Assessment of health inequality between urban-to-urban and rural-to-urban migrant older adults in China: a cross-sectional study

Income inequality, trust, and depressive symptoms among Chinese adults (CFPS): A causal mediation analysis

OBJECTIVE

Income inequality has been linked to depressive disorders, but the pathways behind this impact are insufficiently understood. Hence, we aimed to investigate the impact of income inequality on depressive disorders and evaluate the extent to which this impact is mediated by trust.

METHODS

Two waves (2012 and 2018) of the China Family Panel Studies (CFPS) were included. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression scale (CESD8) and income inequality was measured using the Gini index calculated with household income. Based on the counterfactual framework, causal mediation analysis was applied with the difference-in-difference (DID) method. The sequential ignorability assumption, an important assumption for mediation analysis, was examined by propensity score matching (PSM) and simulation-based sensitivity analysis.

RESULTS

Compared to the control group (Change of Gini index ≤0), CESD8 scores in the treatment group (Change of Gini index >0) increase by 0.233 (95 % CI: 0.039, 0.430), which 10.1 % (95 % CI: 3.1 %, 46.0 %) was mediated by reductions in trusts at the provincial level. At the county level, income inequality influences depressive symptoms through the indirect path (β=0.008, 95%CI: 0.001, 0.020) instead of the direct path (β= - 0.146, 95%CI: -0.287, 0.000). Dividing the trust, the significant indirect effect appeared in the trust in neighbors, foreigners, government, and doctors at the provincial level.

LIMITATION

This study didn't deal with the impact of post-treatment confounders of the mediator-outcome relationship.

CONCLUSIONS

Severe income inequality directly and indirectly exacerbated depressive symptoms. Government should carry out the implementation of decreasing income inequality and improving trust.

Depression and Anxiety among Migrant Older Adults during the COVID-19 Pandemic in China: Network Analysis of Continuous Cross-Sectional Data

Many Chinese migrant older adults are more prone to mental health problems due to their "migrant" status. During the COVID-19 pandemic, restrictions on their mobility exacerbated these conditions. Mental health is a crucial dimension of healthy aging. Network analysis offers a novel method for exploring interactions between mental health problems at the symptom level. This study employs network analysis to examine the interactions between comorbid depressive and anxiety symptoms across different stages of the COVID-19 pandemic. Surveys were conducted from September 2019 to January 2020 (T1), September 2020 to January 2021 (T2), and September 2021 onwards (T3). Depression and anxiety symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Expected Influence (EI) and Bridge Expected Influence (Bridge EI) were used to identify central and bridge symptoms in the network. Network stability and accuracy tests were performed. Among the Chinese migrant older adults, the anxiety prevalence was 18.50% at T1, 21.11% at T2, and 9.38% at T3. The prevalence of depression was 26.95% at T1, 55.44% at T2, and 60.24% at T3. The primary central symptoms included 'Afraid something will happen' (A2), 'Irritability' (A6), 'Panic' (A7), 'Feeling of worthlessness' (D6), 'Anhedonia' (D1), and 'Feeling of fear' (A5). The major bridge symptoms included 'Feeling of fear' (A5), 'Panic' (A7), 'Irritability' (A6), 'Fatigue' (D4), 'Anhedonia' (D1), and 'Depressed or sad mood' (D2). Differences in network structure were observed across the periods. The network analysis further revealed the evolving relationships between central and bridge symptoms over time, highlighting the importance of targeted intervention strategies for central and bridge symptoms of comorbid depression and anxiety at different periods.

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.

Health inequality of rural-to-urban migrant workers in eastern China and its decomposition: a comparative cross-sectional study

Objectives

As a specific group with high health inequality, it is crucial to improve the health status and health inequalities of rural-to-urban migrant workers. This study aimed to evaluate the health inequality of migrant and urban workers in China and decompose it.

Methods

A cross-sectional study was carried out, using a standardized questionnaire to obtain basic information, self-rated health to evaluate health status, concentration index to measure health inequalities, and WDW decomposition to analyze the causes of health inequalities.

Results

The concentration index of health for migrants was 0.021 and 0.009 for urban workers. The main factors contributing to health inequality among rural-to-urban migrant workers included income, exercise, and age. In contrast, the main factors of health inequality among urban workers included income, the number of chronic diseases, social support, and education.

Conclusion

There were health inequalities in both rural-to-urban migrant and urban workers. The government and relevant authorities should formulate timely policies and take targeted measures to reduce income disparities among workers, thereby improving health inequality.

Association between self-reported oral health and life satisfaction among China's migrant elderly following children: The mediating effect of social support

Purpose

Focusing on the life satisfaction of the migrant elderly following children (MEFC) is of great theoretical and practical significance. We aimed to examine the effect of self-reported oral health on life satisfaction among the MEFC in Weifang, China, and to further explore the mediating role of social support on the relationship between self-reported oral health and life satisfaction.

Methods

We conducted a cross-sectional survey for 613 participants using multi-stage random sampling in Weifang, China, in August 2021. The Social Support Rating Scale was used to assess social support for the MEFC. We used the Chinese version of the Geriatric Oral Health Assessment Index (GOHAI) to evaluate self-reported oral health. We assessed life satisfaction for the MEFC via the Satisfaction with Life Scale. The data were scrutinized through descriptive analysis, a chi-square test, a t-test, Pearson correlation analysis, and structural equation modeling (SEM).

Results

The mean GOHAI, social support, and life satisfaction scores were 54.95 ± 6.649, 38.89 ± 6.629, and 27.87 ± 5.584, respectively. SEM analysis indicated that the self-reported oral health of the MEFC exerts a positive effect on life satisfaction and social support, and social support has a positive and direct effect on life satisfaction. Social support partially mediates the association between self-reported oral health and life satisfaction (95% confidence interval: 0.023-0.107, P < 0.001), with its mediating effect accounting for 27.86% of the total effect.

Conclusion

The mean score of life satisfaction was 27.87 ± 5.584 among the MEFC in Weifang, China, suggesting relatively high life satisfaction. Our findings underscore an empirical association between self-reported oral health and life satisfaction and imply that social support mediates this relationship.

The Relationship Between Mental Health and Psychosocial Stress of Reservoir Migrants in the Middle Route of China's South-to-North Water Diversion Project (SNWDP): The Mediating Role of Social Support

BACKGROUND

South-North Water Diversion Project (SNWDP) migrants were vulnerable to developing mental health problems due to post-migration stresses and lack of social support. However, the evidence on the mental health, psychosocial stress and social support of SNWDP migrants and their interrelationships are limited and inconclusive. We aimed to explore the mechanism of influence of social support on the relationship between mental health and social psychosocial stress of SNWDP migrants.

METHODS

We performed a cross-sectional analysis of the data of 983 SNWDP migrants. The mental health status, psychosocial stress and social support of the participants were evaluated by Symptom Checklist-90-Revised (SCL-90-R), Psychosocial Stress Survey for Groups (PSSG) and Social Support Rating Scale (SSRS). Multiple stepwise regression model was used to analyze the data.

RESULTS

Among the 983 individuals, the average SCL-90-R score was 1.47, the PSSG score was 30.50, and the SSRS score was 40.30. The SCL-90-R was positively correlated with PSSG (r=0.483, P<0.001) and negatively correlated with SSRS (r=-0.257, P<0.001), PSSG was negatively correlated with SSRS (r=-0.516, P<0.001). Multiple regression analysis showed that PSSG and SSRS had significant effects on SCL-90-R prediction and that SSRS played a partial intermediary role in SCL-90-R and PSSG (46.87%).

CONCLUSION

The SNWDP migrants performed a strong correlation between social support, mental health and psychosocial stress. Social support plays a part role in mediating mental health and psychosocial stress.

How does social capital affect individual health among the elderly in rural China?-Mediating effect analysis of physical exercise and positive attitude

BACKGROUND

The elderly in rural areas comprise over half of the older population in China, and their health problems are a matter of great concern for the Chinese government and society. Among the many factors affecting health, social capital has generated much interest in academic research. Exploring the relationship between social capital and individual health among the elderly in rural China provides ways to improve the health of Chinese people, which has a positive impact on policy.

METHODS

We selected 3719 respondents from the 2016 China Family Panel Studies (CFPS). Structural and cognitive social capital were obtained via exponentiation of variables (mean of zero and a standard deviation of one) and by giving them equal weight. Ordinary least squares (OLS) and two-stage least squares (2SLS) estimators were used to analyze the association between social capital and individual health. We explored the mechanism linking structural and cognitive social capital with individual health through a mediation effect analysis.

RESULTS

After correcting for endogeneity bias, structural social capital had a positive correlation with individual health among the elderly, with a coefficient of 0.062 (95% CI: 0.020-0.104). Cognitive social capital also had a positive correlation with individual health, with a coefficient of 0.097 (95% CI: 0.060-0.135). Physical exercise and positive attitude were two significant mediating variables of the relationship between social capital and individual health in the study group, with mediating effects of 0.018 and 0.054, respectively.

CONCLUSIONS

Cognitive social capital played a stronger role than structural social capital in promoting individual health among the elderly. Physical exercise and positive attitude mediated the relationship between social capital and individual health. Policymakers should not only build basic medical and health care systems but also consistently cultivate and strengthen structural and cognitive social capital among the elderly in rural China.