AN EXAMINATION OF THE RELATIONSHIP BETWEEN DEPRESSIVE SYMPTOMS AND SOCIAL ENGAGEMENT AMONG OLDER ADULTS IN NIGERIA AND ITS RELEVANCE TO NURSING PRACTICE

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Depression is a prevalent mental health condition affecting approximately 5% of adults worldwide, significantly reducing overall quality of life and imposing a substantial burden on global healthcare systems (WHO, 2023). It accounts for about 7.5% of total years lived with disability (YLDs) (Moreno-Agostino, 2020), and it is frequently associated with self-harm and suicide, making it a major contributor to the global disease burden. Among the elderly population, depressive symptoms are especially widespread and present serious health risks. Globally, about 13.3% of older adults are affected by depressive symptoms (Abdoli et al., 2022). In Nigeria, the prevalence varies with living arrangements: 47.8% for those living alone, 33.2% for those living with a spouse, and 39.5% for those living with children (Fu, Cao & Yang, 2023). Consequently, addressing and reducing the risk of depression in older adults is an urgent public health concern. One factor believed to influence depressive symptoms is social participation. Although a universally accepted academic definition is lacking, the definition by Levasseur is widely cited (Liao & Zhou, 2022). Levasseur and colleagues, after analysing 43 studies, defined social participation as individual involvement in activities that foster interaction with others in society or community settings (Levasseur, Richard, Gauvin & Raymond, 2020). Research has shown that social engagement enables older individuals to participate in meaningful daily routines and develop important social roles. However, there is no consensus on how to categorize social participation. For the purpose of this research, 10 major forms of social activities among older Nigerians have been identified, reflecting the country's unique cultural and social practices. Activities such as playing cards or draughts and visiting friends during festive seasons are deeply rooted in Nigerian culture and are particularly popular among older adults (Liao & Zhou, 2022). Exercises like Tai Chi and group dancing also offer both physical and social benefits, fostering interaction and shared experiences among seniors. Increasingly, older Nigerians are forming groups to schedule and perform exercises together. Passive activities such as reading, watching TV, or listening to the radio also serve as ways for the elderly to stay informed and connected to the world (Wang, Fu, Hsieh, Lin & Yang, 2022). Tasks such as house chores, gardening, and animal care are integral to daily life, helping to reinforce familial relationships and express traditional family values (Fu, Cao & Yang, 2023). Although political involvement among older Nigerians is relatively low, services organized by communities for the elderly have been on the rise. There is a growing body of evidence suggesting that participation in social activities positively influences the psychological well-being of older adults. Longitudinal studies have shown that continuous social activity in later life is strongly linked to lower rates of depressive symptoms. Similar trends have been observed in older populations in countries like Japan, Korea, and the United States (Guo, Qin & Lee, 2022). According to social capital theory, participating in social activities helps older adults build stronger emotional and material bonds, which can improve their mental health (Fu, Cao & Yang, 2023). The theory of social integration also supports this, suggesting that social participation promotes a sense of belonging and purpose, enhancing life satisfaction and emotional well-being. However, not all forms of social engagement are beneficial. For instance, a study by Yue et al. (2015) revealed that frequent involvement in household chores may actually increase the risk of depression. This suggests that different types of social activities may have varied and sometimes opposing effects on mental health. Therefore, it is essential to distinguish between the impacts of various social interactions on depressive symptoms. Unfortunately, the literature on this topic remains limited. In addition, sociodemographic factors should be taken into account when examining the relationship between social participation and mental health. Gender differences are notable; Takagi et al. (2015) found that socially active women experienced fewer depressive symptoms, while for older men, membership in interest-based social groups had a more significant impact on their mental health. Residential location also plays a role. Urban older adults benefit more from formal volunteer programs, whereas rural older adults show improved mental well-being through informal social gatherings like card games or mahjong (Wang, Li & Fu, 2021). Age differences further complicate this issue. As people age and face increasing physical and social challenges, their ability to participate in social activities tends to decline, often leading to isolation and heightened depression. Given these complexities, this study aims to explore the relationship between depressive symptoms and social participation among older adults in Nigeria, and to examine what this means for nursing practice. 1.2 Statement of the Problem Depression poses a serious public health concern, particularly among the elderly, as it can drastically reduce overall well-being and life satisfaction. The likelihood of depressive symptoms in older adults is often intensified by socioeconomic pressures, health conditions, and environmental limitations, leading to isolation and reduced social involvement (Okoye, 2013). Engaging in social activities—ranging from community events and family gatherings to recreational activities—is widely recognized as essential for maintaining mental health in older populations (Levasseur et al., 2010). However, in Nigeria, various cultural, infrastructural, and economic barriers often restrict the elderly from actively participating in social life, potentially worsening their mental health challenges. Despite increasing recognition of these issues, there remains a notable gap in research specifically examining how social participation affects depression in older Nigerians. Since older adults are frequently overlooked in healthcare planning and delivery, it is crucial to understand how their level of social engagement can impact their mental health. This underscores the need to investigate the correlation between depressive symptoms and social participation among older adults in Nigeria and to explore how nursing care can respond to these findings. 1.3 Objective of the Study The general aim of this study is to investigate the correlation between depressive symptoms and social participation among older adults in Nigeria, and to consider the implications for nursing care. The specific objectives are to: i. Assess the prevalence of depressive symptoms among older adults in Nigeria. ii. Identify the various types of social participation activities that older adults in Nigeria engage in. iii. Explore the relationship between social participation and the severity of depressive symptoms in older adults. iv. Recommend appropriate nursing interventions that could enhance social participation and reduce depressive symptoms among older Nigerian adults. 1.4 Research Questions The study is guided by the following research questions: i. What is the prevalence of depressive symptoms among older adults in Nigeria? ii. What kinds of social participation activities do older adults in Nigeria engage in? iii. Is there a relationship between social participation and the severity of depressive symptoms among older adults? iv. What nursing interventions can be recommended to promote social participation and reduce depressive symptoms in older adults in Nigeria? 1.5 Significance of the Study This study is significant for several reasons. First, it offers important insights for nursing practice by highlighting how nurses can play a pivotal role in identifying depressive symptoms early and implementing social participation-focused interventions as part of comprehensive patient care. As frontline caregivers, nurses are uniquely positioned to design personalized care plans that address both the psychological and social needs of elderly individuals. Secondly, the research findings can help in the creation of community-based programs and nursing initiatives that aim to alleviate depression and improve the overall well-being of older adults, thereby enhancing their quality of life. Lastly, this study contributes to academic literature, enriching the knowledge base, providing useful materials for libraries, and serving as a reference point for future research. 1.6 Scope of the Study This study focuses on examining the relationship between depressive symptoms and social participation among older adults in Nigeria and assessing the implications for nursing. Empirically, the study will investigate the prevalence of depressive symptoms, identify common social activities, examine the link between social participation and depressive symptoms, and suggest nursing strategies to address these issues. Geographically, the study will be conducted at the University Teaching Hospital in Ibadan, Oyo State. 1.7 Limitations of the Study As with any research, this study encountered several challenges. One major limitation was time, as the researcher had to balance academic responsibilities, such as attending lectures, alongside conducting the research. Financial constraints also posed a challenge due to the costs involved in printing, typing, literature sourcing, and data collection. Another limitation was the availability of relevant materials, as the niche nature of the topic made it difficult to find sufficient literature to support some aspects of the study. 1.8 Definition of Terms Depressive Symptoms: These refer to emotional and physical signs commonly associated with depression, including sadness, hopelessness, fatigue, and loss of interest in daily activities. In this study, depressive symptoms among older adults are identified using standardized tools like the Geriatric Depression Scale (GDS). Social Participation: This refers to involvement in activities that promote interaction with others, such as community gatherings, religious events, family functions, or participation in clubs. For this study, it specifically refers to how frequently and in what ways older Nigerians engage in social life. Older Adults: Individuals aged 60 years and above, commonly referred to as senior citizens. In this study, it pertains to elderly Nigerians residing within the study area. Nursing Interventions: These are actions taken by nurses to support the mental, physical, and emotional health of patients. In this context, it refers to targeted strategies designed to reduce depression and promote social involvement among older adults