Gender differences in association between psychological distress and detailed living arrangements among Japanese older adults, aged 65–74 years

  • Hiroyuki Kikuchi
  • Tomoko Takamiya
  • Yuko Odagiri
  • Yumiko Ohya
  • Tomoki Nakaya
  • Teruichi Shimomitsu
  • Shigeru Inoue
Original Paper



Past studies have shown that living alone is detrimental to older adults’ mental health. However, there has been little focus on how older adults’ psychological distress differed by more detailed living arrangement, as well as by gender. The present study investigates various living arrangements in association with psychological distress among older men and women.


Data from community-dwelling Japanese older adults were collected through a mail survey (n = 1,807, aged 65–74 years, 51.5 % men). Psychological distress level was measured using Kessler’s six-item psychological distress scale. Living arrangements were categorized into four groups; “living with spouse only”, “living with spouse and other family”, “living with other family without spouse” or “living alone”. Multiple logistic regression analyses were used to examine the associations of living arrangements with psychological distress level.


Older adults living alone were observed to have higher psychological distress. In addition, gender-stratified analyses showed that higher distress levels were observed among older men living with family, but without a spouse (OR: 2.85, 95 % CI: 1.51–5.39). In contrast, higher distress was observed among older women living with spouse and other family (OR: 1.53, 95 % CI: 1.03–2.28).


Psychological distress in older Japanese adults was associated with living arrangements, but such associations differed by gender. The association of living with a spouse on older men’s mental health was striking, while living with any family was found to be rather important for older women, aged 65–74 years.


Population-based survey Older adults K6 Psychological distress Living arrangement 



This study was supported by the Grant-in-Aid for Scientific Research (C): 20500604 from the Japan Ministry of Education, Culture, Sports and Science and Technology. All authors have no other conflicts of interest, including related directorship, stock holdings or contracts.


  1. 1.
    Jeste DV, Alexopoulos GS, Bartels SJ, Cummings JL, Gallo JJ, Gottlieb GL, Halpain MC, Palmer BW, Patterson TL, Reynolds CF 3rd, Lebowitz BD (1999) Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Arch Gen Psychiatry 56(9):848–853PubMedCrossRefGoogle Scholar
  2. 2.
    The Ministry of Health L, and Welfare of Japan (2010) The patient survey 2010Google Scholar
  3. 3.
    Bartels SJ, Horn S, Sharkey P, Levine K (1997) Treatment of depression in older primary care patients in health maintenance organizations. Int J Psychiatry Med 27(3):215–231PubMedCrossRefGoogle Scholar
  4. 4.
    Karlin BE, Norris MP (2006) Public mental health care utilization by older adults. Adm Policy Ment Health 33(6):730–736. doi: 10.1007/s10488-005-0003-5 PubMedCrossRefGoogle Scholar
  5. 5.
    Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62(9):975–983. doi: 10.1001/archpsyc.62.9.975 PubMedCrossRefGoogle Scholar
  6. 6.
    Larsen TK, Melle I, Auestad B, Haahr U, Joa I, Johannessen JO, Opjordsmoen S, Rund BR, Rossberg JI, Simonsen E, Vaglum P, Friis S, McGlashan T (2011) Early detection of psychosis: positive effects on 5-year outcome. Psychol Med 41(7):1461–1469. doi: 10.1017/S0033291710002023 PubMedCrossRefGoogle Scholar
  7. 7.
    Davis MA, Neuhaus JM, Moritz DJ, Segal MR (1992) Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study. Am J Public Health 82(3):401–406PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Koskinen S, Joutsenniemi K, Martelin T, Martikainen P (2007) Mortality differences according to living arrangements. Int J Epidemiol 36(6):1255–1264. doi: 10.1093/ije/dym212 PubMedCrossRefGoogle Scholar
  9. 9.
    Russell D, Taylor J (2009) Living alone and depressive symptoms: the influence of gender, physical disability, and social support among Hispanic and non-Hispanic older adults. J Gerontol B Psychol Sci Soc Sci 64(1):95–104. doi: 10.1093/geronb/gbn002 PubMedCrossRefGoogle Scholar
  10. 10.
    Joutsenniemi K, Martelin T, Martikainen P, Pirkola S, Koskinen S (2006) Living arrangements and mental health in Finland. J Epidemiol Community Health 60(6):468–475. doi: 10.1136/jech.2005.040741 PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Joutsenniemi K, Martelin T, Kestila L, Martikainen P, Pirkola S, Koskinen S (2007) Living arrangements, heavy drinking and alcohol dependence. Alcohol Alcohol 42(5):480–491. doi: 10.1093/alcalc/agm011 PubMedCrossRefGoogle Scholar
  12. 12.
    Klinenberg E (2001) Dying alone, the social production of urban isolation. Ethnography 2(4):501–531CrossRefGoogle Scholar
  13. 13.
    Umberson D (1992) Gender, marital status and the social control of health behavior. Soc Sci Med 34(8):907–917PubMedCrossRefGoogle Scholar
  14. 14.
    Davis MA, Randall E, Forthofer RN, Lee ES, Margen S (1985) Living arrangements and dietary patterns of older adults in the United States. J Gerontol 40(4):434–442PubMedCrossRefGoogle Scholar
  15. 15.
    Bierman A (2009) Marital status as contingency for the effects of neighborhood disorder on older adults’ mental health. J Gerontol B Psychol Sci Soc Sci 64(3):425–434. doi: 10.1093/geronb/gbp010 PubMedCrossRefGoogle Scholar
  16. 16.
    Ng K-M, Lee TMC, Chi I (2004) Relationship between living arrangements and the psychological well-being of older people in Hong Kong. Australas J Ageing 23(4):167–171. doi: 10.1111/j.1741-6612.2004.00044.x CrossRefGoogle Scholar
  17. 17.
    Dean A, Kolody B, Wood P, Matt GE (1992) The influence of living alone on depression in elderly persons. J Aging Health 4(1):3–18. doi: 10.1177/089826439200400101 CrossRefGoogle Scholar
  18. 18.
    Magaziner J, Cadigan DA, Hebel JR, Parry RE (1988) Health and living arrangements among older women: does living alone increase the risk of illness? J Gerontol 43(5):M127–M133PubMedCrossRefGoogle Scholar
  19. 19.
    Chou KL, Chi I (2005) Prevalence and correlates of depression in Chinese oldest-old. Int J Geriatr Psychiatry 20(1):41–50. doi: 10.1002/gps.1246 PubMedCrossRefGoogle Scholar
  20. 20.
    Inoue S, Ohya Y, Odagiri Y, Takamiya T, Kamada M, Okada S, Oka K, Kitabatake Y, Nakaya T, Sallis JF, Shimomitsu T (2011) Perceived neighborhood environment and walking for specific purposes among elderly Japanese. J Epidemiol 21(6):481–490 pii JST.JSTAGE/jea/JE20110044PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand SL, Manderscheid RW, Walters EE, Zaslavsky AM (2003) Screening for serious mental illness in the general population. Arch Gen Psychiatry 60(2):184–189 pii yoa20567PubMedCrossRefGoogle Scholar
  22. 22.
    Gill SC, Butterworth P, Rodgers B, Mackinnon A (2007) Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population. Psychiatry Res 152(1):63–71. doi: 10.1016/j.psychres.2006.11.005 PubMedCrossRefGoogle Scholar
  23. 23.
    Furukawa T, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, Tachimori H, Iwata N, Uda H, Nakane H, Watanabe M, Naganuma Y, Hata Y, Kobayashi M, Miyake Y, Takeshima T, Kikkawa T (2008) The performance of the Japanese version of the K6 and K10 in the world mental health survey Japan. Int J Methods Psychiatr Res 17(3):152–158. doi: 10.1002/mpr.257 PubMedCrossRefGoogle Scholar
  24. 24.
    Schmitz N, Lesage A, Wang J (2009) Should psychological distress screening in the community account for self-perceived health status? Can J Psychiatry 54(8):526–533PubMedGoogle Scholar
  25. 25.
    Sakurai K, Nishi A, Kondo K, Yanagida K, Kawakami N (2011) Screening performance of K6/K10 and other screening instruments for mood and anxiety disorders in Japan. Psychiatry Clin Neurosci 65(5):434–441. doi: 10.1111/j.1440-1819.2011.02236.x PubMedCrossRefGoogle Scholar
  26. 26.
    Tokuda Y, Okubo T, Ohde S, Jacobs J, Takahashi O, Omata F, Yanai H, Hinohara S, Fukui T (2009) Assessing items on the SF-8 Japanese version for health-related quality of life: a psychometric analysis based on the nominal categories model of item response theory. Value Health 12(4):568–573. doi: 10.1111/j.1524-4733.2008.00449.x PubMedCrossRefGoogle Scholar
  27. 27.
    Murase N, Katsumura T, Ueda C, Inoue S, Shimomitsu T (2002) Validity and reliability of Japanese version of International Physical Activity Questionnaire. J Health Welf Stat 49(11):1–9Google Scholar
  28. 28.
    Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C (2007) Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1094–1105. doi: 10.1161/CIRCULATIONAHA.107.185650 PubMedCrossRefGoogle Scholar
  29. 29.
    Zunzunegui MV, Beland F, Otero A (2001) Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain. Int J Epidemiol 30(5):1090–1099PubMedCrossRefGoogle Scholar
  30. 30.
    Jeon GS, Jang SN, Rhee SJ, Kawachi I, Cho SI (2007) Gender differences in correlates of mental health among elderly Koreans. J Gerontol B Psychol Sci Soc Sci 62(5):S323–S329 pii 62/5/S323PubMedCrossRefGoogle Scholar
  31. 31.
    Takagi E, Silverstein M, Crimmins E (2007) Intergenerational coresidence of older adults in Japan: conditions for cultural plasticity. J Gerontol B Psychol Sci Soc Sci 62(5):S330–S339 pii 62/5/S330PubMedCrossRefGoogle Scholar
  32. 32.
    Veiel HOF, Baumann UE (eds) (1992) The meaning and measurement of social support. Hemisphere Publishing CorpGoogle Scholar
  33. 33.
    Koizumi Y, Awata S, Kuriyama S, Ohmori K, Hozawa A, Seki T, Matsuoka H, Tsuji I (2005) Association between social support and depression status in the elderly: results of a 1-year community-based prospective cohort study in Japan. Psychiatry Clin Neurosci 59(5):563–569. doi: 10.1111/j.1440-1819.2005.01415.x PubMedCrossRefGoogle Scholar
  34. 34.
    Nobe M (1999) An examination of sex differences in the structure of social Networks and in the availability of social support for the elderly (in Japanese). Jpn Sociol Rev 50(3):375–392CrossRefGoogle Scholar
  35. 35.
    The Gender Equality Bureau Cabinet Office of Japan (2012) Whitepaper of Gender Equality Bureau Cabinet Office. Shobi printing, JapanGoogle Scholar
  36. 36.
    Parker G, Gibson NA, Brotchie H, Heruc G, Rees AM, Hadzi-Pavlovic D (2006) Omega-3 fatty acids and mood disorders. Am J Psychiatry 163(6):969–978. doi: 10.1176/appi.ajp.163.6.969 PubMedCrossRefGoogle Scholar
  37. 37.
    Raymo JM, Kikuzawa S, Liang J, Kobayashi E (2008) Family structure and well-being at older ages in Japan. J Popul Res (Canberra) 25(3):379–400. doi: 10.1007/BF03033896 CrossRefGoogle Scholar
  38. 38.
    Kadokawa S (2009) Examining the introduction of grandparenting classes for child-care support (in Japanese). Maternal Health 50(2):300–309Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hiroyuki Kikuchi
    • 1
  • Tomoko Takamiya
    • 1
  • Yuko Odagiri
    • 1
  • Yumiko Ohya
    • 1
  • Tomoki Nakaya
    • 2
  • Teruichi Shimomitsu
    • 1
    • 3
  • Shigeru Inoue
    • 1
  1. 1.Department of Preventive Medicine and Public HealthTokyo Medical UniversityShinjuku-kuJapan
  2. 2.Department of Geography and Research Centre for Disaster Mitigation of Urban Cultural HeritageRitsumeikan UniversityKyotoJapan
  3. 3.Japan Health Promotion Fitness FoundationTokyoJapan

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