D = 100% – prevalence (24.4%) and P = admissible errors, defined as 15% of the estimated prevalence (0.15 × 75.6 = 11.34). Thus, P 2 = 11.342 = 128.6 (approximated to 129). Therefore, n = (45 × 75.6 × 24.4)/128.6 = 643. The minimum required sample size was 643 participants. To account for a potential 10% non-response rate, the sample size was increased to 720. Ultimately, 718 valid responses were analyzed. This final sample achieved 80% statistical power to detect medium effect sizes (Cohen’s d = 0.5) at α = 0.05, consistent with standard methodological recommendations (Cohen et al., Reference Cohen, Manion and Morrison2011).
Data collection instrument and procedure
Data were obtained using the Geriatric Depression Assessment Questionnaire (GDAQ), a structured instrument developed for this study and adapted from validated tools to ensure cultural relevance in Nigerian settings. The questionnaire comprised three sections: Section A assessed sociodemographic characteristics, including educational attainment, which was self-reported and categorized as no formal education, primary education, secondary education and tertiary education (defined as completion of university, polytechnic, college of education or equivalent post-secondary training), consistent with classifications used in the Nigeria Demographic and Health Survey (NPC and ICF, 2019). Section B: Assessment of depressive symptoms using the Geriatric Depression Scale – Short Form (GDS-15). The GDS-15 comprises 15 items that assess depressive symptoms experienced by older adults. The items are scored on a binary “yes/no” scale. Depression severity is categorized as: Normal (0–5), Mild depression (6–10) and Severe depressive symptoms (11–15). A total score of ≥10 is considered indicative of significant depressive symptoms (Sheikh and Yesavage, Reference Sheikh and Yesavage1986). Section C: Ethical consent and participant information, aligned with the Declaration of Helsinki (World Medical Association, 2013) and Nigeria’s National Health Research Ethics Code (National Health Research Ethics Committee, 2025). The instrument was translated into English, Hausa, Igbo and Yoruba, followed by back-translation to ensure accuracy. Although the study was conducted in southeastern Nigeria, where Igbo is the predominant language, Hausa and Yoruba versions were included to accommodate minority populations such as internal migrants, traders and retirees residing in the study communities who may have greater proficiency in these languages. This approach was adopted to enhance inclusivity, ensure accurate comprehension of survey items and reduce language-related response bias. Pre-testing was conducted with 20 older adults not included in the main study. A panel of 13 public health experts reviewed the instrument for content validity. Internal consistency reliability was assessed for the GDS-15 component (Section B) only, as Section A comprises non-scaled sociodemographic variables. The GDS-15 demonstrated strong internal consistency (Cronbach’s α = 0.85). Data were collected through face-to-face interviews conducted by 30 trained research assistants, each assigned to one of the 30 study communities. All research assistants were public health professionals who completed a standardized 35-min training session covering ethical principles, informed consent procedures, standardized administration of the study instrument and cultural sensitivity relevant to the local context. Given that all research assistants were qualified public health professionals with prior experience in community-based data collection, the training was designed as a focused refresher rather than a full introductory course. The session included a step-by-step guidance on questionnaire administration, role-playing exercises to ensure consistency in interviewing techniques, clarification of key concepts within the GDS-15 and practical demonstrations on obtaining informed consent and maintaining cultural sensitivity in diverse community settings. This structured and competency-based approach ensured standardization and data quality despite the relatively brief duration. Interviews were conducted in participants’ homes to enhance comfort, privacy and participation. Written informed consent was obtained from all participants prior to data collection, either by signature or thumbprint, depending on literacy level.
Ethical approval statement
Ethical approval was granted by the National Health Research Ethics Committee (NHREC), Nigeria (Ref: REC/FE/2024/00014). Additional administrative permission was obtained from community leaders and traditional rulers (“Igwe”) in participating communities. Participants were assured of confidentiality and anonymity in line with international ethical guidelines, including the Declaration of Helsinki (World Medical Association, 2013) and the APA Ethical Principles of Psychologists (American Psychological Association, 2017). No monetary incentives were offered to maintain voluntary participation.
Data analysis
Data analysis was performed using IBM SPSS Statistics Version 28 (International Business Machine Corporation, 2021). Descriptive statistics (frequencies and percentages) were used to summarize participants’ sociodemographic characteristics and prevalence of depression. Inferential analyses were limited to bivariate chi-square tests to assess associations between depression and sociodemographic factors. Unadjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to determine the strength and direction of these bivariate associations. No multivariable logistic regression analysis was conducted; therefore, all reported associations represent unadjusted relationships. Statistical significance was established at p < 0.05. The sample size of 718 ensured 80% power to detect meaningful associations, enhancing the reliability and generalizability of findings. All reporting followed STROBE guidelines (von Elm et al., Reference von Elm, Altman, Egger, Pocock, Gøtzsche and Vandenbroucke2008).
Results
Sample characteristics
A total of 718 community-dwelling older adults aged 60 years and above (mean age = 71.5 years) participated in the study, yielding a response rate of 99.7%. The majority of respondents were aged 70 years or older (66.4%), female (60.6%) and identified as Christians (70.6%). Most participants had attained tertiary (university-level) education (67.1%; 482/718). This distribution likely reflects the characteristics of the purposively selected communities, including urban centers and areas with a high concentration of retirees and pensioners, rather than the educational profile of the general older adult population in southeastern Nigeria. Majority were married (56.3%) and resided with family members (95.1%). Only 4.9% lived alone or were institutionalized. All participants scored within the GDS-15 categories of mild depression (6–10) or severe depressive symptoms (11–15); no participants scored in the “Normal” category (0–5). This complete absence of “normal” scores is notable and likely reflects selection bias arising from purposive sampling of communities with a higher burden of age-related stressors, chronic conditions and socioeconomic challenges. As such, the distribution of depressive symptom severity in this sample may not reflect that of the general older adult population. Accordingly, the observed prevalence of severe depressive symptoms (61.3%) should be interpreted with caution, as it may be inflated due to the concentration of higher-risk individuals within the selected communities and the exclusion of lower-risk populations. Therefore, although 61% of participants were tertiary-educated, education level did not significantly predict depression severity, suggesting that higher education alone may not protect against the psychosocial stressors prevalent in these communities. The overall prevalence of severe depressive symptoms among participants was 61.3% (n = 440), while 38.7% (n = 278) presented with mild depressive symptoms based on scores from the Geriatric Depression Scale – Short Form (GDS-15) (Refer to Table 1).
Sociodemographic characteristics of the participants (N = 718)
Table 1. Long description
A table with four columns: Variables, Category, Frequency f, and Percentage %.
* Age: greater than or equal to 70 years (477, 66.4%); 60 to 69 years (241, 33.6%).
* Gender: Male (283, 39.4%); Female (435, 60.6%).
* Religious affiliation: Christianity (507, 70.6%); Others including Pagan, African traditional religion, and Islam (211, 29.4%).
* Education level: Tertiary (482, 67.1%); Others including non-formal, primary, and secondary (236, 32.9%).
* Marital status: Married (404, 56.3%); Others including single, divorced or separated, and widowed (314, 43.7%).
* Living situation: With family (683, 95.1%); Others including alone or institutionalized (35, 4.9%).
* Geriatric depression: Severe (440, 61.3%); Mild (278, 38.7%).
Keys: n = sample size, () = bracket sign, ≥ = greater than sign, ≤ = less than sign, f = frequency, % = percentage.
Association between sociodemographic variables and geriatric depression
Chi-square analysis revealed significant associations between geriatric depression and several sociodemographic factors: Age: Older adults aged ≥70 years had a significantly higher prevalence of severe depressive symptoms compared to those aged 60–69 years (67.7% vs. 48.5%, χ 2 = 25.89, p = 0.001). Gender: Female participants exhibited significantly higher rates of severe depressive symptoms than males (72.6% vs. 43.8%, χ 2 = 52.57, p = 0.001). Religious Affiliation: Those who identified as Christians had a higher likelihood of severe depressive symptoms compared to those practicing other religions (70.6% vs. 38.9%, χ 2 = 63.62, p = 0.001). Marital Status: Married individuals experienced significantly higher rates of severe depressive symptoms than their unmarried counterparts (72.8% vs. 47.1%, χ 2 = 47.47, p = 0.001). Living Situation: Participants living with family were significantly more likely to report severe depressive symptoms compared to those living alone or institutionalized (62.7% vs. 34.3%, χ 2 = 11.44, p = 0.001). No statistically significant association was found between educational level and severe depressive symptoms (χ 2 = 1.11, p = 0.2920) (Refer to Table 2).
Chi-square analysis of geriatric depression by sociodemographic variables (N = 718)
Table 2. Long description
The table contains seven columns: Variables, Category, N, Severe [440 (61.3 percent)] f (percent), Mild [278 (38.7 percent)] f (percent), Chi-square, and p-value.
* Age: For those greater than or equal to 70 years (N=477), 323 (67.7 percent) have severe depression and 154 (32.3 percent) have mild. For 60 to 69 years (N=241), 117 (48.5 percent) have severe and 124 (51.5 percent) have mild. Chi-square 25.89, p-value 0.001.
* Gender: Males (N=283) show 124 (43.8 percent) severe and 159 (56.2 percent) mild. Females (N=435) show 316 (72.6 percent) severe and 119 (27.4 percent) mild. Chi-square 52.57, p-value 0.001.
* Religious affiliation: Christianity (N=507) has 358 (70.6 percent) severe and 149 (29.4 percent) mild. Others (N=211) has 82 (38.9 percent) severe and 129 (61.1 percent) mild. Chi-square 63.62, p-value 0.001.
* Education level: Tertiary (N=482) has 302 (62.7 percent) severe and 180 (37.3 percent) mild. Others (N=236) has 138 (58.5 percent) severe and 98 (41.5 percent) mild. Chi-square 1.11, p-value 0.2920.
* Marital status: Married (N=404) has 294 (72.8 percent) severe and 110 (27.2 percent) mild. Others (N=314) has 148 (47.1 percent) severe and 166 (52.9 percent) mild. Chi-square 47.47, p-value 0.001.
* Living situation: With family (N=683) has 428 (62.7 percent) severe and 255 (37.3 percent) mild. Others (N=35) has 12 (34.3 percent) severe and 23 (65.7 percent) mild. Chi-square 11.44, p-value 0.001.
Keys: n = sample size, () = bracket sign, ≥ = greater than sign, ≤ = less than sign, f = frequency, % = percentage.
Sociodemographic factors associated with severe geriatric depression
OR analysis further substantiated the unadjusted, bivariate associations between selected sociodemographic variables and the likelihood of severe depressive symptoms. Table 3 presents the odds, ORs and 95% CIs, without duplicating the frequencies reported in Table 2. Age ≥ 70 years was associated with more than twice the odds of severe depressive symptoms compared to ages 60–69 (OR = 2.23; 95% CI: 1.63–3.05). Gender was a strong bivariate correlate: using females as the reference category, males had significantly reduced odds of severe depression (OR = 0.29; 95% CI: 0.21–0.39), indicating that females were more likely to experience severe depressive symptoms. Religious affiliation showed that Christians were nearly four times more likely to experience severe depressive symptoms compared to other religious groups (OR = 3.75; 95% CI: 2.73–5.15). Marital status was also a significant predictor: Married participants had three times the odds of severe depressive symptoms relative to unmarried respondents (OR = 3.00; 95% CI: 2.23–4.04). Living with family was associated with higher odds of severe depressive symptoms (OR = 3.23; 95% CI: 1.53–6.79). Therefore, although 67.1% of participants were tertiary-educated, education level did not significantly predict the presence of severe depressive symptoms (OR = 1.18; 95% CI: 0.86–1.63). All ORs reflect unadjusted associations derived from bivariate analyses and should not be interpreted as independent effects (Refer to Table 3).
Odds ratios of geriatric depression by sociodemographic factors (Unadjusted, derived from bivariate analyses, N = 718)
Table 3. Long description
The table consists of five columns: Variables, Category, Odds, Odds ratio, and 95 percent C I. Data is presented for a sample size of N equals 718.
* Age: For greater than or equal to 70 years, the odds are 2.10, the odds ratio is 2.23, and the 95 percent C I is 1.63 to 3.05. For 60 to 69 years, the odds are 0.94.
* Gender: For Male, the odds are 0.78, the odds ratio is 0.29, and the 95 percent C I is 0.21 to 0.39. For Female, the odds are 2.66.
* Religious affiliation: For Christianity, the odds are 2.40, the odds ratio is 3.75, and the 95 percent C I is 2.73 to 5.15. For Others including Pagan, African traditional religion, and Islam, the odds are 0.64.
* Education level: For Tertiary, the odds are 1.67, the odds ratio is 1.18, and the 95 percent C I is 0.86 to 1.63. For Others including non-formal, primary, and secondary, the odds are 1.41.
* Marital status: For Married, the odds are 2.67, the odds ratio is 3.00, and the 95 percent C I is 2.23 to 4.04. For Others including single, divorced or separated, and widowed, the odds are 0.89.
* Living situation: For With family, the odds are 1.68, the odds ratio is 3.23, and the 95 percent C I is 1.53 to 6.79. For Others including alone or institutionalized, the odds are 0.52.
Note: All odds ratios are presented using the following reference categories: age 60–69 years, female gender (reference for gender comparisons), other religions, non-tertiary education, unmarried status and living alone/institutionalized status. Odds ratios <1 indicate lower odds relative to the reference category, while values >1 indicate higher odds. Keys: n = sample size, () = bracket sign, ≥ = greater than sign, ≤ = less than sign, f = frequency, % = percentage.
Discussion
The present study reveals an alarmingly high prevalence of severe depressive symptoms (61.3%) among community-dwelling older adults in southeastern Nigeria, exceeding both prior national estimates (Kareem et al., Reference Kareem, Uwemedimo and Ebong2024; Ugwu and Ene, Reference Ugwu and Ene2025) and global prevalence ranges of 10%–30% in similar populations (WHO, 2022; Jeong et al., Reference Jeong, Shin and Kim2023). It is important to note that the use of screening tools like the GDS-15 can overestimate the prevalence of depressive symptoms compared to gold-standard diagnostic interviews (Thombs et al., Reference Thombs, Kwakkenbos, Levis and Benedetti2018). In Sub-Saharan Africa, studies using structured clinical interviews, such as the Mini-International Neuropsychiatric Interview (MINI), report lower prevalence estimates of major depressive disorder among older adults – for example, a study in Ghana found a prevalence of 18.3% using a diagnostic interview (Lloyd-Sherlock et al., Reference Lloyd-Sherlock, Agrawal, Amoakoh-Coleman, Adom, Adjetey-Sorsey, Rocco and Minicuci2019), substantially lower than estimates obtained with self-report screening tools such as the GDS-15. This discrepancy underscores the likelihood of overestimation when symptom-based cut-off scales are used in isolation, particularly in community-based surveys. This finding signals a pressing public health concern with significant implications for Nigeria’s healthcare system and for LMICs undergoing rapid demographic and epidemiological transitions (Prince et al., Reference Prince, Saxena and Wu2023; UNFPA, 2024). Future studies are therefore recommended to incorporate structured diagnostic tools, such as the MINI or other clinician-administered interviews, to improve diagnostic precision and enable more accurate estimation of true depressive disorder prevalence among older adults. Adults aged 70 years and older exhibited more than twice the odds of severe depressive symptoms, reflecting established geriatric vulnerabilities. Age-related transitions, including bereavement, physical decline, reduced autonomy and chronic illness, interact with social isolation and limited access to age-friendly healthcare, perpetuating depressive symptoms across late life (Akinyemi et al., Reference Akinyemi, Ojo and Adebowale2020; Rajkumar, Reference Rajkumar2021; WHO, 2022). In sub-Saharan Africa, insufficient integration of mental health into primary care exacerbates these vulnerabilities, limiting timely identification and management of late-life depression (Ogunbode et al., Reference Ogunbode, Olusina and Adekunle2022; Okoye and Asaolu, Reference Okoye and Asaolu2023). Female gender emerged as a significant association of severe depressive symptoms, consistent with regional and international evidence on gendered mental health disparities (Gureje et al., Reference Gureje, Oladeji and Salawu2021). Older women frequently experience intersecting stressors economic insecurity, caregiving responsibilities, social marginalization, which increase susceptibility to psychological distress. These patterns underscore the importance of gender-responsive interventions that address life-course inequities (Nwosu and Ekezie, Reference Nwosu and Ekezie2024; Surkan et al., Reference Surkan, Kane, Fischer and Salam2024). In the results section, we clarified that all reported ORs represent unadjusted associations derived from bivariate analyses, and language implying independence or explanatory power has been removed. Accordingly, interpretations of sociodemographic correlates are framed conservatively.
A notable and context-specific finding is the association between Christian religious affiliation and increased depressive symptoms. This association should be interpreted with caution, as it is based on unadjusted analyses and the study did not include measures of religiosity, denomination, religious coping styles or help-seeking behaviors. However, this finding should be interpreted with caution, as the study did not collect measures of religiosity, denomination, religious coping styles or mental health help-seeking behaviors. Accordingly, no causal interpretation can be made regarding religious affiliation and depressive symptom severity. While religiosity is often protective globally (Culpepper et al., Reference Culpepper, Smith and Rodriguez2023), the present findings do not allow conclusions about the direction or mechanism of this association within the study population. The observed pattern may therefore reflect residual confounding, including socioeconomic status, physical health burden, access to healthcare or social support networks, rather than religious affiliation itself. Religious institutions remain central community anchors in Nigeria, and future research incorporating detailed measures of religious practice and belief is needed to clarify these relationships (Adegoke, Reference Adegoke2021; Nweke et al., Reference Nweke, Onuoha and Uzo2024).
Similarly, contrary to conventional assumptions, being married and co-residing with family were associated with higher odds of severe depressive symptoms. Rather than being interpreted as “risk factors,” these findings are best understood as context-specific associations that challenge commonly held assumptions about the protective role of marriage and co-residence in later life. Given the absence of multivariable adjustment, these associations may reflect unmeasured factors such as marital quality, caregiving strain, financial dependency, household conflict or loss of autonomy. These results underscore the importance of examining relationship quality and household dynamics, rather than structural arrangements alone, when assessing mental health outcomes among older adults (Zhou et al., Reference Zhou, Li and Chen2021; Akinrinmade and Ojo, Reference Akinrinmade and Ojo2022; Babatunde et al., Reference Babatunde, Doe and Adeyemi2023; Ekoh et al., Reference Ekoh, Uche and Nwankwo2023; Ifeagwazi et al., Reference Ifeagwazi, Nnamani and Okeke2023; Asagwara et al., Reference Asagwara, Nwosu and Eze2024). Overall, explicit acknowledgment of residual confounding has been added to align interpretation with the bivariate analytical strategy and the cross-sectional design of the study. The findings should therefore be viewed as hypothesis-generating, pointing to areas where more rigorous longitudinal and mixed-methods research is needed.
Educational attainment did not show a significant association with depressive symptom severity, which should be interpreted cautiously given the relatively high proportion of participants reporting tertiary education. This pattern likely reflects selection factors related to purposive sampling of communities with higher concentrations of retirees and urban residents, as well as differential willingness or ability to participate among more educated older adults. While educational attainment was measured using standard national categories, the resulting distribution may not be representative of the broader older adult population in southeastern Nigeria. This overrepresentation of tertiary-educated participants may partly explain the absence of a significant association between education and depressive symptom severity, as structural and psychosocial stressors prevalent in the study communities may override advantages typically conferred by formal education (Ogunlana et al., Reference Ogunlana, Adeoye and Fagbohun2023). Previous Nigerian studies similarly report inconsistent associations between education and mental health, often moderated by local sociocultural and economic contexts (Akinyemi et al., Reference Akinyemi, Ojo and Adebowale2020; Oluwole et al., Reference Oluwole, Ayeni and Bello2020).
The high prevalence of severe depressive symptoms and its complex sociodemographic predictors underscore the urgency of strategic, solution-focused interventions. First, routine mental health screening for older adults should be integrated into primary care, drawing lessons from successful perinatal mental health programs in LMICs (Surkan et al., Reference Surkan, Kane, Fischer and Salam2024). Second, task-shifting initiatives can empower community health workers to deliver foundational psychosocial support in underserved rural areas, expanding access to early intervention (Ogunbode et al., Reference Ogunbode, Olusina and Adekunle2022; WHO, 2022). Third, faith-based organizations, central to Nigerian community life, should be engaged in mental health literacy and stigma reduction, while ensuring that such efforts complement, rather than replace, formal healthcare pathways (Nweke et al., Reference Nweke, Onuoha and Uzo2024). Fourth, gender-sensitive programs must address the intersecting social, economic and caregiving pressures disproportionately affecting older women (Nwosu and Ekezie, Reference Nwosu and Ekezie2024). Finally, family-based interventions should move beyond mere cohabitation support, focusing on strengthening emotional bonds and promoting healthy intergenerational dynamics through counseling, community education and home-based interventions (Ekoh et al., Reference Ekoh, Uche and Nwankwo2023; Asagwara et al., Reference Asagwara, Nwosu and Eze2024). Further research is warranted to explore the counterintuitive associations of marital status, co-residence and religious affiliation with depression. Longitudinal and mixed-methods approaches incorporating measures of religiosity, marital quality, household dynamics, health status and economic conditions are particularly needed to disentangle residual confounding and clarify causal pathways.
Strengths of this study include a large, diverse sample encompassing both rural and urban populations, culturally adapted instruments (GDAQ, GDS-15) and adherence to STROBE guidelines. The study is not without its limitations. The use of multistage purposive sampling at both community and participant levels limits the generalizability of findings beyond the study settings and introduces potential selection bias. In particular, the high proportion of tertiary-educated participants, likely reflecting urban, pensioner or selective participation bias, limits the generalizability of findings related to educational attainment and may attenuate observed associations between education and depressive symptoms. Additionally, the cross-sectional design and absence of multivariable adjustment restrict causal inference and the ability to isolate independent sociodemographic effects.
Conclusion
This study provides robust, community-based evidence that severe depressive symptoms are highly prevalent among older adults in southeastern Nigeria, affecting over 60% of participants. Advanced age (≥70 years), female gender, Christian religious affiliation, marital status and co-residence with family emerged as significant sociodemographic factors associated with severe depressive symptoms in unadjusted, bivariate analyses. These associations should not be interpreted as independent or causal effects but rather as patterns that warrant further investigation. Educational attainment was not significantly associated with depressive symptom severity. Future longitudinal and mixed-methods studies are needed to disentangle social structure, relationship quality and mental health outcomes in later life. Despite these limitations, the findings underscore the urgent need for culturally sensitive, community-based mental health interventions integrated into primary healthcare systems to promote healthy aging and mental health equity among older adults in Nigeria and similar LMIC settings.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2026.10324.
Data availability statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Acknowledgments
The authors sincerely thank all participants, older adults from 30 communities across Abia, Anambra, Ebonyi, Enugu and Imo States, for their time and insights. We appreciate local health workers, community leaders and traditional rulers (Igwe) for facilitating engagement and the 30 research assistants for their dedication to ethical data collection. Special thanks to the public health experts who guided the Geriatric Depression Assessment Questionnaire (GDAQ) development, the Federal Ethics Committee of Nigeria (REC/FE/2024/00014) for oversight and administrative leaders for clearances. We also acknowledge the Nigerian Union of Pensioners and NDHS teams for essential data that informed site selection.
Author contributions
All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by U.C.U, A.N.O. and C.C.E. The first draft of the manuscript was written by U.C.U. and all the authors commented on previous versions of the manuscript. All the authors have read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Ethics and approvals
The approval for the study was obtained from the National Health Research Ethics Committee (NHREC), Nigeria [Ethical Approval Reference Number: REC/FE/2024/00014]. This was in accordance with the tenets of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.
Funding statement
No funding was received for conducting this study.
Patient and public involvement
Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Clinical trial registration
Not applicable.
Open access
Comments
Date: November 28, 2025
To
The Editor-in-Chief
Global Mental Health
Subject: Submission of manuscript titled “Status of Geriatric Depression among Older Adults in Rural-Urban Communities Across Southeastern States of Nigeria: A Cross-Sectional Study”
Dear Sir,
We are submitting original article titled “Status of Geriatric Depression among Older Adults in Rural-Urban Communities Across Southeastern States of Nigeria: A Cross-Sectional Study” for consideration for publication in the Global Mental Health
Our study is relevant because the study sought to determine the prevalence of geriatric depression and identify its sociodemographic predictors among older adults in southeastern Nigeria. The most important conclusion which can be drawn from our study was that geriatric depression is highly prevalent among older Nigerians and significantly influenced by age, gender, religion, and living arrangement. Culturally sensitive mental health strategies and strengthened geriatric care policies are urgently required.
The manuscript has not been published and is not under consideration for publication in any other journal. Instructions to the author were read. We accept all conditions and publication rights. All authors have read and approved the manuscript and its submission to the journal.
We have no conflicts of interests to declare. We have no funding sources to declare
Thank you,
Yours sincerely,
November 28, 2025
Uchenna Cosmas Ugwu
(For authors)