Urban-Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies

Interrelationships of frailty, hemoglobin, cognition, and depressive symptoms in aging: a path analysis of the ELSI-Brazil study

This study analyzed the interrelationships of anemia, depression, and cognition, as well as some of their associated factors to understand the paths to frailty. Data from 2,174 baseline participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Path analysis was used to assess the relationships of exogenous variables (place of residence, education level, number of diseases, diet score, and number of natural teeth), one endogenous variable (frailty), and three mediators (cognition, depression, and hemoglobin level). Cognition and hemoglobin level showed a negative path to frailty, while depressive symptoms showed a positive path. Among the exogenous variables, rural area had a negative effect on hemoglobin, depressive symptoms, and frailty; a higher education level showed a positive path to cognition; number of diseases showed a negative path to hemoglobin and a positive path to depressive symptoms and frailty; diet score showed a negative path to hemoglobin and depressive symptoms; number of teeth had a positive effect on cognition and hemoglobin and a negative effect on frailty. Two paths without direct effects had significant indirect effects - rural area showed an indirect relationship with cognition via hemoglobin and depressive symptoms; and education level showed an indirect path to frailty, mediated by the three intermediate variables. These results show complex interrelationships of frailty, hemoglobin, cognition, and depressive symptoms, which help understand the syndrome in a broad way and support the planning of more comprehensive prevention and intervention measures.

Tracking the Prevalence of Depression Among Older Adults in Singapore: Results From the Second Wave of the Well-Being of Singapore Elderly Study

Background: Late-life depression has serious public health implications due to its impact on healthcare systems and the economy. As the prevalence of depression tends to change over time across populations, continuous disease surveillance is warranted to inform evidence-based preventive interventions. The well-being of the Singapore elderly (WiSE) is the second study in the series that looked at the prevalence and correlates of depression in a multiethnic population in Singapore. Methods: This single-phase and comprehensive cross-sectional study employed stage 1 diagnosis of geriatric mental state-automated geriatric examination for computer-assisted taxonomy (GMS-AGECAT) to capture depression and subsyndromal depression. Results: The prevalence of depression and subsyndromal depression was 4.4% and 11.9%, respectively, compared to 3.7% and 13.4% in 2013 (p=0.425). Indians, those who were divorced and had below primary education had higher odds of depression (2.2, 3.6, and 4.2 times, respectively). Depression was associated with severe disability, loneliness, suicidal ideations, poor life satisfaction, health status, and social connections. Conclusion: Despite a decade of preventive efforts for the population, there has not been any decrease in the prevalence of depression. There needs to be continued efforts to strengthen prevention, detection, and access to care of those with depression. A multiprong community-based preventive strategy focusing on social as well as health factors is needed to promote social connections, reduce loneliness, and promote the overall wellbeing of the elderly.

Association between adverse childhood experiences and self-reported physician-diagnosed depression: The moderating effect of race/ethnicity

OBJECTIVES

Although research indicates that individuals with a history of adverse childhood experiences (ACEs) are at greater risk of experiencing chronic conditions, including depression, less is known about the association between ACEs and depression and how this association is dependent on race/ethnicity. This study examined the moderating effects of race/ethnicity on the association between ACEs and self-reported physician-diagnosed depression among adults.

STUDY DESIGN

Cross-sectional study.

METHODS

Data for this study came from the 2021 Behavioral Risk Factor Surveillance System. An analytic sample of 26,877 adults 18-64 years old (50.4% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was self-reported physician-diagnosed depression, the main explanatory variable was ACE score, and the moderating variable was race/ethnicity.

RESULTS

Of the 26,877 respondents, 28.1% had no ACEs, 47.2% had one to three ACEs, and 24.7% had four or more ACEs. About one in four respondents had physician-diagnosed depression. In the multivariable logistic regression, we found that the effect of ACEs on self-reported physician-diagnosed depression depends on race/ethnicity. Specifically, the effect of four or more ACEs is significantly stronger when the respondent identifies as Hispanic compared to those who identify as non-Hispanic Black or another race (AOR = 2.80, 95% CI = 1.42, 5.53).

CONCLUSION

The findings of this study demonstrate that experiencing four or more ACEs is associated with self-reported physician-diagnosed depression during adulthood, and this association is moderated by race/ethnicity.

Analysis of the prevalence and influencing factors of depression in middle-aged women: A nationwide study from CHARLS

Depression accounts for a large portion of the global burden of disease, and few large-sample studies have investigated the prevalence of depression in middle-aged women. This study examined the prevalence and factors influencing depression in middle-aged women. Cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) were used, selecting middle-aged women aged 45-59 years. Binary logistic regression was used to analyze the influencing factors. 3723 middle-aged women were included in the study, 1537 (41.28 %) had depressive symptoms, 2186 (58.72 %) had no depressive symptoms. The results of binary logistic regression analysis showed that sleep duration, old-age insurance, body pain, drinking, fall, self-related health, life satisfaction, residence, education and marital status were the influencing factors for middle-aged women (P<0.05). Depression in middle-aged Chinese women is influenced by a variety of factors. This study suggests that this population can be targeted for prevention in terms of demographic characteristics, behavioral habits, and healthcare configuration for middle-aged women who are in poor health, and with low life satisfaction.

Deciphering the mechanism of women's mental health: a perspective of urban-rural differences

Background

Mental health accounts for a significant proportion of holistic health and affects women more significantly than men. Livelihood capital, defined as an indicator of these sources available for individuals or households to survive and develop, is a cost-effective field for ameliorating women's mental health. However, the impact of these multiple factors of livelihood capital on mental health still requires further research Therefore, this study evaluates women's mental health and investigates the correlation between livelihood capital (including human capital, physical capital, social capital, and financial capital) and women's mental health.

Methods

Based on the 2018 China Labor-force Dynamics Survey, this study explores the relationship and pathways between livelihood capital and women's mental health, with the structural equation model. It also aimed to examine the impact of relative deprivation under the influence of livelihood capital on women's mental health, focusing on urban-rural differences.

Results

The results of this study are as follows: (1) Human capital, social capital and physical capital were positively correlated with women's mental health, while financial capital showed a negative correlation; (2) Relative deprivation mediates the impact of livelihood capital on women's mental health; (3) The impact of livelihood capital on women's mental health is different between urban and rural regions. Urban women were more likely to be influenced by financial capital, whereas human capital, social capital and physical capital were key factors affecting rural women's mental health. (4) Relative deprivation mediates the impact of livelihood capital on mental health in the rural sample, but not in the urban sample.

Discussion

This study shows a complex relationship among livelihood capital, relative deprivation, and women's mental health, with notable urban-rural differences. In rural areas, human, social, and physical capital positively affect women's mental well-being. For example, better education reduces relative deprivation. Social support and improved housing also help. Conversely, financial capital has a negative link with mental health, more so in urban areas, likely due to urban pressure and the wealth-mental health relationship. Based on the findings, several actions are warranted. In social welfare, allocate more resources to rural areas for stronger women's livelihood capital. Public services should improve rural housing and community integration. Expand and enhance mental health education for rural women. These steps can ease rural women's mental health challenges and promote fairness in mental health outcomes.

From work to community: how social participation and retirement can benefit older adults' depression

Objectives

The retirement phase and social participation influence the depressive symptoms of older individuals. Nonetheless, the fundamental mechanisms connecting these factors remain unclear. This analysis examined mediating social participation in the relationship between older adults' retirement and depressive symptoms.

Methods

The study analyzed 9,103 Chinese individuals aged 60 and above utilizing the 2020 China Health and Retirement Longitudinal Study (CHARLS). Researchers evaluated participants' depression utilizing the Center for Studies in Epidemiology Depression Scale (CESD-10). The hierarchical multiple regression models were utilized to evaluate the link between retirement and depression, through cross-sectional analyses, along with the possible influence of social participation on this relationship.

Results

Retirement significantly reduce older individuals' depression and improves their mental health state. In addition, social participation as a mediating variable further enhanced the beneficial impacts of retirement on the mental health state.

Conclusion

This research discovered that retirement indirectly influences older adults' depression, with social participation playing a significant impact. Thus, it establishes a foundation for mitigating psychological issues in this demographic. Engaging in or sustaining social activities during later life enhances the mental well-being of older individuals. Promoting social participation among older individuals is a viable approach to reduce depression and facilitating successful aging initiatives in this demographic.

A Systematic Review of the Effectiveness of Treatments for Depression in Rural and Remote Residents

Rural and remote populations have a high burden of depression and poorer access to mental healthcare services than their urban counterparts. This systematic review aimed to assess the effectiveness of psychological and pharmacological treatments on reducing depression specifically in rural and remote residents. Cochrane Library, Medline, PsycInfo, Embase and Scopus, and two clinical trial registries were searched. Included studies were randomised or cluster randomised trials conducted with rural and remote adult populations; examined the effectiveness of any treatment for depression; included a control group or comparator; measured depression; and were published in English. Two authors independently screened records for eligibility, extracted information from eligible studies and assessed risk of bias and certainty of evidence. Seventeen studies were included. Meta-analyses found a small benefit of behavioural activation therapy (standardised mean difference -0.43, 95% CI -0.78, -0.08, I2 = 40%), a large benefit of group therapy (standardised mean difference -1.80, 95% CI -2.80, -0.79, I2 = 93%) and no evidence of benefit of interpersonal therapy (standardised mean difference -0.89, 95% CI -2.30, 0.52, I2 = 96%) and cognitive behavioural therapy (standardised mean difference -2.39, 95% CI -5.83, 1.05, I2 = 98%) for reducing depression in rural populations. Behavioural activation and group therapy appear effective for treating depression among rural populations, although the certainty of evidence is low, and so further research is warranted. Further research on the effectiveness of psychological and pharmacological treatments on depression in rural and remote populations is needed.

Healthy lifestyle behaviors and depressive symptoms: a national cross-sectional study of the older adults in China

Introduction

This investigation assesses the impact of healthy lifestyle behaviors on depressive symptoms among older adults in China, utilizing data from the 2020 China Health and Retirement Longitudinal Study (CHARLS).

Methods

The analysis included 9,020 valid samples from individuals aged 60 and above. Sleep duration, social participation, and physical exercise were examined as independent variables. Depressive symptoms were measured using the CESD-10 scale, with relationships analyzed through an ordered logistic regression model.

Results

The study reveals significant correlations between healthy lifestyle behaviors - specifically adequate sleep, regular physical exercise, and active social participation - and reduced prevalence of depressive symptoms in the elderly (p < 0.05).

Discussion

These findings underscore the potential of healthy lifestyle interventions as key strategies in alleviating the mental health burden among China's aging population. Integration of these results into public health policies is recommended to enhance the mental well-being of older adults.

Key modifiable factors in urban-rural differences in depression among older adults in China: A comparative study between China and the United States

OBJECTIVES

Urban-rural differences in depression are evident among older adults in China but not in the United States. By comparing the two countries, this study aims to explore strategies for promoting regional equality in depression in China.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were utilized. Longitudinal data were used to describe urban-rural differences in depression prevalence among older adults in China (2011-2020) and the United States (2010-2020). Cross-sectional data from 2018 (CHARLS: 9840 participants; HRS: 10,381 participants) were used to identify key modifiable factors. A random forest algorithm was employed to determine the most important factors influencing depression, and comparisons between the two countries were made to identify modifiable factors. Multivariate logistic regression was used to analyze the relationship between these key modifiable factors and depression. A mediation model was applied to assess the mediating role of key modifiable factors in the relationship between residence and depression.

RESULTS

1) From 2011 to 2020, Urban-rural differences in depression prevalence among older adults were observed in China, but not in the United States. 2) In both China and the U.S., the top five factors ranked by importance were activities of daily living disability (ADLs), instrumental activities of daily living disability (IADLs), pain levels, self-reported health (SRH), and age. However, Urban-Rural Differences in ADLs, IADLs, and SRH were present in China but not in the United States. 3) ADLs, IADLs, and SRH collectively mediated 31.6 % (95 % CI: 0.268 - 0.360) of the relationship between residence and depression scores among older adults in China.

CONCLUSION

Urban-rural differences in physical health status (ADLs, IADLs, and self-reported health) among older adults in China are associated with Urban-Rural Differences in depression. The absence of such inequalities in the U.S. may offer insights for developing policies to promote regional equality in depression among older adults in China.

Rural-urban differences in the association between afternoon napping and depressive symptoms among middle-aged and older adults in China

OBJECTIVE

This study aimed to examine the association between afternoon napping and depressive symptoms among Chinese middle-aged and older adults and to evaluate the rural-urban differences.

METHODS

A total of 11,056 participants, aged≥45, 5646 rural and 5410 urban, were included using data from CFPS. Each participant provided data on afternoon napping through field interviews. CESD8 was used to measure depressive symptoms. Multivariable logistic regressions were used to investigate the association.

RESULTS

2654 (24.01 %) participants had depressive symptoms and 7239 (65.48 %) napped. Nappers were likely to have a lower risk of depressive symptoms (OR = 0.899; 95%CI =0.816-0.991). A significantly lower risk of depressive symptoms was found in the moderate-duration afternoon napping groups (31-60 min/day) compared with non-nappers (OR = 0.816; 95%CI =0.727-0.917). In terms of rural-urban differences, rural participants had a lower risk of depressive symptoms compared with non-nappers (OR = 0.813; 95%CI =0.716-0.926). A significant association was also found between age groups. Participants aged 65-74 years old had a lower risk of depressive symptoms compared with non-nappers (OR = 0.776; 95%CI = 0.627-0.959).

LIMITATIONS

First, the cross-sectional study may limit the ability to infer causality. Second, only those who responded to the questionnaire were included; selection bias was unavoidable. Finally, answers were retrospective self-reported, which may cause recall bias and social desirability bias.

CONCLUSIONS

Afternoon napping was associated with a lower risk of depressive symptoms among Chinese middle-aged and older adults. The associations varied between rural-urban and age groups. We recommend taking a moderate-duration afternoon napping every day to prevent the risk of potential depression.

Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study

BACKGROUND

Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited.

OBJECTIVE

This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression.

RESULTS

The findings indicate that internet usage results in a 1.41% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure.

CONCLUSIONS

Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults.

Depression among people living in rural and urban areas of Thailand: A cross-sectional study

BACKGROUND

Depression has a growing trend in the population worldwide. In this cross-sectional study, we investigated the prevalence and associated factors of depression among individuals residing in rural (Ban Luang district, Nan Province) and urban (Lak Si, Bangkok) areas of Thailand. Understanding the differences in depression between these two settings can provide insights for specific targeted interventions and mental health policies.

METHODS

The multistage stratified random sampling was applied to select the study participants. We recruited participants from rural and urban communities in Thailand using a structured survey questionnaire through either face-to-face interviews or in paper or electronic form. We collected data on depression using the Patient Health Questionnaire-9 (PHQ-9) tool and sociodemographic characteristics and conducted descriptive statistics and logistic regression analysis.

RESULTS

Of 867 survey participants, 420 were from rural areas (Nan) and 447 were from urban areas (Bangkok). Participants' mean age was 55.9±9.5 years in rural areas and 56.0±12.0 years in urban areas. Most participants in urban areas were women, married, and had lower education levels (71.1%, 50.3%, 58.8%, respectively). The overall prevalence of depression across both settings was 18.6%. We found a higher prevalence of depression in the urban (31.8%) than the rural (4.5%) setting. In multiple logistic regression analysis, urban residence was significantly associated with higher rates of depression compared with rural residence (adjusted odds ratio [AOR] 9.43, 95% confidence interval [CI] 5.08-17.52). Nuclear family and using social media were associated with lower levels of depression in urban areas (AOR 0.50 and 0.43, 95% CI 0.27-0.93 and 0.22-0.84, respectively). Higher education level was significantly associated with higher levels of depression in rural areas (AOR 3.84, 95% CI 1.19-12.42).

CONCLUSION

This study emphasized the difference in depression and related factors between rural and urban areas of Thailand, highlighting a greater prevalence in urban areas. To help prevent depression, it is important to address specific challenges in each setting, such as those faced by highly educated individuals living in rural areas with high depression rates, exploring social media use patterns in urban populations, and understanding dynamics of the nuclear family. Our findings can inform the development of public health policies aimed at effectively mitigating the burden of depression and improving overall mental well-being in specific settings.

Relationship between leisure activity and depression in Chinese older adults: chain mediating effect of diet and cognition

BACKGROUND

Leisure activity was associated with depression in older adults. However, the specific processes by which diet and cognition mediate the role of leisure activities and depression remain uncertain. The study aims to investigate the relationship between leisure activity and depression in older people and the underlying mechanisms involved, while constructing a comprehensive model that links these variables.

METHODS

Data came from the 2018 Chinese Longitudinal Healthy Longevity Survey. Mini-Mental State Examination and CES-D-10 were used to assess cognition and depression, respectively. PROCESS macro was employed to assess the mediation effects of diet and cognition on the relationship between leisure activity and depression.

RESULTS

Leisure activity was negatively associated with depression, with 35.90% of the total effect mediated through dietary diversity and cognitive function, of which 1.28% was from the chain-mediated effect of dietary diversity and cognition. In addition, 20.94% of the total effect mediated through a plant-based diet and cognitive function, of which 0.43% was from the chain-mediated effect of plant-based diet and cognition.

CONCLUSIONS

Leisure activities are linked to depression, with diet and cognition acting as chain-mediating factors. Public health experts recommend that older adults engage in leisure activities, ensure a broad spectrum of dietary intake, and prioritize the augmentation of plant-based diets as preventative strategies against depression.

Influencing factors of subjective well-being trajectory based on the group-based trajectory modeling (GBTM): Results from a healthy aging cohort study in Ma'anshan

AIM

This study aimed to explore the trajectory and predictors of subjective well-being (SWB).

METHODS

Elderly in Ma'anshan were followed up for 5 years. SWB was measured using the Memorial University of Newfoundland Scale of Happiness (MUNSH). GBTM was used to group the trajectories of SWB, and multivariate logistic regression was used to explore the influencing factors of the different trajectories.

RESULTS

2495 adults aged ≥60 years completed the survey. Four SWB trajectories were identified: low score ascending group [130(5.2 %)], high score decline group [316(14.7 %)], high score stable group [1827(73.2 %)], moderate score fluctuation group [172(6.9 %)]. With the high score stable group as the reference, social support, depressive symptoms and self-reported health were predictors of SWB for all the groups.

CONCLUSIONS

The SWB of the elderly has different developmental trajectories. Nursing staff may be carry out intervention on SWB of the elderly from social support, reducing depression and improving physical health.

Decomposing rural-urban differences in depression prevalence: a cross-sectional analysis of two community-based southern Indian cohorts

Introduction

Depression is a growing public health concern in India but its prevalence is uneven across the country, possibly influenced by several sociodemographic factors. We aimed to assess the rural-urban disparity in the prevalence of depression and their associated sociodemographic and lifestyle-related factors.

Methods

Participants were middle-aged and older adults (≥45 years) from two parallel, prospective cohorts from rural (CBR-SANSCOG, n=4493) and urban (CBR-TLSA, n=972) southern India. We used cross-sectional data from the baseline clinical and biochemical assessments of the above two cohorts. The Geriatric Depression Scale (GDS-30) was used to screen for depression (cut-off ≥10). Logistic regression was used to assess the relationship between place of residence (rural vs urban) and prevalence of depression, adjusting for age, sex, education, income, marital status, Body Mass Index (BMI), alcohol use, tobacco use and number of comorbidities. The Fairlie decomposition analysis was used to decompose the rural-urban disparity.

Results

We found that the prevalence of depression was significantly higher in rural than in urban participants (14.49% vs 8.23%, p<0.001). The fully adjusted binary logistic regression model showed that rural-dwelling individuals were 1.57 times more likely to have depression than urban residents (AOR: 1.57, 95% CI: 1.03, 2.39). In the decomposition analysis, the variables included in this model (age, sex, education, income, marital status, BMI, alcohol use, tobacco use and number of comorbidities) explained 35.21% of the rural-urban disparity in the prevalence of depression, with sex and marital status being the significant contributors.

Conclusion

Participants in our rural cohort had significantly higher odds for depression as compared to their urban counterparts, with sociodemographic factors playing a key role in this disparity. This underscores the need for scaling up mental health services in the rural communities of India including training primary healthcare providers to promptly identify and manage depression.

Urban and Rural Differences in the Efficacy of a Mobile Health Depression Treatment for Young Adults

Depression among young adults represents a growing health problem in the U.S., but access to effective treatment remains a challenge. Mobile health (mHealth) approaches promise to deliver accessible and effective depression treatment; however, questions remain regarding how mHealth depression treatment efficacy may vary geographically based on urban and rural environmental contexts. The present study addresses this knowledge gap by leveraging data from a randomized clinical trial of an mHealth depression treatment called Cognitive Behavioral Therapy-text (CBT-txt) as applied to a sample of 103 U.S. young adults (ages 18-25). Prior research has demonstrated the efficacy of CBT-txt to reduce depressive symptoms. In the present study, we conduct an exploratory, post hoc analysis employing moderated growth curve modeling to investigate whether observed treatment efficacy differed between study participants residing in rural versus urban areas. The findings indicate that CBT-txt treatment effects in terms of reducing depression symptoms were significantly stronger for young adults residing in rural, as compared to urban, regions (β = 13.759, 95% CI = 0.796, 26.723, p < 0.038). We speculate that this is because of the lack of mental healthcare resources in rural, as compared to urban areas, as well as the greater level of environmental stressors, such as artificial light and noise, found in cities, which may mitigate treatment effects.

Factors Influencing Mental Well-being Among Older Malaysians

Older adults are at greater risk of mental health issues. This study examined the factors influencing mental well-being among 2230 Malaysian older adults, using data from the 2018 to 2019 Malaysia Ageing and Retirement Survey. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess mental well-being, and linear regression analysis identified the significant factors. Women had lower mental well-being scores than men (P = .012, β = -0.016). Chinese (P = .024, β = -0.020), Indian (P < .001, β = -0.043), and other ethnicities (P < .001, β = -0.031) reported lower scores than Malays. The factors associated with better well-being were secondary (P = .001, β = 0.032) and tertiary education (P < .001, β = 0.063), and good (P < .001, β = 0.081) and moderate (P < .001, β = 0.038) health status. Diseases-limiting activities were associated with poor well-being (P < .001, β = -0.030). Support from family (P < .001, β = 0.062) and friends (P < .001, β = 0.032), social activity participation (P < .001, β = 0.026), and functional ability (P < .001, β = 0.043) were significant positive factors. There is a need for targeted interventions to enhance mental health among Malaysian older adults.

Oral Function, Loneliness, Depression, and Social Participation Among Physically Disabled Middle-Aged and Older Adult Individuals: Insights from a Japanese Cross-Sectional Study

Background/Objectives: In the context of an aging society, physical disability and its relationship with frailty is of growing concern. The aim of this study was to examine the associations between oral function, social participation, and loneliness among community-dwelling middle-aged and older adult physically disabled individuals. Methods: In this cross-sectional study, the participants were 140 individuals with certified physical disabilities living in the studied area. Demographic characteristics, outing activities, loneliness (Three-Item Loneliness (TIL) Scale), and frailty/ability to live independently (Kihon Checklist (KCL)) were assessed using a questionnaire survey. The participants were divided into two groups based on the presence or absence of oral dysfunction (OD), and statistical analyses were performed to compare the groups. Results: The group with OD had significantly higher TIL and KCL total scores and significantly lower mobility, confinement, cognitive function, greater levels of depression, and fewer outing activities (volunteering, movies, festivals, sports) compared to the group without OD. In a multivariate, age- and sex-adjusted binomial logistic regression analysis, outing activities (OR = 0.011, 95% CI: 0.000-0.529, p = 0.023) and loneliness (OR = 6.174, 95%CI: 1.292-29.502, p = 0.023) were identified as significant factors. Conclusions: An association was found between OD, loneliness, and social activities among middle-aged and older individuals with physical disabilities. The results suggest that future interventions should consider the relationship between oral function and factors such as depression, loneliness, social isolation, and social engagement as a means to mitigate frailty and other health and well-being concerns for physically disabled individuals.

Prevalence of depressive disorders among the very old in the 21st century

BACKGROUND

The aim of this study is to explore the prevalence of depressive disorders in very old adults over time, in rural/urban environments, between men/women, as well as to explore other factors associated with depressive disorders.

METHODS

This study was conducted utilizing the GERDA-database data, which consists of four cohorts of 85, 90 and 95+ year olds living in Northern Sweden. Participants could reside independently or in residential care. Data collections took place between 2000 and 2017. Descriptive data and logistic regression models were utilized to explore data.

RESULTS

The prevalence of depressive disorders increased between 2000/02 and 2015/17 in all age groups, with the highest percentages observed in the 95+ age group, reaching 53.6 % in 2015/17. The prevalence varied from 20.3 % in those without dementia to 65.1 % in those with dementia. Sex or living in an urban/rural environment was not associated with an increased risk of depression in the fully adjusted models. Dementia and reduced capacity in activities of daily living were associated with depressive disorders among 85 and 90-year-olds, while living alone was associated with depressive disorders in the 95+ age group.

LIMITATIONS

Potentially limited generalizability, as this study took place in northern Sweden.

CONCLUSIONS

The prevalence of depressive disorders among very old adults increases with age and the prevalence also increases throughout cohorts and time. These alarming rates of depressive disorders among the very old require immediate measures and further investigation. Future studies are needed to explore and monitor trends and to plan and design tailored interventions.

Health survey on anxiety, depression, and stress in Afghanistan: A large-scale cross-sectional study amid ongoing challenges

BACKGROUND

One of the most significant events in recent Afghan history is the rise of the Taliban and the war that followed, which had profound impacts on the lives of Afghans. The present study examined the mental health of Afghans living under the Taliban government.

METHODS

Between June 5, 2023 and February 12, 2024, a cross-sectional study was conducted among the Afghan population in three key regions of Afghanistan. Data were collected using a pre-tested structured questionnaire. The 21-item Depression, Anxiety and Stress scale (DASS-21) was utilized to assess depression, anxiety and stress of the Afghan population. Ethical permission for this study was granted by the Afghanistan Center for Epidemiological Studies (ACES). Logistic regression models were employed to explore the relationship between socio-demographic characteristics and depression, anxiety, and stress among 2,698 participants.

RESULTS

The prevalence of depression was 72.05%, anxiety was 71.94%, and stress was 66.49%. Multiple regression analysis indicated that gender (being female), economic status (being poor), residency (living in rural areas), education level (being illiterate), being a cigarette smoker, and having experienced a bad event during the past month were significantly associated with depression, anxiety and stress.

CONCLUSION

The findings of the present study show very high levels of anxiety, depression, and stress, most likely reflecting the profound impact of recent political, social, and economic changes. Notably, a significant majority of participants, particularly females and individuals above 35 years of age, reported severe to extremely severe mental health symptoms. The mental health crisis in Afghanistan is a complex and urgent issue that requires a comprehensive and compassionate response.

Social determinants of health and depressive symptoms before and after cancer diagnosis

Despite frequent reports of mental health needs among older women with cancer, depressive symptoms often go unrecognized and untreated, particularly in socially vulnerable survivors. Here, we examined associations of sociodemographic factors and social limitations with depressive symptoms from pre-diagnosis to post-diagnosis in older women diagnosed with breast or gynecological cancer. Using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linked dataset, we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between sociodemographic factors (race, ethnicity, marital status, rurality) and social limitations (i.e., health interfering with social activities) on depressive symptoms in women aged ≥65 years with breast or gynecologic cancer (n = 1,353). Most participants had breast cancer (82.0%), stage I-II cancer (85.8%), received surgery for their cancer (94.8%), and radiation treatment (50.6%). Prior to diagnosis, 11.8% reported depressive symptoms, which nearly doubled to 22.4% at follow-up. Participants were 2.7 times more likely of reporting depressive symptoms after cancer diagnosis compared with pre-cancer diagnosis (95%CI: 2.10-3.48). Race, ethnicity, rurality, marital status, and social interference were significantly associated with an increased risk of depressive symptoms after cancer diagnosis than before their cancer diagnosis (p < 0.05). In summary, depressive symptoms increased following a cancer diagnosis. Our results suggest potential avenues for intervention that could lead to reduced depressive symptoms among older female cancer survivors.

Interpersonal interactions, sense of loneliness and perceived depressive emotions among older adults: A cultural-psychological perspective from heterogeneous roles of different relationships

In the context of the "Chinese Differential Mode of Association" in traditional Chinese culture, this paper examines the heterogeneous effects of interpersonal interactions in different relationships on older adults' depressive emotions from a cultural-psychological perspective. Results using data from Chinese General Social Survey demonstrate that: interactions with children are the most helpful in reducing perceived depression for the elderly, followed by communications with siblings and relatives. However, interactions with friends and other fellows do not significantly reduce older people's perceived depression. This reflects the "Chinese Differential Mode of Association" in interpersonal relationships. When using different perceived depression measures, and Double Debiased Machine Learning (DDML) approaches for robustness and endogeneity tests, above findings are very robust. The impact mechanism is that interactions with children and siblings reduce depressive emotions by decreasing older adults' sense of loneliness, while communications with others do not have such a significant effect. This paper further discusses the roles of different types of interactions with adult children. It is found that receiving and providing emotional support can prominently decrease depressive emotions for older people, whereas the effects of monetary support and non-material assistance are less pronounced. In addition, interpersonal interactions' impacts are more significant for those who are female, older than 75 and with poorer health, as well as older people who exercise less frequently, have higher social status, and hold more traditional beliefs. In the current context of active promotion of healthy aging, findings of this paper have important implications for a deeper understanding and scientific management of depressive emotions among the elderly.

The Effect of Social Determinants of Health on Psychological Health Among Older Adults in Ghana

This study examines the effects of various factors, including socioeconomic status, built environment, access to healthcare, educational level, social participation, and economic stability, on older adults' psychological health. The current study analyzed a nationally representative sub-sample of 2,577 respondents aged 50 and above from the World Health Organization's Study on Global AGEing and Adult Health (WHO SAGE) Wave 2. WHO SAGE Wave 2 is cross-sectional data collected via in-person structured interviews. Ordinal least square (OLS) was used to measure the average effect of social determinants of health (SDoH), and quantile regression analysis was used to determine the effects of SDoH on older adults' psychological health at different quantiles, specifically 10th, 50th, and 90th percentiles. Significant determinants of psychological health across all quantiles included age, healthcare access, marital status, economic stability, and neighborhood and built environment. However, the degrees of significance for residence, gender, educational level, chronic diseases, and social participation varied between quantiles, showing differing effects on older adults with high or low psychological health. Religion was insignificant across all quantiles. This study highlights the need for governments and public health agencies to develop targeted interventions and strategies that support the psychological well-being of older adults in the country.

The relationship between mental well-being and wealth varies by wealth type, place and sex/gender: Evidence from Namibia

This paper explores the impact of livelihood strategies and place on mental well-being. Identifying different socioeconomic factors that impact mental well-being across contexts is pressing given the global rise in mental health disorders. Numerous studies in the population and social sciences have emphasized the protective role of material wealth on human health and well-being; however, scholars frequently assess wealth as a one-dimensional variable, which may fail to capture diverse forms of wealth. Acknowledging different forms of wealth may be particularly important in settings where agricultural economies coexist with cash economies. Using data from the 2013 Namibia Demographic Health Survey (n = 13 377), we use a newly developed measure of success in agricultural activities, an agricultural wealth index, or AWI, generated by Hackman et al., (2021). To examine the role of different forms of wealth on mental health symptoms. We find mental well-being, assessed through three survey questions, is lower among urban dwellers and females and shows varied associations with wealth type and sex/gender. In general, success in agricultural activities is associated with better mental well-being, while the association with market success is null or and conditional upon sex/gender and place. This study adds to recent work on the value of using multidimensional measures of wealth and raises important questions about why wealth type and sex/gender differentially impact mental well-being.

Age, period, cohort effects in trends of depressive symptoms among middle-aged and older Chinese adults

Objectives

To investigate the effects of age, period, and cohort on the trends of depression; and to examine the influence of these three temporal effects on residential disparities in depression.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011 to 2020, involving 77,703 respondents aged 45 years old and above. The measurement of depressive symptoms was the score of 10-question version of the Center for Epidemiologic Studies Depression Scale (CES-D 10). The hierarchical age-period-cohort cross-classified random effects models were conducted to examine trends in depressive symptoms related to age, period and cohort.

Results

CES-D scores increased with age and slightly decreased at older age. The cohort trends mostly increased except for a downward trend among those born in 1950s. As for the period effect, CES-D scores decreased gradually from 2011 to 2013 followed by a upward trend. Rural residents were associated with higher level of depression than those live in urban area. These residence gaps in depression enlarged before the age of 80, and then narrowed. The urban-rural disparities in CES-D scores gradually diminished across cohorts, while the corresponding period-based change in urban-rural gaps was not significant.

Conclusion

When age, period, cohort factors are considered, the age effects on depression dominated, and the period and cohort variations were relatively small. The residence disparities in depression reduced with successive cohorts, more attention should be paid to the worsening depression condition of younger cohorts in urban areas.

The influence of residential Environment and residential experience on psychological depression in older adults: Evidence from China and Europe

This cross-national study examined the influence of residential environment and experience on depression in older adults in China and Europe to address existing research gaps. Using data from the China Health and Retirement Longitudinal Study (CHARLS) and Survey of Health, Ageing, and Retirement in Europe (SHARE) and employing ridge regression, it was found that residential environment and experience have a significant influence on older adults' depression. The influence of residential experience aligns with the sensitivity period hypothesis. The environment in which older adults live during specific age periods leaves an imprint on their psyche. This imprint is activated when specific environments are encountered in old age, thereby influencing the level of depression. This study examined how their influence on depression contributes to understanding older adults' housing preferences and can guide housing-related policies.

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.

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases

Introduction

It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.

Results

Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).

Conclusion

Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

Thwarted Belongingness and Depressive Symptoms Among Older Adults: The Moderating Roles of Self-Warmth, Self-Coldness, and Place of Residence

OBJECTIVES

This study investigated whether the relationship between thwarted belongingness and depressive symptoms was moderated by self-warmth and self-coldness and whether the moderating effects were conditional on place of residence (urban versus rural).

METHODS

A sample of 236 Australian adults aged 65 to 97 years (M = 73.63, SD = 6.53) completed the Geriatric Depression Scale, Interpersonal Needs Questionnaire, and Self-Compassion Scale.

RESULTS

The interaction between thwarted belongingness and self-warmth was significant for urban but not rural older adults. For urban older adults, the relationship between thwarted belongingness and depressive symptoms weakened as levels of self-warmth increased. The association between thwarted belongingness and depressive symptoms was significantly stronger for older adults living in rural areas than in urban areas. The relationship between thwarted belongingness and depressive symptoms strengthened as self-coldness levels increased.

CONCLUSIONS

Self-warmth is a protective factor for older adults living in urban areas and experiencing thwarted belongingness. Self-coldness is an additional risk factor for older adults experiencing thwarted belongingness.

CLINICAL IMPLICATIONS

Interventions focusing on increasing self-warmth among urban older adults and decreasing self-coldness among older adults might weaken the relationship between thwarted belongingness and depressive symptoms.

A predictive model for depression in Chinese middle-aged and elderly people with physical disabilities

BACKGROUND

Middle-aged and older adults with physical disabilities exhibit more common and severe depressive symptoms than those without physical disabilities. Such symptoms can greatly affect the physical and mental health and life expectancy of middle-aged and older persons with disabilities.

METHOD

This study selected 2015 and 2018 data from the China Longitudinal Study of Health and Retirement. After analyzing the effect of age on depression, we used whether middle-aged and older adults with physical disabilities were depressed as the dependent variable and included a total of 24 predictor variables, including demographic factors, health behaviors, physical functioning and socialization, as independent variables. The data were randomly divided into training and validation sets on a 7:3 basis. LASSO regression analysis combined with binary logistic regression analysis was performed in the training set to screen the predictor variables of the model. Construct models in the training set and perform model evaluation, model visualization and internal validation. Perform external validation of the model in the validation set.

RESULT

A total of 1052 middle-aged and elderly persons with physical disabilities were included in this study, and the prevalence of depression in the elderly group > middle-aged group. Restricted triple spline indicated that age had different effects on depression in the middle-aged and elderly groups. LASSO regression analysis combined with binary logistic regression screened out Gender, Location of Residential Address, Shortsightedness, Hearing, Any possible helper in the future, Alcoholic in the Past Year, Difficulty with Using the Toilet, Difficulty with Preparing Hot Meals, and Unable to work due to disability constructed the Chinese Depression Prediction Model for Middle-aged and Older People with Physical Disabilities. The nomogram shows that living in a rural area, lack of assistance, difficulties with activities of daily living, alcohol abuse, visual and hearing impairments, unemployment and being female are risk factors for depression in middle-aged and older persons with physical disabilities. The area under the ROC curve for the model, internal validation and external validation were all greater than 0.70, the mean absolute error was less than 0.02, and the recall and precision were both greater than 0.65, indicating that the model performs well in terms of discriminability, accuracy and generalisation. The DCA curve and net gain curve of the model indicate that the model has high gain in predicting depression.

CONCLUSION

In this study, we showed that being female, living in rural areas, having poor vision and/or hearing, lack of assistance from others, drinking alcohol, having difficulty using the restroom and preparing food, and being unable to work due to a disability were risk factors for depression among middle-aged and older adults with physical disabilities. We developed a depression prediction model to assess the likelihood of depression in Chinese middle-aged and older adults with physical disabilities based on the above risk factors, so that early identification, intervention, and treatment can be provided to middle-aged and older adults with physical disabilities who are at high risk of developing depression.

Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

The association between dual sensory loss and healthcare expenditure: Mediating effect of depression

BACKGROUND

Previous studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous.

OBJECTIVES

The current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above.

METHODS

We first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE.

RESULTS

Depression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05).

LIMITATIONS

The DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias.

CONCLUSION

Significant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.

Depressive symptoms in the entire spectrum of cognitive ageing in Greece: evidence from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD)

OBJECTIVES

To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data.

METHODS

The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model.

RESULTS

Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly.

CONCLUSIONS

Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.

Childhood intelligence and risk of depression in later-life: A longitudinal data-linkage study

Background

Lower childhood intelligence test scores are reported in some studies to be associated with higher risk of depression in adulthood. The reasons for the association are unclear. This longitudinal data-linkage study explored the relationship between childhood intelligence (at age ∼11) and risk of depression in later-life (up to age ∼85), and whether childhood family structure and adulthood socio-economic and geographical factors accounted for some of this association.

Methods

Intelligence test scores collected in the Scottish Mental Survey 1947 were linked to electronic health records (hospital admissions and prescribing data) between 1980 and 2020 (n = 53,037), to identify diagnoses of depression. Mixed-effect Cox regression models were used to explore the relationship between childhood intelligence test scores and risk of depression in later-life. Analyses were also adjusted for childhood family structure (size of family) and adulthood socio-economic and geographical factors (Carstairs index, urban/rural).

Results

Twenty-seven percent of participants were diagnosed with depression during follow-up (n = 14,063/53,037). Greater childhood intelligence test scores were associated with a reduced risk of depression in an unadjusted analysis (HR = 0.95, 95% CI = 0.93 to 0.97, P < 0.001), and after adjustment for factors experienced in childhood and adulthood (HR = 0.95, 95% CI = 0.91 to 1.00, P = 0.032). When identifying depression using only hospital admissions data, greater childhood intelligence test scores were associated with a reduced risk of depression following unadjusted analysis (HR = 0.86, 95% CI = 0.82 to 0.90, P < 0.001), and after adjusting for risk factors in childhood and adulthood (HR = 0.94, 95% CI = 0.89 to 0.99, P = 0.026). There was no association between childhood cognitive test scores and depression when identifying cases of depression using only prescribed drugs data.

Conclusions

This study provides additional evidence suggesting that higher childhood intelligence predicts reduced risk of later-life depression only when depression is assessed based on hospital admission records. Childhood family structure and adulthood socio-economic and geographical factors did not seem to be substantial confounders.

Predictors of Depression in Elderly According to Gender during COVID-19: Using the Data of 2020 Community Health Survey

BACKGROUND

This study aimed to examine factors influencing depression according to gender in people during COVID-19.

METHODS

This study was conducted on 61,147 elderly individuals over the age of 65 who participated in the 2020 Community Health Survey (CHS). Data analysis was conducted using SAS 9.4.

RESULTS

Elderly females had a higher perceived fear of COVID-19 than males. The common factors affecting depression in elderly individuals were age, monthly income, economic activity, stress, subjective health status, and social support. Among elderly women, changes in residential areas and daily life due to COVID-19 were identified as factors affecting depression.

CONCLUSIONS

Therefore, during COVID-19, it was necessary to provide customized depression relief programs for the elderly, and it was necessary to find ways for them to positively perceive their health status and increase healthcare efficacy. In the future, it is necessary to pay attention to elderly women living in rural areas and make efforts to ensure that their daily lives are not interrupted by infectious diseases.

The association between urbanization and adolescent depression in China

Background

With the rapid urbanization in many countries, more attention is being paid to the relationship between urbanization and mental health, especially depression. However, in countries with rapid urbanization, few empirical studies exist on the relationship between urbanization and adolescent depression.

Methods

Nationally representative survey data from the China Family Panel Studies in 2012, 2016 and 2018 were used. Data of 1,588 adolescents were obtained from 25 provinces. Depression was measured using the Center for Epidemiology Studies of Depression 20-item score. The urbanization rate was obtained from the National Bureau of Statistics of China. The generalized estimating equation was used to estimate the statistical relationship.

Results

The participants' mean age at baseline was 15 years, and 51.2% (813/1,588) of participants were male. After adjusting for all covariates (gender, age, ethnicity, level of education, marital status, urban/rural areas, body mass index, self-rated health, academic pressure, smoking, drinking and exercise), the rate of urbanization was monotonically and negatively associated with adolescent depression (odds ratio 0.34, 95% CI [0.14-0.79]). Compared with female adolescents, male adolescents had a lower risk of depression (odds ratio 0.80, 95% CI [0.67-0.97]).

Conclusion

In the context of China, urbanization has a positive effect on the mental health of adolescents. Female adolescents are more likely to experience depression than male adolescents.

Socioeconomic inequalities in depressive symptoms in China: The role of social capital

This cohort study used the China Health and Retirement Longitudinal Study (CHARLS, 2015-2018) to investigate the effects of socioeconomic status and social capital to the incidence of depressive symptoms among middle-aged and older individuals in China, incorporating a sample size of 9949 participants. Socioeconomic status, social capital and other explanatory variables were collected in 2015, while depressive symptoms were assessed in 2018. Basic characteristics and social capital measures were compared between urban and rural residents using the chi-square test. Logistic regression was used to explore the relationship between socioeconomic status, social capital and depressive symptoms, and the Karlson, Holm, and Breen (KHB) method was employed to verify the mediating role of social capital. We reported persistent socioeconomic inequalities in depressive symptoms, with rural residents and the illiterate having 1.45 times and 1.34 times higher odds of depression. We ascertained social capital from both the cognitive and structural constructs, where we enriched the measurement of structural social capital from three specific dimensions, i.e., informal interaction, altruism, and formal social participation. We found that both cognitive and structural social capital were associated with lower incidence of depressive symptoms, where informal interaction had the largest effect. The mediation analysis further illustrated that informal interaction contributed most to explain 6 %-12 % of the socioeconomic inequalities in depressive symptoms. These results highlighted the unsatisfied mental wellbeing of the vulnerable older people living in rural areas. The finding suggested that older people may benefit more from personal interactions than formal participations. To fulfill the Health in All vision, government and social organizations should consider how to create opportunities to better integrate the older people into the community.

Regional differences in the effects of healthy aging on depressive symptoms: a Korean longitudinal study of aging (2006-2020)

Background

Depression is a widely prevalent, often recurrent condition. To analyze the regional differences in depressive symptoms over time, we investigated urban-rural differences in change in depression over time in South Korea and the association between healthy aging and depressive symptoms among middle-aged and older adults.

Methods

Data collected in the Korean Longitudinal Study of Aging, from 2006 to 2020, of adult participants aged ≥45 years without depressive symptoms were analyzed. Healthy aging was defined under five principal components: absence of chronic disease, good physical function, normal cognitive function, active social engagement, and good psychological adaptation. Depressive symptoms were measured using the short version of the Center for Epidemiologic Studies Depression Scale. Using the Andersen-Gill model for recurrent time-to-event, we examined the effect of healthy aging on depressive symptoms, with a subgroup analysis based on the residential area.

Results

Of the 7,708 participants, 78.2% lived in urban areas and 39.4% achieved healthy aging. In 2008, rural residents had a higher incidence of depressive symptoms (rural 11.8%; urban 8.9%); however, after 2016, the depressive symptoms of urban residents gradually increased (rural 6.4%; urban 12.1%). Unhealthy aging (adjusted hazard ratio = 3.04, 95% confidence interval: 2.72-3.39) and urban residence (adjusted hazard ratio = 1.15, 95% confidence interval: 1.06-1.24) were risk factors for depressive symptoms. The subgroup analysis revealed that individuals who did not achieve healthy aging had an increased risk of depressive symptoms, regardless of their residential area (hazard ratio [95% confidence interval]: urban, 3.13 [2.75-3.55]; rural 2.59 [2.05-3.28]).

Conclusion

As urbanization accelerates, urban residents have a higher risk of depressive symptoms than rural residents. Healthy aging is an essential factor in reducing depressive symptoms. To achieve healthy aging, appropriate interventions and policies that target the middle-aged adults and gradually extend to older adults are needed, considering individual and regional factors.

Association between digital engagement and urban-rural disparities in Chinese women's depressive symptoms: A national-level cross-sectional study

Objectives

This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women.

Methods

Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method.

Results

Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms.

Conclusion

There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.

Sociodemographic and Behavioral Factors Associated With Hypertension and Depression in 4 Rural Communities in Northern Ghana: A Cross-Sectional Study

OBJECTIVES

The prevalences of hypertension and depression in sub-Saharan Africa are substantial and rising, despite limited data on their sociodemographic and behavioral risk factors and their interactions. We undertook a cross-sectional study in 4 communities in the Upper East Region of Ghana to identify persons with hypertension and depression in the setting of a pilot intervention training local nurses and health volunteers to manage these conditions.

METHODS

We quantified hypertension and depression prevalence across key sociodemographic factors (age, sex, occupation, education, religion, ethnicity, and community) and behavioral factors (tobacco use, alcohol use, and physical activity) and tested for association by multivariable logistic regression.

RESULTS

Hypertension prevalence was higher in older persons (7.6% among 35- to 50-year-olds vs 16.4% among 51- to 70-year-olds) and among those reporting alcohol use (18.9% vs 8.5% between users and nonusers). In multivariable models, only older age (AOR 2.39 [1.02, 5.85]) and residence in the community of Wuru (AOR 7.60 [1.81, 32.96]) were independently associated with hypertension, and residence in Wuru (AOR 23.58 [7.75-78.25]) or Navio (AOR 7.41 [2.30-24.74]) was the only factor independently associated with depression.

CONCLUSIONS

We report a high prevalence of both diseases overall and in select communities, a trend that requires further research to inform targeted chronic disease interventions.

Association between depression and risk of type 2 diabetes and its sociodemographic factors modifications: A prospective cohort study in southwest China

BACKGROUND

Depression may be associated with the risk of developing type 2 diabetes. The goal of this study was to explore the association of severe of depression with the risk of type 2 diabetes in adults in Guizhou, China.

METHODS

A 10-year prospective cohort study of 7158 nondiabetes adults aged 18 years or older was conducted in Guizhou, southwest China from 2010 to 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to measure the prevalence of depression. Cox proportional hazard models were used to estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) of depression and incident type 2 diabetes. A quantile regression (QR) analytical approach were applied to evaluate the associations of PHQ-9 score with plasma glucose values.

RESULTS

A total of 739 type 2 diabetes cases were identified during a median follow-up of 6.59 years. The HR (95% CI) per 1-SD increase for baseline PHQ-9 score was 1.051 (1.021, 1.082) after multivariable adjustment. Compared with participants without depression, those with mild or more advanced depression had a higher risk of incident type 2 diabetes (HR:1.440 [95% CI, 1.095, 1.894]). Associations between depression with type 2 diabetes were suggested to be even stronger among women or participants aged ≥45 years (p < .05). There are significant positive associations of PHQ-9 score with 2-h oral glucose tolerance test blood glucose levels.

CONCLUSION

Depression significantly increased the risk of incident type 2 diabetes, especially in women, participants aged ≥45 years, Han ethnicity, and urban residents. These findings highlighted the importance and urgency of depression health care.

Urbanicity and depression: A global meta-analysis

BACKGROUND

Previous meta-analyses have revealed that in adult and older adult populations of developed countries, depression is more prevalent in urban than rural areas. No meta-analyses have identified the effects of urbanicity on the general age demographic for developing countries. We conducted a meta-analysis of urban-rural differences in depression across all age demographics for developed and developing countries.

METHODS

PubMed and PsycINFO databases were searched for studies published between 1980 and 2020. Studies were included if they reported prevalences of urban and rural depression, or odds ratios comparing urban-rural depression prevalence. Studies were excluded for: nonrepresentative samples, non-standard measures of depression, and reporting continuous outcomes only. Meta-analytic models of urban-rural differences in the odds of depression were conducted across country development levels and age demographics.

RESULTS

From 1597 records screened and 302 full texts assessed for eligibility, 80 studies (N = 539,557) were included for meta-analysis. Urban residence was significantly associated with a higher prevalence of depression in developed countries (OR = 1.30, 95 % CI [1.17, 1.46], z = 4.75, p < .001), which was primarily driven by urban-rural differences in the general population age demographic (OR = 1.37, 95 % CI [1.22, 1.54], z = 5.38, p < .001).

LIMITATIONS

Studies reporting urban-rural differences in depression in terms of continuous symptom severity scores were not included.

CONCLUSIONS

Urbanicity appears to uniquely be associated with a higher prevalence of depression in developed countries, but not in developing countries.

Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors

BACKGROUND

This study aimed to examine urban-rural disparities in the prevalence and trends of depressive symptoms (DS) among Chinese elderly and associated factors.

METHODS

A total of 8025, 7808, and 4887 respondents aged 60 years and above were selected from the China Family Panel Studies (CFPS) in 2016, 2018, and 2020, respectively. DS was assessed using a short version of Center for Epidemiologic Studies Depression Scale (CES-D). Twenty-two associated factors from six categories were included in random forest (RF) models. All urban-rural comparisons were conducted based on good model performance.

RESULTS

The DS prevalence among all rural elderly was significantly higher than corresponding urban elderly. This disparity continued to widen among younger elderly, while it continued to narrow among older elderly. The top 10 common leading factors were sleep quality, self-rated health, life satisfaction, memory ability, child relationship, IADL disability, marital status, educational level, and gender. Urban-rural disparities in sleep quality, interpersonal trust, and child relationship continued to widen, while disparities in multimorbidity, hospitalization status, and frequency of family dinner continued to narrow.

LIMITATION

This study may exist recall bias and lacks causal explanation.

CONCLUSIONS

Significant and continuing disparities in the DS prevalence were observed between urban and rural elderly in China, showing opposite trends in younger and older elderly. The top 10 leading associated factors for DS were nearly consistent across urban and rural elderly, with sleep quality having strongest contribution. Urban-rural disparities in associated factors also showed different trends. This study provides a reference for mental health promotion among Chinese elderly.

Differences in the influence of daily behavior on health among older adults in urban and rural areas: evidence from China

Background

As the population of older adult in China keeps growing, the degree of aging is becoming increasingly serious and the health of older adults is a growing concern. Comparing the personal characteristics and health levels of urban and rural older adults and determining the relationship between these factors are of great significance in maintaining their health. In addition, exploring how these relationships differ between urban and rural areas is important.

Method

This study conducted a literature review to examine the impact of various factors on the physical and mental health of older adults in urban and rural areas in China. Moreover, based on cross-sectional data from the 2017 Chinese General Social Survey (CGSS), urban-rural differences in the factors' degree of influence on the perceived health of older adults were studied using multiple logistic regression.

Results

Regular physical exercise had a powerful protective effect on urban older adults' physical and mental health, whereas regular participation in social activities had a positive impact on rural older adults' health. Low income, low educational level, low social trust, lack of a partner, and having more than one child negatively affected the physical health of rural older people. Low socioeconomic status had a negative impact on rural people's health both in mind and body. Overall, the rural adults' health status was found to be relatively low and deserves more attention.

Conclusion

This study demonstrated that older people's physical and mental health levels can be significantly affected by the frequency of daily activities and individual and family characteristics. Furthermore, urban-rural differences were observed. These findings could provide feasible suggestions for governments, communities, and older adults' family members to help alleviate health inequality.

Prolonged grief disorder prevalence in adults 65 years and over: a systematic review

BACKGROUND

Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well.

METHOD

Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken.

RESULTS

From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors.

CONCLUSION

This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.

The Nonlinear Relationship Between Body Mass Index (BMI) and Perceived Depression in the Chinese Population

PURPOSE

Existing studies on the association between BMI and depression report conflicting results with some demonstrating a positive relationship, while others a negative link or insignificant correlation. Very limited research on the nonlinear relationship between BMI and depression has yet to clarify the reliability and robustness of the potential nonlinearity and whether a more complex association exists. This paper aims to systematically investigate the nonlinear relationship between the two factors applying rigorous statistical methods, as well as explore the heterogeneity of their association.

MATERIALS AND METHODS

A large-scale nationally representative dataset, Chinese General Social Survey, is used to empirically analyze the nonlinear relationship between BMI and perceived depression. Various statistical tests are employed to check the robustness of the nonlinearity.

RESULTS

Results indicate that there is a U-shaped relationship between BMI and perceived depression, with the turning point (25.718) very close to while slightly larger than the upper limit of the range of healthy weight (18.500 ≤ BMI < 25.000) defined by World Health Organization. Both very high and low BMIs are associated with increased risk for depressive disorders. Furthermore, perceived depression is higher at almost all BMI levels among individuals who are older, female, lower educated, unmarried, in rural areas, belonging to ethnic minorities, non-Communist Party of China members, as well as those with lower income and uncovered by social security. In addition, these subgroups have smaller inflection points and their self-rated depression is more sensitive to BMI.

CONCLUSION

This paper confirms a significant U-shaped trend in the association between BMI and depression. Therefore, it is important to account for the variations in this relationship across different BMI categories when using BMI to predict depression risk. Besides, this study clarifies the management goals for achieving an appropriate BMI from a mental health perspective and identifies vulnerable subgroups at higher risk of depression.

Life course rural/urban place of residence, depressive symptoms and cognitive impairment among older adults: findings from the Longitudinal Aging Study in India

BACKGROUND

Given the unique socioeconomic structures, and the rural/urban differentials in the prevalence of mental illnesses in the country, this study aimed to explore the associations of childhood, adulthood and late-life rural/urban place of residence with mental health outcomes, namely depressive symptoms and cognitive impairment, among older adults in India. The study also examined the relationship between older individuals' life-course rural/urban place of residence and late-life mental and cognitive health.

METHODS

Utilizing data from the Longitudinal Aging Study in India (n = 28,027 older adults age 60 years and above), the study employed multivariable logistic and linear regression models to examine the association between urban/rural residential status, life-course residence, depressive symptoms and cognitive impairment among older adults.

RESULTS

Childhood and adulthood place of residence was not associated with depressive symptoms in older men and women. Current rural place of residence was positively associated with depressive symptoms in older women [adjusted odds ratio (aOR): 1.37, confidence interval (CI): 1.05-1.80] but not men. Childhood [aOR: 1.88, CI: 1.16-3.04], adulthood [aOR: 2.00, CI: 1.26-3.16] and current rural residence [aOR: 1.93, CI: 1.27-2.91] was positively associated with cognitive impairment in men. Only current rural residence [aOR: 1.71, CI: 1.29-2.27] was associated with cognitive impairment in women. There was no significant association between life-course place of residence and depressive symptoms except in case of lifetime rural residence Respondents with urban-urban-urban (childhood-adulthood-current) place of residence were less likely to have depressive symptoms [adjusted coefficient (aCoef.): -0.14, CI: -0.21- -0.07] compared to those with rural-rural-rural place of residence. There were significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants, showing an urban advantage in cognitive function among older adults.

CONCLUSIONS

This study showed significant associations between life-course residence and depressive symptoms among permanent rural/urban residents. The study also showed significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants. Considering the rural disadvantage in mental and cognitive health among older adults, the government should continue to support policies that can improve access to education and healthcare among people residing in rural areas and women, in particular. The findings also urge social scientists and gerontologists in particular, to consider the importance of lifetime historical context while evaluating mental and cognitive health of older persons.

Urban-Rural Differences in the Prevalence of Depressive Symptoms in Korean Adults

This study aimed to investigate the prevalence of depression among Koreans living in urban and rural areas, stratified by socioeconomic status. The study included 216,765 participants from the 2017 Korean Community Health Survey. Depressive symptoms were assessed using the PHQ-9, with a score of 10 or higher indicating depressive symptoms. Residences with the words Eup and Myeon in their addresses were categorized as rural areas, and residences with Dong in their addresses as urban areas. Socioeconomic status was evaluated by household income and education level. A Poisson regression analysis with sampling weights was conducted and adjusted for demographic, lifestyle, socioeconomic status, and comorbidity. The adjusted prevalence rate of depressive symptoms was 3.33% (95% CI, 3.21-3.45) in urban areas and 2.59% (95% CI, 2.43-2.74) in rural areas. The prevalence of depressive symptoms in urban areas was 1.29 times (95% CI, 1.20-1.38) higher than in rural areas. The prevalence rate ratio for depressive symptoms in urban areas compared to rural areas sorted by monthly incomes was 1.39 (95% CI, 1.28-1.51) for less than 2 million won, 1.22 (95% CI, 1.06-1.41) for 2 to 3.99 million won, and 1.09 (95% CI, 0.90-1.32) for more than 4 million won, and the urban-rural difference was more evident in lower household income subjects (p for interaction=0.033). However, urban-rural differences did not differ according to sex, age, or education level. In conclusion, we found urban-rural differences in depressive symptoms in a representative sample of Koreans, and revealed that these differences may vary according to income level. These results suggest that mental health policy must consider the health disparities according to residence and income.

Depression and Associated Factors Among Older Adults in a North Indian State: A Cross-Sectional Study

INTRODUCTION

India is currently experiencing a significant increase in its elderly population, and it is predicted to rise. Depression is prevalent among the elderly population. This study aimed at measuring the prevalence of depression among the elderly population in India.

METHODOLOGY

This cross-sectional study was conducted in both urban and rural regions of Delhi, with a total of 230 participants recruited through systematic random sampling. This sampling method involved selecting households from a comprehensive list. The Patient Health Questionnaire 9 (PHQ-9) was used as a screening tool for depression. Participants with a PHQ-9 score above 9 were considered to potentially experience depression.

RESULTS

The study findings revealed that 68.2% (95%CI: 61.8%-74.2%) of the total sample of 230 participants screened positive for depression. Gender (p = 0.02), age category (p < 0.01), place of residence (p < 0.01), and diabetes (p < 0.01) were significantly associated with depression.

CONCLUSION

The study found a high prevalence of depression among the elderly population, with females, urban dwellers, and those with a history of diabetes being significantly associated with depression. Early detection through screening programs and community-based interventions could help manage depression in this vulnerable group.

Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States

Background Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18-49 years) from the 2017 to 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of noninstitutionalized US adults. Exposures were self-reported depression and poor mental health days (PMHDs; categorized as 0, 1-13, and 14-30 days of poor mental health in the past 30 days). Outcomes were self-reported CVD (composite of myocardial infarction, angina, or stroke) and suboptimal CVH (≥2 cardiovascular risk factors: hypertension, hypercholesterolemia, overweight/obesity, smoking, diabetes, physical inactivity, and inadequate fruit and vegetable intake). Using logistic regression, we investigated the association of depression and PMHDs with CVD and suboptimal CVH, adjusting for sociodemographic factors (and cardiovascular risk factors for the CVD outcome). Of the 593 616 participants (mean age, 34.7±9.0 years), the weighted prevalence of depression was 19.6% (95% CI, 19.4-19.8), and the weighted prevalence of CVD was 2.5% (95% CI, 2.4-2.6). People with depression had higher odds of CVD than those without depression (odds ratio [OR], 2.32 [95% CI, 2.13-2.51]). There was a graded association of PMHDs with CVD. Compared with individuals with 0 PMHDs, the odds of CVD in those with 1 to 13 PMHDs and 14 to 30 PHMDs were 1.48 (95% CI, 1.34-1.62) and 2.29 (95% CI, 2.08-2.51), respectively, after adjusting for sociodemographic and cardiovascular risk factors. The associations did not differ significantly by sex or urban/rural status. Individuals with depression had higher odds of suboptimal CVH (OR, 1.79 [95% CI, 1.65-1.95]) compared with those without depression, with a similar graded relationship between PMHDs and suboptimal CVH. Conclusions Depression and poor mental health are associated with premature CVD and suboptimal CVH among young adults. Although this association is likely bidirectional, prioritizing mental health may help reduce CVD risk and improve CVH in young adults.