Abstract

Objectives
This study aimed to explore the role of community-level social welfare expenditures in depressive symptoms among older adults, with a particular focus on living arrangements.
Methods
Multi-level data—comprising individual-level data from the 2019 Community Health Survey and regional-level data from the Korean Statistical Information Service—were analyzed using multi-level ordered logistic regression. The dependent variable was the severity of depressive symptoms as measured by the PHQ-9 score, and the primary independent variables were per capita social welfare expenditure, living arrangements, and their cross-level interaction term.
Results
Older adults living alone exhibited more severe depressive symptoms compared to those living with others (odds ratio [OR]=1.218, p=0.006). Higher community social welfare expenditure was significantly associated with reduced depressive symptom severity (OR=0.729, p=0.019). Moreover, the protective effect of social welfare expenditure was more pronounced among older adults living alone than among those not living alone (OR=0.922, p=0.046). Social welfare expenditure was highly correlated with social cohesion, which weakened its independent association with depressive symptoms.
Conclusions
This study highlights the potential of community-level social welfare expenditure to mitigate depressive symptoms among older adults, particularly those who live alone. In light of the rising number of older adults living alone, these findings suggest that non-medical interventions, such as enhanced social welfare programs, may help alleviate depression in this vulnerable population. The strong positive correlation between social welfare expenditure and social cohesion also raises further research questions regarding their interrelationship.

• Keywords: Depressive symptoms; Aged; Living arrangement; Social welfare; Multi-level analysis