Neglect as a Predictor of Anxiety and Depression Among Elderly Persons in Abia State, Nigeria

adults' need for assistance with activities of daily living is repeatedly ignored. The consequences of neglect may extend beyond immediate physical needs. The elderly frequently depends on family members, caregivers and community networks for practical assistance, emotional support and protection. When such support is inadequate, the older person may experience insecurity, helplessness, abandonment and diminished psychological wellbeing. These experiences may be associated with anxiety and depression.

Recent empirical evidence has demonstrated an association between elder mistreatment and mental-health outcomes. A recent systematic review and meta-analysis of Fang et al., (2025) found that older adults who experienced elder abuse had elevated risks of adverse mental-health outcomes, including depression and anxiety. The authors reported significantly higher odds of both depression and anxiety among older adults who had experienced elder abuse. Neglect is particularly important because it may remain hidden within ordinary family and caregiving arrangements. Whereas physical abuse may leave observable signs, neglect can occur through persistent failure to provide care or attention. This may make it more difficult to identify, particularly where older adults depend heavily on relatives for their daily needs.

Anxiety is an important psychological concern among older adults. It may involve excessive worry, fear, apprehension, restlessness and concerns about health, safety, family relationships and future wellbeing. For an older person experiencing neglect, uncertainty about whether basic needs will be met may constitute an additional source of psychological distress. Depression is similarly important in later life. It may involve persistent sadness, loss of interest, hopelessness, social withdrawal and reduced psychological wellbeing. Persistent neglect may potentially contribute to such experiences by reducing the older person's sense of security, belonging and perceived value within family and community relationships.

Evidence from longitudinal research also indicates that elder mistreatment may have lasting psychological implications. Wong and Waite, (2017)  found that older adults who had experienced mistreatment had poorer subsequent physical and psychological health outcomes. Their findings also highlighted the potential protective role of social support in the relationship between mistreatment and later wellbeing. Research examining older adults specifically has similarly identified relationships between mistreatment and anxiety. A longitudinal national study found that older adults who experienced mistreatment subsequently reported more anxiety symptoms and greater loneliness than those who did not report mistreatment. More specifically, Yalçın Gürsoy and Uçan Yamaç, (2024) research involving community-dwelling older adults has found significant associations between elder neglect and both depression and anxiety. Such findings suggest that neglect deserves separate attention rather than being considered only as part of the broader category of elder abuse.

The Nigerian context is particularly relevant. Family relationships have traditionally constituted a major source of support for older adults. However, socioeconomic changes, migration, changing family structures, urbanization and increasing economic pressures may influence the availability and quality of family-based care. Recent Nigerian study by Folorunsho and Okyere, (2025), highlighted concerns regarding the mental-health needs of older adults, including the effects of social isolation, weakening traditional family support and elder mistreatment. The study also emphasizes the importance of strengthening community-based services and integrating mental-health care into services for older persons.

Older adults may become increasingly dependent on family members and caregivers as they experience declining physical capacity, chronic illness or functional limitations. This dependence may make some elderly persons vulnerable to neglect. Some may receive inadequate attention to their health needs, insufficient assistance with activities of daily living, inadequate provision of basic necessities or limited emotional support. Such experiences may be particularly problematic for older persons who have few alternative sources of assistance. Neglect may have important psychological implications. An elderly person whose needs are repeatedly ignored may experience worry about whether necessary care will be available, fear concerning personal safety and feelings of abandonment or helplessness. Such experiences may be associated with anxiety. Similarly, prolonged neglect may be accompanied by sadness, withdrawal, hopelessness and reduced interest in everyday activities, which may be associated with depression.

Although previous studies have demonstrated relationships between elder mistreatment and adverse mental-health outcomes, relatively limited evidence exists regarding the specific contribution of neglect to anxiety and depression among elderly persons in Abia State. Furthermore, neglect is often examined together with other forms of elder abuse, making it difficult to determine its statistical contribution to individual psychological outcomes. The present study therefore examined whether neglect significantly predicts anxiety and depression among elderly persons in Abia State, Nigeria.

Aim and Objectives

The study aimed to examine the extent to which neglect predicts anxiety and depression among elderly persons in Abia State. Specifically, the study sought to:

1.       determine the extent to which neglect predicts anxiety among elderly persons in Abia State; and

2. determine the extent to which neglect predicts depression among elderly persons in Abia State.

Research Questions

The following research questions guided the study:

1. To what extent does neglect predict anxiety among elderly persons in Abia State?
2. To what extent does neglect predict depression among elderly persons in Abia State?

Hypotheses

The following null hypotheses were tested at the 0.05 level of significance:

H₀1: Neglect does not significantly predict anxiety among elderly persons in Abia State.

H₀2: Neglect does not significantly predict depression among elderly persons in Abia State.

Literature Review

Concept of Neglect among Older Adults

Neglect is an important form of elder mistreatment involving failure to meet an older person's legitimate needs for care, attention, assistance or protection. It may occur when caregivers lack the resources or knowledge required to provide appropriate care, but it may also involve persistent disregard for the needs of an older person. Neglect can be physical, emotional, social or medical. Physical neglect may involve inadequate food, hygiene, clothing, shelter or assistance. Medical neglect may involve failure to obtain necessary healthcare or administer prescribed treatment. Emotional neglect may involve lack of companionship, affection, communication or emotional attention. The distinction between neglect and other forms of elder mistreatment is important. An older adult may experience several forms of mistreatment simultaneously, but neglect has characteristics that justify examining it independently.

Recent systematic evidence indicates that neglect among older adults is associated with adverse wellbeing outcomes. A systematic review of Marshall et al., (2020) examined neglect, physical abuse and financial abuse and found evidence linking neglect to loneliness and deterioration in mental wellbeing, although the authors emphasized limitations in the available literature, particularly the predominance of cross-sectional studies.

Neglect may therefore be understood as both a social and psychosocial problem. It concerns not only the provision of physical care but also the older person's sense of dignity, security, belonging and social value.

Neglect and Anxiety

Anxiety among older adults can arise from multiple sources, including health concerns, financial insecurity, bereavement, reduced independence and uncertainty about the future. Neglect may add another source of insecurity. When an older person cannot rely on caregivers for necessary assistance, uncertainty may increase. For example, an older person who depends on others for medication, transportation or help with daily activities may experience worry when such assistance is unavailable or inconsistent.

Recent research supports the relationship between elder mistreatment and anxiety. Fang et al., (2025), in their systematic review and meta-analysis found significantly increased odds of anxiety among older adults experiencing elder abuse. More directly relevant to the present study is Yalçın Gürsoy and Uçan Yamaç, (2024) research among community-dwelling older adults found that neglect was significantly associated with anxiety after controlling for relevant factors. Wong and Waite, (2017) longitudinal research has also demonstrated that mistreatment may have psychological consequences extending beyond the immediate period of exposure. Older adults who reported mistreatment were subsequently more likely to report anxiety symptoms. These findings provide a basis for examining neglect as a predictor of anxiety among elderly persons in Abia State.

Neglect and Depression

Depression is a major psychological concern among older adults. Its occurrence may be associated with health problems, bereavement, social isolation, economic difficulties, reduced independence and other adverse experiences. Neglect may be relevant to depression because it can reduce social and emotional support. An older person who repeatedly experiences inadequate attention may interpret the experience as rejection or lack of concern from significant others. Prolonged exposure to such experiences may be associated with emotional distress. Evidence from systematic research indicates that elder mistreatment is associated with depression. Fang et al., (2025) found substantially elevated odds of depression among older adults who experienced elder abuse. Research focusing specifically on neglect has also reported significant associations between neglect and depression among older adults. The systematic review of Marshall et al. (2020) examined neglect and other forms of elder abuse similarly found evidence linking neglect with deteriorating mental wellbeing.

These findings support the importance of examining neglect independently as a psychosocial predictor of depression. However, the relationship may be bidirectional. Depression may affect an older person's social behaviour, communication and ability to seek assistance, potentially influencing caregiving relationships. Consequently, cross-sectional research cannot establish whether neglect precedes depression or whether depression contributes to vulnerability to neglect.

Method and Materials

Research Design

The study adopted a correlational design, which was appropriate because the study examined the statistical relationship between neglect and psychological outcomes Simple linear regression was used to determine the extent to which neglect statistically predicted anxiety and depression.

Population of the Study

The population comprised elderly persons aged 60 years and above in Abia State, Nigeria. The estimated elderly population for the study was approximately 185,000 persons.

Sample and Sampling Procedure

A sample of 399 elderly persons were selected through a multistage sampling procedure. The multistage procedure enabled participants to be selected from different geographical and administrative areas within Abia State. Eligible participants were elderly persons aged 60 years and above who met the study's inclusion criteria and participated voluntarily.

Instruments for Data Collection

Data were collected using a structured questionnaire consisting of demographic information and measures of the variables under investigation. The instruments relevant to this article assessed: neglect; anxiety; and depression. Anxiety was assessed using the Geriatric Anxiety Inventory (GAI), while depression was assessed using the Geriatric Depression Scale (GDS). The questionnaire and instruments underwent appropriate validity and reliability procedures as part of the larger study.

Data Analysis

Simple linear regression was used to analyze the data. For Research Question 3: Neglect → Anxiety. For Research Question 4: Neglect → Depression. The coefficient of determination (R²) was used to determine the proportion of variance in each outcome accounted for by neglect. Regression coefficients and significance tests were used to determine whether the predictive relationships were statistically significant. The hypotheses were tested at the 0.05 level of significance.

Results and Discussion

Neglect Predicting Anxiety among Elderly Persons

Simple Linear Regression of Neglect Predicting Anxiety among Elderly Persons in Abia State was presented in Table 1. The results show that neglect significantly predicted anxiety among elderly persons in Abia State. The regression model produced R = .317, R² = .100 and adjusted R² = .092. The R² value indicates that neglect accounted for approximately 10.0% of the variance in anxiety, while the adjusted R² indicates that approximately 9.2% of the variance remained accounted for after adjustment. Because this is a simple linear regression with one predictor, the standardized regression coefficient is equivalent in magnitude to the correlation coefficient. The standardized coefficient was therefore β = .317. The regression relationship was statistically significant, t = 2.520, p < .001. Since the p-value was below the 0.05 significance level. The finding indicates that neglect was a statistically significant predictor of anxiety among elderly persons in Abia State. Approximately 10.0% of the observed variance in anxiety was statistically accounted for by neglect.

Table 1: Neglect Predicting Anxiety among Elderly Persons

The first finding demonstrated that neglect significantly predicted anxiety among elderly persons in Abia State. The regression model produced R = .317 and R² = .100, indicating that neglect statistically accounted for approximately 10.0% of the variance in anxiety. This finding suggests that neglect is an important psychosocial factor associated with anxiety among elderly persons. Older adults who depend on others for essential assistance may experience uncertainty and worry when such assistance is inadequate or inconsistent. Neglect may increase feelings of vulnerability. An older person who cannot independently manage certain aspects of daily living may reasonably depend on family members or caregivers. When assistance is not provided, the person may worry about health, safety and future care.

The finding is consistent with Fang et al. (2025) evidence linking elder mistreatment with anxiety. A recent systematic review and meta-analysis found increased odds of anxiety among older adults exposed to elder abuse. It is also consistent with Yalçın Gürsoy and Uçan Yamaç, (2024), which specifically examined neglect among community-dwelling older adults, where neglect was significantly associated with anxiety after multivariate analysis. The longitudinal evidence reported by Wong and Waite, (2017) also provides relevant support. Their findings indicated that elder mistreatment was associated with subsequent adverse psychological outcomes. The present finding therefore adds evidence from Abia State to the broader literature concerning mistreatment and psychological wellbeing in later life. Nevertheless, the finding should not be interpreted as demonstrating that neglect causes anxiety. Anxiety may also influence social relationships and perceptions of caregiving. Longitudinal studies are needed to establish temporal ordering.

Neglect Predicting Depression among Elderly Persons

Simple linear regression of neglect predicting depression among elderly persons in Abia State was presented in Table 2. The results show that neglect significantly predicted depression among elderly persons in Abia State. The regression coefficient was R = .383. The coefficient of determination was obtained by squaring the correlation coefficient: R² = (.383)² = .146689 ≈ .147 Therefore, neglect accounted for approximately 14.7% of the variance in depression. For a sample of 399 participants and one predictor, the adjusted R² is approximately .145, indicating that approximately 14.5% of the variance in depression remained accounted for after adjustment. Since the model contains one predictor, the standardized regression coefficient has the same magnitude as the correlation coefficient. Thus, β = .383. The corresponding t-statistic is approximately 8.261, and the relationship is statistically significant at p < .001. The result indicates that neglect significantly predicted depression among elderly persons in Abia State. Neglect accounted for approximately 14.7% of the variance in depression.

Table 2: Neglect Predicting Anxiety among Elderly Persons