, Volume 54, Issue 4, pp 1529–1558 | Cite as

The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context

  • Iliana V. KohlerEmail author
  • Collin F. Payne
  • Chiwoza Bandawe
  • Hans-Peter KohlerEmail author


Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime—for instance, 52 % for a 55-year-old woman—affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.


Aging Malawi Mental health Depression Anxiety 



We gratefully acknowledge the generous support for the Malawi Longitudinal Study of Families and Health (MLSFH) by the Rockefeller Foundation; the National Institute of Child Health and Human Development (NICHD, Grant Nos. R03 HD05 8976, R21 HD050653, R01 HD044228, R01 HD053781); the National Institute on Aging (NIA, Grant Nos. P30 AG12836 and R21 AG053763); the Boettner Center for Pensions and Retirement Security at the University of Pennsylvania; and the NICHD Population Research Infrastructure Program (Grant Nos. R24 HD-044964), all at the University of Pennsylvania. We are also grateful for support through the Swiss Programme for Research on Global Issues for Development (SNF r4d Grant 400640_160374) as well as pilot funding received through the Penn Center for AIDS Research (CFAR), supported by NIAID AI 045008 and the Penn Institute on Aging. Collin Payne also gratefully acknowledges support through a United States National Science Foundation Graduate Research Fellowship (Grant No. DGE-0822).

Supplementary material

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Copyright information

© Population Association of America 2017

Authors and Affiliations

  1. 1.Population Studies Center and Department of SociologyUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Harvard Center for Population and Development StudiesCambridgeUSA
  3. 3.Department of Mental HealthCollege of MedicineBlantyreMalawi
  4. 4.Population Studies Center and Department of SociologyUniversity of PennsylvaniaPhiladelphiaUSA

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