Neighborhood, social cohesion, and the Elderly's depression in Shanghai

Effect of social participation on the trajectories of activities of daily living disability among community-dwelling older adults: a 7-year community-based cohort

INTRODUCTION

Studies examining the effects of social participation on activities of daily living (ADL) disability are still scarce.

AIM

To assess the reciprocal relationship between ADL disability trajectories and social participation among older Chinese people aged ≥ 60 years.

METHODS

This study included 2976 participants aged ≥ 60 years in six waves of a community-based survey from 2015 to 2022. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were used to assess the ADL disability in each survey. Social participation was assessed by involvement in four social activities and an extensive social participation score. Group-based trajectory modeling was used to identify potential heterogeneity in longitudinal changes over 7 years and explore associations between baseline predictors of group membership and these trajectories.

RESULTS

Two BADL disability trajectories were identified: stable (94.8%) and increase (5.2%). Additionally, three IADL disability trajectories were distinguished: stable (73.2%), moderate (20.2%), and increase (6.6%). After controlling for the potential covariates, each point increase in the extensive social participation score correlated with a 17% decrease in the odds of older individuals belonging to the increase BADL trajectory group (OR = 0.83, 95% CI = 0.68-1.00). For IADL, it decreased the odds of being assigned to the moderate trajectory group by 16% (OR = 0.84, 95% CI = 0.75-0.95) and to the increase trajectory group by 23% (OR = 0.77, 95% CI = 0.64-0.93).

CONCLUSIONS

Higher levels of social participation among older individuals were more likely to be classified as stable trajectories in both BADL and IADL. Increased participation in social activities by community-dwelling elderly adults may promote healthy aging.

Individual-level community-based social capital and depressive symptoms among older adults in urban China: the moderating effects of socioeconomic status

OBJECTIVES

This study aimed to examine the moderating role of socioeconomic status in the association between community-based social capital-based on individual-level cognitive and structural social capital-and depressive symptoms among older adults in urban China.

METHODS

Data were collected in 2020 through a community survey of 800 respondents aged 60 years and older living in Shijiazhuang and Tianjin. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Multiple-group analyses were conducted to analyze the data.

RESULTS

Measurement models of cognitive social capital and structural social capital were established. Measurement invariance was established across different socioeconomic groups. Additionally, socioeconomic status significantly moderated the association between social capital and depressive symptoms. The association between cognitive social capital and depressive symptoms was statistically significant among respondents with relatively low incomes and high levels of education, whereas the association between structural social capital and depressive symptoms was significant only among those with relatively high incomes.

CONCLUSION

Future social capital policies and interventions should adopt different strategies to provide services to older adults from different socioeconomic backgrounds. Furthermore, educational programs should promote the effects of cognitive social capital on depressive symptoms later in life.

Urban-rural differences in key factors of depressive symptoms among Chinese older adults based on random forest model

BACKGROUND

Depression is a major challenge in the global healthy aging process, and exploring the key factors of depression in urban and rural older adults is essential for differentiated and precise interventions.

OBJECTIVE

To explore the urban-rural differences and key influencing factors of depressive symptoms among Chinese older adults.

METHODS

The data of 5267 older adults were obtained from the China Health and Retirement Longitudinal Survey (CHARLS2018). Random forest model and logistic regression were used to analyze the key factors influencing depressive symptoms 19 variables.

RESULTS

The detection rate of depressive symptoms in older adults was 31.0 %, with 22.3 % and 34.8 % in urban and rural areas, respectively. Education, self-rated health, self-rated pain, and self-rated vision were common factors. Physical activity (OR = 0.716 for Moderate PA), social activity (OR = 0.671 for social activity), and self-rated hearing (OR = 0.602 for good) were key factors specific to urban older adults, and alcohol consumption (OR = 0.716 for drinking more than once a month) and marital status (OR = 0.689 for cohabitation) were key factors specific to depressive symptoms in rural older adults (all P < 0.05).

LIMITATION

Cross-sectional data cannot reflect dynamic processes among variables; The cultural background might affect the cross-cultural validity of the study.

CONCLUSION

The key factors of depressive symptoms among older adults in urban and rural areas differed, which provides priority and references for differential prevention and precise intervention of depressive symptoms to promote the process of healthy aging.

Characterization of soundscape assessment in outdoor public spaces of urban high-rise residential communitiesa)

Soundscape perceptual models were developed in various contexts. However, as the outdoor public space in high-rise residential communities differs in terms of space planning and management, the soundscape perceptual characteristics are still unclear. In this study, an on-site survey was conducted to obtain the perceptual dimensions of soundscape in outdoor public spaces in urban high-rise residential communities based on evaluations of residents. Meantime, the soundscape of the space in different community layouts were compared. It was found that: (1) Four dimensions of outdoor soundscape in high-rise communities were extracted, namely Relaxation, Communication, Quietness, and Spatiality. The first three dimensions were positively correlated with overall soundscape satisfaction significantly. (2) Relaxation was mostly correlated with dominance of noise; Communication and Quietness were primarily related to sounds from human beings. (3) Lower traffic noise and higher levels of human sounds were perceived in enclosed communities, resulting in higher Relaxation and lower Quietness scores in outdoor public spaces in enclosed communities than non-enclosed ones. These findings evoke insights into the understanding of soundscape assessment in different contexts, and provide implications for sound environment design in urban high-rise communities.

The relationship between frailty, walking ability, and depression in elderly Chinese people

To explore the relationship between depression symptoms, frailty, and walking ability in Chinese elderly people, and to provide new evidence for research on the prevention and treatment of depression in Chinese elderly people. The data of this study is sourced from the 2018 CHARLS data (China Health and Retirement Longitudinal Study). Z-test, logistic regression, and linear stratified regression were used to analyze the walking ability, frailty, and depressive symptoms of 2927 participants. Good walking ability and non frailty were significantly negatively correlated with depression symptoms in the elderly (P < .05). This important negative association persists even after adjusting for demographic, health condition, and lifestyle factors. (P < .05). Elderly women are at a higher risk of developing depression than men, while elderly people with good walking ability and no frailty are at a lower risk of developing depression. At the same time, elderly people with disabilities, hypertension, arthritis, and low levels of physical activity are more likely to experience depressive symptoms. It is recommended that elderly people pay attention to maintaining walking ability and avoiding frailty to reduce the risk of depression.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

An analysis of the influencing factors of depression in older adults under the home care model

Objectives

To explore and analyze the influencing factors of depression in older adults living at home, so as to propose suggestions for improving the quality of older adults living at home.

Methods

We conducted a cross-sectional study on 498 older adults living at home based on questionnaire survey on the general information, daily living ability, health status, and care perception (including self-care, care for cohabitants, and care for non-cohabitants) of older adults living at home, as well as their willingness to help each other, and analyzed the influencing factors of depression among older adults living at home.

Results

The results showed a willingness to help older adults, self-care, and total activities of daily living (ADL), health status was an influential factor for depression in older adults (p < 0.05).

Conclusion

It aims to take targeted measures, such as encouraging older adults at home to actively participate in mutual assistance activities for older adults and care for themselves, so as to prevent and reduce the occurrence of depression in older adults.

Social determinants of health and gender differences in depression among adults: A cohort study

The role of social determinants of health (SDoH) in gender differences in depression remains unclear among Chinese adults. We aimed to explore the association between SDoH and depression and investigate their role in explaining gender differences in depression. This prospective longitudinal cohort study used four wave surveys (2012, 2016, 2018, and 2020) of the China Family Panel Study (CFPS). Fourteen SDoH variables were assessed, and depression was measured using the 8-item short version of the Center for Epidemiologic Studies Depression Scale. The Cox proportional hazards regression and multiple mediation analysis were performed to estimate the effect sizes. The longitudinal sample included 18,874 participants aged 18-92 years (51.4 % males and 48.6 % females). Women had higher risk of depression than men. Unfavorable SDoH were associated with higher risk of depression. After including multiple SDoH in mediation analysis, multiple SDoH mediated 15.7 % of the total effect of gender on depression. In sum, SDoH significantly influenced depression, and specific factors explained gender differences in depression. Supporting women in education, employment, and community involvement could help reduce gender differences in depression.

Does social capital aid in leveling the income gradient in child mental health? A structural analysis of the left-behind and not-left-behind Chinese children

BACKGROUND

Few prior studies have investigated the income gradient in child mental health from a socio-environmental perspective. In an age when child mental health problems in a rapidly changing social environment have become a worldwide issue, an understanding of the socio-environmental mechanisms of the income disparities in child mental health outcomes is imperative and cost-effective.

METHODS

By conducting structural equation analyses with Chinese nationally representative survey data, this study explored the family income gradient in child depression and its potential socio-environmental pathways at the neighborhood, family and school levels, differentiating left-behind and not-left-behind children.

RESULTS

We found a robust family income gradient in depressive symptoms. Neighborhood cohesion mitigated the income gradient in depressive symptoms by playing a suppression role. School social capital acted as a mediator. Neighborhood trust, neighborhood safety and family social capital played no significant impact. The mitigating and mediating roles of social capital components were significant among only the not-left-behind children.

CONCLUSIONS

To reduce income-related inequalities in child mental health in the long run, integrating policies that directly reduce poverty with policies that improve distal socio-environments is necessary.

Impacts of combined childhood exposures to poor neighborhood quality, peer friendships and family relationships on adult depression: A seven-year longitudinal study

BACKGROUND

Little is known about how multisystemic childhood exposures predict adult depression. This study aims to examine the effects of multisystemic childhood exposures on the onset and remission of adult depression.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Survey (CHARLS) (wave 1-4), which is a nationally representative longitudinal survey of people 45 years of age or older in China. Childhood family relationships (CFR), childhood peer friendships (CPF), and childhood neighborhood quality (CNQ) scores were recoded into binary (No = 0, Yes = 1) according to the first quantile value. Participants were divided into four groups based on the total number of poor childhood exposures (group 0-3). The generalized linear mixed model was used to test the longitudinal relationship between combined poor childhood exposures and adult depression.

RESULTS

Of the 4696 participants (55.1 % males), 22.5 % suffered from depression at baseline. The incidence of depression increased from group0 to group3 in four waves, reaching the peak in wave 2018 (incidence of group0 to group3: 14.1 %, 18.5 %, 22.8 %, 27.4 %, p < 0.001), with declining remission rates that reached its lowest in wave 2018 (50.8 %, 41.3 %, 34.3 %, 31.7 %, p < 0.001). The persistent depression rate increased from group0 to group3 (2.7 %, 5.0 %, 8.1 %, 13.0 %, p < 0.001). The risk of depression in group1 (AOR = 1.50, 95%CI: 1.27-1.77), group2 (AOR = 2.43, 95%CI: 2.01-2.94) and group3 (AOR = 4.24, 95%CI: 3.25-5.54) were significantly higher than that in group0.

LIMITATIONS

Childhood histories were collected via self-reported questionnaires, and thus recall bias was inevitable.

CONCLUSIONS

Multisystem poor childhood exposures jointly increased the onset and persistence of adult depression, as well as reduced the remission rate of depression.

Frailty in Older Adults and Internal and Forced Migration in Urban Neighborhood Contexts in Colombia

Objective: We investigated the association between the density of internal human migration, in the urban neighborhood, on frailty in the older adult population in Colombia. Methods: The data used in this study are from four Colombian population surveys. We analyzed 633 census tracts with a sample of 2,194 adults 60 years and over for frailty (measured using the Fried criteria). We considered the proportion of inhabitants in a census tract with a history of internal migration as the exposure variable considering three temporalities. For contextual forced migration, we identified two types: 5-year, and 1-year. Poisson multivariable regression models with two hierarchical levels (individual and census tracts) were estimated. Results: The prevalence of pre-fragile/frailty was 80.63% [CI 95%: 77.67, 83.28]. The prevalence ratio were significantly higher for the older adults who live in neighborhoods where a higher proportion of internal migrants reside. Conclusion: We conclude that older adults who lived in neighborhoods with a high proportion of internal migrants experience more frailty. Potential explanations are that neighborhoods with high internal migration could experience social (l increase in cultural heterogeneity, in the perception of insecurity, violence and physical conditions (pressure on local economies and services, leading elderly residents to compete for neighborhood resources), translated into social stress.

Economic development, weak ties, and depression: Evidence from China

OBJECTIVES

Weak ties are becoming mainstream in daily relationships and play an essential role in the improvement of individuals' mental health. Despite growing concerns on depression, inclusion of weak ties is limited. To address the gap, this study empirically shed light on the role of weak ties on individual depression in the context of economic development.

METHOD

A cross-sectional study was conducted based on 2018 China Health and Retirement Longitudinal Study (CHARLS) with a sample of 16,545 individuals. A moderated mediation model is constructed to evaluate the impact of economic development (GDP) on the degrees of depression, the mediating effect of weak ties, and the moderating effect of residents' residence types (living in urban or rural areas).

RESULTS

Economic development exerts a significant direct impact on depression (β=-1.027, p<0.001). Weak ties are significantly negatively correlated with depression (β=-0.574, p<0.001), and act as a mediator between economic development and local individual depression. In addition, the residence type plays a moderating role between economic development and weak ties (β=0.193, p<0.001). That is, living in urban areas would introduce the higher the level of weak ties.

CONCLUSIONS

Higher economic development is largely conducive to alleviating the degrees of depression, weak ties play a mediating role in economic development and depression, and residence types have a positive moderating effect on the economic development and weak ties.

The role of community cohesion in elderly people during the COVID-19 epidemic: a cross-sectional study

BACKGROUND

Elderly people were regarded as the most impacted and most vulnerable social group during the COVID-19 epidemic. The community environment is vital for their health. The elderly people had to stay home during the implementation of the management and control of the COVID-19 epidemic. They lack resources and suffer from anxiety. Thus, determining environmental factors beneficial for their physical and mental health is very important.

OBJECTIVE

This study aims to assess the association between community cohesion and physical and mental health among elderly people and to identify the related community service and environmental factors that may promote community cohesion.

METHODS

This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method is applied to this study. A total of 2,036 participants aged ≥ 60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of three-dimensional scales was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community service and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 2,017 participants. Separate logistic regression analysis was conducted to assess the association between community cohesion and physical and mental health factors, as well as related community service and environmental factors, among elderly people.

RESULTS

The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction and high levels of self-efficacy and psychological resilience, and their odds ratios (ORs) were 1.27 (95% CI, 1.01-1.59) and 1.20 (95% CI, 1.15-1.27) and 1.09 (95% CI, 1.05-1.13) and 1.05 (95% CI, 1.03-1.06), respectively. The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the educational level was negatively associated with the community cohesion scores (P < .05). Community cohesion was also associated with low level of depression and high level of cognitive function. The community cohesion was significantly associated with community services and environmental factors from four dimensions. High levels of community cohesion were associated with transportation service, rental of rehabilitation equipment, high levels of satisfaction for community doctors' technical level and community waste disposal, and their ORs were 3.14 (95% CI, 1.87-5.28), 3.62 (95% CI, 2.38-5.52), 1.37 (95% CI, 1.08-1.73), and 1.23 (95% CI, 1.01-1.50), respectively.

CONCLUSIONS

Community cohesion was associated with the physical and mental health of elderly people. Our research suggests that enhancing community services and environmental management may be an effective strategy to increase community cohesion during the epidemic period of major infectious diseases.

CLINICALTRIAL

Internet use and depressive symptoms among Chinese older adults: Two sides of internet use

Objective

To explore the relationship between internet use which includes time spent on the internet, internet skills, types of online activities, and depressive symptoms in older adults.

Methods

We used 2020 China Family Panel Studies (CFPS) data with 3,171 older adults aged 60 years. Depression symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D), and internet use was measured by time spent on the internet, internet skills, and types of online activities. Multiple linear regression models were used to explore the relationship between internet use and depressive symptoms in older adults.

Results

Longer time spent on the internet was associated with higher scores of depressive symptoms (β = 0.14). Higher internet skills were associated with lower scores of depressive symptoms (β = −0.42). Watching short-form videos (β = 1.34) was associated with higher depressive symptom scores, and the use of the WeChat function (β = −0.96) was associated with lower depressive symptom scores, while online games and online shopping were not significant.

Conclusion

The effect of internet use on depressive symptoms in older adults is a double-edged sword. Controlling the time spent on the internet, improving internet skills, and guiding specific a type of online activities in older adults can improve depressive symptoms through rational use.

Effects of types and levels of social capital on emotional well-being for older people in Indonesia: A longitudinal study

OBJECTIVES

The purpose of this study was to examine the effects of different types and levels of social capital and emotional well-being in older adults in Indonesia by a longitudinal data.

METHODS

The fourth and the fifth waves of Indonesian Family Life Survey data were used for this study. The participants aged 60 years or older who participated in both waves were included for analysis (n = 1374). Depressive symptoms and happiness were used to assess emotional well-being. Cognitive social capital (neighborhood trust) and structural social capital (participating in arisan, community meetings, volunteers, village improvement programs, and religious activities) were the main independent variables. The generalized estimating equations model was used for analysis.

RESULTS

Participation in arisan (B = -0.534) and attending religious activities (B = -0.591) were related to lower depressive symptoms, but the effect of religious activities would offset over time. Both a low or high social participation showed protective effects on depressive symptoms at the intercept and the time slope. Having higher neighborhood trust was related to more chance of feeling very happy (OR = 1.518).

CONCLUSION

Structural social capital is protective from depressive symptoms, while cognitive social capital contributes to happiness. Facilitating social participation and improving neighborhood trust through policies and programs is suggested to promote emotional well-being for older people.

Predicting depression and anxiety of Chinese population during COVID-19 in psychological evaluation data by XGBoost

BACKGROUND

Due to the onset of sudden stress, COVID-19 has greatly impacted the incidence of depression and anxiety. However, challenges still exist in identifying high-risk groups for depression and anxiety during COVID-19. Studies have identified how resilience and social support can be employed as effective predictors of depression and anxiety. This study aims to select the best combination of variables from measures of resilience, social support, and alexithymia for predicting depression and anxiety.

METHODS

The eXtreme Gradient Boosting (XGBoost¹) model was applied to a dataset including data on 29,841 participants that was collected during the COVID-19 pandemic. Discriminant analyses on groups of participants with depression (DE²), anxiety (AN³), comorbid depression and anxiety (DA⁴), and healthy controls (HC⁵), were performed. All variables were selected according to their importance for classification. Further, analyses were performed with selected features to determine the best variable combination.

RESULTS

The mean accuracies achieved by three classification tasks, DE vs HC, AN vs HC, and DA vs HC, were 0.78, 0.77, and 0.89. Further, the combination of 19 selected features almost exhibited the same performance as all 56 variables (accuracies = 0.75, 0.75, and 0.86).

CONCLUSIONS

Resilience, social support, and some demographic data can accurately distinguish DE, AN, and DA from HC. The results can be used to inform screening practices for depression and anxiety. Additionally, the model performance of a limited scale including only 19 features indicates that using a simplified scale is feasible.

Perceived social cohesion and depressive symptoms among internal migrants in China: The mediating role of social adaptation

Background

Internal migrants are exposed to higher risks of depressive symptoms due to migration-related stress. It has been recognized that perceived neighborhood social cohesion has direct and indirect associations with depressive symptoms. However, the pathway from perceived social cohesion to internal migrants' depressive symptoms was less discussed.

Objectives

To assess mental health disparities among internal migrants. To investigate the association between social cohesion and depressive symptoms among urban-to-urban and rural-to-urban migrants and to examine the mediating role of social adaptation.

Methods

Data from the "2017 Urbanization and New Migrant Survey" was used, including 2,584 internal migrants age 18-65 from 10 cities in China. Social cohesion was measured by a six-item modified Community-level Cohesion Scale. Depressive symptoms was measured using the Center for Epidemiological Studies Depression Scale, and social adaptation was assessed by a single-item question of migrants' adaptation to local life. Multivariate linear regression models were used to examine the association between social cohesion and depressive symptoms. Baron and Kenny's mediation tests were conducted to examine the mediating role of social adaptation on the association. All analyses were adjusted using sampling weights to account for this survey's sampling design.

Results

Rural-to-urban migrants were found to have more clinically significant depressive symptoms, lower perceived social cohesion, and fair or low social adaptation than urban-to-urban migrants (all p < 0.001). Being rural-to-urban migrants as compared with urban-to-urban migrants [Odds Ratio (OR) = 1.46, 95% Confidence Interval (CI) = 1.456, 1.461, p < 0.001], had lower perceived social cohesion (OR = 1.46, 95% CI = 1.458, 1.463, p < 0.001), and poorer social adaptation (OR = 1.94, 95% CI = 1.932, 1.941, p < 0.001), are associated with higher odds of having clinically significant depressive symptoms. Social adaptation partially mediated the association between social cohesion and depressive symptoms by explaining 15.39% of its effect for urban-to-urban migrants and 18.97% for rural-to-urban migrants.

Conclusions

Findings from this study reveal mental health inequalities among internal migrants and demonstrate the importance of social adaption on the association between social cohesion and depressive symptoms. Social strategies and public policies are needed to build a more cohesive community that serves both local residents and internal migrants, especially rural-to-urban migrants.

Does the Internet Moderate the Neighborhood Effect? Internet Use, Neighborhoods, and Mental Health among Older Adults in Shanghai

Internet use may reduce the impact of the neighborhood on residents' well-being by helping people utilize resources beyond their immediate neighborhoods or strengthen neighborhood influences by widening the digital divide across neighborhoods. This study investigates how internet use moderates neighborhood effects on mental health among older adults in Shanghai. Using data from the Shanghai Urban Neighborhood Survey (SUNS) and population census, hierarchical linear models reveal that older adults who more frequently use the internet report lower levels of mental distress. Internet use attenuates the negative effects of living in low-socioeconomic status (SES) neighborhoods. We also examine the roles of three types of internet use: social networking, leisure, and information seeking. The results show that only social networking and leisure internet use are significantly associated with improved mental health among older adults. The results suggest that social programs are needed to increase internet literacy among older adults to promote active aging, and priority should be given to relatively disadvantaged neighborhoods.

Living alone and all-cause mortality in community-dwelling older adults: The moderating role of perceived neighborhood cohesion

OBJECTIVES

The adverse effect of living alone on health has been well-documented in community-dwelling older adults. A less understood topic in this research area is whether some neighborhood characteristics may mitigate the negative impact of living alone on health outcomes and mortality. This study aimed to extend the existing work on living arrangements and health by examining the potential interactive effect of living alone and perceived neighborhood cohesion on all-cause mortality among older Chinese Americans.

METHODS

Data were drawn from 3154 (58.0% female) participants from a prospective cohort study of community-dwelling US older Chinese adults aged 60 and older in the greater Chicago area. Living arrangements and perceived neighborhood cohesion were assessed at baseline from 2011 to 2013. Mortality status was tracked through December 2021. Covariates, including sociodemographic characteristics, health and behavioral covariates, loneliness, depression, and social engagement, were assessed at baseline. Cox proportional hazards regression model was used to test our hypotheses.

RESULTS

Living alone was significantly associated with an increased risk of all-cause mortality among participants reporting low levels of perceived neighborhood cohesion but not among those reporting high levels of perceived neighborhood cohesion. This protective effect of perceived neighborhood cohesion was robust to the inclusion of covariates.

CONCLUSIONS

Our results suggest that strong perceived neighborhood cohesion may protect against the increased risk of premature mortality associated with living alone in community-dwelling older Chinese Americans.

Formal volunteering and depressive symptoms among Community-Dwelling older adults in China: A longitudinal cross-level analysis

The role of formal volunteering in mental health promotion among older adults in China has been widely discussed during recent decades. However, the relationship connecting mental health with cross-level interaction (i.e., average levels of participation in the community vs. individual participation) is still unclear. This paper examined the effects of cross-level formal volunteering on depressive symptoms among older adults living in China. Using two waves of the China Longitudinal Aging Social Survey, a sample of 3128 Chinese older adults was surveyed in 2014 and 2016. Depressive symptoms were measured using the abbreviated CES-D-9. Individual fixed-effects ordinary least squares regression models assessed the associations between individual- and community-level formal volunteering and depressive symptoms in urban and rural areas separately. We found that in the urban sample, formal volunteering activities were negatively associated with depressive symptoms at the individual level (β = -0.49, SE = 0.22, p < 0.05). Higher community-level formal volunteering was positively associated with depressive symptoms (β = 2.82, SE = 1.42, p < 0.05). When adding interactions between individual and community levels, engagement in individual-level formal volunteering was associated with lower rates of depressive symptoms as community volunteering participation levels increased (β = -3.07, SE = 1.07, p < 0.01). High community-level volunteering participation was detrimental for non-volunteers. In rural areas, neither community- nor individual-level formal volunteering was associated with changes in depressive symptoms. The current findings demonstrate formal volunteering may not always benefit mental health for all. The effects may depend on the community context and individual choices. Social policies aimed to promote mental health through formal volunteering need to be tailored according to the specific community social environment.

Design and process optimization of combined medical and elderly care services: An integrated service blueprint-TRIZ model

China's increasingly aging population is resulting in an imbalance between supply and demand for elderly care resources. The theory of "combined medical and elderly care" (CMEC) has introduced a new perspective in the conception of China's elderly care problems. This study employed the service blueprint, fuzzy failure mode and effects analysis (Fuzzy-FMEA), and the theory of inventive problem solving (TIPS or the Russian acronym TRIZ) for the process optimization of CMEC services in three phases. In the first phase (service process analysis), potential service failure points in the service process were analyzed using the service blueprint technique. In the second phase (service failure diagnosis), Fuzzy-FMEA was applied to diagnose the service failure modes and explore the possible causes and effects. The service failure modes were then prioritized based on fuzzy numbers and the cumulative fuzzy risk priority number (Fuzzy-RPN). Finally, in the third phase (generation of service optimization solutions), the TRIZ parameters, inventive principles, and contradiction matrix were first employed to select TRIZ inventive principles. The selected TRIZ inventive principles were then used to inspire inventive solutions for new service processes. Finally, a case study was conducted on the service processes of elderly care institutions to demonstrate the applicability of the optimization solutions.

Neighborhood collective efficacy in stressful events: The stress-buffering effect

Although research on neighborhood effects has shown positive outcomes of collective efficacy in mental health, few studies have examined whether its protective role is universally applicable to all residents or the vulnerable population. Building on a stress-buffering model, this study examines whether or not neighborhood collective efficacy serves as a stress buffer to ameliorate the deleterious effects of exposure to stressful events across different population groups. Analyses are conducted based on a city-wide representative sample in Hong Kong linked to suicide events through spatial and temporal information. Neighborhood-level collective efficacy is constructed by the aggregated mean score of individual perceived collective efficacy within the same residential neighborhoods. Results from the logistic regression models show that individuals exposed to suicide in the residential surroundings have a higher risk of mental distress symptoms. Moreover, neighborhood-level collective efficacy tends to alleviate the mental distress upon exposure, but such a stress-buffering effect is only observed in older adults. Our findings provide a new perspective informed by the variation of stress-buffering effect across population groups. Thus, this study contributes to the understandings of neighborhood collective by demonstrating the stress-buffering effects among the vulnerable population.

Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review

Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.

Social Integration as Mediator and Age as Moderator in Social Capital Affecting Mental Health of Internal Migrant Workers: A Multi-Group Structural Equation Modeling Approach

The rise of migrant workers has been a unique social phenomenon as China goes through industrialization, urbanization, and modernization. They are a special social group formed during the economic and social transition of the country. Migration of rural labor has pushed China on its new path toward industrialization and urbanization. Because of the urban-rural dual system of the country, however, it is difficult for migrant workers to be fully integrated into host cities, making them susceptible to negative emotions and mental health issues. Therefore, their mental health is an issue of great volume in the domains of social undertakings, people's livelihood, and public health. However, existing studies have paid limited attention to the psychological profile of migrant workers and even less to the interplays among their social capital, social integration, and mental health. Targeting China's internal migrant workers, this article tapped the interactions among their social integration, social capital, and mental health with a sample of the cross-sectional data from the China Labor Dynamics Survey (CLDS) in 2018. Multi-group structural equation modeling (SEM) was employed to test the moderating action of age by analyzing whether the mediation model differed significantly in the paths among young, middle-aged, and older migrant workers. The SEM based on bootstrapping suggested that, after controlling for the influence of gender, education, marital status, personal annual income, employer type, and self-rated health, migrant workers' social capital positively affect their mental health in a significant way, with social integration playing a mediating role. In terms of age difference, middle-aged migrant workers were more subject to the aforementioned mechanism than young ones, and young migrant workers were more affected by the mechanism than older ones. This study revealed different psycho-social interplays among social capital, social integration, and mental health across young, middle-aged, and elderly migrant workers. The findings could serve as an important theoretical reference and as practical guidance for improving policies concerning migrant workers' mental health and social benefits in the context of economic transition.

The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China

BACKGROUND

There was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship.

METHODS

Using data from the China Health and Retirement Longitudinal 2011-2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used.

RESULTS

Community SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents.

CONCLUSIONS

This study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.

Neighborhood Makes or Breaks Active Ageing? Findings from Cross-Sectional Path Analysis

Mental ill-health prolongs and complicates other chronic illnesses, which is a major public health concern because of the potential stress it places on health systems. Prevention via active aging and place-based interventions thus became increasingly important with population aging, e.g., through health promotion and age-friendly neighborhoods. However, how the targeted outcomes of these efforts are related remains unclear. This paper examined whether the relationship between active living and mental health or health-related quality of life is mediated by neighborhood cohesion. Cross-sectional data were drawn from n = 270 community-dwelling adults aged 50 and above in the Gerontology Research Program—Center for Ageing Research in the Environment (GRP-CARE) Survey. Path analysis showed that one can live actively for better mental health (B_total = 0.24), but it is largely mediated by neighborhood cohesion (37%). Further examination of the factors of neighborhood cohesion showed that this mediation is explained by communal affordance (B_indirect = 0.05) and neighborhood friendship (B_indirect = 0.05). Additional study of the association between these mediators and factors of mental health revealed two psychosocial processes: (1) better community spaces (e.g., greenery and third places) support communal living (B = 0.36) and help older adults obtain emotional support (B = 0.32) for greater autonomy (B = 0.25); (2) spending more time outdoors enhances neighborhood friendship (B = 0.33) and interpersonal skills (B = 0.37), which in turn improves coping (B = 0.39). In short, the effects of active living on health are limited by one’s neighborhood environment. Neighborhood cohesion must be considered or it may stifle individual and policy efforts to age actively and healthily in urban environments. Context-sensitive implementations are required.

Community-Level Social Support Infrastructure and Adult Onset of Major Depressive Disorder in a South Asian Postconflict Setting

IMPORTANCE

Individual-level social support protects against major depressive disorder (MDD) among adults exposed to trauma. Little is known about the consequences of community-level interventions in the general population.

OBJECTIVE

To determine the potential consequences of neighborhood social infrastructure on incident MDD in a high-risk general population.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal, multilevel study estimated associations between a neighborhood-level program in a case-control design and subsequent individual outcomes across 10 years (2006-2015) in a cohort of young adults. Exogenously placed social programs simulate natural experiment conditions in a high-poverty population experiencing armed conflict (1998-2006). The western Chitwan valley in Nepal has a general population at high risk of MDD, with neighborhoods exposed to interventions to improve social support. From a random sample (response rate 93%) selected to represent the general population in 2016, participants aged 25 to 34 years in 2006 were studied. These individuals resided within 149 neighborhoods that varied in their availability of active social support programs. The analyses were conducted between October 2020 and November 2021.

EXPOSURES

The Small Farmers Development Program (SFDP) uses shared, joint liability financial credit among neighbors to build social capital and cohesion within neighborhoods.

MAIN OUTCOMES AND MEASURES

Onset of DSM-IV MDD after the conflict, assessed by the Nepal-specific, clinically validated World Mental Health Composite International Diagnostic Interview with a life history calendar. The hypothesis tested was that exposure to SFDP reduced adult onset of MDD.

RESULTS

Of the 1917 survey participants, 886 (46.2%) were women, and 856 (44.7%) were of Brahmin or Chhetri ethnicity. Of the 149 neighborhoods, 21 had an active SFDP group, and 156 of 1917 (8.1%) participants experienced MDD between 2006 and 2015. Discrete-time hazard models showed participants living in neighborhoods with an SFDP experienced incident MDD at nearly half the rate as others (odds ratio = 0.55; 95% CI, 0.30-1.02; P = .06). A multivariate, multilevel matching analysis showed the incidence of MDD among adults living in neighborhoods with an SFDP was 19 of 256 (7.4%), compared with 33 of 256 (12.9%) in the matched sample with no SFDP (z = 2.05; P = .04).

CONCLUSIONS AND RELEVANCE

Living in a neighborhood with community-level social support infrastructure was associated with reduced subsequent rates of adult-onset MDD, even in this high-risk population. Investments in such infrastructure may reduce population-level MDD, supporting clinical focus on potentially unpreventable cases.

Community welfare resources and late-life depression among older adults in Seoul: A multi-level analysis

OBJECTIVES

This study aimed to examine whether community welfare resources in neighborhoods (recreational facilities, healthcare access, and public welfare expenditure) are associated with late-life depression among older adults in Seoul, South Korea.

METHODS

Data for this study were obtained by merging two different data sources: the 2018 Seoul Elderly Survey for individual-level variables and publicly available administrative data for neighborhood-level variables. The sample included 3036 older adults (unweighted n = 3034) living in 25 neighborhoods (Gu) in Seoul. Multilevel regression models examined the effects of neighborhood-level variables on late-life depression while controlling for individual-level variables. We also explored the extent to which individual characteristics moderate the main effects of neighborhood characteristics on late-life depression.

RESULTS

The results indicated that recreational facilities, health care centers, and public welfare expenditure in the neighborhoods were associated with late-life depression among older adults beyond individuals' predisposing conditions. Also, the effects of recreational facilities and public welfare expenditure on depressive symptoms were larger for those with higher education level.

CONCLUSIONS

Older adults living in neighborhoods with more recreational facilities, more health care centers, and high public welfare expenditure were less likely to experience late-life depression. Of note is that the effects of neighborhoods' recreational facilities and public welfare expenditure varied by certain individual characteristics. Hence, local governments should introduce neighborhood-based health promotion policies to prevent depression among older adults. In doing so, local governments should also consider ways to improve access to community welfare resources for underprivileged older adults.

Effects of Healthcare Policies and Reforms at the Primary Level in China: From the Evidence of Shenzhen Primary Care Reforms from 2018 to 2019

Countries worldwide are making efforts to achieve health equity. China focuses on the implementation of the policy goal of “improving the primary level” to eliminate the health equity gap. The main purpose of this study is to examine the effects of the healthcare reforms at the primary level in China and to analyze the key factors that can help to improve their effectiveness. From the perspectives of the policy attention mechanism and public policy analysis, this study will explore primary care reforms from policy formulation to policy implementation on the basis of grounded theory and empirical research on primary care reforms in Shenzhen, China, that was conducted from 2018 to 2019. The present study found that the government pays close attention to the medical level and service level of primary care services at the policy formulation phase but less attention to talent level and information sharing. At the same time, this study combined with empirical data from primary care centers in Shenzhen for the period covering 2018 to 2019 evaluates policy implementation and its effect. Multiple regression analysis revealed that the medical level, talent level, service level, and information sharing helped to develop primary care services and improved health equity. Nevertheless, this study reflects a deviation between policy formulation and policy implementation for the development of primary care policies. Empirical experience shows that the development of talent level and information sharing can significantly promote primary care services and health management. Therefore, this study implies that in the process of promoting the health equity at the primary level, more attention should be paid to the consistency between policy formulation and policy implementation. Additionally, the policy promotion and influence mechanism can be improved, particularly in terms of talent development and information sharing, in order to effectively promote the development of health equity at the primary level.

A Role of Socioeconomic Status in Cognitive Impairment Among Older Adults in Macau: A Decomposition Approach

Background

To explore the prevalence and inequality of cognitive impairment among older adults in Macau and the contributions of influencing factors to inequality in cognitive impairment.

Methods

The Montreal Cognitive Assessment (MoCA) was used to measure the prevalence of cognitive impairment. Socioeconomic status scores were used to describe economic level of the subjects. The concentration index was applied to measure the inequality of cognitive impairment associated with socioeconomic status (SES) and decomposed into its influencing factors.

Results

The prevalence of cognitive impairment was 44.35% in Macau. The concentration index of cognitive impairment among the elderly was −0.165 (95% CI: −0.232 to −0.098), indicating that the prevalence of cognitive impairment was concentrated in households with poor SES. Older age, poor SES, long or short sleep duration, other marital status, poor appetite, no tea/coffee drinking, no religious belief, and depression contributed positively to the inequality of cognitive impairment. Among these factors, SES made the largest contribution to inequality, accounting for 76.74%.

Conclusion

In Macau, the prevalence of cognitive impairment among people aged 65 years and older is concentrated among those who are in poor economic conditions. Reducing the gap between the rich and the poor at the source, increasing educational level of low SES population and improving their access to healthcare services will help to improve the inequity of cognitive impairment.

Mediating Role of Depressive Symptoms on the Association Between Neighborhood Social Cohesion and Quality of Life in Individuals with Type 2 Diabetes Mellitus

PURPOSE

Few studies have explored the association between neighborhood social cohesion (NSC), a type of social capital, and the quality of life of patients with type 2 diabetes mellitus (T2DM). In addition, the potential mechanism for this association remains unclear. The current study examined the mediation effect of depressive symptoms on the relationship between NSC and quality of life among diabetes patients in China.

PATIENTS AND METHODS

A cross-sectional study of 1747 T2DM patients was conducted. The specific quality of life (DSQL), Center for Epidemiological Survey Depression (CES-D), and social capital scales were administered using a face-to-face survey. Partial correlation analysis and a linear regression model were employed to explore the relationship between NSC, depressive symptoms, and quality of life. Bootstrap analysis using PROCESS was used to test the mediation model.

RESULTS

After controlling for covariates, NSC was negatively correlated with depressive symptoms (r=-0.24, P<0.01) and DSQL score (r=-0.20, P<0.01) while depressive symptoms were positively correlated with DSQL score (r=0.46, P<0.01). Linear regression analysis also found that NSC was negatively associated with the DSQL score, while depressive symptoms were positively associated with the DSQL score. Depressive symptoms mediated the relationship between NSC and quality of life in T2DM patients (explaining 50.7% of the total variance).

CONCLUSION

NSC was positively associated with improved quality of life among Chinese T2DM patients in this study, and depressive symptoms were likely to partially explain this relationship. These findings may be used to help maintain a good quality of life among at-risk individuals. Additional prospective studies are needed to confirm these findings.

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).

The association between childhood neighborhood relationship and mental health in middle and later life: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

It is unclear that whether childhood neighborhood relationship is associated with mental health among middle-aged and older adults. To overcome this research gap, this study aimed to investigate the association between childhood neighborhood relationship and mental health among the middle-aged and older adults in China.

METHODS

The data of this study was sourced from the 2014 and 2015 waves of China Health and Retirement Longitudinal Study. We used ordinary least squares and logit regression models to explore the association between childhood neighborhood relationship and mental health among the middle-aged and older adults in China.

RESULTS

The regression results indicate that the middle-aged and older adults who lived in place where neighbors had close-knit relationships at childhood was significantly associated with decreased odds of suffering from depressive symptoms (OR = 0.4259, p < 0.001). Furthermore, compared to the middle-aged and older adults who lived in place where neighbors were not close-knit at childhood, those who lived in place where neighbors were close-knit at childhood had a reduced CES-D score (coefficient = - 2.7822, p < 0.001).

CONCLUSION

This study demonstrates the importance of living in place where neighbors had close-knit relationships at childhood. The integrated interventions, including maintaining close-knit neighborhood relationships and strengthening the construction of community, may be useful to improve mental health.

The Effect of Social Cohesion on Interest, Usefulness, and Ease of Use of a Driving Assistance System in Older Adults

This study examined the relationship between social cohesion and the perceived interest in, the usefulness of, and the ease of use of an instructor-based driver assistance system in a sample of older adults. With the aging of the population, the use of technologies to support the driving skills of the elderly is expected, and it is necessary to clarify the conditions under which the elderly will be interested in these advanced technologies. Traditionally, social cohesion has been focused on as a function of instrumental and practical support in the lives of the elderly. Since social cohesion reflects the intention to help each other, it could be an opportunity to provide information on advanced driving skill techniques to older people who are becoming more difficult to drive. As an initial exploration, this study examined whether social cohesion was associated with the interest in, the usefulness of, and the ease of use of an instructor-based driver assistance system in 150 elderly people. The results showed that a greater social cohesion was significantly associated with these evaluations, and that a comprehension of the system also contributed. The possession of a license was significantly associated with interest in the program. These findings are an essential step toward the understanding of the roles of social cohesion and positive perception of advanced technology in older adults.

Neighborhood-Based Social Capital and Depressive Symptoms among Adults: Evidence from Guangzhou, China

This study examined the association between neighborhood-based social capital (NSC) and depressive symptoms in the context of urban neighborhoods in China, with special attention given to the association heterogeneity across socioeconomic groups. Drawing on cross-sectional data collected from 39 neighborhoods in Guangzhou, this research demonstrated that adults’ depressive symptoms were higher among those with lower cognitive (trustworthiness, reciprocity, and cohesion within a neighborhood) and structural (social network and participation) dimensions of NSC. Further analysis showed that the negative association between NSC and depressive symptoms was significantly heterogeneous across socioeconomic groups. Specifically, this negative relationship was more prominent in the lower socioeconomic classes than in the upper socioeconomic classes, indicating that the lower accumulation of NSC among disadvantaged groups may aggravate depression unequally across social classes. In addition, the negative association between social participation and depressive symptoms was stronger for people who are older or unemployed. The findings of this study not only provide new evidence concerning the significance of the beneficial effects of NSC in the Chinese context, but also, more importantly, highlight that NSC plays a crucial role in creating mental health inequality across social classes. Thus, the relevant social interventions including fostering neighborhood relationships and social activities should be carefully tailored against the backdrop of community building during the urbanization process. The implications of our study for urban governance to promote healthy cities are discussed.

Urban-rural differences in the association between social activities and depressive symptoms among older adults in China: a cross-sectional study

BACKGROUND

Participation in social activities has positive health effects among older adults; however, few studies have investigated the association between social activity and depressive symptoms among Chinese older adults. This study aimed to examine the association between social activities and depressive symptoms among older adults in China regarding urban-rural differences.

METHODS

Data were collected from 8255 respondents from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Type and frequency of social activities were collected via a questionnaire. Multivariate logistic regression analysis was used to explore the relationship between social activities and depressive symptoms.

RESULTS

In our study, the prevalence of depressive symptoms was lower in urban older adults compared with rural older adults (25.2% vs. 40.7%). After adjustment for all covariates, our results indicated that interacting with friends almost weekly or almost daily (almost weekly: OR = 0.568, 95%CI: 0.337-0.955; almost daily: OR = 0.664, 95%CI: 0.453-0.973) and participating in community organizations almost daily were inversely associated with depressive symptoms among urban older adults (OR = 0.107, 95%CI: 0.012-0.952). Interacting with friends almost daily (OR = 0.847, 95% CI: 0.720-0.996) and participation in hobby groups either almost every week or almost daily were both inversely associated with depressive symptoms among rural older adults (almost weekly: OR = 0.683, 95%CI: 0.518-0.902; almost daily: OR = 0.567, 95%CI: 0.440-0.731). Participating in sports groups almost daily was inversely associated with depressive symptoms among both urban and rural older adults (urban: OR = 0.664, 95%CI: 0.445-0.991; rural: OR = 0.506, 95%CI: 0.366-0.700).

CONCLUSIONS

Our findings indicated that there is a cross-sectional association between participation in social activities and depressive symptoms among Chinese older adults, and the association differed between urban and rural older adults. This implies that participation in social activities may be significant for alleviating depressive symptoms of older adults. When encouraging older adults to participate in social activities, the government should consider urban-rural differences and take effective measures accordingly. Longitudinal studies are needed to examine the causal relationships between social activities and depressive symptoms among older adults.

Volunteer activity and depression among the elderly in China: A study on rural-urban differences

ABSTRACT

Participation in volunteer activity has positive effects on health among elderly. Few studies have investigated the association between volunteer activity and depression among Chinese elderly. This study aimed to examine the association between volunteer activity and depression among the elderly in China regarding rural-urban differences.Totally 8255 subjects from the 2015 China Health and Retirement Longitudinal Study were selected in this study. Depression was assessed by 10-item Center for Epidemiologic Studies Depression Scale. Types and frequency of volunteer activity were measured in the questionnaire. Multiple linear regression analysis was used to explore the relationship between volunteer activity and depression of elderly.In our study, the urban elderly had lower depressive scores than rural elderly (6.7 ± 5.8 vs. 9.1 ± 6.7). After adjustment for all covariates, our results revealed that almost daily participation in formal volunteer activities was negatively associated with depression among urban elderly (B = -2.69, SE = 1.05, P = .010); almost daily caring for a sick or disabled adult was positively associated with depression among both urban and rural elderly (urban:B = 3.13, SE = 1.54, P = .043; rural:B = 2.56, SE = 1.18, P = .031).These findings suggested that there was a negative association between formal volunteer activity and depression among urban elderly, while there was a positive association between caring for a sick or disabled adult and depression among both urban and rural elderly. The government should take effective measures to encourage the elderly to participate in formal volunteer activities to prevent them from depression.

Does social capital interact with economic hardships in influencing older adults' health? A study from China

BACKGROUND

The importance of social and economic capital as predictors of health is widely documented, yet the complexity of interactions between them and effects on older people's health is still unclear. Combining the material and psychosocial explanations of health, this study explores the potential interactions between social and economic capital in influencing older adults' health in urban and rural China.

METHODS

Using data from the China Family Panel Survey, physical and mental health in 2018 were regressed on social and economic capital indicators in 2016, controlling for sociodemographic characteristics of 3535 respondents aged 65 and older. Rothman's synergy index was calculated to investigate potential interaction effects.

RESULTS

Economic hardships were significantly related to both self-reported health and mental health. Neighborhood cohesion and social participation were significantly associated with mental health for all, bonding trust was significantly associated with mental health for urban older people. We found no significant associations between social capital components and self-reported health. There was an interaction effect between low neighborhood cohesion and economic hardships, and between low social participation and economic hardships, creating an increased burden of poor mental health. The interaction effect between low bonding trust and economic hardships on mental health was apparent only among urban older people.

CONCLUSIONS

Geographical settings are important factors in the complexity between social and economic capital in affecting older health. Intervention efforts directed towards reducing simultaneously multiple dimensions of deprivation, such as poverty, social exclusion, social isolation, could be helpful in improving older people's health. In materially deprived places, policies to promote health equity by improving social capital but without eliminating poverty may be less effective.

Urban Nature and Public Health: How Nature Exposure and Sociocultural Background Relate to Depression Risk

As the world’s population becomes more urbanized, there is an associated decrease in nature exposure and a rise in noncommunicable diseases, including depression. Previous cross-sectional studies examining urban nature exposure and depression have reported favorable associations. However, many of these studies rely primarily on nature exposure metrics that measure the intensity of nature exposure, while other dimensions of urban nature exposure remain understudied. Therefore, in a cross-sectional, questionnaire-based case study targeting a general urban population (n = 282), we examined the relationship between two less commonly studied urban nature exposure variables (i.e., gardening behavior and greenspace visit frequency) and depression risk while also considering sociocultural background (multivariate logistic regression model). Results indicated that being a gardener was significantly associated with a reduced odds of being at risk of depression and that having a family migration history, but not a self-migration history, was associated with increased odds of being at risk of depression. In the examination of neighborhood socialization frequency and depression risk, we did not determine any significant association. The results of this study, therefore, highlight the importance of considering both people’s sociocultural backgrounds and urban nature exposure in more detail to help plan for and support healthier cities in the future.

Do perceived social neighborhood factors explain the association between neighborhood age composition and mental health among Dutch older adults?

BACKGROUND

In the light of urbanization and aging, a crucially relevant policy question is how to shape neighborhoods to foster healthy aging. An important debate is whether older adults should group in neighborhoods, or whether a more mixed neighborhood age composition is more beneficial to health and well-being. We therefore assessed the association between neighborhood age structure and mental health and the mediating role of individual perceptions of neighborhood social factors.

METHODS

We conducted multivariable linear regression models and causal mediation analyses in 1255 older adults of the Dutch Globe study. The neighborhood age structure was measured in 2011 as the homogeneity of the age composition (using the Herfindahl-Hirschman index, range from 0 to 100, a higher score indicating more homogeneity) and the percentage of specific age groups in a neighborhood. Mental health was measured in 2014 by the Mental Health Inventory-5 score (range 0 to 100, a higher score indicating better mental health). Potential mediators were assessed in 2011 and included perceptions of neighborhood social cohesion, feeling at home in a neighborhood, and social participation.

RESULTS

A more homogeneous age composition (not specified for age) and a higher percentage of children living in a neighborhood were associated with better mental health, the other age categories were not. Social cohesion, feeling at home and social participation did not mediate the associations.

CONCLUSIONS

The neighborhood age composition may be an interesting but currently insufficiently understood entry point for policies to improve older adult's mental health status.

The effect of social participation on income-related inequality in health outcome among Chinese older adults

Background

This study aimed to investigate the effect of social participation on income-related inequality in health outcome among older adults in China.

Methods

The panel data used in this study were sourced from the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Furthermore, this study employed a concentration index to assess the income-related inequality in health outcome. Moreover, this study used the decomposition method of concentration index to analyse the effect of social participation on income-related inequality in health outcome.

Results

The total concentration index of Instrumental Activity of Daily Living (IADL) status decreased from 0.0257 in 2011 to 0.0172 in 2014. Furthermore, the total concentration index of psychological health decreased from 0.0309 in 2011 to 0.0269 in 2014. The decomposition analysis indicates that social participation made a major contribution to the pro-rich inequality in IADL status. Moreover, the results also indicate that social participation made a minor contribution to the pro-rich inequality in psychological health.

Conclusions

This study demonstrated that overall there were pro-rich inequalities in IADL status and psychological health among older adults in China. Moreover, social participation made a major contribution to the pro-rich inequality in IADL status, while it made a minor contribution to the pro-rich inequality in psychological health.

Investigating Factors of Active Aging among Chinese Older Adults: A Machine Learning Approach

BACKGROUND AND OBJECTIVES

With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in three domains, i.e., paid/unpaid work, caregiving, and social activities, among Chinese older adults.

RESEARCH DESIGN AND METHOD

Data were drawn from the first wave of the China Health and Retirement Longitudinal Study (CHARLS), which surveys a nationally representative sample of adults aged 60-year-old and above (N=7,503). We estimated Random Forest and the least absolute shrinkage and selection operator (LASSO) regression models to determine the most important factors related to active aging.

RESULTS

Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multi-generational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities.

DISCUSSION AND IMPLICATIONS

The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging.

Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis

OBJECTIVES

To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model.

DESIGN

Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007-2010).

SETTING

National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas.

PARTICIPANTS

A total of 9,663 adults aged 50 years and older.

MEASUREMENTS

We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses.

RESULTS

Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas.

CONCLUSION

This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults' community involvement, especially in urban areas, will help to enhance QoL.

Age-friendly neighbourhoods and depression among older people in China: Evidence from China Family Panel Studies

BACKGROUND

Older population with depression symptoms reached about 64 million in China. Under the World Health Organization's (WHO) age-friendly communities framework, this study explored relationships between neighbourhood environment characteristics and depressive symptoms among community-dwelling older adults in China.

METHODS

Data were obtained from the China Family Panel Studies (CFPS), a national multi-stage probability sample in China. The final analytic sample comprised 5,641 older adults in China. Neighbourhood environment characteristics were measured in three ways: objective facilities, interviewers' evaluation, and respondents' own perceptions on the neighbourhood environment. Depressive symptoms were measured by the 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Multilevel regression models were applied.

RESULTS

Neighbourhoods with more exercise and recreational facilities, better interviewers' evaluations, and better objective respondents' perceptions on neighbourhood environment at a neighbourhood level were significantly negatively associated with depressive symptoms, but these association were influenced by respondents' demographic characteristics, socioeconomic status and respondents' own perceptions of neighbourhood environment at the individual level. On the other hand, respondents' subjective positive perceptions of neighbourhood environment at the individual level were also significantly negatively associated with depressive symptoms.

LIMITATIONS

The actual conditions of affordability, accessibility and utilization of public facilities and social services within neighbourhoods were not known.

CONCLUSIONS

This research extended the current knowledge of the associations between neighbourhoods and mental health among older adults, to promote ageing in place in China. Great importance should be attached to the improvement of both physical and social aspects of the neighbourhoods to develop age-friendly communities.

Evidence that loneliness can be reduced by a whole-of-community intervention to increase neighbourhood identification

RATIONALE

Social identification with the people in one's neighbourhood has a wide variety of benefits for individual and community health and wellbeing. In particular, previous research shows that residents' social identification with their neighbourhood is protective of mental health. However, researchers are only just beginning to design and evaluate interventions that directly target social identification on health grounds.

OBJECTIVE

This longitudinal study evaluated a whole-of-community intervention at scale (Neighbour Day, 2019), in which Australian residents were encouraged to build social connections in their local community. Neighbour Day is a campaign that seeks to raise public awareness of the importance of connecting with neighbours and had a reach of approximately 300,000 people in 2019.

METHODS

Participants were 437 hosts of neighbourhood events held across 276 diverse suburbs across Australia. Participants were surveyed at three-time points; before and after Neighbour Day, as well as at six-month follow up.

RESULTS

Hosting a Neighbour Day event led to a significant increase in neighbourhood social identification, which was sustained six months later. This increase in social identification predicted increased social cohesion, reduced loneliness and improved wellbeing.

CONCLUSIONS

This study provides evidence that neighbourhood identification is an effective target mechanism to curb loneliness and social fragmentation in the community. Implications are discussed with a focus on how social identity-building interventions can be effectively implemented in community settings to benefit public health.

Internet use and mental health problems among older people in Shanghai, China: the moderating roles of chronic diseases and household income

Objectives: This study investigates whether the impact of Internet use on old adults' mental health problems differs across health conditions and income groups in Shanghai, China.Methods: This study uses data from a large-scale sample of 2117 respondents aged 60-80 years in Shanghai, China. This study measures mental health problems with the 10-item version of the Hopkins Symptom Checklist, assesses Internet use with a 4-item scale and chronic diseases with a 12-item scale. This study applies ordinary least square regression models to assess associations between Internet use and mental health problems across income groups and health conditions.Results: Elderly people using the Internet more frequently have substantially lower odds of having mental health problems. Further analyses find the moderating roles of chronic diseases and household income on mental health problems. Chronic diseases significantly increase the correlation of Internet use with mental health problems. Meanwhile, Internet use reduces more elders' mental health problems in the low-income group than in the high-income group.Conclusion: This study sheds evidence on the negative correlation of Internet use with mental health problems. It also indicates that Internet use may reduce more mental health problems in the low-income group and the unhealthy group. Therefore, increasing Internet use in the low-income group and the unhealthy group is suggested as a promising strategy to promote elders' mental health.

Neighborhood Environment, Internet Use and Mental Distress among Older Adults: The Case of Shanghai, China

As the Internet evolves in urban communities, its consequences on mental distress have drawn significant research attention. We examine the relationships of mental distress with neighborhood environment and Internet use among older adults, using data from a representative sample of 2036 adults aged older than 60 years in Shanghai, China. We assess mental health with a 10-item scale from the Symptom Checklist 90 and Internet use with a 4-item scale and obtain information of neighborhood environment from an online map platform. Results from multilevel models show that both neighborhood environment and Internet use are significantly related to mental distress. Moreover, a worse neighborhood environment may strengthen the correlation between Internet use and mental distress, indicating the strong moderating role of the neighborhood environment. Thus, promoting Internet use among elderly people might result in a reduction in the prevalence of mental distress in disadvantaged neighborhoods.

From Traditional and Socialist Work-Unit Communities to Commercial Housing: The Association between Neighborhood Types and Adult Health in Urban China

The urban structure in China has been transformed profoundly through rounds of economic reforms. Over the past 60 years, various types of neighborhoods have emerged at different stages of economic and social transition. Formed and organized in different ways, these neighborhoods provide distinct economic, social, and physical environments to residents. However, little is known about the link between neighborhood types and the health of residents in urban China. Using longitudinal data from the China Labor-Force Dynamics Survey (2012-2014), we estimate multilevel regression models to predict self-rated health (SRH) while controlling for a lagged measure of SRH. Results show that living in traditional communities in old districts and work-unit compounds for state-owned enterprises is associated with better SRH among older adults (≥50 years old) compared with living in other types of neighborhoods, such as commercial-housing communities and migrant enclaves. Neighborhood types do not matter for the health of younger adults (< 50 years old). Neighborhood water quality and distance to facilities are associated with SRH for older adults but do not account for the relationships between neighborhood types and SRH.