Factors associated with depression and loneliness among older adults of Nagarjun Municipality: a mixed-method study

Abstract

Introduction: Depression and loneliness are major mental health concerns among older adults, particularly in low- and middle-income countries like Nepal. Despite rapid demographic transition toward an aged society, mixedmethod evidence on psychosocial determinants remains limited.
Method: A convergent parallel mixed-method design was used. For the quantitative arm, 44 older adults (≥60 years) were recruited by convenience sampling from Ward No. 1 of Nagarjun Municipality. Depression was assessed using the Geriatric Depression Scale (GDS-15) and loneliness using the UCLA Loneliness Scale (UCLA-20). Bivariate analyses were conducted using chisquare and one-way ANOVA. For the qualitative arm, five purposively selected in-depth interviews were analyzed thematically using Braun and Clarke’s framework with RQDA. Findings were integrated through triangulation.
Result: The mean age was 75.47 ± 7.78 years. Depression prevalence was 50% (n=22), and the mean loneliness score was 53.59 ± 14.32. Widowhood was significantly associated with higher loneliness (p=0.003). Exclusion from family decision-making was associated with both depression (p=0.005) and loneliness (p=0.002). Nine qualitative themes emerged, including loneliness and neglect, child migration, and financial decision-making. Triangulation revealed a migration paradox, where children’s migration evoked both pride and longing despite no quantitative association, and identified caregiving burden as an additional factor.
Conclusion: Depression and loneliness among older adults were associated with psychosocial exclusion, particularly widowhood and limited participation in family decision-making. Larger community-based studies are needed to confirm these findings.