Introduction

India demonstrates a clear decline in birth rates and a lifetime change, with a major decrease in
mortality among older people. According to the 2011 Population Census, there are
approximately 104 million aged people in India (age 60 or above); 53 million female and 51
million men. A study published by the international organization Population Fund and Aid Age
India indicates that by 2026, the number of elderly people are projected to rise to 173 million. In
a few years, a growing proportion of older people in India will need psychological state
intervention Specific social, environmental and private factors increase high psychiatric
morbidity among the older population, but the precise problem burden is not clear because there
are few studies available to concentrate on this topic. There are various aging-related changes,
such as physical, psychological, hormonal and social factors. It has been reported that the elderly
are more vulnerable to psychological problems, and the most prevalent geriatric mental
conditions are depression. Indeed, Indian elderly face a multitude of psychological, financial, and
physical health issues. When age increases, morbidity and functional loss increase, as well as the
prevalence of a number of depressive factors and the frequency of different events in life;
Significantly changes one's psychological state and makes them more vulnerable to depression.
The cycle of aging is universal. In Seneca's phrase, "old age is an incurable condition," but, as
Sir James sterling said, "you're not curing old age, you're defending it, you're fostering it, and
you're expanding it."
Meaning and Definition of Old Age.
Various definitions of an old age given by relevant departments are as under.
I. World Health Organization (WHO) views that:-
The age of 60 or 65, roughly equivalent to retirement ages in most developed countries is said to
be the beginning of old age. In many parts of the developing world, chronological time has little
or no importance in the meaning of old age.
II. According to Medical Dictionary
Adjective referring to a person who is defined by statute or perception as being old.
III. Ministry of Social justice and Empowerment, Government of India
A Senior citizen means any person being a citizen of India, who has attained the age of sixty year
or above.

IV. Ministry of Civil Aviation, Government of India

A Senior citizen of Indian Nationality, permanently residing in India and should have attained
the age of 60 years on the date of commencement of journey.
V. Ministry of Indian Railways, Government of India
As per Indian railway norms regarding senior citizens, “Males above 60 years of age while
Females above 58 years of age considered to be senior citizens and eligible to avail respective
concessions in ticket rates.
VI. Ministry of Finance, Income Tax Department, Government of India
Under the Income-tax Act, 1961, A ‘Senior Citizen’ has been defined as an individual who
attains the age of 60 years at any time during a financial year, while an individual who is 80
years or more is categorized as Very Senior Citizen.
VII. Census (2011) Government of India
Senior citizen means the persons who has attained the age of 60 years or above.
VIII. Maintenance and welfare of parents and senior citizens act, 2007
Senior citizen is any citizen of India of 60 years and above whether living in India or not.
IX. National policy on older persons (Jan, 1999) Government of India.
The policy defines “senior citizen or elderly” as a person who is of age 60 years or above.
Theoretical Background of Ageing
Different theories have been advocated to address the dynamic process of ageing. The following
section will review some of the theories of ageing in an attempt to present an outline for an
improved comprehension of the latter phase of life.
1. Disengagement Theory
The most implicit theory initiated in the gernotological text is the disengagement theory.
Cumming and Henry (1961) proposed this theory with the contention that with the growing age
the elderly start disengaging themselves in almost all the activities they used to do in their prime
age. This can be due to diminished physical strength, vigour, declined cognitive faculties and
psychological and social withdrawal. This withdrawal from social interactions is mutually
consented by the individual himself or by the society. The individual due to economic
interdependence, loss of spouse, intergenerational gap, and other losses withdraw himself from
the society and society turns down these unproductive individuals and treats them as fragile,
weak, disabled and sick. In other words, this theory postulates that it is advantageous for both
individual and society to contribute in the course of departure from significant roles, activities
and relationships as that person is growing old. The theory is not directly in favour of that person
should disunite from all the relationships which he made in his prime life and become a sage,
rather it suggests that an elderly person shall be relatively less involved in the social interactions
in which he/ she was formerly bound, and a diminished level of participation will take place at
four stages. Firstly, the number of persons would be reduced with whom he/she regularly used to
meet. Secondly, the quantity of interactions with persons would also be reduced. Thirdly, the
manner of interaction would be altered due to the distorted state which the elderly is carrying.
Lastly, which is quite important is that\ the elderly person would focus entirely on his/her state of
condition with withdrawing from society which in turn society would also withdraw from the
individual.
But this theory has been criticized by behaviourists on the ground that the fundamental
motive of the theory is faulty and as well as the basic postulates cannot be sufficiently verified
by some empirical research. But Cumming and Henry argued on the basis that this theory of
aging has created many scientific but social thoughts for continuously for a number of years
devoid of being properly postulated or sufficiently verified. Nonetheless, this theory has posited
a significant position in the area of gerontology as well as in the field of life span development.
Moreover, disengagement theory has led to the materialization of other theories like continuity
theory and activity theory.
2. Continuity Theory
The continuity theory ageing was proposed by Robert Atchley in 1971. This theory postulated
that some elderly people maintain their lives with the same kind of activities which they used to
do in their prime lives. They maintain similar kind of interactions with friends, relatives despite
bereavement as they did when they were young. According to this, elderly people who not only
maintain their interactions, relationships but also maintain the old habits, likings and disliking
and their lifestyles age successfully. But it does not mean that the habits which were not good
like excessive drinking, gambling or other such things and if they continue with the similar
preferences, likings or disliking which were not good for his life would not age successfully.
Basically the persons who had comfortable life in their mid years and had almost all good habits
would age successfully otherwise not. People who continue the good stuff to carry on for their
later life would survive hale and hearty.
This theory was basically criticized on the grounds of its definition of normal ageing. The
theory did not differentiate normal ageing from the pathological ageing in which the elderly
people are not keeping well due to physical or mental ailments, how a person in this condition
can continue with the similar kind of lifestyle by ignoring his health and wellbeing. It was also
criticized on the basis of being surrounded around a male approach. It also fails to emphasize
upon the role of social institutions like family, marriage and the circumstances, which can affect
their lives in later years.
3. Lifespan Perspective
Based on life-span perspective, old age is an enduring process. During this process, there
exist many changes and transformations, which are related to loss or deterioration.
According to this approach, with advancing age old people are required to accomplish various
taxing developmental tasks for successful aging. For this purpose they have to adjust and make
harmonious balance between changes they already made in their adulthood and the changes
which are occurring during old age. At this stage of life the elderly person has to face many
challenges and confrontations and he/she has to make maximum adjustments. It not only
restricted to physical domain but also to the personal, social and economic domains. One of the
chief developmental tasks acknowledged by old people associated with the challenges in hand
are ill health, lack of physical vitality and vigour and approval and acceptance to avoid death and
integration of certain issues related to their continued existence.
Taking into consideration of above sighted issues related to lifespan approach, generally
one can perceive that during aging there are two major issues, which need to be taken care of i.e.
somatic and psychological confrontations. The somatic issue is contingent upon the unavoidable
and irreversible changes due to degeneration with advancing age. On the other hand the
psychological challenge is dependent upon the feeling of being stigmatized and prejudiced from
which they have to overcome in order to maintain the feelings of self-esteem, efficacy,
proficiency and mastery (Kleinke, 1998). But in particular, some of the issues which need to be
taken care of include adjustment to biological degeneration, adjustment to living partner,
adjustment to retirement process and decline in economic status, adjustment to present living
arrangements, adjustment to decline in cognitive functioning, adjustment to new social roles,
adjustment to family, community and society by making obligations and adjustment to new
social relationships. According to Louw et al (1998) the above cited developmental tasks should
be accomplished successfully and these are more or less dependent upon how the previous
developmental tasks have been achieved that would in turn results in successful aging.
According to Strumpfer (2001) “successful aging will be associated with an individual’s ability
to live to an advanced age while holding on to the ability to function independently and remain
mentally alert”.
The lifespan approach is in the realm of other psychological approaches on aging, which
give some productive knowledge about human development. These comprise of
Erikson (1976), Peck (1968) and Levinson (1986) who all were involved in identifying various
psychosocial developmental responsibilities whereas Piaget (1972) was interested in the
cognitive development (Kimmel, 1974).
Erikson considered much popular and utilized theory, which was related to the old age. In
his theory there is a description of development, which starts from birth and ends with death.
This theory is very much related with components interconnected with old age.
4. Erikson’s Theory of Psychosocial Development
According to Erikson, the development of an individual depends upon heredity and environment,
which act concurrently. The inheritance refers to the development that occurs in each stage is in
congruence with specific age and manner. He talked about eight stages of mankind and called
them psychosocial stages. Each stage has some specific peculiar tasks which are to be
accomplished by interacting with society. Kimmel (1974) submitted that Erikson's first five
stages are like "the building blocks upon which success or failure in later life depends. Each
stage presents a new challenge, a new point of turbulence in the stream of life that must be
negotiated successfully”.
According to Erikson (1976) for every psychosocial stage the individual has to analyze the
solution keeping in view the two poles instead of only the positive or the negative. When he/she
achieves successfully he/she must go the next stage to get the solution. Erikson called the
sequence of his theoretical framework as ‘epigenetic’. The eighth psychosocial stages proposed
by Erikson have an importance at old age because it is related to the end of human life. The
seventh stage is related to middle age. According to Kleinke (1998) “the life task associated with
middle age is known as generativity versus stagnation. Generativity refers to “as being used to
express the desire of two mature people, who have found a satisfying mutuality in their
relationship, to combine their personalities and energies in the production and care of their
offspring" as compared to stagnation which is related to non- productivity. Erikson's (1976)
eighth psychosocial stage is called "ego integrity versus despair" which is of great significance to
the present study as it is related to old age. Ego- integrity is the resultant to the outcome or
successfully accomplishing the first seven stages which gives a meaning to life. Gerdes(1988)
recommended that "integrity is based on the belief that one's life has been meaningful… it
enables the individual to face death with greater equanimity, because what (has been) generated
in life will not be negated by death".
The Erikson's Theory has been criticized on the grounds that this theory cannot be either
be measured or replicated. This theory lacks scientificity which describes human development.
Though it deals with many psychosocial aspects of development yet it does not touch the
important aspects of development like cognition and emotions. In spite of the above criticism
this theory is widely documented as an important theory of human development. According to
Erikson (1963) the person who is maladjusted display anguish, hopelessness and discontentment
with their lives and often is afraid of death. The old people host a large number of difficulties in
their lives which have been underlined below.
LONELINESS
Loneliness is an individual and pessimistic trepidation related to an individual’s own
speculation of unsatisfactory social relations. Paplau and Perlman (1992) analysed 12 definitions
of loneliness and concluded three rudiments. Firstly, “loneliness is a result of deficiencies in a
person’s social relations. Secondly, it is a subjective feeling, not synonymous with isolation and
thirdly, the feeling is negative and unpleasant”. Due to degeneration and advancement in age, it
becomes difficult to keep pace with the younger generation. Moreover, they experience age-
related losses, which hamper the grip of social relationships. Their inability to participate in
cultural and community activities results in a higher incidence of loneliness. They feel neglected
and lonely as the family members on which they are dependent are pre- occupied with their own
lives and work. Loneliness is “an emotional and cognitive reaction to having fewer and less
satisfying relationships than one desires” (Archibald, Bartholomen and Marx, 1995). Loneliness
refers to a personal experience that what and how we feel about our interpersonal life. Loneliness
“reflects an individual’s subjective evaluation of his or her social participation or social isolation
and is the outcome of the cognitive evaluation of having a mismatch between the quantity and
quality of existing relationships on the one hand and relationship standards on the other” (de
Jong Gierveld, Fokkema, and van Tilburg, 2011). According to Victor (2012) “loneliness is a
dynamic state that varies across the life course and is influenced by the resources available to
individuals and their socio-environmental context as well as individual personality traits”.
It was found in a study accomplished in Netherlands that approximately 20 percent of its
population of elderly people were found to be mildly lonely and 8 to 10 percent of oldest old
were found to have severe loneliness (de Jong Gierveld et al. 2011). According to a report based
on UK population cited by Canada’s National Seniors Council (2014b) stated that about 5 to 16
percent of elderly people are believed to have loneliness. Additionally, it was also projected that
approximately 10 percent of the elderly population in the UK exhibit chronic level of loneliness.
In another study from UK also confirmed that “the prevalence of severe loneliness among older
people living in care homes is at least double that of community-dwelling populations” (Victor
2012). Another study showed that, factors like presence of chronic diseases or physical
disabilities, use of medications regularly, lack of hobbies and living with a spouse were
associated with increased feelings of loneliness among the elderly (Arslantas, Adana,
Abacigilergin, Kayar and Acar (2015). Parikh (2013) in a prominent and leading newspaper
‘Hindustan Times’ reported that 34% of old people in India feel loneliness, 26% of old people
have the feelings of emptiness and about 67% of the elderly people need assistance to deal with
their daily routine.
Most researchers agree upon that feeling lonely is not the same as being alone. One can
expend longer periods of time without the company of others without having the feeling of
loneliness and on the contrary one can feel lonely in the company of others. In reality, studies
have shown that one can not differentiate the lonely and non-lonely people on the basis of
amount of their social interactions rather it can be differentiated on the basis of quality of social
networks. Sometimes it has been observed that alone person can spend his time more with
unknown people rather than with friends and family. Loneliness is an unavoidable state of being
which refers to the incapability to retain the level of associations one wants to have. Loneliness
is a personal and subjective feeling of being lost, uninvited, discontinuance, disengaged and
detached and estranged from other people. The lonely person may have the feeling of pain in the
form of sadness, gloominess, depression, sorrow, emptiness. Such people may feel no sense of
direction, no person to praise to or support to, no sense of identity and no sense of affiliation.
They persistently feel that they are being abandoned, secluded, isolated, desolated and deserted.
This type of feeling is beyond their control and may burst into tears exhibiting the signs of
helplessness, hopelessness and depression. Sometimes they wish to be dead and have constant
suicidal ideations.
Types of Loneliness
A large number of researchers focused on the classification of loneliness and divided it from
different point of view. First type of classification laid emphasis on the duration of loneliness and
divided it into two types i.e. short- term loneliness and long- term loneliness. Short-term
loneliness refers to a loneliness where an individual feels lonely. That means their loneliness is
short lived and for a short period of time but on the contrary long- term loneliness refers to a
loneliness that lasts for a longer period. With the increase in long- term loneliness there is a
drastic increase in comorbidity. It also increases the incidence of having depression and suicidal
ideations, which have the most debilitating, and devastating effects in the well-being in later life.
Based on above-mentioned typology loneliness can be classified as state loneliness and trait
loneliness. State loneliness is momentary and is contingent upon the circumstances in which an
individual is occupied. For example, a person has been transferred to a new place and there he is
not acquainted with anybody and the person is feeling lonely. This is called state loneliness.
Second type of categorization centered upon relationships as proposed by Weiss (1973). He
divided loneliness into major categories as emotional loneliness and social loneliness. Emotional
loneliness refers to the lack of emotional regard endowed with close relationships or the loss of
significant figure in one’s life. Death of near and dear ones, divorce and break up marriages are
the possible precursors of this kind of loneliness. The signs and symptoms of emotional
loneliness contain a feeling of nervousness, anxiety, a sense of complete isolation, cautious about
danger, risk and death, an inclination of misapprehending the antagonistic or loving intent of
others. On the other hand, social loneliness refers to the lack of appropriate social interactions
and contacts. “Weiss believed it to be about the absence of an engaging social network of
friends, co-workers, and members of their community” (de Jong Gierveld, Fokkema, and van
Tilburg 2011). For example some of the antecedents of social isolation include transfer,
retirement, shifting from one place to another, fired from job, being secluded by friends, family
members or peers, debarred, or to put in an old age home and a feeling of not belonging to a
community. The signs and symptoms of social loneliness can be thoughts of boredom, feelings
of impatience, uneasiness, restlessness, eccentricity and isolation. The affective components of
emotional loneliness are more or less more strong, unapproved and inappropriate than the
components of social loneliness. Weiss (1973) opined that emotional and social loneliness can
co-occur simultaneously or can co- exist independently. It has also been assumed that personality
of a person and his social networks also play an important role in the development of emotional
and social loneliness. “Lack or low levels of social relationships, discontent with the quality of
such relationships, or low levels of social engagement and participation are all linked to having
damaging effects on the quality of life for elderly persons (Victor et al. 2005). “Intense
loneliness is found to be more frequent in divorces, widows or widowers, individuals who are
living alone or in deprived areas, or those threatened with deteriorating health” (de Jong
Gierveld, Fokkema, and van Tilburg 2011).
The third type of classification is based on belief or judgment which pointed out two types
of loneliness as objective loneliness and subjective loneliness. Objective loneliness refers to a
pleasant experience that might be sought after an inspirational experience. This type of feeling is
created by the community or the society in which the person lives. Most elderly people who live
alone have been forced to do so. More than half of elderly population asserted that they have
been directed to do so and make them learn helplessness and make them to adapt that is why
most of the old people prefer to live alone but due to some constraints most prefer to live with
their children or families.

Loneliness among Elderly People

Loneliness is usually occurred in a large segment of elderly people in different types of
situations. According to Forbes (1996) “the elderly persons who experience loneliness comprise
of elderly married women, older people who live with married children, those living in
residential care or in sheltered housing, older people who are care-givers, and older immigrants,
particularly those who do not speak the language of their host country”. Holmén et al (2000)
found that “women reported both social and emotional loneliness significantly more than men
and older subjects in the older age group reported more frequent loneliness than their younger
counterparts as females survive to a greater age and live without a partner for longer than men”.
 Loneliness is a frequent and universal feeling among elderly persons. It may be
triggered by different reasons. The elderly persons experience loneliness when their relations
with adult children or family members are not cordial. The old people who hold very less social
interactions and those who are not in favour of keeping social relations with relatives and friends
experience strong feelings of loneliness. Those persons who keep themselves idle, who do not
indulge in any kind of recreational or pleasurable activities, who do not utilize their leisure time
properly and who do not use religious coping are being forced to have the feeling of loneliness.
This loneliness always accompanied by negative and suicidal thoughts and depression as
compared to the elderly persons who claim to be active in their recreational and leisure time.
They always indulge in some or the other activity and participate in social gatherings frequently.
They indulge themselves in household chores, visit to parks and religious places or a club for
retired people. The elderly people usually feel lonely when their children leave them for the good
with the result they experience ‘empty nest syndrome’. They anticipate their children to support
them when they fall sick or in other type of assistance. Next most important reason could be
retirement. After retirement, old people may have more free time which they are not able to
reschedule and they do not know how to spend it. Moreover, the pension impedes the potentials
of enjoying the time. People in some jobs used to cultivate social interactions among colleagues
and other professionals but after retirement, they have to give them up.

They also start feeling the fear of death. Research indicated that “the lack of
social network and social support are associated with increased loneliness, complicated grief,
poorer coping levels, lower levels of quality of life, increased levels of depression, poorer mental
health and decreased psychological well-being” (Fry, 2001).

DEPRESSION
Depression is a widespread but often non-documented or inefficiently treated state
among elderly people (Cindy and Helen 2011). According to Kim, Byeon, Kim, Endo, Akahosh
and Ogasawara (2009), “depression in elderly people is a widespread problem that is often not
diagnosed and frequently under treated. Depression can be associated with an increased risk of
incidence of dementia and ideation of suicide in the elderly” (Kim et al 2009). Generally
speaking depression is a mental illness which can affect both the mind and the body of an
individual and is a leading cause of disability, absence from place of work, diminished
productivity and elevated suicidal rates (National Institute of Mental Health, 2001).
 Depression is the most common psychiatric illness found in general practice
which is presented with depressed mood, lack of interest or happiness, diminished energy, guilt
feelings, feelings of worthlessness or hopelessness, disrupted pattern of sleep or appetite, and
reduced attentiveness. Additionally, depression frequently appears with the symptoms of anxiety.
These troubles become so persistent or intermittent that can lead to considerable deterioration in
person’s capability to take care of his or her routine roles and responsibilities and hinders his/her
performance. At its worst, in depression many people take extreme step of attempting or
committing suicide. “While depression is the leading cause of disability for both males and
females, the burden of depression is 50% higher for females than males. In fact, depression is the
leading cause of disease burden for women in both high-income and low- and middle-income
countries” (World Health Organization, 2008). It has been anticipated that “between 5 and 25%
of the population will experience depression at some point in their life and up to 15% of severely
depressed individuals will commit suicide” (Gotlib and Hammen, 1992).

The essential characteristic features of clinical depression are gloomy mood and
diminished interest and enjoyment in day-to-day activities. The persons with depression may
have the feelings of sadness, emptiness, hopelessness, personal dissatisfaction, negativity,
worthlessness, sluggishness and sometimes heaviness. They usually experience loss of appetite
and weight. Besides this, they may have a negative or pessimistic attitude about everything. The
eating and sleeping patterns of these people usually change, sometimes they eat a lot and
sometimes they do not feel like eating at all. They suffer from sleep disturbances like insomnia
and sometimes hypersomnia. The psychomotor activities in these persons vary like sometimes
they get agitated and sometimes their psychomotor activity slows down. They have a strong
feeling of guilt and shame and for that matter, they sometimes try to commit suicide. Because of
extreme guilt or worthlessness at times, they end up their lives. They are preoccupied with their
failures and wrong doings and feel that they are inadequate and incompetent and because of this
reason, they make silly mistakes in life. They hold themselves responsible for every mistake or
wrong deed. They also may have an impractical feeling of personal liability and view most of the
things as being their own fault. Moreover, they tend to have the feeling of drained energy,
tiredness and fatigue.

Depression has a propensity to be prevalent more among people who are unmarried,
widowed, divorced or separated, or without social networking or are living without families or
living in institutions, are issueless and are aged. The elderly people having physical or medical
difficulties with degeneration experience higher degree of having depression. The elderly people
who live alone and do not have financial back up report more signs of depression. In an Indian
study, “about16% of depressed subjects with suicidal ideation had a suicidal attempt and risk
was especially higher for individuals less than 30 years of age, single men, married women,
students and those with higher education” (Srivastava and Kumar, 2005). Depression can differ
in degree of mild, moderate or severe which usually depends upon the quantity and severity of
depressive symptoms. Most of the persons with severe depression may probably have
unjustifiable and unacceptable guilt feelings or other psychotic symptoms like hallucinations,
delusions, paranoia, etc.

According to Sadock, Kaplan and Sadock (2007), “a good prognosis may be indicated by
milder episodes, good social support, stable familial and social functioning before onset of
depression, absence of a comorbid medical or psychiatric disorder, while patients with a younger
age of onset, co-existing medical illness, substance use or anxiety disorder, multiple episodes or
poor functioning in the premorbid period are likely to have a poorer prognosis”.

Theories of Depression
1. Behavioural Theory of Depression
Lewinsohn (1974) contended that “depression is caused by a combination of stressors in
a person's environment and a lack of personal skills”. More exclusively, the environmental
stressors can make a person to obtain relatively less positive reinforcement. The positive
reinforcement arises when people do something from which they receive pleasure and reward.
According to learning theory, “receiving positive reinforcement increases the chances that people
will repeat the sorts of actions they have taken that led them to receive that reinforcement. In
other words, people will tend to repeat those behaviors that get reinforced”. For example, many
people work with dedication and devotion in order to receive money or other perks or benefits.
Many children study hard to get high grades in class. These examples clearly show that working
and studying are behaviors that are motivated by perks or benefits and good grades respectively
are called the positive reinforcers. According to Lewinsohn, “people with depression are those
who do not know how to cope with the fact that they are no longer receiving positive
reinforcements like they were before”.

2. Beck’s Cognitive Theory of Depression

 Some theorists emphasized the role of cognitive processes in depression. This theory
was postulated by Beck in 1976 in which he talked about negative triad. According to him when
the primary symptoms are cured the secondary symptoms are resolved automatically. The triad
involves "automatic, spontaneous and seemingly uncontrollable negative thoughts”.

Figure 1.1: Beck’s Cognitive Triad

From figure 1.1 it can be understood on the basis of cognitive triad viewpoint that depression is
caused by person’s worthless negative analysis of themselves, their know-how (and the world in
general), and their future. Persons with depression often perceive themselves as un adorable,
vulnerable, destined or incomplete. They have a tendency to attribute their unlikable experiences to
their acknowledged physical, mental, and/or moral insufficiencies. They experience extreme guilt,
believing that they are useless, at fault, and redundant by self and others. They tend to have a
complicated time perceiving themselves as people who could never accomplish something, not
acknowledged, or feel inferior about themselves which in turn may lead to abandonment, loneliness
and social isolation, which further deteriorates the mood. Cognitive behavioral theorists suggest that
depression results from distorted thoughts and judgments. These can be learned socially as is the case
when children in a dysfunctional family watch their parents fail to successfully cope with stressful
experiences or traumatic events. Or, they ca n result from a lack of experiences that would lead to the
development of adaptive coping skills.

3. Social Cognitive Theory of Depression

 Albert Bandura (1986) in social cognitive theory (SCT) pointed out that individuals are
produced by the communications between their behaviors, thoughts and environment. Human
behavior is totally explained by a product of learning which is through observation, as well as
through direct experience. Bandura emphasized that the self- concepts are different for people
with depression and people without depression. Those individuals who are in depression have a
tendency to blame themselves and hold accountable completely for every misdeed by self
blaming. In addition to that, they feel that success is caused by external factors, which are
beyond their control. People with depression experience low self-efficacy as they think that they
do not have the ability to influence the circumstances. These individuals also have a faulty
hypercritical process, they have a tendency to lay down their personal aims too high, and when
they are not able to achieve them they fall short of them. These kinds of repeated failures
produce the dejected feelings which in turn lead to depression.

4. Learned Helplessness Theory of Depression

Learned Helplessness theory was postulated by Seligman (1975) in which he contended that
individuals having depression are more likely to use a pessimistic justification when confronting
stressful events than did individuals who were not having depression. On the contrary the
individuals not having depression are more likely to use an optimistic explanation when facing
some stressful events. The individuals who have a tendency to analyze the causes of negative
events as ‘internal, global, and stable’ are supposed to have a pessimistic style whereas the
individuals who have a tendency to perceive the causes of negative events as ‘external, specific,
and unstable’ have an optimistic style. Individuals who become depressed are more likely to
have pessimistic styles than optimistic styles. Furthermore the revised version of this theory
suggested that the individuals with a pessimistic style are more likely to develop learned
helplessness in them. Additionally, constant experience with unmanageable and unpreventable
events can lead individuals to develop a pessimistic style. They become unenthusiastic and
unresponsive even if they are not that way to start. This theory further suggests that depression is
not the outcome of helplessness only, but it also derives from hopelessness. “The hopelessness
theory attributes depression to a pattern of negative thinking in which people blame themselves
for negative life events, view the causes of those events as permanent, and over generalize
specific weaknesses to many areas of their life”.

4. Diathesis-Stress Model of Depression

 The diathesis-stress model was proposed by Monroe and Simons (1991) suggested two
general factors that give rise to depression. First of these factors is a negative life event. These
life events characteristically include the loss of some significant source of love, safety,
identification, or self-respect. The examples can be death of a near and dear one, the breakup of a
love affair, or an important personal failure. This model can be explained in fig 1.2.

Genetics
Predisposition

Depressive
Reaction

Environmental
Stressors

Figure 1.2: Representation of Diathesis-Stress Model of Depression

Figure 1.2 depicts that a depressive reaction takes place when a person experiences a negative
life event. Besides negative life event, this depressive thought is accompanied by feelings of
hopelessness and/or worthlessness. The figure also indicates the dotted lines, which suggest that
this depressive reaction or thought may last for a short period and may resolve rapidly or it may
convert into a long- term depressive episode. This further has guided to ponder upon certain
variables that verify who turns out to be depressed when experience stress and who does not.
These variables are formally called ‘diatheses’. A diathesis is a susceptible factor that can relate
how much harm a stressful experience generates. It has been sorted out to recognize variables
with which people turn out to be depressed when confronted with a stressful experience.

Depression among Elderly People

 Depression is a public health problem, which is more prevalent among elderly people.
Depression in old age is more frequently related to significant physical, psychological and
cognitive impairment, which influence the functional deficit and disability. Due to such
conditions their well being and quality of life decrease which in turn result into having the
feelings of helplessness, hopelessness and worthlessness. This may further “increase the rate of
suicide, increase use of health care services and expenses and can result in early death and
disturbance in the general state of wellness” (Serby and Yu, 2003). Loneliness as another major
concern is associated with poor quality of life and well-being confronted by elderly people. They
are at higher at risk for loneliness as there are certain disturbances in their social life. Adult
children move out on the pretext of their jobs or assignments another city or country leaving
them behind to look after them independently. This type of ‘empty nest syndrome’ makes them
feel lonely, helpless and depressed. Even after retirement, the social relationships and
interactions reduce which make them constricted and confined to limited social circle. Leaving
the locality or home in which they stayed for most of their life is quite difficult. They find it
difficult to transit as sometimes they have to move to a smaller accommodation and had to
sacrifice many things, which make them helpless. After retirement the financial crisis usually
starts and sometimes-elderly have to literally beg to their children in order to meet their daily
needs making them dependent, weak, reliant and helpless. Disability, impairment, infirmity,
immobility or ill health may prevent them from taking part in normal activities with others. This
results in loss of independence which is required to keep in touch with friends, relatives, familiar
people and communities.

Lack of social support in the form of family members mainly children makes more
vulnerable to depression. Bereavement is another issue in which the aged people experience
helplessness. The loss of spouse amongst them is the chief irreparable loss which shatters them
to be in the condition of depression. Spousal bereavement is very distressing, life-changing event
which becomes more prominent in advancing age. “Some elderly women experience the onset of
depressive symptoms during a spouses terminal illness phase with symptoms persisting through
the first year following the spouse’s death” (Stek, Vinkers and Gussekloo, 2005; Barg, Huss-
Ashmore and Wittink, 2006). Sometimes it also happens that due to economic dependence the
elderly have been exploited, maltreated, oppressed and subjugated. This leaves them in a
helpless, susceptible, pathetic and vulnerable condition. And they really have to beg to their
children or relatives for their daily needs.

Single and unmarried elderly people face with triple jeopardy like the old age, functional
disability and impairment, and lack of companionship. According to Pinquart (2003) concluded
that the “functional status affected unmarried older individuals more than married peers because
partnership was an effective coping strategy of married couples. Seniors with functional
restrictions may depend more on others for care and support, so they are more likely to
experience social support deficits, especially when they withdraw from social life not to be a
burden for others”. Hence tend to have more depressive feelings. The effect of childlessness on
depression has also been presented in many studies. The elderly who do not have any children
throughout their life repent for the curse or deeds of their previous life do not maintain a good
quality of life. They always have and had a feeling of incompleteness in their life. This feeling of
incompleteness becomes aggravated when they enter the old age and when they need some
significant support for their personal care and other emotional needs leaving them with no option
but to have the feelings of helplessness and depression.

Elderly people who are engaged in high levels of self caregiving, such as working all the day
taking care of their own physical or mental health, can lead to isolation, stress or depression.
Aged persons who live alone in community sometimes have to face hurdles related to
transportation when they are supposed to visit hospitals and clinics or to some social events
making them helpless and depressed. Moreover lack of autonomy is another important variable
which plays significant role in developing depressive thoughts in older people. When they were
in their youth they used to take decisions for all family and other matters which have been taken
away from them making them feel depressed. The discrepancy between ‘what the children do
and what the parents expect from them’ is another potential reason for the parents to have
depressive feelings. Sometimes it happens that the parents build up the reputation from continual
labour of years and the children do not hesitate to shatter the name and fame of their parents by
indulging in antisocial activities, or the child does not come up to the expectation of parents.
Another possibility of elderly to have depressive thoughts when their child is born with multiple
disabilities, they are under extreme stress and anxiety that how the situation can be handled
because due to their age, immobility or other physical difficulties they themselves are not able to
manage themselves then what to talk about the management and caregiving of their child with
disabilities. Moreover, they are more worried about the future of such children that who will take
care of them, hence tend to have depression and anxiety.