The roles of depression and social relationships in the onset and course of loneliness amongst Nigerian elders

Int J Geriatr Psychiatry. 2021 Apr;36(4):547-557. doi: 10.1002/gps.5451. Epub 2020 Oct 31.

Abstract

Objectives: Few studies in Africa have investigated the risk profile and course of loneliness in old age. This study examined the risk factors for onset and chronicity, as well as the predictors of recovery from loneliness in a large representative sample of community dwelling older Africans.

Methods/design: A household multistage probability sample of Nigerians who were 65 years or older was drawn from a geographical area with approximately 25 million population. Loneliness was measured using the 3-item University of California (UCLA) scale in 2007 and annually in 2008 and 2009. Social engagement, social network, and depression were evaluated using the WHO Composite International Diagnostic Interview. Respondents were also administered the 30-item Geriatric Depression Scale. Multivariate logistic regression models were used to explore for risk factors. Estimates of adjusted hazard ratios (HR) for recovery were derived with the discrete time version of the Cox regression model for time invariant explanatory variables.

Results: Of 1704 respondents, 1525 were free of loneliness, using the UCLA scale, in 2007. A total of 209 (18.8%) persons developed new onset of loneliness in 2008 and 2009. Depression (O.R = 2.9, 95% C.I = 1.3-6.7), unmarried status (OR = 2.1, 95% C.I = 1.2-3.9) and social isolation (OR = 1.8, 95% CI = 1.0-3.2) independently predicted loneliness onset. Baseline demographic, health, social, and lifestyle factors were not associated with a chronic course of loneliness. The overall recovery rate estimated over two years was 89.5% (95% CI = 75.3-106.4). Being male (HR = 1.3, 95% C.I = 1.0-1.6), ≥80 years (HR = 1.4, 95% CI = 1.2-1.8) and having good social engagement at baseline (HR = 1.5, 95% C. = 1.1-2.0) independently predicted recovery from loneliness.

Conclusions: Over a 2-year period, nearly one in five community-dwelling Africans developed new onset loneliness in old age, with a similar proportion having a chronic course of the emotional experience. While depression and indices of social isolation at baseline were associated with onset, good social engagement predicted recovery from loneliness.

Keywords: loneliness; low- and middle-income countries; social relationships; social support.