Gender inequality in
Late-life depression and loneliness: different preconditions of active ageing in Europe
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Stereotypes of old age
Loneliness and depressive symptoms are widely perceived as problems of old age, as part of “normal” ageing. These beliefs have validity, as ageing often involves events and conditions associated with a higher risk of loneliness and depression, including health problems, loss of loved ones, increased risk of cognitive impairment, and limited socio-economic resources. Research from Western countries shows, however, that rates of loneliness and depression are quite stable from midlife and well into old age; yet strongly increasing in very old age (from about age 80). Age-related increases in loneliness may, however, be stronger and occur earlier in countries with poorer living conditions and welfare provision. Little is known about the risk of late-life loneliness in Eastern Europe, where the challenges of caring for the material, social, and health needs of the older populations are severe. These countries have limited health service provisions, overall population health is relatively poor, and poverty rates are high.
Nationally representative data from the Generations and Gender Survey show marked country variation in loneliness and depressive symptoms among older (age 60–80) men and women. An East-West gradient is evident, with rates of loneliness and depression up to three times higher in eastern European than in north-western European countries. In the former socialist countries, between 25% and 40% (depending on the country) report a serious level of loneliness, many more than the 8-12% who are lonely among their peers in north-western Europe. Similarly, depressive symptoms are reported by 20-30% in the East and 10-18% in the West. These divides seem to emerge in later life. Analyses using the full adult life span (age 18-80) show only minor country differences in the experience of loneliness and depression in young and middle adulthood. Whereas rates of loneliness and depression in the East tend to double or triple from the youngest (age 18-30) to the oldest (age 60-80) age cohorts, in the West, the rates for the old are actually comparable to those for young adults.
Figure 1. Gender differences in levels of loneliness, ages 60–80
Note: N=33,832. Loneliness is measured with a six-item version of the de Jong-Gierveld Scale (de Jong-Gierveld et al. 2006). By using a strict operationalization, “lonely” individuals report a serious level of loneliness (Hansen & Slagsvold, 2016). Countries ordered by the rate among women. Source: GGS data.
Figure 2. Gender differences in levels of depressed mood, ages 60–80
Note: N=27,543. Depressive symptoms are measured with a seven-item version of the CES-D scale. A cut-off of six identifies people with depressive symptoms, which matches the widely used cut-off point of 16 on the original 20-item CES-D scale. Source: GGS data.
An East-West divide is also evident regarding gender differences (see Figures 1 and 2). Whereas there are relatively small gender differences in the West, women report far higher rates of loneliness (up to 9 percentage points) and depressive symptoms (up to 20 percentage points) than men in the East.
Looking for explanations
Why are Eastern seniors so vulnerable to loneliness and depressed mood? Part of the answer lies in their poorer socioeconomic status, health, support availability, and thus poorer preconditions for active aging. The social network of older Eastern Europeans may also suffer due to decreasing fertility and increasing out-migration of younger adults. Many older adults thus lack children and grandchildren to care for them, and when government provision falls short, they may lack resources to help them combat loneliness. These factors may contribute to loneliness and depressive symptoms, especially when combined, by compromising opportunities for meaningful activities and relationships and by decreasing feelings of self-worth, a positive outlook on life and hope for the future. They may also decrease the chance of recovery for those who become lonely or depressed.
The pronounced risk of loneliness and depression faced by eastern European women can be attributed – at least partly – to the fact that a relatively high number are ageing without a partner (because of low life expectancy among men) and with health problems and financial concerns. Part of the explanation may also be that women are more likely to admit to feelings of loneliness or psychological distress.
The role of the welfare state
It appears that in countries with generous social security schemes, where per capita public expenditure on health and welfare services is among the highest in Europe, people enjoy better social and psychological well-being than in countries where the state provides less. Adequate welfare support and healthcare systems may act as a buffer against, or they may postpone, the risk of poor quality of life in later life, especially in lower social strata. More specifically, stronger and more generous welfare states may prevent or reduce mental health problems by providing adequate healthcare and social services, income and housing conditions, public transport, support to family caregivers and better neighbourhoods. Such measures may promote better conditions for social integration and self-reliance and thus enable and stimulate social participation, in particular among elderly with health limitations or low socio-economic resources.
Cultural factors may also play a role. Eastern Europeans may, because of high expectations of strong family and community ties, have a relatively low threshold for experiencing loneliness, especially when social contact and support is limited. Loneliness occurs when the quality of one’s social relationships falls short of the expected or desired quality of social relationships. People in the familistic and collectivistic Eastern European countries, because of high expectations of strong family and community ties, may have a lower threshold for experiencing loneliness than other Europeans. A low loneliness threshold may make matters worse for seniors in countries with high rates of widowhood, decreasing fertility rates, and increasing out-migration. In sum, the combination of a low loneliness threshold and negative changes in social integration may help to explain high levels of loneliness in Southern and Eastern European countries.
Contrary to common belief, loneliness and depression are not normal or inevitable outcomes of ageing. Yet in many eastern European countries, so far under-researched in the literature, data suggest that up to one-third of the older population report loneliness and/or depressed mood. Loneliness and depression are particularly high among older women in this region. There are comparably small gender differences in the western European countries. Findings attest to and reflect the unequal conditions of ageing across Europe and indicate serious deficits in late-life quality of life in some European countries.
The importance of preventing and reducing depression extends beyond the emotional realm. Depression appears to hasten physiological and cognitive decline and to increase the use of health and care services. Depressed and unhappy people are also generally less socially engaged and altruistic in their behaviour, which may in turn affect mental health in their social network and community. Alleviating loneliness and depression is thus important for both individuals and societies, and the costs of loneliness and depression may exacerbate the costs of population ageing, especially in the eastern European countries. For these countries, keeping health inequalities high on the agenda at a time of great economic strain will be no mean feat, but nevertheless important to improve population health and to reduce health inequality. The combination of economic and social strain and an ageing population implies potentially greater harm to the wellbeing of large numbers of older people. There may also be positive spiral effects since non-depressed and happier people generally are more socially engaged and prosocial in their behaviour, which in turn may bolster mental health in their social network and community.
Hansen T. & Slagsvold, B. (2016). Late-life loneliness in 11 European countries: Results from the Generations and Gender Survey. Social Indicators Research, 124, 1-20.
Hansen T, Slagsvold, B, Veenstra, M. (2017). Educational inequalities in late-life depression across Europe. European Journal of Ageing, 14, 407-418.
Hansen T, Slagsvold, B. (2017). The East-West divide in late-life depression in Europe. Scandinavian Psychologist, 4, e4.