Associations between widowhood status/duration, depression, and cognitive function among community-dwelling Indians age 60 years or older: Exploration of sex and residential factors.

BACKGROUND: The death of a spouse is considered one of the most life challenging stressors. Widowhood has a profound influence on health and may increase the risk of depression and poorer cognitive function. Discriminatory practices in India, such as taboos against remarrying, a lack of occupational opportunities, and social support, may lead to differential widowhood experiences, especially among women. This study examined the associations between widowhood status/duration, depression and cognitive function among community-dwelling men and women in India. Considering the unique cultural and societal context in India, this study also sought to examine differences by sex, rural/urban residence, and multigenerational living status.

METHODS: We used baseline data from the Longitudinal Aging Study in India. Data were collected between 2017 and 2019. The study sample consisted of 14,691 men and 15,948 women age ≥ 60 years. Depression was measured using the Short Form Composite International Diagnostic Interview and global cognitive functioning was measured using an assessment adapted from the Mini-Mental State Examination and the cognitive module of the United States Health and Retirement Study, and its sister studies. We employed adjusted multivariable logistic and linear regression models to examine the association of widowhood status/duration with the risk of depression, and cognitive function.

RESULTS: Compared to currently married, those widowed within 0-9 years had a higher risk of depression (Men: aOR = 1.65, 95% CI: 1.20, 2.27; Women: aOR = 1.57, 95% CI = 1.25, 1.98) and worse cognitive functioning (Men: B = 0.80, 95% CI: 0.30, 1.30; Women: B = 0.55, 95% CI = 0.20, 0.91). Among those widowed within 0-9 years, men had a slightly greater risk of worse cognitive functioning than women. As widowhood duration increased, the association between widowhood and worse cognitive functioning was no longer significant among men but remained significant among women. Analyses stratified by rural/urban residence and multigenerational living status and their interactions with widowhood status/duration revealed similar trends. However, the associations between widowhood status/duration and worse cognitive function were more pronounced among women in non-multigenerational households (interaction p <.05).

CONCLUSIONS: Older adults who were widowed within 0-9 years had a higher risk of depression and worse cognitive functioning. The adverse effects of widowhood on cognition were no longer significant among men but persisted for women with longer widowhood duration. Non-multigenerational households exacerbated the influence of widowhood on the higher risk of depression and worse cognitive functioning, but findings by urban/rural residence were mixed. Future research should explore what other factors moderate widowhood and health relations and examine changes in widowhood duration over time.