A syndemic perspective to understanding the intersection of self-directed ageism and depression in older adults: structural determinants and policy implications in Africa

Africa’s aging population is growing at an unprecedented rate, bringing with it profound social, political, and economic challenges. Underneath this demographic shift lies a silent but widespread issue:self-directed ageism (SDA) -the type of ageism mostly linked to poor health outcomes. SDA is more prevalent in low-income settings which characterise many African countries. While extensively studied, its drivers and impact within the unique African context remain largely unexplored. Using a syndemic framework, we conceptually analyze the intersection between SDA and depression, framing their interaction as a mutually reinforcing cycle influenced by deeply rooted systemic issues: SDA manifests as distortions in thinking patterns that result in feelings of hopelessness, worthlessness, and low self-esteem -key symptoms of depression, while depression, in turn, reinforces SDA through cognitive decline that makes negative aging stereotypes difficult to challenge. The proposed conceptual SDA-Depression Syndemic Synergy Framework highlights the cognitive, behavioral, and physiological pathways through which these conditions may interact to worsen health outcomes for older adults. By shifting the focus from individual risk factors to systemic level drivers, this article highlights the need for urgent research, policy, and practice interventions. Strategies such as integrating mental health into primary healthcare, expanding social protection schemes, promoting age-inclusive media representation and digital technology, and encouraging intergenerational engagement are critical to addressing the root causes. As older adults become a prominent feature across various African settings in the coming years, it is important to tackle this syndemic to improve the aging experience and redefine aging well.