Fear of Falling, Anxiety, and Depressive Symptoms Among Older Adults in Bangladesh: Prevalence, Correlates, and Mediation Pathways.

Fear of falling (FoF) is a common psychological burden among older adults, while FoF is closely linked to heightened anxiety and depressive symptoms, yet evidence from Bangladesh and South Asia remains inadequate. This study examined the mediated relationship between FoF, anxiety, and depressive symptoms among older adults in Bangladesh. A community-based cross-sectional survey was conducted with 251 participants using face-to-face structured interviews. Validated tools included the Falls Efficacy Scale-International (FES-I-16), Geriatric Depression Scale (GDS-15), and Generalized Anxiety Disorder Scale (GAD-7). Statistical analyses comprise descriptive statistics, analysis of variance (ANOVA) with effect size estimation, linear regression, and mediation analyses using bias-corrected bootstrapping. The mean age of the older adults was 70.19 years, ranging from 60 to 85. A substantial proportion of participants (72.3%) reported having high concern about falling. Anxiety symptoms were more evenly distributed (33.9% minimal/mild, 26.3% moderate, and 39.8% high), while depressive symptoms were largely mild (57.8%), with fewer moderate (26.3%) and severe (15.9%) cases. Mediation analysis showed a significant total effect of FoF on depressive symptoms (β = 0.615, p  < 0.001). Anxiety symptoms partially mediated this relationship (indirect effect, β = 0.215, p  < 0.001), accounting for an about 35% of the total effect, while the direct effect remained significant (β = 0.400, p  < 0.001). FoF was directly associated with anxiety symptoms (β = 0.471, p  < 0.001), which in turn were positively associated with depressive symptoms (β = 0.457, p  < 0.001). Findings highlight FoF as a critical psychosocial factor associated with older mental health in Bangladesh. Integrating fall-prevention strategies with psychosocial interventions may reduce anxiety and depressive symptoms, underscoring the need for context-sensitive strategies in older populations.