Spousal bereavement and depression: Testing moderating effects of pre-loss circumstances and social support in India.

Widowhood represents a critical life transition with profound implications for mental health, yet causal evidence from low and middle income countries (LMICs) remains scarce. This gap is particularly acute in contexts like India, where population ageing is accelerating rapidly, and traditional family support systems are evolving. The causal effect of spousal loss on depression is estimated using panel data from India's Longitudinal Ageing Study (LASI) and doubly robust difference-in-differences (DRDID) estimation. Depression trajectories were compared between 343 older adults who experienced widowhood and 2305 married controls (sample mean age 65 years 2 months), adjusted for baseline characteristics. Widowhood increases depressive symptoms by 1.07 CES-D points, representing an 11% increase relative to baseline. The effects vary substantially by characteristics of the loss and social context. Individuals who lost healthy spouses experienced significantly greater mental health deterioration compared to those whose spouses were chronically ill, suggesting that sudden, unexpected loss generates more severe psychological consequences than anticipated bereavement. The findings also show larger effects among socially isolated individuals, though this difference does not reach conventional significance levels. Interestingly, even socially connected individuals show substantial effects, indicating that spousal relationships provide unique mental health benefits that cannot be fully replaced by other social ties. These findings have important implications for targeting bereavement, support interventions in ageing populations and provide supportive evidence for the identification strategy by demonstrating effect patterns inconsistent with anticipatory grief bias.