Beyond the individual: Household activity of daily living limitations, urban-rural residence, and mental health.

Activity of daily living (ADL) limitations, such as difficulty walking or dressing, are increasing as populations age and experience more chronic conditions. To understand the scope of ADLs and make interventions more effective, it is important to examine ADLs beyond the individual to other levels and contexts, such as the household. Thus, using household and individual level survey data in India, we assess how household ADLs relate to the mental health of others in the household. We find that around 40 % of households have at least one resident with an ADL limitation, with ADL limitations more likely in households that are in rural areas, have older residents, and are socioeconomically disadvantaged. Household ADL limitations are associated with increased symptoms of depression and anxiety with the relation varying by the number of household members with an ADL limitation. For adults, having any household member with an ADL limitation is associated with increased mental health symptomology, whereas for young adults, this association only appears for those with multiple household members with an ADL limitation. Further, we find that the relation between household ADL limitations and mental health is stronger for those living in rural areas compared to urban areas. That is, when comparing individuals with the same number of household members with ADL limitations, predicted mental health symptomology is higher for those living in rural areas than for those in urban areas. These findings suggest the need for household centered accommodations and supports that consider the social and environmental context.