Perception of family relationships and depressive symptoms in older adults in Loja, Ecuador: an analytical cross-sectional study

Abstract

Background Family relationships are an important psychosocial determinant of mental health in older adults. Their perception of family functioning may differ from that of other household members and influence the presence of depressive symptoms. Objective To characterize older adults' perception of family relationships in Loja, Ecuador, and examine its association with depressive symptoms. Methods An observational, analytical, cross-sectional study was conducted among 171 older adults and one cohabiting family member attending primary healthcare centers in Loja, Ecuador, between January and December 2024. Validated instruments assessed cognitive function (Mini-Mental State Examination), depressive symptoms (Geriatric Depression Scale-15), functional capacity (Barthel Index and Lawton and Brody Index), older adults' perception of family relationships (PRF), and family functioning reported by relatives (FF-SIL). Descriptive analyses, Spearman correlation, and multivariate binary logistic regression were performed. Crude and adjusted odds ratios (OR and aOR) with 95% confidence intervals (95% CI) were estimated, considering p < 0.05 as statistically significant. Results Participants had a mean age of 75.1 years (SD = 8.3), and 70.2% were women. Most older adults (59.6%) perceived their family relationships as disharmonious, whereas 74.3% of family members reported adequate family functioning. Agreement between both perspectives was moderate (ρ = 0.315; p < 0.001). Older adults reporting disharmonious family relationships had significantly higher odds of depressive symptoms in the crude analysis (OR = 3.00; 95% CI: 1.40–6.42). This association remained significant after adjustment for sociodemographic variables (aOR = 2.41; 95% CI: 1.07–5.39) and after additional adjustment for clinical confounders (aOR = 2.35; 95% CI: 1.04–5.28). Per capita income below the unified basic salary was also independently associated with depressive symptoms (aOR = 3.67; 95% CI: 1.65–8.17). Conclusion Older adults' perception of family relationships is independently associated with depressive symptoms, even after controlling for sociodemographic and clinical factors. These findings highlight the importance of incorporating older adults' own perspectives into the assessment of family dynamics and strengthening family-centered mental health promotion and prevention strategies within primary healthcare.