Comparison of Depressive Symptoms and Its Influencing Factors among the Elderly in Urban and Rural Areas: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Association of the intergenerational structure with the onset of depressive symptoms among middle-aged and older adults in China

BACKGROUND

Chinese family structure has undergone tremendous changes over the past few decades. Moreover, the association of the intergenerational structure with depression remains controversial.

AIMS

This study aimed to find out the association of the intergenerational structure and the onset of depressive symptoms among Chinese middle-aged and older adults.

METHODS

This study included 4,868 participants of the China Health and Retirement Longitudinal Study (CHARLS), who were enrolled in 2011 without depressive symptoms and followed up at least once later in 2013, 2015, 2018, and 2020. Taking the time-varying confounding effect into account, the time-dependent Cox regression models were used to estimate the association of the intergenerational structure and the onset of depressive symptoms.

RESULTS

Among the studied middle-aged and older adults, compared to one-generation households, higher hazard ratios (HR) of developing depressive symptoms were found in three-generation households in the study population (HR = 1.21, 95% CI [1.08, 1.36]). Further, for female participants, skipping-generation households (HR = 1.38, 95% CI [1.05, 1.83]) and three-generation lineal households (HR = 1.21, 95% CI [1.02, 1.43]) were found to be significantly associated with new-onset depressive symptoms compared to empty-nest couples. For male participants, living alone (HR = 1.65, 95% CI [1.30, 2.11]), living in standardized nuclear households (HR = 1.27, 95% CI [1.06, 1.54]), impaired nuclear households (HR = 1.80, 95% CI [1.18, 2.76]), or three-generation lineal households (HR = 1.34, 95% CI [1.12, 1.60]) were found to have a significant association with the onset of depressive symptoms.

CONCLUSIONS

This study found that males living alone, with unmarried children, or in three-generation lineal households, and females living with grandchildren were more likely to suffer from depressive symptoms. Therefore, special attention should be paid to people in these intergenerational structure subtypes.

Post-COVID social engagement and depression among Chinese older adults: exploring rural/urban and gender differences

PURPOSE

This study investigates the impact of post-COVID social engagement on depression levels among Chinese older adults, with a focus on rural/urban and gender differences.

METHODS

Using the year 2018 and year 2020 data from the China Health and Retirement Longitudinal Study (CHARLS), this study analyzed pre- and post-COVID depression levels and social engagement indicators, including going-out, activities and networking among Chinese older adults (N = 8,793).

RESULTS

Results showed a significant increase in depression levels across all demographic groups post-COVID, with rural females exhibiting the highest levels of depression. Reduced social engagement was associated with increased depression, particularly among rural males and females. Subgroup analyses highlighted nuanced patterns: rural males suffered from decreased intense activities and online contacts, while urban males experienced heightened depression with reduced visiting and light activities. Rural females reported increased depression with decreased moderate activities and dancing outdoors but decreased levels with reduced online contacts. Conversely, urban females experience decreased depression with reduced social engagements, suggesting areevaluation of priorities amidst pandemic challenges.

CONCLUSION

This study has underscored the importance of considering individual, cultural, and contextual factors in understanding mental health outcomes among Chinese older adults. Findings inform targeted interventions aimed at promoting psychological well-being and resilience among Chinese older adults in the post-COVID era, including community-based programs and mental health screenings, to foster social connection and emotional support.

Demographic, socioeconomic and health determinants of depressive symptoms in adults 50 years and older from Mexico: a secondary data longitudinal analysis from the Mexican Health and Aging Study

BACKGROUND

Depression in ageing adults is a public health problem. Worldwide studies have identified social and health risk factors for depressive symptoms. However, little is known about their longitudinal determinants in Mexico.

OBJECTIVES AND SETTING

To find the prevalence of depressive symptoms and their longitudinal individual and contextual risk factors in Mexican adults aged 50 and older.

DESIGN

Secondary data of 6460 persons aged 50 years and older from the Mexican Health and Aging Study were analysed using a 'between-within' panel data analysis approach.

RESULTS

The prevalence of depressive symptoms increased from 35% in 2003 to 38% in 2015. The significantly longitudinal factors associated with these symptoms were getting older (OR 1.02, 95% CI 1.01 to 1.03), being a woman (OR 2.39, 95% CI 2.16 to 2.64), less time spent in formal education (0 years and less than 6 years OR 1.52, 95% CI 1.32 to 1.75 and OR 1.33, 95% CI 1.19 to 1.50, respectively), lower net worth (OR 1.13, 95% CI 1.08 to 1.17), being recently unemployed (OR 1.25, 95% CI 1.10 to 1.25), increased (OR 1.17, 95% CI 1.10 to 1.25) or increasing number (OR 1.23, 95% CI 1.15 to 1.31) of chronic conditions, poor (OR 4.68, 95% CI 4.26 to 5.15) or worsened (OR 1.71, 95% CI 1.61 to 1.81) self-rated health and having impairments on instrumental activities of daily living (IADLs) (OR 2.94 95% CI 2.35 to 3.67) or a new IADL impairment (OR 1.67, 95% CI 1.48 to 1.89), as well as having impairments on ADLs (OR 1.51, 95% CI 1.23 to 1.86) or a new ADL impairment (OR 1.34, 95% CI 1.21 to 1.48).

CONCLUSIONS

The prevalence of depressive symptoms in Mexican adults aged 50 and older is high. Our findings show that they are longitudinally associated with the individual's demographic, socioeconomic, health and disability characteristics. Efforts in public policy should focus on preventing chronic conditions and disability, as well as fighting inequalities to reduce the prevalence of depressive symptoms.

Network analysis of the urban-rural differences in depressive symptoms among older adults with multiple chronic conditions: Evidence from a national survey

BACKGROUND

Evidence on the differences in depressive symptoms among older adults with multiple chronic conditions (MCCs) in urban and rural areas is limited.

METHODS

Measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale-10) and demographic factors (age, gender, and urban-rural distribution) were used.

RESULTS

A total of 4021 older adults with MCCs were included in this study. Significant differences were observed in both network global strength (Urban: 3.989 vs. Rural: 3.703, S = 0.286, p = 0.003) and network structure (M = 0.139, p = 0.002) between urban and rural residents.

CONCLUSIONS

The study highlights the need for region-specific approaches to understanding and addressing depression and holds the potential to enhance understanding of the psychological health status of older adults with MCCs in urban and rural settings.

Life satisfaction among Spanish children and adolescents participating in Physical Education

Life satisfaction has been determined as a cognitive indicator of subjective wellbeing, a term that acquires vital relevance during adolescence as a protective factor against numerous psychological, mental and social disorders. Therefore, the objectives of this study are: (1) to evaluate differences in life satisfaction as a function of gender and school environment in Spanish children and adolescents; and (2) examine the possible associations between life satisfaction and age and/or body mass index (BMI) of the student body. For this purpose, a cross-sectional study was carried out with 723 students (aged 6 to 18 years) in which the "Satisfaction with life Scale" was applied, consisting of 5 items that measure self-perception of life satisfaction. Nonparametric statistics (Mann-Whitney U test) were used to explore differences in scores according to sex and school environment, in addition to Spearman's Rho test to identify associations between scale scores and students' age and BMI. Significant differences were obtained in terms of sex in favor of the male gender, and between the two environments of the centers in favor of the rural ones. In addition, the two variables explored (age and BMI) showed significant inverse associations with life satisfaction levels. Therefore, educational interventions and policies must take this information into account to design and develop actions aimed at improving this cognitive factor.

Decomposition analysis of the difference in depressive symptoms between urban and rural employed people in China: Unpaid work plays an important role

OBJECTIVE

Focusing on the relationship between unpaid labor and the occurrence of depressive symptoms, this study aimed to explore the factors influencing the inequality of depressive symptoms and their contribution among Chinese urban and rural employed people.

METHODS

This study utilized the 2020 China Family Panel Studies' national resampling data. Multivariate logistic regression was used to explore the factors influencing the occurrence of depressive symptoms among employed persons in urban and rural areas in China, respectively. Fairlie decomposition was used to explore the contribution of influencing factors such as unpaid labor to the difference in the occurrence of depressive symptoms between urban and rural areas.

RESULTS

About 2,136 (21.70%) participants had depressive symptoms, of which 1,197 (24.75%) rural employed people had depressive symptoms and 939 (18.75%) urban employed people had depressive symptoms. The results of Fairlie decomposition analysis showed that 70.51% of the differences in depressive symptoms between urban and rural Chinese employed people could be explained by the covariates included in this study, including education level (52.44%), age (-11.91%), housework time (10.42%), self-rated health status (10.22%), self-rated income status (2.53%), exercise (2.36%), job satisfaction status (1.99%), chronic disease status (1.90%), and marital status (1.79%).

CONCLUSION

This study found that the proportion of depressive symptoms was lower among urban employed residents than among rural employed residents. This difference was mainly caused by unpaid labor time, socioeconomic status, personal lifestyle, and health status. Housework, which is one of the unpaid labor, contributed to this depressive symptom difference in the third place.

Association between home and community-based services utilization and self-rated health among Chinese older adults with chronic diseases: evidence from the 2018 China Health and Retirement Longitudinal Study

BACKGROUND

As global aging intensifies, older adults with chronic diseases are of increasing concern. Home and community-based services (HCBSs) have been proven to promote self-rated health (SRH) in older adults, but no research explored the associations between the use of overall HCBSs, three different types of HCBSs (health care, daily care, and social support services) and SRH among older adults with chronic diseases. Consequently, this study applies a national publicly available database to examine these associations among older adults with chronic diseases.

METHODS

8,623 older adults with chronic diseases (≥ 60 years old) were included in this study. SRH was evaluated applying a concise question with a 1 - 5 scale. HCBSs utilization was assessed through the question, "What kind of HCBSs were used in the community?". Univariate general linear regression models aimed to compare the mean values of SRH in terms of HCBSs utilization in each group. This study is a cross-sectional study design and the relationship between HCBSs utilization and SRH was assessed by multilevel linear regression.

RESULTS

The mean score for SRH among the respondents was 3.19, of whom 20.55% used one or more HCBSs, 19.47% utilized health care services, 2.44% utilized social support services, and only 0.55% utilized daily care services. The use of HCBSs was found to be linked to SRH among older adults with chronic diseases (β = 0.085, SE = 0.025, p < 0.001). SRH among older adults with chronic diseases was strongly linked to the use of health care and social support services (β = 0.068, SE = 0.025, p < 0.001; β = 0.239, SE = 0.063, p < 0.001, respectively). However, there was no significant association between the use of daily care services and SRH among older adults with chronic diseases.

CONCLUSION

This study revealed that HCBSs utilization was positively and significantly linked to SRH in Chinese older adults with chronic diseases. Furthermore, this study supposes the low utilization of social support and daily care services may be due to a mismatch between supply and demand. The government should offer the targeted HCBSs for older adults with chronic diseases according to their unique features to enhance their health status.

Loneliness, Psychological Well-being, Depression, and Social Participation in the Older Persons: Rural and Urban Differences

INTRODUCTION

The purpose of this study is to compare the loneliness, psychological well- being, depression, and social participation of elderly people living in Turkish society between rural and urban areas. The sample group of the study, in which a correlational survey model was used, consisted of 610 elderly adults.

METHOD

The study population consists of two groups: the first group consists of individuals over 65 years of age living in the city (Istanbul) (n= 291), and the second group consists of individuals over 65 years of age living in rural areas (rural areas of Ordu) (n= 319). Socio-demographic Information Form, Loneliness in the Elderly Scale, Geriatric Depression Scale, Psychological Well-Being in the Elderly Scale, and Social Inclusion Scale were applied online. Statistical analyses of the study were conducted using SPSS 27.00, and the Independent Samples t-test and ANOVA test were used.

RESULTS

According to the findings of this study, statistically significant results were found in psychological well-being, social inclusion, social relations, loneliness and depression, and place of residence. It was observed that the social isolation and social acceptance levels of those living in urban areas were higher than those living in rural areas. Social, loneliness, and depression scores of those living in the village/town were found to be higher than those living in the city centre. Furthermore, the social relationship scores of those living in the village/town were found to be higher than those living in the city centre.

CONCLUSION

The increasing elderly population worldwide has become an issue that requires global measures. Place of residence is one of the factors thought to affect older people's health and well- being. It is thought that the study data will contribute to new policies that will ensure the protection and promotion of elderly health and those working in this field. In addition, the study, which provides information about Turkish culture, will also enable intercultural comparisons.

Exploring factors influencing visual disability in the elderly population of China: A nested case-control investigation

Background

Factors influencing visual disability among the elderly in China remain largely unclear. We sought to determine the prevalence and identify risk factors for visual disability among older adults in China.

Methods

We employed a nested case-control study design, utilising data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2018. Cases and controls were matched by a ratio of 1:3 by age and sex. Conditional logistic regression identified factors associated with visual disability.

Results

Prior to data matching, the cohort comprised 4729 complete samples, with 785 (16.6%) newly diagnosed cases of visual disability during the follow-up period. Following matching, 3132 subjects remained, with 783 in the case group and 2349 in the control group. Factors associated with the occurrence of visual disability in the elderly included per capita family income (odds ratio (OR) = 0.98; 95% confidence interval (CI) = 0.97-0.99), adequate sleep (OR = 0.75; 95% CI = 0.63-0.90), cognitive function (OR = 0.98; 95% CI = 0.96-0.99), heart disease (OR = 1.51; 95% CI = 1.20-1.89), kidney disease (OR = 1.45; 95% CI = 1.05-1.98), depression (OR = 1.04; 95% CI = 1.03-1.06), history of falls (OR = 1.34; 95% CI = 1.09-1.65), and cataracts (OR = 2.71; 95% CI = 1.81-4.07).

Conclusions

Visual disability among the elderly in China remains a major concern. Per capita family income, adequate sleep, and cognitive function are protective factors, while heart disease, kidney disease, depression, history of falls, and cataracts are risk factors. Future efforts in preventing and treating visual disability in the elderly should target these high-risk factors and provide early interventions to this population.

Exploring the relationship between depression and multimorbidity in Chinese middle-aged and older people based on propensity score matching

BACKGROUND

This study aimed to explore the relationship between depression and multimorbidity among middle-aged and older people in China.

METHODS

The cross-sectional study used the 2018 China Longitudinal Study of Health and Retirement and included a sample of 19,761 middle-aged and older adults aged 45 years and above. Propensity score matching was used to match samples of individuals with and without depression symptoms. The association between depression symptoms and multimorbidity and dose-response relationships were analyzed using logistic regression and restricted cubic spline (RCS) models for matched samples.

RESULTS

Logistic regression analysis showed that the prevalence of multimorbidity was 1.49 times higher among middle-aged and older adults in the depression symptom group compared to the non-depression group (95% CI:1.24, 1.80). The RCS curves for the relationship between depression and multimorbidity showed an overall increasing trend (P = 0.028). And prevalence of arthritis and digestive disease in the depressed and non-depressed groups is 3.6% and 3.9%, respectively.

LIMITATIONS

It was difficult to draw conclusions about causation since the study was cross-sectional, and CESD-10 scores do not represent the population study finally diagnosed with depression, the conclusions should be promoted with caution.

CONCLUSIONS

Middle-aged and older people with depressive symptoms are more likely to have multimorbidity than non-depressed individuals. Furthermore, the likelihood of multimorbidity increases with higher depression scores, and the binary combinations were similarly distributed. Therefore, attention should be paid to the management of mental health in the middle-aged and older adult population to alleviate and prevent any mental health issues they might face.

Chronic conditions and depressive symptoms in middle-aged and older Chinese adults: Roles of perceived social support and area of residence

BACKGROUND

Many studies have shown that having noncommunicable chronic diseases (NCDs) is strongly associated with depressive symptoms in elderly people; however, the mechanisms of this association are not fully understood. This study aims to investigate whether perceived social support (PSS) mediates the effect of NCDs on depressive symptoms and whether these relationships differ depending on where middle-aged and elderly people live.

METHODS

The study population was from the psychology and behavior investigation of Chinese residents (PBICR). A total of 8732 people aged 45 and older were included in the hypothetical modulated model. Perceived Social Support Scale (PSSS) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate PSS and depressive symptoms.

RESULTS

NCDs were positively related to depressive symptoms (β = 0.81, p < 0.01) and indirectly mediated through PSS (β = 0.08). Residency moderated the relationship between NCDs and PSS (β = -0.16, p < 0.01) and between NCDs and depressive symptoms (β = 0.29, p < 0.01). Specifically, the effect of NCDs on PSS and depressive symptoms was greater in rural middle-aged and older adults.

CONCLUSIONS

NCDs raise the risk of depressive symptoms in middle-aged and older Chinese, with PSS playing a partially protective role. In addition, the area of residence moderated the connection between the number of NCDs and PSS, NCDs, and depressive symptoms in middle-aged and older adults.

Decomposition and comparative analysis of depressive symptoms between older adults living alone and with others in China

Objective

This research dealt with investigating and measuring the contribution of the factors that impact depression in older adults living alone vs. those living with others (hereafter referred to as "not alone") in China.

Design

This investigation adopts a cross-sectional research design. The dataset employed for this study comprises data from 2018 the Chinese Longitudinal Health Longevity Survey (CLHLS).

Setting

The research involved data sourced from China, specifically from 23 of its provinces. From the 8th CLHLS, 12,197 older adults were selected who met the study requirements.

Measures

Binary logistic regression models were established to delve into the primary factors impacting the depressive symptoms of the individuals. Furthermore, Fairlie models were employed to assess these factors between older adults living alone and those not living alone. This approach facilitated an in-depth analysis of their respective contributions.

Results

It was observed that the demographic of Chinese older adults exhibited depressive symptoms at a rate of 11.92%. Older adults who resided alone (15.76%) exhibited a higher prevalence of depressive symptoms in comparison to their counterparts living in not-alone settings (11.15%). Employing Fairlie decomposition analysis, it was determined that this observed disparity in depressive symptoms, amounting to 55.33% of the overall difference, could be primarily attributed to distinct factors. This encompassed variance in marital status (20.55%), years of school (4.63%), self-reported local income status (7.25%), self-reported sleep status (17.56%), and self-reported health status (4.24%).

Conclusion

The resulting data indicated that depressive symptoms exhibited an elevated prevalence in older adults living alone than in those living not alone. This discrepancy was predominantly attributed to variance in socioeconomic marital status, years of school, self-reported local income status, self-reported sleep status, and self-reported health status by living alone vs. not alone. Mitigating these influential factors could help develop targeted and meticulous intervention strategies, precisely tailored to improve the mental well-being of older adults at high risk.

Association between home and community-based services and depressive symptoms in Chinese older adults: a multilevel analysis

BACKGROUND

As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have been increasingly important in China. However, the association between HCBSs utilization and depressive symptoms in older adults in China is unclear. Consequently, this study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults.

METHODS

This study included 7,787 older adults (≥ 60 years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, "What kind of HCBSs were being utilized in their community?". Data were analyzed using binary logistic regression models and generalized hierarchical linear models (GHLM).

RESULTS

Of the 7,787 participants, 20.0% (n = 1,556) reported that they utilized HCBSs, and 36.7% (n = 2,859) were evaluated that they had depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.180, 95% CI: 1.035-1.346, p < 0.05). Additionally, the depressive symptoms were significantly associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health (SRH), smoking, and provincial Gross Domestic Product (GDP) per capita.

CONCLUSIONS

This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is of utmost significance for the government to provide targeted HCBSs at the community level to address the unmet care needs of older adults, which can reduce the occurrence of negative emotions, consequently contributing to less severe depressive symptoms.

Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS

Background

With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models.

Results

After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese.

Conclusion

The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Association of urbanization with psychological well-being in Chinese adults aged 50 years and older: a population-based study

OBJECTIVE

To examine the association between urbanization and psychological well-being (PWB) in China.

METHODS

Data were obtained from the 2015 China Health and Nutrition Survey (CHNS) and included 3,071 men and 3,385 women aged 50 years or older who lived in 288 communities across 12 provinces and municipalities. The urbanization index, which summarizes 12 urbanization dimensions at community level, was categorized into tertiles representing low, medium, and high levels of urbanization. PWB was assessed by scoring three self-reported questions. Gender-stratified multilevel analyses were used to estimate the association between urbanization and PWB.

RESULTS

After controlling for individual-level factors, the urbanization index was associated positively with PWB. More specifically, an increase of one SD in the score of community population density, economic activity, housing, education, sanitation, or diversity was associated significantly with PWB in both genders. In addition, increases in the score of community communications, social services, transportation, or modern markets were associated significantly with PWB in women, but not in men.

CONCLUSION

Urbanization has, on average, had an independent and positive effect on PWB in middle-aged and older Chinese populations, with many components of urbanization being separately and positively associated with PWB, especially in women.

Association between specific social activities and depressive symptoms among older adults: A study of urban-rural differences in China

Background

Engaging in social activities can help older persons with their depressed symptoms. Few studies, however, have looked into the connection between social interactions and depressed symptoms in Chinese older persons. The aim of this study was to investigate differences in older Chinese individuals' social activity involvement and depressive symptoms across urban and rural settings.

Methods

A cross-sectional investigation using information from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which was limited to older individuals aged 60 and over. Generalized linear models were constructed to assess the effects of participants' characteristics and specific social activities on CES-D scores. The association between specific social activities and depressed symptoms was investigated using multivariate logistic regression analysis.

Results

In this study, it was discovered that older individuals had a prevalence of depressed symptoms of 36.2%, with rural older adults having a greater prevalence of depressive symptoms (39.7%) than urban older adults (30.9%). Our results showed that for urban respondents, providing help to others (not regularly. OR = 0.753, 95% CI: 0.579–0.980, P = 0.035), going to a sport (not regularly. OR = 0.685, 95% CI: 0.508–0.924, P = 0.013), and using the Internet (not regular. OR = 0.613, 95% CI: 0.477–0.789, P &lt; 0.001; almost weekly. OR = 0.196, 95% CI: 0.060–0.645, P = 0.007) were all significantly and negatively associated with depressive symptoms, while for rural respondents, interacting with friends (not regularly. OR = 1.205, 95% CI: 1.028–01.412, P = 0.021) and using the Internet (not regularly. OR = 0.441, 95% CI: 0.278–0.698, P &lt; 0.001) were significantly and negatively associated with depressive symptoms.

Conclusions

According to our research, there is a cross-sectional relationship between participating in a specific social activity and depressed symptoms in Chinese older adults, and this relationship varies across urban and rural older adults. This suggests that taking part in specific social activities may be crucial for reducing depression symptoms in older persons, developing more focused interventions that might support healthy aging, and offering a guide for policymakers and activists working to improve the mental health of seniors.

Temporal trend and subgroup disparities in the prevalence and treatment of those who screen positive for depression in China: A population-based study

Background

In China, improving mental health has been far behind its accomplishments for other diseases. With depression as one of the most prevalent mental disorders, the aim of this study was to evaluate temporal trends in the prevalence and treatment of those who screen positive for depression in China, by age, gender, and province.

Methods

We used data from three nationally representative sample surveys: the China Health and Retirement Longitudinal Study (CHARLS), the China Family Panel Studies (CFPS), and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Access to treatment was judged by two items: if respondents received any treatment like anti-depressants, or if respondents received counselling from a mental health professional. Survey-specific weighted regressions were fitted to estimate the temporal trend and subgroup disparities, and then pooled by meta-analysis.

Results

In total 168,887 respondents were investigated. The overall prevalence of China populations who screen positive for depression was 25.7% (95% CI 25.2-26.2) during 2016-2018, decreased from 32.2% (95% CI 31.6-32.8) during 2011-2012. The gender gap increased with age and had no significant improvement from 2011-2012 to 2016-2018. The prevalence of depression in developed areas is more likely to show a lower value and decreasing trend, while the prevalence in underdeveloped areas is more likely to show a higher value and increasing trend, from 2011-2012 to 2016-2018. The overall proportion of those who received any needed treatment or counselling from a mental health professional slightly increased from 2011 (0.5%, 95% CI 0.4-0.7) to 2018 (0.9%, 95% CI 0.7-1.2), and mainly occurred for older adults aged 75 and above.

Conclusion

The prevalence of those who screen positive for depression decreased by about 6.5% from 2011-2012 to 2016-2018 in China, but only tiny improvements were made in accessibility to mental health care. Corresponding disparities were identified in age, gender, and province.

Prevalence and gender disparity of those who screen positive for depression in China by the classification of the employer and industry: a cross-sectional, population-based study

BACKGROUND

The important role of mental health in sustainable economic development is gradually being recognized. This study aimed to evaluate the prevalence and gender disparity of those who screen positive for depression in China by the employer and industrial classification.

METHODS

We used data from a nationally representative survey, the China Family Panel Studies. Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Employer classifications were categorized according to the local characteristics of Mainland China. Industrial classifications were defined using level-1 of the China version of the International Standard Industrial Classification of All Economic Activities. Weighted logistic regressions were fitted to estimate the gender disparities, controlling for confounders.

RESULTS

Forty eight thousand six hundred twenty eight adults were included. 18.7% (95%CI 18.1-19.4) of sampled adults were screened positive for depression symptoms, with 16.6% (95%CI 15.8-17.5) in males vs 21.0% (95%CI 20.1-22.0) in females. By classification of the employer, the prevalence was lowest among those employed by Government/party organisations (11.8%, 95%CI 8.9-15.4), and highest in those self-employed (21.8%, 95%CI 20.8-22.9); the gender disparity was mainly found in those employed by Sole proprietorship (Adjusted odds ratio [AOR] = 1.95, 95%CI 1.19-3.19) and Private enterprise (AOR = 1.34, 95%CI 1.13-1.59), as well as those self-employed (AOR = 1.49, 95%CI 1.3-1.17). By industrial classification, the prevalence was lowest among those who worked in the industry of Real estate (7.2%, 95%CI 4.8-10.6), and highest among those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (22.9%, 95%CI 15.5-32.4); the gender disparity was mainly found in those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (AOR = 3.29, 95%CI 1.18-9.15), Manufacturing (AOR = 1.41, 95% CI 1.09-1.82), Wholesale and retail trade (AOR = 1.48, 95% CI 1.07-2.06), and Accommodation and food service (AOR = 1.91, 95% CI 1.15-3.18).

CONCLUSION

The prevalence of depression in China had a wide variation by classifications of the employer and industry. Gender disparities were identified among workers from Sole proprietorship, Private enterprise, and self-employed, or workers from the industry of Agriculture, forestry, animal husbandry and fishing, Manufacturing, Wholesale and retail trade, and Accommodation and food service.

Incidence of cognitive impairment after hypothetical interventions on depression, nighttime sleep duration, and leisure activity engagement among older Chinese adults: An application of the parametric g-formula

Background

Cognitive impairment is an age-relevant intermediate stage where cognition declines to a state between the normal aging process and dementia. Earlier studies reported that depression, inappropriate nighttime sleep duration (NSD), and limited leisure activity engagement are cognitive impairment risk factors among older adults. Thus, we postulated that interventions on depression, sleep duration, and leisure activity engagement can reduce cognitive impairment risk. However, no earlier research ever explored this.

Methods

The data of 4,819 respondents aged 60 years and above, without cognitive impairment at baseline and with no prior history of memory-related diseases, including Alzheimer's disease, Parkinson's disease, and encephalatrophy, were obtained from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. The parametric g-formula, an analytic tool for estimating standardized outcome distributions using covariate (exposure and confounders)-specific estimates of the outcome distribution, was used to estimate 7-year cumulative cognitive impairment risks among older Chinese adults, under independent hypothetical interventions on depression, NSD, and leisure activity engagement, which was subdivided into social activity (SA) and intellectual activity (IA) for the different intervention combinations.

Results

The observed cognitive impairment risk was 37.52%. Independent intervention on IA was the most effective factor in reducing incident cognitive impairment, with a risk ratio (RR) of 0.75 (95% confidence interval [CI]: 0.67-0.82), followed by depression (RR: 0.89, 95% CI: 0.85-0.93) and NSD (RR: 0.88, 95% CI: 0.80-0.95). The joint intervention combining depression, NSD, and IA interventions could reduce the risk by 17.11%, with an RR of 0.56 (95% CI: 0.48-0.65). In subgroup analyses, independent interventions on depression and IA had analogously significant effects on men and women. However, interventions on depression and IA had stronger effects on literate than illiterate individuals.

Conclusions

Hypothetical interventions on depression, NSD, and IA reduced cognitive impairment risks among older Chinese adults, both independently and jointly. The findings of the present study suggest that the intervention measures on depression, inappropriate NSD, limited intellectual activities, and their combination may prove to be effective strategies for preventing cognitive impairment among older adults.

Association between air quality satisfaction, family relationships, and depression symptoms among middle-aged and elderly chinese people: the mediation role of perceived health status

BACKGROUND

Population aging has led to depression becoming a serious public health problem both in China and worldwide. Marital relationships, relationships with their children, and air pollution might play an important role in the process of depressive disorders. In this study, we aimed to reveal the mechanism of the effects of these factors on depression.

METHODS

Participants were recruited from The China Health and Retirement Longitudinal Study (CHARLS) (wave 4) from July 2018 to March 2019. Depression symptoms were evaluated using the 10-item Center for Epidemiologic Studies depression scale (CESD-10). Marital relationships, relationships with their children, air quality satisfaction, and perceived health status were analyzed using Likert 5-point evaluation methods. Structural equation modeling-path (SEM) models were used to explore these variables' mediation effects on depression symptoms.

RESULTS

Marital relationships, relationships with their children, air quality satisfaction, perceived health status, and depression symptoms were significantly associated with each other (P < 0.001). Mediation analysis showed that family relationships (standardized beta = -0.28 [-0.31, -0.26]) and quality satisfaction (standardized beta = -0.03 [-0.05, -0.01]) had negative effects on depression symptoms. The total indirect effects of family relationships and air quality satisfaction on depression symptoms were -0.06 (95% confidence interval (CI) = [-0.07, -0.05]) and -0.016 (95% CI = [-0.02, -0.01]), respectively.

CONCLUSION

Family relationships, air quality satisfaction, and perceived health status influenced depression symptoms. The effects of family relationships and air quality satisfaction on depression symptoms were significantly mediated by perceived health status. Therefore, perceived health status aspects should be considered when conducting targeted intervention toward depression symptoms among middle-aged and elderly adults.

Urbanization and depressive symptoms among middle-aged and older adults in China

Aims

Urbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.

Methods

Using the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.

Results

Our final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.

Conclusions

Planned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

The Relationship between Social Support and Anxiety among Rural Older People in Elderly Caring Social Organizations: A Cross-Sectional Study

BACKGROUND

Social support and anxiety have a major impact on later life quality in rural, older people in elderly caring social organizations (SOs). This study aimed to explore the relationship between social support and anxiety and their relevant influential factors among rural older people in elderly caring SOs in Anhui Province, China.

METHODS

This cross-sectional study was conducted through a multi-stage stratified cluster random sampling method. Independent t-tests, one-way ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, and a generalized linear model were employed.

RESULTS

A significantly negative association between friends' support and anxiety were found among rural older people in elderly caring SOs. Statistically significant relationships were found between social support and gender, marital status, education level, whether visited by relatives, and institutional satisfaction. Similarly, anxiety was associated with gender, institutional satisfaction, comorbid chronic diseases, and friends' support.

CONCLUSIONS

Social support from friends plays an important role in preventing and regulating anxiety among rural older people, especially those from elderly caring SOs. To reduce the occurrence and level of anxiety among rural elderly in elderly caring SOs, an effort should be given to strengthening social support, improving institutional satisfaction, and emphasizing comorbid chronic diseases.

Predictors of Depression Level among Community-Dwelling Elderly Persons

Elderly people in the community have difficulty taking care of themselves because of their inability to care for themselves in daily life as well as their poor social support system, which leads to loneliness, resulting in depression. The primary objective was to investigate the level of depression and related factors among community-dwelling elderly persons (CDEP). This was a cross-sectional study, and 150 participants were interviewed. The questionnaires included demographics, the Functional Independence Measure, the Interpersonal Support Evaluation List, the UCLA Loneliness Scale, and the Geriatric Depression Scale Short Form. It was found that participants with different levels of depression accounted for 26%, and education level, living status, chronic disease, daily life function, social support, and loneliness were all significant factors influencing the depression level among the CDEP that could significantly predict 63.4% of the variation in depression level. Nursing staff must understand the level of depression and its influencing factors, encourage the elderly in the community to increase social networks, and integrate leisure into their lives, thereby enhancing the sense of value and meaning of life and reducing feelings of loneliness and depression.

Anxiety, Depression, Chronic Pain, and Quality of Life Among Older Adults in Rural China: An Observational, Cross-Sectional, Multi-Center Study

PURPOSE

To determine the incidence of anxiety and depression and examine their cross-sectional associations with chronic pain and quality of life among older adults in rural China.

DESIGN

Observational, multi-center, cross-sectional study.

METHODS

A structured, self-report questionnaire was administered. Descriptive statistics analysis and stepwise multiple linear regression analysis were performed.

FINDINGS

244 participants (female: 47.1%) filled out the questionnaires. 87 (35.7%) had symptoms of anxiety and 123 (50.4%) had symptoms of depression. The sensory pain descriptor, affective pain descriptor, physical component summary, and mental component summary significantly influenced symptoms of anxiety while affective pain descriptor, physical component summary, and mental component summary significantly influenced symptoms of depression.

CONCLUSION

Subjective pain experiences and QoL, including physical and mental domains, are strongly related to symptoms of anxiety and depression among older adults in rural China.

CLINICAL EVIDENCE

Interventions that highlight subjective pain experiences and QoL may help to relieve symptoms of anxiety and depression in older adults.

The Additional Medical Expenditure Caused by Depressive Symptoms among Middle-Aged and Elderly Patients with Chronic Lung Diseases in China

Depression is one of the most common comorbidities in patients with chronic lung diseases (CLDs). Depressive symptoms have an obvious influence on the health function, treatment, and management of CLD patients. In order to investigate the additional medical expenditure caused by depressive symptoms among middle-aged and elderly patients with CLDs in China, and to estimate urban–rural differences in additional medical expenditure, our study used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) investigation. A total of 1834 middle-aged and elderly CLD patients were included in this study. A generalized linear regression model was used to analyze the additional medical expenditure on depressive symptoms in CLD patients. The results show that depressive symptoms were associated with an increase in medical costs in patients with CLDs. Nevertheless, the incremental medical costs differed between urban and rural patients. In urban and rural patients with more severe comorbid CLD and depressive symptoms (co-MCDs), the total additional medical costs reached 4704.00 Chinese Yuan (CNY) (USD 711.60) and CNY 2140.20 (USD 323.80), respectively. Likewise, for patients with lower severity co-MCDs, the total additional medical costs of urban patients were higher than those of rural patients (CNY 4908.10 vs. CNY 1169.90) (USD 742.50 vs. USD 176.90). Depressive symptoms were associated with increased medical utilization and expenditure among CLD patients, which varies between urban and rural areas. This study highlights the importance of mental health care for patients with CLDs.

Ambient Ozone, PM1 and Female Lung Cancer Incidence in 436 Chinese Counties

Ozone air pollution has been increasingly severe and has become another major air pollutant in Chinese cities, while PM₁ is more harmful to human health than coarser PMs. However, nationwide studies estimating the effects of ozone and PM₁ are quite limited in China. This study aims to assess the spatial associations between ozone (and PM₁) and the incidence rate of female lung cancer in 436 Chinese cancer registries (counties/districts). The effects of ozone and PM₁ were estimated, respectively, using statistical models controlling for time, location and socioeconomic covariates. Then, three sensitivity analyses including the adjustments of smoking covariates and co-pollutant (SO₂) and the estimates of ozone, PM1 and SO₂ effects in the same model, were conducted to test the robustness of the effects of the two air pollutants. Further still, we investigated the modifying role of urban-rural division on the effects of ozone and PM₁. According to the results, a 10 μg/m³ increase in ozone and PM₁ was associated with a 4.57% (95% CI: 4.32%, 16.16%) and 4.89% (95% CI: 4.37%, 17.56%) increase in the incidence rate of female lung cancer relative to its mean, respectively. Such ozone and PM₁ effects were still significant in three sensitivity analyses. Regarding the modifying role of urban-rural division, the effect of PM₁ was greater by 2.98% (95% CI: 1.01%, 4.96%) in urban than in rural areas when PM1 changed by 10 μg/m³. However, there was no modification effect of urban-rural division for ozone. In conclusion, there were positive associations between ozone (and PM₁) and the incidence rate of female lung cancer in China. Urban-rural division may modify the effect of PM₁ on the incidence rate of female lung cancer, which is seldom reported. Continuous and further prevention and control measures should be developed to alleviate the situation of the two air pollutants.

Urban-Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

Introduction: Multimorbidity has become one of the key issues in the public health sector. This study aimed to explore the urban–rural differences in patterns and associated factors of multimorbidity in China and to provide scientific reference for the development of health management strategies to reduce health inequality between urban and rural areas.

Methods: A cross-sectional study, which used a multi-stage random sampling method, was conducted effectively among 3,250 participants in the Shanxi province of China. The chi-square test was used to compare the prevalence of chronic diseases among older adults with different demographic characteristics. The Apriori algorithm and multinomial logistic regression were used to explore the patterns and associated factors of multimorbidity among older adults, respectively.

Results: The findings showed that 30.3% of older adults reported multimorbidity, with significantly higher proportions in rural areas. Among urban older adults, 10 binary chronic disease combinations with strong association strength were obtained. In addition, 11 binary chronic disease combinations and three ternary chronic disease combinations with strong association strength were obtained among rural older adults. In rural and urban areas, there is a large gap in patterns and factors associated with multimorbidity.

Conclusions: Multimorbidity was prevalent among older adults, which patterns mainly consisted of two or three chronic diseases. The patterns and associated factors of multimorbidity varied from urban to rural regions. Expanding the study of urban–rural differences in multimorbidity will help the country formulate more reasonable public health policies to maximize the benefits of medical services for all.