Depressive Symptoms, Anxiety Symptoms, and Low Subjective Well-Being as a Co-Occurring Pattern of Psycho-Emotional Vulnerability Among Older Adults in Northeast Kazakhstan: A Cross-Sectional Study

Abstract

Background: Depressive symptoms, anxiety symptoms, and low subjective well-being are highly prevalent among older adults, but they are typically assessed separately, and their co-occurrence remains insufficiently explored, particularly in Central Asia. Objectives: This study aimed to assess the prevalence and co-occurrence of depressive symptoms, anxiety symptoms, and low subjective well-being among older adults in northeastern Kazakhstan and to identify associated factors. Methods: A cross-sectional study was conducted among 387 individuals aged 60 years and older. Depressive symptoms, anxiety symptoms, and well-being were screened using the Geriatric Depression Scale (GDS-15), the Short Anxiety Screening Test (SAST), and the World Health Organization Five Well-Being Index (WHO-5), respectively. Analyses included Spearman’s rank correlation and multivariable binary logistic regression. Results: The prevalence of clinically significant depressive symptoms, elevated anxiety symptoms, and low subjective well-being was 22.7%, 20.7%, and 25.3%, respectively; at least one screening-positive indicator was identified in 36.4% of participants. Simultaneous screening positivity on all three indicators (10.3%) was the most common single pattern, exceeding the prevalence of any isolated indicator. Depressive and anxiety symptom scores were strongly positively correlated (r = 0.695, p < 0.001), and both were inversely correlated with well-being. Functional limitations in self-care and income level were independently associated with all three outcomes, with the strongest association observed for functional limitations (adjusted odds ratio (aOR) = 6.40; 95% confidence interval (CI): 3.05–13.86). Conclusions: Depressive symptoms, anxiety symptoms, and low subjective well-being co-occurred more frequently than expected under statistical independence, indicating a co-occurring pattern of psycho-emotional vulnerability rather than entirely independent indicators. Screening focused on a single outcome may miss a substantial share of vulnerable older adults, underscoring the need for integrated detection and management at the primary health care level.