Impact of migration status on incidence of depression in the middle-aged and elderly population in China: Exploring healthy migrant and salmon bias hypotheses from a mental health perspective

The determinants of mental health inequalities between Chinese migrants and non-migrants during the Shanghai 2022 lockdown: a Blinder-Oaxaca decomposition

BACKGROUND

The mental health inequality between migrants and non-migrants was exacerbated by the COVID-19 pandemic. Identifying key determinants of this inequality is essential in promoting health equity.

METHODS

This cross-sectional study recruited Shanghai residents by purposive sampling during the city-wide lockdown (from April 29 to June 1, 2022) using an online questionnaire. Migration statuses (non-migrants, permanent migrants, and temporary migrants) were identified by migration experience and by household registration in Shanghai. Mental health symptoms (depression, anxiety, loneliness, and problematic anger) were assessed by self-report scales. The nonlinear Blinder-Oaxaca decomposition was used to quantify mental health inequality (i.e., differences in predicted probabilities between migration groups) and the contribution of expected correlates (i.e., change in predicted probability associated with variation in the correlate divided by the group difference).

RESULTS

The study included 2738 participants (771 [28.2%] non-migrants; 389 [14.2%] permanent migrants; 1578 [57.6%] temporary migrants). We found inequalities in depression (7.1%) and problematic anger (7.8%) between permanent migrants and non-migrants, and inequalities in anxiety (7.3%) and loneliness (11.3%) between temporary migrants and non-migrants. When comparing permanent migrants and non-migrants, age and social capital explained 12.7% and 17.1% of the inequality in depression, and 13.3% and 21.4% of the inequality in problematic anger. Between temporary migrants and non-migrants, age and social capital also significantly contributed to anxiety inequality (23.0% and 18.2%) and loneliness inequality (26.5% and 16.3%), while monthly household income (20.4%) and loss of monthly household income (34.0%) contributed the most to anxiety inequality.

CONCLUSIONS

Significant inequalities in depression and problematic anger among permanent migrants and inequalities in anxiety and loneliness among temporary migrants were observed. Strengthening social capital and economic security can aid in public health emergency preparedness and promote mental health equity among migrant populations.

Applying Kumpfer's resilience framework to understand the social adaptation process of the trailing parents in China

BACKGROUND

Trailing parents, a distinct group emerging from China's rapid social change and urbanization, are experiencing migration in old age, posing challenges for their social adaptation. Existing research has mainly focused on the hardships faced by this group, but few studies have focused on how they cope with change and achieve some degree of successful social adaptation. This study aimed to understand the coping and social adaptation process of trailing parents in China.

METHODS

This study used a qualitative research approach. A total of 24 trailing parents were invited to participate in a semi-structured interview and share their experiences and efforts to cope with the many challenges. Kumpfer's resilience framework was used as the theoretical framework for the study design, data collection, and data analysis.

RESULTS

This study identified several intra-family and community stressors that trailing parents may face when moving to a new environment and uncovered five key resilience characteristics that may be triggered or fostered in the presence of these stressors, including physical fitness, psychological stability, open-mindedness, learning ability, and nurturing hobbies. Individuals with resilience traits have been observed to engage in positive cognitive processing and transform the new environment. Consistent with Kumpfer's resilience framework, this study revealed the dynamics of the stressors faced by trailing parents in the new environments, the role of resilience characteristics, and the critical influence of social support in shaping the interplay between the individual and the environment that enabled them to adapt positively.

CONCLUSIONS

This study highlights the importance of fostering resilience traits and leveraging positive coping mechanisms to facilitate a smoother adaptation process for trailing parents. Meanwhile, there is an urgent need to focus on creating opportunities that strengthen their social support networks.

Trajectories of psychological adaptation to Chinese older internal migrants: a latent transition model

OBJECTIVES

Little is known about the heterogeneity and transitions between psychological adaptation patterns in Chinese older internal migrants. This study addressed two questions: (a) Do distinct patterns of psychological adaptation exist among Chinese older internal migrants? (b) If so, what factors predict different trajectories?

METHOD

The study drew on two waves of data and involved 405 older internal migrants into Nanjing, China. First, a latent transition analysis was performed to visualize the different patterns of psychological adaptation. Second, an ecological model of resilience was used to identify the factors explaining the differences between adaptation patterns.

RESULTS

Three main trajectories of psychological adaptation among Chinese older internal migrants over time were: recovery, stability and deterioration. Adaptation trajectories were associated with age, gender, length of stay, psychological resilience, self-esteem, family support, social participation, and living with a spouse.

CONCLUSION

Chinese older internal migrants undertake heterogeneous psychological adaptation trajectories, and their positive adaptation is closely associated with coping resources. Our data may provide references for the identification of vulnerable older internal migrants, as well as the making of targeted interventions.

A comparative study of health outcomes between elderly Migrant and non-migrant population in India: Exploring health disparities through propensity score matching

Migrants constitute a vulnerable segment of the population, particularly susceptible to various health challenges. Despite this, limited research has delved into the comparative health statuses of migrants and non-migrants in the rising elderly population. This study aims to bridge this gap by exploring health disparities between these two groups. Leveraging data from a nationally representative, large-scale Longitudinal Ageing Study in India (LASI) survey (n = 29002; 3103 Migrants and 25899 Non-migrants), this research focuses on four health indicators: self-rated health (SRH), depression, multimorbidity, and functional limitations. The study undertakes descriptive and bivariate analyses for migrant and non-migrant groups and employs propensity score matching techniques to fulfil its objectives. The findings reveal that for respective migrant and non-migrant populations, the prevalence of poor-SRH was 24.04 % and 16.29 %; depression was 12.32 % and 6.62 %; multimorbidity was 26.78 % and 15.71 %, and functional limitation was 28.35 % and 23.13 %. The study uncovers a 2.4 percentage point increase in poor self-rated health, a 1.0 percentage point rise in depression, and notably, a 4.2 and 1.0 percentage point elevation in multimorbidity and functional limitations among migrants relative to non-migrants. Evident from the outcomes is a stark health disparity, emphasising migrants' heightened vulnerability across multiple health dimensions. The implication of this research highlights the necessity for policy interventions aimed at eliminating health inequalities between migrant and non-migrant populations.

A novel online training programme for healthcare professionals caring for older adults

The proportion of older people in the world population is growing rapidly. Training and retaining healthcare professionals in sufficient numbers in the field of ageing represents a major challenge for the future, to deal with the healthcare needs of this ageing population. The COVID pandemic has unfortunately compounded shortages of healthcare workers worldwide. There is therefore a pressing need to scale-up the education of healthcare professionals in geriatrics and gerontology. Over the last 30 years, a group of motivated geriatrics physicians from Europe have been striving to educate healthcare professionals in geriatrics and gerontology through various initiatives, and using innovative pedagogic approaches to train physicians, nurses and other healthcare professionals around the world. The COVID-19 pandemic unfortunately put a stop to presence-based training programmes, but prompted the development of the online International Association of Gerontology and Geriatrics (IAGG) eTRIGGER (e-Training In Geriatrics and GERontology) course, a new training course in geriatrics and gerontology for healthcare professionals from a wide range of backgrounds. We outline here the history of the educational initiatives that have culminated in the roll-out of this new programme, and the perspectives for the future.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 2022 Lockdown: A cross-sectional study

BACKGROUND

Common mental disorders and suicidal ideation are associated with exposures to COVID-19 pandemic stressors, including lockdown. Limited data is available on the effect of city-wide lockdowns on population mental health. In April 2022, Shanghai entered a city-wide lockdown that sealed 24 million residents in their homes or residential compounds. The rapid initiation of the lockdown disrupted food systems, spurred economic losses, and widespread fear. The associated mental health effects of a lockdown of this magnitude are largely unknown. The purpose of this study is to estimate the prevalence of depression, anxiety, and suicidal ideation during this unprecedented lockdown.

METHODS

In this cross-sectional study, data were obtained via purposive sampling across 16 districts in Shanghai. Online surveys were distributed between April 29 and June 1, 2022. All participants were physically present and residents of Shanghai during the lockdown. Logistic regression was used to estimate the associations between lockdown-related stressors and study outcomes, adjusting for covariates.

FINDINGS

A total of 3230 Shanghai residents who personally experienced the lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on ASQ. The prevalence of all outcomes was higher among younger adults, single people, lower income earners, migrants, those in poor health, and with a previous psychiatric diagnosis or suicide attempt. The odds of depression and anxiety were associated with job loss, income loss, and lockdown-related fear. Higher odds of anxiety and suicidal ideation were associated with being in close contact with a COVID-19 case. Moderate food insecurity was reported by 1731 (51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food insecurity was associated with a >3-fold increase in the odds of screening for depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); severe food insecurity was associated with >5-fold increased odds for depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to being food secure.

INTERPRETATION

Lockdown stressors, including food insecurity, job and income loss, and lockdown-related fears, were associated with increased odds of mental health outcomes. COVID-19 elimination strategies including lockdowns should be balanced against the effects on population wellbeing. Strategies to avoid unneeded lockdown, and policies that can strengthen food systems and protect against economic shocks are needed.

FUNDING

Funding was provided by the NYU Shanghai Center for Global Health Equity.

Voting with Your Feet: The Impact of Urban Public Health Service Accessibility on the Permanent Migration Intentions of Rural Migrants in China

The accessibility of urban public health services is not only relevant to the health status of rural migrants but also plays an increasingly important role in their migration decisions. Most existing studies have focused on the effects of the level of public health service provision and parity on rural migrants' migration behavior, ignoring the role of public health service accessibility. This paper systematically examines the overall impact, heterogeneous impact and mechanism of action of public health service accessibility on rural migrants' intentions to migrate permanently based on data from the 2017 China Mobile Population Dynamics Monitoring Survey using probit, IVprobit, eprobit, omitted variable test model and KHB mediating effect model. It was found that: (1) public health service accessibility significantly increased rural migrants' intentions to migrate permanently, and the results remained robust after using instrumental variables to mitigate endogeneity problems and omitted variable tests. (2) Heterogeneity analysis shows that public health service accessibility has a greater effect on enhancing the intentions to migrate permanently among females and rural migrants born in 1980 and later. (3) Further mechanism testing revealed that public health service accessibility could indirectly increase rural migrants' intentions to migrate permanently by improving health habits, health status, identity, and social integration, with identity playing a greater indirect effect. The findings of this paper not only provide empirical evidence for the existence of Tiebout's "voting with your feet" mechanism in China but also contribute to the scientific understanding of the role of equalization of public health services in the process of population migration.