Depressive costs: medical expenditures on depression and depressive symptoms among rural elderly in China

Patterns of gender inequality perception and depressive symptoms among Chinese adults: The mediating role of marital life satisfaction

OBJECTIVES

As one of the most severe public health issues, depressive symptoms have attracted wide attention around the world. This study aims to investigate the mediating role of marital life satisfaction in the relationship between gender inequality perception and depressive symptoms.

METHODS

Data were obtained from the China Family Panel Studies (CFPS) conducted in 2020. This study incorporated a total of 13,409 married residents aged 20 and above.

RESULTS

The residents with middle (B = 0.19, 95 % CI = 0.01, 0.40) or high perception of gender inequality (B = 0.55, 95 % CI = 0.34, 0.75) were more likely to develop depressive symptoms. Marital life satisfaction plays a mediating effect in the relationship between patterns of gender inequality perception and depressive symptoms, and the mediating effect accounted for 4.89 % or 1.37 % of the total impact in the residents with middle or high patterns of gender inequality perception.

LIMITATIONS

Further studies need to understand the mechanisms of perceived patterns of gender inequality and depressive symptoms, because the cross-sectional design in this study cannot draw causal inferences.

CONCLUSION

Patterns of gender inequality perception are significantly associated with depressive symptoms. Marital life satisfaction plays a mediating role in the relationship between patterns of gender inequality perception and depressive symptoms. It is plausible that nurturing healthy marital relationships could mitigate depressive symptoms in individuals who perceive high degrees of gender disparity.

The effect of outdoor activities on the medical expenditure of older people: multiple chain mediating effects of health benefits

BACKGROUND

With the global aging population, attention to the health and medical issues of older adults is increasing. By analyzing the relationship between older people's participation in outdoor activities and medical expenditure, this study aims to provide a scientific basis for improving their quality of life and reducing the medical burden.

METHODS

Data on outdoor activity participation, medical expenditures, and relevant variables were collected through questionnaires and databases. A multi-chain mediation effect model was established to analyze the impact of outdoor activities on the medical expenditure of older people, considering mediation effects and heterogeneity.

RESULTS

Results revealed that increased participation in outdoor activities among older adults correlated with lower medical expenditures. Outdoor activities positively influenced their health by improving mental health, cognition, eating habits, and activities of daily living, resulting in reduced medical expenditures. Robustness tests confirmed the consistent effect of outdoor activities on older people's medical expenditure.

CONCLUSION

These findings contribute to understanding the relationship between outdoor activities, health, and medical expenditure in older people, guiding policy formulation and interventions. Encouraging and supporting older adults in outdoor activities can enhance their quality of life and alleviate medical resource strain. The study's conclusions can also inform health promotion measures for other populations and serve as a basis for future research in this area.

Internet use, physical activity and depressive symptoms in older adults: A cross-lagged panel analysis

BACKGROUND

Existing cross-sectional studies suggest a strong positive association between Internet use, physical activity, and mental health in older adults; however, longitudinal studies reporting the relationship between Internet use, physical activity, and levels of depressive symptoms in older adults are lacking. This study aimed to examine the bidirectional relationship between Internet use and depressive symptoms in older adults and its underlying mechanisms.

METHODS

We used two waves of follow-up data (2016 and 2018) from the China Family Panel Studies, including 5837 participants aged 60 years or above. The bidirectional relationship between Internet usage time and depressive symptoms was examined using a cross-lagged model. The mediating role of physical exercise was examined using a half-longitudinal mediation model.

RESULTS

The results revealed a bidirectional relationship between Internet use time, frequency of physical activity, and depressive symptoms. Longer Internet use predicted lower levels of depressive symptoms, and the frequency of physical activity mediated the longitudinal relationship between Internet use and depressive symptoms in older adults.

LIMITATIONS

First, our study used self-report-based variables. Second, our study did not obtain the specific timing of the application of various functions of the Internet and the intensity of physical activity among older adults. Finally, based on the availability of data, our study involved only two waves of data. This may not be sufficient for a full longitudinal mediation effect test.

CONCLUSIONS

Internet use and depressive symptoms were interrelated over time among older adults. The frequency of physical activity was a mediator of Internet use and depressive symptoms. This underscores the importance of Internet-based technologies to enable healthy living and prevent depression and loneliness in older adults.

How provider payment methods affect health expenditure of depressive patients? Empirical study from national claims data in China from 2013 to 2017

BACKGROUND

This study aimed to investigate the associations between provider payment methods and expenditure of depressive patients, stratified by service types and hospital levels.

METHODS

We used a 5 % random sample of urban claims data in China (2013-2017), collected by China Health Insurance Research Association. Provider payment methods (fee-for-services, global budget, capitation, case-based and per-diem payments) were the explanatory variables. A generalized linear model was fitted for the associations between provider payment methods and expenditure. All analyses were adjusted for patient"cioeconomic and health-related characteristics.

RESULTS

In total, 64,615 depressive patient visits were included, 59,459 for outpatients and 5156 for inpatients. Female patients accounted for 63.00 %. The total and out-of-pocket (OOP) expenditure significantly differentiated by provider payments. Among outpatient services, when comparing with fee-for-services, capitation payment was associated with substantial marginal reduction in total and OOP expenditure (-$34.18, -$9.71) in primary institutes, yet increases ($27.26, $24.11) in secondary hospitals. Similarly, global budget was associated with lower total and OOP expenditure (-$13.51, -$1.61) in secondary hospitals, while higher total and OOP expenditure ($7.43, $32.27) in tertiary hospitals than fee-for-services. For inpatients, total and OOP expenditures under per-diem (-$857.65, -$283.48) and case-based payments (-$997.93, -$137.56) were remarkably smaller than those under fee-for-services in primary and secondary hospitals, respectively. Besides, case-base payment was only linked with the largest reduction in OOP expense (-$239.39) in inpatient services of tertiary hospitals.

LIMITATION

Only urban claims data was included in this study, and investigations for rural population still warrant. And updated data are needed for future studies.

CONCLUSIONS

There were varying correlations between provider payment methods and expenditure, which differed by service types and hospital levels. These findings provided empirical evidence for optimizing the mixed payment methods for depression in China.

The association between intergenerational relationships and depression among older adults: A comprehensive systematic literature review

OBJECTIVE

This systematic review aims to comprehensively examine the relationship between intergenerational relationships and depression among older adults in Eastern Asian countries.

METHODS

For this research, a systematic search was conducted on several electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar search engine up until June 2023.

RESULTS

Out of 953 articles initially identified, 33 met the inclusion criteria. Emotional support and financial support emerged as crucial factors that can significantly reduce depressive symptoms among older individuals. However, there are diverse and sometimes contradictory results regarding the impact of intergenerational instrumental support on depression in older adults.

CONCLUSION

Promoting positive intergenerational relationships and enhancing support systems can greatly benefit the mental health of older adults by addressing depression within this population. This review enhances our understanding of the complex relationship between intergenerational relationships and depression among older adults. The diverse findings on intergenerational instrumental support and depression in older adults suggest the need for further research to clarify this relationship and its nuances. This research may have practical implications for policies and interventions aimed at improving the mental well-being of older adults in Eastern Asian countries.

Incidence and risk factors of depression in patients with metabolic syndrome

BACKGROUND

Many studies have explored the relationship between depression and metabolic syndrome (MetS), especially in older people. China has entered an aging society. However, there are still few studies on the elderly in Chinese communities.

AIM

To investigate the incidence and risk factors of depression in MetS patients in mainland China and to construct a predictive model.

METHODS

Data from four waves of the China Health and Retirement Longitudinal Study were selected, and middle-aged and elderly patients with MetS (n = 2533) were included based on the first wave. According to the center for epidemiological survey-depression scale (CESD), participants with MetS were divided into depression (n = 938) and non-depression groups (n = 1595), and factors related to depression were screened out. Subsequently, the 2-, 4-, and 7-year follow-up data were analyzed, and a prediction model for depression in MetS patients was constructed.

RESULTS

The prevalence of depression in middle-aged and elderly patients with MetS was 37.02%. The prevalence of depression at the 2-, 4-, and 7-year follow-up was 29.55%, 34.53%, and 38.15%, respectively. The prediction model, constructed using baseline CESD and Physical Self-Maintenance Scale scores, average sleep duration, number of chronic diseases, age, and weight had a good predictive effect on the risk of depression in MetS patients at the 2-year follow-up (area under the curve = 0.775, 95% confidence interval: 0.750-0.800, P < 0.001), with a sensitivity of 68% and a specificity of 74%.

CONCLUSION

The prevalence of depression in middle-aged and elderly patients with MetS has increased over time. The early identification of and intervention for depressive symptoms requires greater attention in MetS patients.

The Impact of Physical Activity on Depressive Symptoms among Urban and Rural Older Adults: Empirical Study Based on the 2018 CHARLS Database

Using data from the China Health and Retirement Longitudinal Study 2018, we employed the propensity score matching method to examine the effect of physical activity on depressive symptoms among older adults across rural and urban areas. The study sample consisted of 5055 participants, with urban and rural populations representing 31.3% and 68.7%, respectively. This study found that rural older adult individuals exhibited a greater incidence of depressive symptoms and lower physical activity levels when compared to their urban counterparts. Engagement in high-intensity physical activity was identified as an effective method for mitigating depressive symptoms among older adults. However, the moderating effects of physical activity were only observed among urban older adult individuals. Our findings revealed a cross-sectional correlation between physical activity and depressive symptoms among older adult Chinese individuals, and this link differed between urban and rural areas. Although high-intensity physical activity has a positive effect on depressive symptoms among older adults, physical activity interventions should sufficiently consider the variations in older adults' living conditions and environments due to urban-rural differences so that interventions can be customized to improve the mental health of older adults.

Prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in living arrangements: a cross-sectional study

BACKGROUND

Older adults with different living arrangements may have different mental health statuses and different factors that influence their mental health. The aim of the present study is to investigate the prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in their living arrangements.

METHODS

Participants were 6,055 older adults from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms and their determinants were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale and multivariate logistic regression analysis, respectively.

RESULTS

The prevalence of depressive symptoms among older adults living alone, as a couple, and with children was 47.8%, 33.2%, and 39.5%, respectively. The common risk factors for depressive symptoms were shorter sleep duration, poorer activities of daily living, and poorer self-rated health. Women, those with lower educational levels, and those suffering from chronic diseases had a higher risk of depressive symptoms among older adults living as a couple and those living with children. Smoking and participation in economic activities were also risk factors of depressive symptoms among older adults living with children and those living alone, respectively.

CONCLUSIONS

The findings suggest that older adults living as couples had the lowest prevalence of depressive symptoms, while those living alone had the highest prevalence of depressive symptoms. The determinants of depressive symptoms differed by living arrangement; hence, they should be considered in future interventions.

Healthcare costs attributable to abnormal weight in China: evidence based on a longitudinal study

BACKGROUND

The prevalence of abnormal weight is on the rise, presenting serious health risks and socioeconomic problems. Nonetheless, there is a lack of studies on the medical cost savings that can be attained through the mitigation of abnormal weight. The aim of this study was to estimate the impact of abnormal weight on healthcare costs in China.

METHODS

The study employed a 4-wave panel data from China Family Panel Studies (CFPS) between 2012 and 2018 (11,209 participants in each wave). Inpatient, non-inpatient and total healthcare costs were outcome variables. Abnormal weight is categorized based on body mass index (BMI). Initially, the two-part model was employed to investigate the impact of overweight/obesity and underweight on healthcare utilisation and costs, respectively. Subsequently, the estimated results were utilised to calculate the overweight/obesity attributable fraction (OAF) and the underweight attributable fraction (UAF).

RESULTS

In 2018, healthcare costs per person for overweight and obese population were estimated to be $607.51 and $639.28, respectively, and the underweight population was $755.55. In comparison to people of normal weight, individuals who were overweight/obese (OR = 1.067, p < 0.05) was more likely to utilise healthcare services. Overweight/obesity attributable fraction (OAF) was 3.90% of total healthcare costs and 4.31% of non-inpatient costs. Overweight/obesity does not result in additional healthcare expenditures for young people but increases healthcare costs for middle-aged adults (OAF = 7.28%) and older adults (OAF = 6.48%). The non-inpatient cost of underweight population was significantly higher than that of normal weight population (β = 0.060,p < 0.1), but the non-inpatient health service utilisation was not significantly affected.

CONCLUSIONS

Abnormal weight imposes a huge economic burden on individuals, households and the society. Abnormal weight in Chinese adults significantly increased healthcare utilisation and costs, particular in non-inpatient care. It is recommended that government and relevant social agencies provide a better social environment to enhance individual self-perception and promote healthy weight.

Abnormal eye movement features in patients with depression: Preliminary findings based on eye tracking technology

BACKGROUND

Saccadic eye movement (SEM) has been considered a non-invasive potential biomarker for the diagnosis of depression in recent years, but its application is not yet mature. In this study, we used eye-tracking technology to identify the eye movements of patients with depression to develop a new method for objectively identifying depression.

METHODS

Thirty-six patients with depression as the depression group, while thirty-six matched healthy individuals as the control group were recruited and completed eye movement tests, including two tasks: the prosaccade task and the antisaccade task. iViewX RED 500 eye-tracking instruments from SMI were used to collect eye movement data for both groups.

RESULTS

In the prosaccade task, there was no difference between the depression and control groups(t = 0.019， P > 0.05). In general, with increasing angle, both groups showed significantly higher peak velocity (F = 81.72， P < 0.0001), higher mean velocity (F = 32.83, P = 0.000), and greater SEM amplitude (F = 24.23, P < 0.0001). In the antisaccade task, there were significant differences in correct rate (t = 3.219, P = 0.002) and mean velocity (F = 3.253， P < 0.05) between the depression group and the control group. In the anti-effect analysis, there were significant differences in correct rate (F = 67.44, P < 0.0001) and accuracy (F = 79.02, P < 0.0001) between the depression group and the control group. Both groups showed longer latency and worse correct rate and precision in the antisaccade task compared with the prosaccade task.

CONCLUSION

Patients with depression showed different eye movement features, which could be potential biomarkers for clinical identification. Further studies must validate these results with larger sample sizes and more clinical populations.

The sociodemographic characteristics and clinical features of the late-life depression patients: results from the Beijing Anding Hospital mental health big data platform

BACKGROUND

The sociodemographic characteristics and clinical features of the Late-life depression (LLD) patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of LLD patients at a psychiatric hospital in China, with a subgroup analysis, such as with or without anxiety, gender differences.

METHODS

This retrospective study examined outpatients with LLD from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records.

RESULTS

In a sample of 47,334 unipolar depression patients, 31,854 (67.30%) were women, and 15,480 (32.70%) were men. The main comorbidities of LDD are generalized anxiety disorder (GAD) (83.62%) and insomnia (74.52%).Among patients with unipolar depression, of which benzodiazepines accounted for the largest proportion (77.77%), Selective serotonin reuptake inhibitors (SSRIs) accounted for 59.00%, a noradrenergic and specific serotonergic antidepressant (NaSSAs) accounted for 36.20%. The average cost of each visit was approximately 646.27 yuan, and the cost of each visit was primarily attributed to Western medicine (22.97%) and Chinese herbal medicine (19.38%). For the cost of outpatient visits, depression comorbid anxiety group had a higher average cost than the non-anxiety group (p < 0.05). There are gender differences in outpatient costs, men spend more than women, for western medicine, men spend more than women, for Chinese herbal medicine, women spend more than men (all p < 0.05). The utilization rate of SSRIs and benzodiazepines in female patients is significantly higher than that in male patients (p < 0.05).

CONCLUSION

LLD patients are more commonly women than men and more commonly used SSRIs and NaSSAs. Elderly patients with depression often have comorbid generalized anxiety. LLD patients spend most of their visits on medicines, and while the examination costs are lower.

Can community-based care moderate widowhood's health impact? -A longitudinal study among older Chinese adults

The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short-term impact of widowhood on the objective health of older adults and to the moderating role of community-based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM-DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = -0.154, SE = 0.082) and the number of hospitalisations (B = -1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = -0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally.

Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study

BACKGROUND

Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication.

METHODS

A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price.

RESULTS

In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05).

CONCLUSION

Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families’ Wellbeing: An Investigation From Catastrophic Health Expenditure in China

Objectives: Health and health expenditure caused by elderly chronic diseases are a global problem. As China has just lifted itself out of poverty in 2020, the sustainable development of Borderline Poor Families’ Wellbeing faces severe challenges. Therefore, it is of great practical significance to explore the impact of elderly chronic diseases on the catastrophic health expenditure of Borderline Poor Families.

Methods: Based on screening 8086 effective samples from China Health and Retirement Longitudinal Study (CHARLS) database and calculating catastrophic health expenditure, this paper uses two-part model and logit regression to discuss the impact of elderly chronic diseases on the sustainable development of Borderline Poor Families’ Wellbeing.

Results: The results showed that stroke, cancer, and liver disease caused the most catastrophic health expenditures and had the greatest impact on the Borderline Poor Families’ Wellbeing.

Conclusion: Therefore, in order to ensure the sustainable development of Borderline Poor Families’ Wellbeing, the government should strengthen the publicity of pre-prevention and post-healthcare of chronic diseases such as stroke, and combine pre-prevention policy with post-guarantee policy.

What fragile factors hinder the pace of China's alleviation efforts of the poverty-stricken population? A study from the perspective of impoverishment caused by medical expenses

OBJECTIVE

China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3 and 14.4% of the total poverty-stricken population, respectively. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. In this study, we analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty.

METHOD

Data were extracted from the Fifth National Health Service Survey in China in 2013 through a multi-stage, stratified, and random sampling method, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants.

RESULTS

The poverty and impoverishment rate in China were 16.2 and 6.3% respectively. The poverty rate in western region was much higher than that of central and eastern regions. The rate of impoverishment by medical expense (IME) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. The New Cooperative Medical Scheme (NCMS) was associated with the highest rate (9.1%) of IME cases. The top three diseases associated with IME were malignant tumor, congenital heart disease, and mental disease. Households with non-communicable disease members or hospitalized members had a higher risk on IME. NCMS-enrolled, poorer households were more likely to suffer from IME.

CONCLUSION

The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of IME. A combined strategy to precise target multiple vulnerabilities of poor population would be more effective.

Association of Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China: analysis of data from a multicentre, cohort study

OBJECTIVES

Our study aimed to assess the association between the Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China.

METHODS

We analysed the data of 2022 Chinese adults aged 55 and over from a community-based neurological disease cohort study from 2018 to 2019. A validated semiquantitative food frequency questionnaire was used to assess eating habits at the time of inclusion. Multiple logistic regression was used for analysis, and social demographics, lifestyle and health-related factors were adjusted.

RESULTS

Among the included population, the prevalence of depression was 23.39%. Mean (SD) and range of the DII in the included population were 1.70 (1.42) and -5.20 to +5.68. The risk of depression was significantly higher in participants in the most pro-inflammatory group (quartile 4) than in the participants in the most anti-inflammatory group (quartile 1) (OR 1.53; 1.37 to 1.82; p-trend=0.01). The subgroup analysis of body mass index (BMI) showed that there is a significant association between DII and the risk of depression in overweight and obese people (p＜0.05). The restricted cubic spline results show that the OR value of depression possesses an upward trend with the increase of the DII score.

CONCLUSIONS

Aged patients with depression present a higher potential for dietary inflammation. Pro-inflammatory diets might increase the risk of depressive symptoms. Further research in different populations is crucial to confirm the association between DII and depression.

Does Social Pension Expansion Relieve Depression and Decrease Medical Costs? Evidence From the Rural Elderly in China

Objectives: This study was designed to explore the effect of the New Rural Pension Scheme on depressive symptoms or medical costs induced by depression.

Methods: We used the Logit, OLS and 2SLS models to explore the impact of the pension on depression and medical costs. We also adopt the method of quantile regression and discontinuity regression to verify the causal relationship between the New Rural Pension Scheme and depression or medical costs induced by depression of the rural elderly.

Results: We have found that the New Rural Pension Scheme decreases depressive symptoms of elderly in rural China (OR = 0.90), and the medical costs induced by depressive symptoms by 4.6%. Regression discontinuity results showed that pension significantly reduced the depressive symptoms (depression) and the medical expenditure caused by depressive symptoms (depression) by using parametric and non-parametric methods, and performing a placebo test. The mediating effect results showed that pension may improve mental health by increasing confidence about the future.

Conclusion: We demonstrate that the pension significantly decreased both mental health problems and the medical expenses due to depressive symptoms and depression of elderly in rural China. Therefore, our results suggest that the Chinese government should perfect the New Rural Pension Scheme to eliminate barriers to mental health resources, especially for the rural elderly.

Factors affecting the evolution of Chinese elderly depression: a cross-sectional study

Background

In the past decades, China’s rapid economic growth has been accompanied by rapid changes in lifestyle and an increasing prevalence of mental disorders. This study explored the changes and factors associated with depression among the elderly population of China from 2011 to 2018.

Method

Data were obtained from the China Health and Retirement Longitudinal Study. The total sample size consists of 21,484 individuals aged ≥60 years, and the sample sizes in 2011, 2013, 2015 and 2018 were 5081, 4853, 5207, 6343, respectively. Depressive symptoms were measured by the 10-item Short-Form developed by the Center for Epidemiological Studies Depression.

Result

We found that the tendency in depression rate of the Chinese elderly from 2011 (36.8%) to 2018 (44.5%). The results showed poor health (OR = 3.553), ADL damage (OR = 2.010), multiple chronic diseases (OR = 1.287), and western (OR = 1.777) are risk factors for depression.

Conclusion

The rate of depression of the elderly people in China has risen dramatically. Therefore, additional steps to prevent, treat and care for the affected population are needed, Mental health prevention and treatment strategies should be incorporated into China’s public health policies in a timely manner to mitigate the serious economic burden caused by the increase of depression.

The major risk factor for depression in the Chinese middle-aged and elderly population: A cross-sectional study

BACKGROUND

The number of patients suffering from depression is continuously increasing in China. Demographic characteristics, physical health levels, and individual lifestyles/healthy behaviors are associated with the severity of depression. However, the major risk factor for depression remains unclear.

MATERIALS AND METHODS

In this investigation, 16,512 patients were screened using the CHARLS (China Health and Retirement Longitudinal Study) database after being determined to be eligible based on the inclusion criteria. Depressive symptoms were evaluated through the CESD-10 (10-item Center for Epidemiological Studies Depression Scale). Consequently, various models were developed based on potential predictive factors, employing stepwise LR (Logistic Regression)/RF (Random Forests) models to examine the influence and weighting of candidate factors that affect depression.

RESULTS

Gender, residential address location, changes in health status following last interview, physical disabilities, chronic pain, childhood health status, ADL (activity of daily living), and social activity were all revealed to be independent risk factors for depression (p < 0.05) in this study. Depression has a synergic effect (across chronic pain and age groups). In comparison to other factors, RF results showed that chronic pain had a stronger impact on depression.

CONCLUSION

This preliminary study reveals that chronic pain is a major risk factor for depression.

Does Participation in Local Non-agricultural Employment Improve the Mental Health of Elderly Adults in Rural Areas? Evidence From China

A rising rate of suicide among the elderly in rural China has been recognized to be triggered by mental health-associated factors. This study uses 3,397 sampled rural elderly adults from China Labor-force Dynamic Survey in 2016 to explore the response mechanism through which non-agricultural employment participation by the elderly adults in rural China can influence their mental health. Utilizing the Multivariate Regression, Instrumental Variable and Propensity Score Matching methods, we find that, the rural elderly adults who participate in local non-agricultural employment significantly improve their mental health. Self-employment tends to have a greater positive contribution to the mental health of the elderly population than waged employment. Further, work income, need for belongingness and respect, and human capital development significantly mediates the influence of participation in local non-agricultural employment on the mental health of the elderly adults. Finally, we put forward relevant policy suggestions to improving the mental health of the elderly in the countryside.

Rural-urban and gender differences in the association between community care services and elderly individuals' mental health: a case from Shaanxi Province, China

Background

While community care services have been developing rapidly as a new way to meet the growing demands of elderly individuals in China, their health benefits are virtually unknown. Thus, the aim of this study was to examine the Chinese elderly individuals’ utilisation of community care services and its association with the mental health with comparing rural-urban and gender differences.

Methods

For this 2019 cross-sectional study, 687 elderly people from 7 counties (districts) of China’s Shaanxi province were enrolled. Respondents’ mental health level was assessed using a self-reported mental health measure. Four categories of community care services utilisation were examined: daily care services, medical care services, social and recreational services and spiritual comfort services. The binary logistic regression model was used in examining the association between community care services utilisation and mental health.

Results

Our results showed that there was a noted difference in mental health level between the male and female groups. Utilisation of medical care services and social and recreational services was significantly higher in the rural group than that in the urban group. Regression analysis showed that utilisation of daily care services (β = 0.809, p = 0.008) and social and recreational service (β = 0.526, p = 0.035) was significantly and positively associated with elderly individuals’ mental health level. Specifically, daily care services utilisation predicted a better mental health of the rural elderly (β = 1.051, p = 0.036) and the male elderly (β = 1.133, p = 0.053), while social and recreational services utilisation predicted a better mental health of the urban elderly (β = 0.927, p = 0.008) and the female elderly (β = 0.864, p = 0.007).

Conclusions

Our findings indicated varied levels of community care services utilisation and mental health are common among the elderly people in China. Community care services utilisation has a positive, albeit selective, association with elderly individuals’ mental health. Further policies should strengthen the equitable development of high-quality community care services in urban and rural areas to improve the mental health of elderly individuals, and focus more on gender differences in terms of community care services needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06113-z.

The Prevalence of Depressive and Insomnia Symptoms, and Their Association With Quality of Life Among Older Adults in Rural Areas in China

Background: There are few studies on the epidemiology of depression, insomnia, and their association with quality of life (QOL) in older adults living in rural China. This study examined the prevalence of depressive and insomnia symptoms, and their association with QOL in community-dwelling older adults in a rural area in Anhui province, China. Methods: This was a cross-sectional study conducted in the rural areas of four cities (Hefei, Huaibei, Anqing, and Xuancheng) in Anhui province between July and October, 2019 using random sampling method. All community-dwelling residents from the selected villages who met the study entry criteria were invited to participate in this study. Depressive and insomnia symptoms and QOL were assessed with the Chinese version of self-reported Center for Epidemiological Survey Depression Scale (CES-D), the Insomnia Severity Index (ISI) and the 26-item World Health Organization Quality of Life Brief version (WHOQOL-BREF), respectively. Results: A total of 871 older adults were included. The prevalence of overall depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms were 34.0% [95% confidence intervals (95% CI): 30.8-37.1%], 45.7% (95% CI: 42.4-49.0%) and 20.3% (95% CI: 17.6-23.0%), respectively. Older adults with depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms had lower scores in QOL compared to those without. Depressive symptoms were positively associated with living with families [Odd Ratio (OR) = 1.82, 95% CI: 1.31-2.54] and negatively associated with current drinking (OR = 0.49, 95% CI: 0.33-0.72). Insomnia symptoms were negatively associated with fair and good financial status (fair: OR = 0.53, 95% CI = 0.38-0.75; good: OR = 0.30, 95% CI = 0.14-0.64) and current drinking (OR = 0.64, 95% CI = 0.45-0.93), and positively associated with more frequent major medical conditions (OR = 1.32, 95% CI = 1.16-1.51). Comorbid depressive and insomnia symptoms were positively associated with living with families (OR = 2.02, 95% CI = 1.36-3.00), and negatively associated with fair and good financial status (fair: OR = 0.61, 95% CI = 0.41-0.89; good: OR = 0.34, 95% CI = 0.12-0.95) and current drinking (OR = 0.57, 95% CI = 0.35-0.92). Conclusion: Depressive and insomnia symptoms were common in older adults living in rural areas in China. Considering the negative health outcomes caused by depressive and insomnia symptoms, regular screening and effective treatments should be developed for this population.

Entrepreneurial entry: The role of social media

Despite the exponential growth of social media use, whether and how social media use may affect entrepreneurial entry remains a key research gap. In this study we examine whether individuals' social media use influences their entrepreneurial entry. Drawing on social network theory, we argue that social media use allows individuals to obtain valuable social capital, as indicated by their offline social network, which increases their entrepreneurial entry. We further posit the relationship between social media use and entrepreneurial entry depends on individuals' trust propensity based on the nature of social media as weak ties. Our model was supported by a nationally representative survey of 18,873 adults in China over two years. As the first paper on the role of social media on entrepreneurial entry, we hope our research highlights and puts forward research intersecting social media and entrepreneurship.