Exploring the contingent associations between functional limitations and depressive symptoms across residential context: a multilevel panel data analysis

Abstract

Objectives: This study examines the multilevel relationship between functional limitations and depressive symptoms among community-dwelling US older adults, and how it is moderated by community environmental characteristics (neighborhood fear, social cohesion, structural disadvantage and residential stability). Method: Data come from two waves of National Social Life, Health and Aging Project (NSHAP) collected in 2005/2006 and 2010/2011, consisting of 2,261 individuals aged 57-85 (mean = 68.5; SD = 7.5) nested in 100 regional areas. Two-level hierarchical linear models are fitted to test if and to what extent limited physical capacity and neighborhood measures are interactively related to depressive symptoms. Results: Adjusting for confounders (e.g. age, gender, education, employment status, social support), we find a significant positive relationship between functional limitations and depressive symptoms. At the aggregate level, socially cohesive neighborhoods are negatively related to depression. Several cross-level interactions are also observed. First, the association between poor functional health and depression is greater in neighborhoods perceived to be less safe. It is also stronger in places with more structural disadvantages. Lastly, the physical impairment-depression link is more pronounced where there is higher residential stability, i.e., greater proportion of long-term residents. Conclusion: Our study bridges an important empirical gap in the literature. Prior studies have rarely investigated how the connection between functional limitations and depressive symptoms among older adults is conditioned by neighborhood characteristics. By using multilevel analysis of population-based longitudinal data, we show that physical space (neighborhood community) plays a critical role in understanding this important, yet understudied, relationship.