Neighborhood environment, standard of living, and depressive severity among older caregivers in a high-density city: moderated mediation analysis (Preprint)

Abstract

Older caregivers have suffered from a high risk of geriatric depression due to low resilience to public health concerns during a critical period during the pandemic confronted with economic crisis and social issues at the same time. Past efforts mainly assessed the impacts of individual and household factors on depressive severity, yet failed to indicate whether the neighborhood environment could reduce depressive severity among older caregivers due to an ambiguous understanding of how environmental factors and any potential mediator together contribute to depression. Empirical evidence suggests that a critical potential mediator in this mechanism can be the standard of living encapsulating the perceived living standard determined by the caregiver’s willingness to achieve a better living and awareness of community resources. In addition, the perceived severity of depression even with the influence of environmental and relational factors can vary by gender groups and their living arrangement.

This study aims to investigate a proposed mechanism in which how older caregivers’ depressive severity can be influenced by the impact factors on the level of individual, household, and environment. In addition, these impacts can be further influenced by the moderators of gender groups and living arrangements being alone or with family members.

In this cross-sectional study, a total of 916 older caregivers across the representative districts in Hong Kong were recruited in 2021. The critical components of depressive severity, neighborhood environment, and standard of living as the critical indices were measured. A mediational model and a moderated mediation model were performed based on the ecological health resilience model to examine the mutual contribution of neighborhood environment and perceived standard of living on the depressive severity moderated by the gender role and relationship closeness.

The sampled older caregivers on average aged 73 years old with mild depressive symptoms. Our results indicated that a better quality of neighborhood environment was positively associated with the perceived living standards of older caregivers, and better-perceived living standards were associated with lower depressive severity. Additionally, the mediating effect of perceived standards of living was stronger among female caregivers, especially those without living alone. In contrast, the mediating effect of perceived standards of living was insignificant among male caregivers.

In a region of high population density, the adequate allocation of neighborhood environment buffers the mental deterioration of older caregivers and reduces the burden in support their family members with chronic diseases, depending on relevant factors: (1) social mobility and housing arrangement, (2) willingness to relocate for better living condition, and (3) available community resources that can be aware of. This study further reveals the intermediating roles of subjective social status and gender preferences as the critical pathways between the impact of neighborhood environment on depressive severity. Additionally, maintaining a living condition with a basic relationship closeness and awareness of gender preferences are needed, especially among male caregivers who more often suffer from issues due to social isolation.