Prevalence and Factors Associated with Comorbid Depression and Anxiety Among Older Adults in South-western Nigeria: A Community-Based Study

  • A Akinsulore
  • OC Adeseiye
  • IO Oloniniyi
  • OA Esimai
Keywords: Aging, Anxiety, Depression, Comorbid depression and anxiety, Geriatrics, Prevalence


Background: Depression and anxiety are common mental disorders that frequently occur in the elderly. When they co-exist, it is known as comorbid depression and anxiety.

Objective: To assess the prevalence and factors associated with comorbid depression and anxiety symptoms among older adults in western Nigeria.

Methods: This is a community-based, cross-sectional descriptive survey conducted among 328 consenting older adults. The Geriatric Depression Scale-Short Form (GDS-SF) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires were administered to assess depressive and anxiety symptoms. Socio-demographic information was obtained using a separate questionnaire.

Results: The mean age of the participants was 70.1 years (SD = 9.2). Sixty per cent of the respondents were females and 58% were married.  The prevalence of comorbid depression and anxiety was 6.0% (2.4% in men and 6.6% in women) and 13% had depression-only while 19.9% had anxiety-only. Socio-demographic factors significantly associated with comorbid depression and anxiety included living alone (p = 0.001) and being not married (p = 0.028). However, only living alone (p = 0.015, OR = 1.79, 95% CI = 1.41- 25.36) independently predicted comorbid depression and anxiety symptoms among older adults.

Conclusion: Although the prevalence rates of “depression only” and “anxiety only” were higher among older adults, comorbid depression and anxiety was also prevalent in later life and living alone is a significant predictor. Therefore, there is a need to increase the recognition and treatment of comorbid depression and anxiety in older adults.


Naidoo K, van Wyk J. Protocol for a scoping review of age-related health conditions among geriatric populations in sub-Saharan Africa. Syst Rev 2019; 8: 133. doi:10.1186/s13643-019-1055-z.

Akosile CO, Mgbeojedo UG, Maruf FA, Okoye EC, Umeonwuka IC, Ogunniyi A. Depression, functional disability and quality of life among Nigerian older adults: prevalences and relationships. Arch Gerontol Geriatr 2018; 74: 39-43. doi:10.1016/j.archger.2017.08.011.

Togonu-Bickersteth F, Akinyemi AI. Ageing and national development in Nigeria: Costly assumptions and challenges for the future. Afr Pop Stud 2014; 27: 361-371.

Igbokwe CC, Ejeh VJ, Agbaje OS, Umoke PI, Iweama CN, Ozoemena EL. Prevalence of loneliness and association with depressive and anxiety symptoms among retirees in Northcentral Nigeria: a cross-sectional study. BMC Geriatr 2020; 20: 1-10. doi:10.1186/s12877-020-01561-4.

National Population Commission. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro; 2009. p. 1-629.

McCombe G, Fogarty F, Swan D, Hannigan A, Fealy GM, Kyne L, et al. Identified mental disorders in older adults in primary care: A cross-sectional database study. Eur J Gen Pract 2018; 24: 84-91. doi:10.1080/13814788.2017.1402884.

Okokon IB, Asibong UE, Ogbonna UK, John EE. Psychogeriatric Problems Seen in the Primary Care Arm of a Tertiary Hospital in Calabar, South-South Nigeria. Int J Geriatr Gerontol 2018; IJGG-107. doi:10.29011/IJGG-107.180007.

John A, McGregor J, Fone D, Dunstan F, Cornish R, Lyons RA, et al. Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data. BMC Med Informatics Decision Making 2016; 16: 35. doi:10.1186/s12911-016-0274-

Li N, Chen G, Zeng P, Pang J, Gong H, Han Y, et al. Prevalence of depression and its associated factors among Chinese elderly people: A comparison study between community-based population and hospitalized population. Psychiatry Res 2016; 243: 87-91. doi:10.1016/j.psychres.2016.05.030.

Pilania M, Bairwa M, Khurana H, Kumar N. Prevalence and Predictors of depression in community-dwelling elderly in rural Haryana, India. Indian J Comm Med 2017; 42: 13-18. doi:10.4103/0970-0218.199792.

Manandhar K, Risal A, Shrestha O, Manandhar N, Kunwar D, Koju R, Holen A. Prevalence of geriatric depression in the Kavre district, Nepal: Findings from a cross-sectional community survey. BMC Psychiatry 2019; 19: 271. doi:10.1186/s12888-019-2258-5.

Thapa SB, Martinez P, Clausen T. Depression and its correlates in South Africa and Ghana among people aged 50 and above: Findings from the WHO Study on Global Ageing and adult health. J Psychiatry 2014;17. doi:10.4172/1994-8220.1000167.

Balsamo M, Cataldi F, Carlucci L, Fairfield B. Assessment of anxiety in older adults: a review of self-report measures. Clin Interventions Aging 2018; 13: 573. doi:10.2147/CIA.S114100.

Hohls J, Wild B, Heider D, Brenner H, Böhlen F, Saum K, et al. Association of generalized anxiety symptoms and panic with health care costs in older age—Results from the ESTHER cohort study. J Affect Disord 2019; 245: 978-986. doi:10.1016/j.jad.2018.11.087.

Fiske A, Wetherell JL, Gatz M. Depression in older adults. Ann Rev Clin Psychol 2009; 5: 363-389. doi:10.1146/annurev.clinpsy.032408.153621.

Lenze EJ, Mulsant BH, Shear MK, Alexopoulos GS, Frank E, Reynolds CF. Comorbidity of depression and anxiety disorders in later life. Depression Anxiety 2001; 14: 86-93. doi:10.1002/da.1050.

Simning A, Seplaki CL. Association of the cumulative burden of late‐life anxiety and depressive symptoms with functional impairment. Int J Geriatr Psychiatry 2020; 35: 80-90. doi:10.1002/gps.5221.

Bierman E, Comijs H, Jonker C, Beekman A. Symptoms of anxiety and depression in the course of cognitive decline. Dement Geriatr Cognit Disord 2007; 24: 213-219. doi:10.1159/000107083.

Van der Weele GM, Gussekloo J, De Waal MW, De Craen AJ, Van der Mast RC. Co‐occurrence of depression and anxiety in elderly subjects aged 90 years and its relationship with functional status, quality of life and mortality. Int J Geriatr Psychiatry 2009; 24: 595-601. doi:10.1002/gps.2162.

Hranov LG. Comorbid anxiety and depression: illumination of a controversy. Int J Psychiatry Clin Pract 2007; 11: 171-189. doi:10.1080/13651500601127180.

Gureje O, Kola L, Afolabi E. Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: a community-based survey. The Lancet. 2007; 370: 957-964. doi:10.1016/S0140-6736(07)61446-9.

Olutoki MO, Olagunju AT, Adeyemi JD. Correlates of depressive illness among the elderly in a mixed urban community in Lagos, Nigeria. Aging Mental Health 2014; 18: 561-569. doi:10.1080/13607863.2013.843156.

Yesavage J, Brink T, Rose T, Adey M. The Geriatric Depression Rating Scale: comparison with other self-report and psychiatric rating scales. In: Crook T, Ferris S, Bartus E (Editors) Assessment in Geriatric Psychopharmacology. New Canaan, Conn: Mark Powley; 1983. p. 153-167.

Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist: The J Aging Mental Health 1986; 5: 165-173..doi:10.1300/J018v05n01_09.

Adegunloye OA, Buhari OI, Abiodun OA. Depression in Elderly Primary Health Care Clinic Attendees in Ilorin, Nigeria. Trop J Health Sci 2018;25: 1-7.

Onya ON, Stanley PC. Prevalence, presentation and co-morbidity pattern associated with depression among geriatric patients attending the GOPD of UPTH. Int Res J Med Sci 2013; 1: 17-24.

Pocklington C, Gilbody S, Manea L, McMillan D. The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta‐analysis. Int J Geriatr Psychiatry 2016; 31: 837-857. doi:10.1002/gps.4407.

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092-1097. doi:10.1001/archinte.166.10.1092.

Ayandele O, Popoola OA, Oladiji TO. Addictive use of smartphone, depression and anxiety among female undergraduates in Nigeria: a cross-sectional study. J Health Res 2020; 34: 443-453. doi:10.1108/JHR-10-2019-0225.

Schoevers R, Beekman A, Deeg D, Jonker C, Tilburg Wv. Comorbidity and risk‐patterns of depression, generalised anxiety disorder and mixed anxiety‐depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry 2003; 18: 994-1001. doi:10.1002/gps.1001.

Simning A, Conwell Y, Fisher SG, Richardson TM, van Wijngaarden E. The characteristics of anxiety and depression symptom severity in older adults living in public housing. Int Psychogeriatr 2012; 24: 614-623. doi:10.1017/S1041610211001979.

Kvaal K, McDougall FA, Brayne C, Matthews FE, Dewey ME. Co‐occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). Int J Geriatr Psychiatry 2008; 23: 229-237. doi:10.1002/gps.1867.

Vink D, Aartsen MJ, Schoevers RA. Risk factors for anxiety and depression in the elderly: a review. J Affect Disord 2008; 106: 29-44. doi:10.1016/j.jad.2007.06.005.

Heikkinen RL, Kauppinen M. Mental well-being: A 16-year follow-up among older residents in Jyväskylä. Arch Gerontol Geriatr 2011; 52: 33-39 doi:10.1016/j.archger.2010.01.017.

Okoye UO. Family caregiving for ageing parents in Nigeria: Gender differences, cultural imperatives and the role of education. Int J Education Ageing 2012; 2: 139-154.

Original Research