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

Assessing the Impact of Internet Skills on Depressive Symptoms Among Chinese Middle-Aged and Older Adults: Cross-Sectional Instrumental Variables Analysis

Background

The potential benefits of IT for the well-being of older adults have been widely anticipated. However, findings regarding the impact of internet use on depressive symptoms are inconsistent. As a result of IT's exponential growth, internet skills have supplanted internet access as the source of the digital divide.

Objective

This study evaluates the effect of internet skills on depressive symptoms through an instrumental variables (IV) approach.

Methods

Data from the China Health and Retirement Longitudinal Study's wave 4 (2018) were used. This included 16,949 community residents aged 45 years and older. To overcome the endogeneity issue, we used an IV approach.

Results

Our results reveal the emergence of a second-level digital divide, the disparity in internet skills, among Chinese middle-aged and older adults. Liner regression suggests that a 1% increase in internet skills is associated with a 0.037% decrease in depressive symptoms (β=-.037, SE 0.009), which underestimates the causal effect. As expected, internet skills are an endogenous variable (F test P value <.001). IV regressions indicate that a 1% increase in internet skills reduces 1.135% (SE 0.471) to 1.741% (SE 0.297) of depressive symptoms. These 2 IV are neither weak (F-1=16.7 and 28.5; both >10) nor endogenous (Wu-Hausman test P value of .10; >.05 or >.01).

Conclusions

Better mental health is predicted through improved and higher internet skills. Consequently, residents and policy makers in China should focus on bridging the digital divide in internet skills among middle-aged and older adults.

Does internet use benefit the mental health of older adults? Empirical evidence from the China health and retirement longitudinal study

The mental health (MH) of older adults is a prominent public health concern. However, research regarding the impact of emerging Internet use on MH among older adults remains limited, particularly in transitional economies experiencing a rapidly aging population such as China. Thus, to address this research gap, this study uses data from the 2013-2018 waves of the China Health and Retirement Longitudinal Study. To investigate the causal relationship between Internet use and MH among older adults and explore the underlying channels through which this relationship operates. The results reveal a notable positive association between Internet use and MH among older adults. Furthermore, the study highlights social interaction, social trust, traveling expenses, and healthy habits as crucial channels through which Internet use can impact MH among older adults. The analysis also reveals how Internet use demonstrates a stronger positive effect on older individuals who have fewer chronic diseases and live with their offspring compared with their counterparts. These findings have significant policy implications, which thus emphasizes the need to enhance Internet use among older adults as a means of improving their MH.

Connecting through clicks: A longitudinal examination of internet use and depressive symptoms among middle- and old-aged Chinese

AIM

While prior investigations into the influence of internet engagement on depressive symptoms in middle-aged and older individuals have largely been favorable, concerns persist. Some research posits that internet use may detract from direct interpersonal interactions, elevating depression risks. Here, we scrutinize these contrasting views, endeavoring to delineate the relationship between internet use, social participation, and the ensuing depressive manifestations.

METHODS

We analyzed nationally representative data from three consecutive waves (2013-T1, 2015-T2, 2018-T3) of the China Health and Retirement Longitudinal Study survey. Measures of social participation encompassed formal social participation (i.e., attending clubs for mahjong, chess, sports, or other activities; participation in community organizations, volunteering, or enrolling in training courses) and informal social participation (i.e., interactions with friends or extending assistance to relatives, friends, or neighbors). Structural equation modeling was used to evaluate a focused longitudinal mediation model.

RESULTS

Our dataset comprised 13 671 individuals aged 45 years or older. Baseline internet use was associated with a decrease in depressive symptoms by T3 (c '  = -0.143, SE = 0.055). The longitudinal association between internet use and the alleviation of depressive symptoms was partially mediated by enhanced formal social participation (indirect effecta 1 × b 1  = -0.023, SE = 0.011).

CONCLUSIONS

For developing nations such as China, grappling with a rapidly aging demographic and scarce mental health infrastructure, pioneering initiatives that merge digital and formal social participation might be a valuable component in a multifaceted approach to alleviate late-life depression. Geriatr Gerontol Int 2024; 24: 218-224.

A study on Internet use and subjective well-being among Chinese older adults: based on CGSS (2012-2018) five-wave mixed interface survey data

Objective

This study is designed to investigate the relationship between Internet use and subjective well-being of the older adults in China, and to analyze the mediating role of subjective social fairness in the above relationship.

Methods

Based on the five-wave mixed interface survey data of China General Social Survey (CGSS) in 2012, 2013, 2015, 2017, and 2018, we select a total of 18,458 older adults aged 60 and above, and comprehensively used ordered probit regression, propensity score matching (PSM), and Karlson-Holm-Breen (KHB) mediating effect test methods.

Results

The analysis results show that (1) Internet use is significantly positively correlated with the subjective well-being of the older adults, and the higher the frequency of use, the stronger the subjective well-being. (2) Place of residence, education, and regional factors moderated the effect of Internet use on subjective well-being. The subjective well-being effect of Internet use is significant among male older adults, as well as on urban, educated, or eastern older adults. (3) Subjective social fairness plays a negative mediating role in the relationship between Internet use and subjective well-being of older adults.

Conclusion

The findings suggest that Internet use contributes to the improvement of subjective well-being in older adults, but attenuates this effect by reducing the subjective social fairness. Future research should further consider other factors such as the purpose, specific function, intensity of Internet use, etc., to gain a deeper understanding of how the Internet can help promote well-being.

The Contribution of the Internet to Promoting Mental Health for Older Adults: Cross-Sectional Survey in China

BACKGROUND

Health is an important topic for everyone and essential to high-quality economic and social development. Recently, some researchers have suggested that older adults' internet use may have a health effect.

OBJECTIVE

This study specifically aims to clarify the relationship between internet use and the mental health of older adults, for which other surveys present contradictory results.

METHODS

Data were obtained from the China Longitudinal Aging Social Survey conducted in 2018. A total of 6648 participants were included. Mental health was assessed by the 12-item Center for Epidemiological Studies Depression Scale. Ordinary least squares regression was adopted to explore the relationship between internet use (independent variable) and the mental health of older adults. Robustness analysis, sensitivity analysis, and heterogeneity analysis were conducted in detail to verify the empirical result. A mediating effect analysis was further conducted to discover the effect mechanism between the dependent and independent variables.

RESULTS

It was found that internet use and smartphone use can significantly improve the mental health of older adults (ordinary least squares, β=.075; P<.001). After endogenous and robustness tests were conducted, the aforementioned conclusion remained robust. In particular, participation in voluntary activities played a mediating role in the relationship between internet use and the mental health of older adults. In addition, younger subjective age enhanced the positive effect of internet use on the mental health of older adults.

CONCLUSIONS

Internet users showed higher levels of mental health among Chinese older adults. To improve the mental health of older adults, the government should not only cultivate the ability to use the internet but also encourage greater participation in voluntary activities among older adults.

Internet accessibility and incident depressive symptoms in middle aged and older adults in China: A national longitudinal cohort study

BACKGROUND

With the rapid development of the Internet over the past ten years, its widespread applications and accessibility may cause dynamic changes in the association between internet use and depressive symptoms.

OBJECTIVE

We aim to explore the association between internet accessibility (including broadband connection, internet use, frequency, and devices for internet use), as well as its changes, and the risk of incident depressive symptoms for middle aged and older adults based on a cohort study.

METHODS

8772 participants with three repeat waves of follow-up (average 6.04 years) were included. Cox proportional hazards regressions were used to explore risk effects. Hazard ratios (HRs) and 95 % Confidence Intervals [CI] were presented.

RESULTS

Incidence density for depressive symptoms was 53.89 for every 1000 person-years. The rate of internet usage by middle aged and older adults in China increased evidently from 2012 to 2018 (16.39 % vs 77.41 %). Broadband internet connection (BIC) (HR = 0.80, 95%CI: 0.71, 0.90) and moderate frequency of internet use (IU) (HR = 0.30, 95%CI: 0.10, 0.92) were associated with decreased risk of depressive symptoms. Participants who changed from no internet accessibility to internet accessibility were associated with a lower risk of depressive symptoms (BIC: HR = 0.46, 95%CI: 0.41, 0.51; IU: HR = 0.42, 95%CI: 0.34, 0.51). Using large screen devices (HR = 0.64, 95%CI: 0.45, 0.91) for internet access, instead of phones, was associated with lower risk of depressive symptoms.

CONCLUSIONS

Older adults should be encouraged to use the Internet; online time, frequency, and devices for internet use should be considered simultaneously.

Living arrangements, health lifestyles, and health outcomes among Chinese oldest-old

Background

Prior literature has documented a strong correlation between living arrangements and older adults' health outcomes. However, few studies have explained why this association exists. This study took the health lifestyle theory approach and brought health lifestyles into the link between living arrangements and Chinese oldest-old health outcomes. It examined (1) whether healthy lifestyle behaviors among the oldest-old varied by household contexts and (2) whether the health disparities among the Chinese oldest-old in different household contexts could be partially explained by their healthy lifestyles.

Methods

Using the most recent 2018 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among the Chinese oldest-old aged 85-105 years. Regression analyses were used to test the mediating effect of health lifestyles.

Results

Three distinct classes representing the health lifestyles of Chinese oldest-old emerged; health lifestyle patterns were found to vary by elders' living arrangements. The respondent's health lifestyles in diverse residential structures served as a mediator which can partially explain the health disparities among the oldest-old.

Conclusion

The results suggested that health lifestyles can serve as a mediator to explain the association between oldest-old living arrangement patterns and their health outcomes. The findings highlighted the importance of family, lifestyles, and cultural contexts to the health of the oldest-old.

Association of Public Sports Space Perception with Health-Related Quality of Life in Middle-Aged and Older Adults-Evidence from a Survey in Shandong, China

Creating a healthy living environment for middle-aged and older adults is a key strategy for countries to address the aging challenge, but the effects of such an environment on the health-related quality of life (HRQoL) of middle-aged and older adults remain underexplored. This study aimed to examine the link between public sports facilities and the HRQoL of middle-aged and older adult residents in communities. A total of 1169 respondents (average age: 66.84; male: 46.19%) were selected from the Shandong, China. This study measured respondents 'physical activity (PA) using the International Physical Activity Questionnaire, the HRQoL of respondents using the 36-item Short Form Health Survey, and the Public Sports Space Perception Scale for respondents' public sports space perception. Correlation analysis and logistic regression analysis were employed to test the relationship among public sports space perception, physical activity (PA), and HRQoL. The mediating role of PA was conducted using the PROCESS macro for SPSS. The results revealed that public sports space perception only influenced the HRQoL of middle-aged and older adults through light-intensity PA (PCS: B  =  0.09, 95% CI 0.01, 0.03; MCS: B  =  0.02, 95% CI 0.01, 0.05) among light-intensity PA, moderate-intensity PA, vigorous-intensity PA., and this mediation model varied across different age groups of middle-aged and older adults. Moreover, digital inclusion only moderated the psychological aspect of HRQoL of middle-aged and older adults (p < 0.05). This study provided empirical evidence for enhancing the HRQoL of middle-aged and older adults and offered useful insights for the planning and design of public sports facilities and the formulation of health management policies for middle-aged and older adults.

Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study

BACKGROUND

Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood.

OBJECTIVE

This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases.

METHODS

We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use.

RESULTS

Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases.

CONCLUSIONS

This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention.

Digital health information on surgical treatment options for overactive bladder is underrepresented

PURPOSE

Digital health information gains growing importance in the medical landscape. Despite its opportunities, there is a risk of patient misinformation which may adversely influence the patient-physician relationship. This investigation aimed to identify and compare differences in the content and quality of online health information on overactive bladder (OAB) between different digital platforms.

METHODS

The platforms Google search, Facebook, Instagram, LinkedIn, and YouTube were searched for the keyword OAB. The search result links were classified as useful or misleading, advertisement and personal experience. Information regarding the organization of the source and available content on treatment modalities was collected. Descriptive analysis was applied. Univariate and multivariate analyses were performed to evaluate heterogeneity regarding the distribution of information depending on the source. A p value < 0.05 was considered statistically significant.

RESULTS

The source with the highest quantity of useful content was YouTube (100%) and Google (100%), whereas LinkedIn included mostly misleading content (73%). YouTube and Google provided the greatest variety of health information and were dominated by professional associations. Surgical procedures for treating OAB were only described in 32% and 48% of Google and YouTube results, respectively. On Google, sacral neuromodulation and OnabotulinumtoxinA were described in 26% and bladder augmentation in only 16% of the search results. In contrast, alternative medicine was present in 76%.

CONCLUSIONS

A large gap in the information on surgical treatments of OAB could be identified independently from the utilized source. In contrast, conservative treatments and alternative medicine dominate the current informational sources.

The longitudinal associations between perceived importance of the internet and depressive symptoms among a sample of Chinese adults

Objective

The aim of this study is to examine the extent to which individuals' cognitive evaluation of the importance of the Internet is associated with depressive symptoms, and in what ways.

Methods

This study utilized a sample of 4,100 participants from the fourth (2016), fifth (2018), and sixth (2020) waves of the China Family Panel Studies. Structural equation modeling was employed for data analysis.

Result

The findings of this study reveal that individuals' cognitive evaluation of the importance of the Internet in 2016 was positively linked with the frequency of Internet use and subjective socioeconomic status in 2018. Furthermore, the frequency of Internet use and subjective socioeconomic status in 2018 were found to be negatively associated with depressive symptoms in 2020. These results indicate that the perceived importance of the Internet has an indirect effect on depressive symptoms through the identified pathway.

Conclusion

The present findings contribute to the existing literature by highlighting the importance of individuals' perceived importance of the internet as a significant factor that influences depressive symptoms. The results suggest that policy makers should take actions to increase public awareness of the importance of the Internet in the digital era, and to ensure equitable access to the internet, thus facilitating convenient internet use and helping individuals adapt to the digital age.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Relationship between Internet Use and Negative Affect

While positive emotions like happiness and life satisfaction have received great attention, how to eliminate negative affect is largely neglected. This study contributes to the literature by examining the relationship between Internet use and people's negative affect. Unlike previous studies that consider only one indicator, we capture negative affect from different dimensions by considering loneliness, sadness, and life hardship. We employ an endogenous ordered probit model to address the selection bias of Internet use and analyze the 20,107 individual-level samples sourced from the 2020 China Family Panel Studies survey. The results show that Internet use significantly reduces people's loneliness, sadness, and life hardship. We also find that studying online and watching short videos would increase people's loneliness feeling and shopping online deepens people's life hardship. In contrast, using WeChat significantly reduces sadness and life hardship. Our findings confirm that guiding people to use the Internet appropriately is necessary to reduce negative affect and improve the quality of their life.

Internet access, support, usage divides, and depressive symptoms among older adults in China: A nationally representative cross-sectional study

OBJECTIVE

This study examines the associations between multiple sub-dimensions of the digital divide, including Internet access, support, usage divides, and depressive symptoms among older adults as well as the potential moderating effects of rural/urban status on these associations in China.

METHODS

Data were obtained from the 2018 China Longitudinal Aging Social Survey, which provided a nationally representative sample of 11,418 participants aged 60 years and older. Multivariate linear regression models were used to analyze the associations between digital divide and depressive symptoms. The moderating role of rural/urban status was tested based on the interaction terms.

RESULTS

After controlling for the covariates, access to Internet devices, support for Internet use from family, and using the Internet for communication, entertainment, or as instruments, were found to be significantly associated with a lower level of depressive symptoms (P < 0.05), and compared with no access to the Internet, accessing and using the Internet was significantly related to decreased depressive risks (P < 0.001), whereas access to the Internet with non-use was not statistically significant. Additionally, the associations between multidimensional aspects of the digital divide and depressive symptoms were moderated by rural/urban status, with these associations being significantly stronger among rural older adults (P < 0.05).

CONCLUSIONS

This study highlights the importance of assessing the associations between digital divide and depressive symptoms from the multidimensional perspectives of access, support, and usage. Policy interventions targeting various aspects of the digital divide should be implemented to ensure active Internet engagement among older adults, especially those living in rural areas.

Latent Profile Analysis of Self-Supporting Ability among Rural Empty-Nesters in Northwestern China

The present study aimed to examine the multi-faceted self-supporting ability profiles of rural empty-nesters in northwestern China on the basis of the self-care ability, economic self-support ability, health self-maintenance ability, physical health self-maintenance ability, and psychological health self-maintenance ability using latent profile analysis. It identified the association of self-supporting ability profiles with demographic variables and sense of coherence. The analysis included 1066 participants (mean age = 70.2; SD = 4.3). The results of latent profile analysis identified three distinctive patterns of self-supporting ability―low physical health self-maintenance ability (C1, 20.5%), low psychological health self-maintenance ability (C2, 31.4%), and high social self-adaption ability (C3, 48.0%). The specific demographic variable age (p < 0.05), monthly income (p < 0.05), education level (p < 0.05), how often their children visit (p < 0.05), how often their children contact them (p < 0.05), whether they drink (p < 0.05), the frequency of physical exercise (p < 0.05), relationship with children (p < 0.05), relationship with neighbours (p < 0.05), medical insurance (p < 0.05), and the number of chronic diseases (p < 0.05) were significantly different among the identified three profiles. A statistically significant positive association existed between self-supporting ability profiles and sense of coherence (SOC) (p < 0.001). The results of multinomial logistic regression showed that a greater sense of coherence (SOC), age ≥ 80, monthly income (RMB) (RMB is the abbreviation for Renminbi) < 1000, a good relationship with neighbours, and one type of chronic disease were significantly associated with C1 when compared with C3 (p < 0.05). Furthermore, a greater SOC, their children visiting and contacting them many times per week or once per week were more significantly related to C2 than to C3 (p < 0.05). This study revealed three groups of self-supporting ability and its related predictors in empty-nesters. The predictors related to particular classes of self-supporting ability can provide information for targeted interventions to improve the self-supporting ability of empty-nesters living in rural areas.

How do digital lives affect resident mental health in the digital era? Empirical evidence based on Chinese general social survey

Having good mental health means we are better able to connect, function, cope and thrive. The widespread application of digital technology in daily life provides new ways and promising tools for residents to maintain their mental health. Given the importance of mental health for everyone, and the fact that mental health problems are prevalent worldwide, this study discusses how digital lives affects the mental health of residents. The results suggest that digital lives are significantly and positively associated with mental health. Mechanisms analysis identifies personal perceptions (self-rated physical exercise and subjective wellbeing) as the important paths for digital lives to promote mental health, while social perceptions (social trust and social fairness) play a suppressing effect on the relationship between them. The results of further discussion show that the degree of the influence of digital lives on mental health of individuals is heterogeneous among different regions. Due to the difference in development level, the positive impact of digital lives is greater in urban areas than in rural areas, and it is stronger in western regions than in eastern and central regions. This study enriches the nascent research stream of digitalization, explores new paths of harnessing digital technologies for mental health, and offers useful insights for the government to guide them in formulating digital development strategies and achieving the Healthy China Strategy.

The Relationship between Internet Use and Self-Rated Health among Older Adults in China: The Mediating Role of Social Support

The development of Internet technology has significantly impacted how people live their daily lives. How this disparity in Internet use affects the self-rated health of older adults needs to be further explored. This paper studies the impact of Internet use on self-rated health, aiming to examine the effect of Internet use and social support on the self-rated health of older adults in China. This study used data from the 2017 China General Social Survey (CGSS) to verify the effect of Internet use on older adults' self-rated health. The results showed that Chinese elderly who used the Internet had a higher self-rated health, and social support from relatives and friends significantly improved the elderly's self-rated health. This social support played a critical, partially mediating role between Internet use and self-rated health. In China, the effect of Internet use on older adults' self-rated health was heterogeneous. Among them, the impact of Internet use was more significant for the male elderly, younger elderly, and rural elderly. The results suggest that the government should formulate targeted policies to improve the utilization of the Internet and maintain a good Internet environment to enhance the well-being of older adults according to the trend of population aging and the popularity of the Internet.

A study on the impact of Internet use on depression among Chinese older people under the perspective of social participation

Purpose

This study aimed to evaluate the role of social participation in the relationship between internet use and depressive symptoms among Chinese older adults and investigate how the internet use interact with social participation to reduce the risk of depressive symptoms.

Methods

Based on the survey from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, we identified 4645 subjects and used the Ordinary Least Square method (OLS) and Propensity Score Matching method (PSM) to identify the association between Internet use and depression of older people, and further test how social participation played a role in the relationship.

Results

The level of depression of older people was significantly reduced in those who using internet in China, and the effect was still robust under different identification methods. The mental health was improved when using internet because of the increase of social participation and social capital. Further, The positive effect was stronger especially in those who were female, living in rural areas, has low education attainments and were 70–79 years old.

Conclusions

The popularity of internet use has a positive effect on the depressive symptoms of Chinese older adults. Effective measures were encouraged to improve the friendliness of internet for older people and promote the popularization of the Internet and older group, achieving the spiritual well-being of them in the Internet society.

Mental health status and associated contributing factors among the Hakka elderly in Fujian, China

Purpose

Little is known about the mental health of the Hakka elderly. This study explores the status of, and factors associated with mental health among Hakka elderly populations from Fujian, China.

Methods

This is a cross-sectional, community-based survey study containing a total of 1,262 valid samples. The Chinese version Symptom Checklist-90-R (SCL-90-R) was used to assess the mental health status of the Hakka elderly. We used t-tests to compare the differences for 10 dimensions of SCL-90-R scores between the Chinese national norm and the Hakka elderly. Univariate and multivariate analysis were performed by using linear regression analysis to identify the main socio-demographic factors that were most predictive of the total score of SCL-90-R in the Hakka elderly.

Results

The scores of somatization (1.78 ± 0.55 vs. 1.40 ± 0.46, P < 0.001) and phobic anxiety (1.21 ± 0.36 vs. 1.17 ± 0.31, P < 0.001) for the Hakka elderly in Fujian appeared to be significantly higher than the Chinese norm. The higher total scores of SCL-90-R were found among females (β = 0.030, P = 0.044), widowed persons (β = 0.053, P = 0.021), those with parent(s) alive (β = 0.047, P = 0.019), and those with poorer self-rated health status (β = 0.110, P < 0.001). The lower total scores of SCL-90-R were found among those who were currently living in town, those with lower education level, those with higher average annual household incomes, and those who were living with spouse or children.

Conclusion

The worse mental health conditions of the Hakka elderly in somatization and phobic anxiety were detected. The overall mental health status was shown to be worse among females, widowed persons, those who were living in village, those with lower education, and those with father or/and mother alive.

Internet Use, Cultural Engagement, and Multi-Dimensional Health of Older Adults: A Cross-Sectional Study in China

With the rapid expansion of the Internet, it continuously penetrates the life of older adults around the world. This study aims to explore the effect of Internet use on the multi-dimensional health of the elderly with the mediating role of cultural engagement. Using data from the Chinese General Social Survey (CGSS) in 2015 and 2017, this study adopts logistic regression and a single-step multiple mediation model to investigate how Internet use affects the multi-dimensional health of older adults in China. The results show that Internet use has positive effects on the self-rated health, physical health, and mental health of the elderly. Endogenous tests, robustness analysis, and sensitivity analysis show that the above conclusions remain robust. Additionally, the mediating effect analysis shows that cultural engagement plays a mediating role in the relationship between Internet use and the three health-related responses. Therefore, to improve the elderly's health level, the government should not only cultivate the ability to use the Internet but also encourage greater cultural engagement amongst the aged.

Social Isolation, Cognitive Function, and Depression Among Chinese Older Adults: Examining Internet Use as a Predictor and a Moderator

Objectives

Despite the theoretical and practical interest in Internet use among older adults, evidence examining the impacts of Internet use on late-in-life health is limited. This study examines how Internet use affects depression and cognitive function in older adults and investigates if Internet use moderates the relationship between social isolation and depression/cognitive function.

Method

We performed regression analyses using data came from the second wave of the China Longitudinal Aging Social Survey of 2016. Our final sample featured 8,835 older adults.

Results

The results show 11.4% of Chinese older adults often used the Internet to engage in at least one activity. Internet use was negatively associated with depression, but it was positively related to cognitive function. Socially isolated older adults were more likely to have more depressive symptoms and higher level of cognitive function. There was also an interaction effect between Internet use and social isolation on depression/cognitive function. The negative effect of social isolation was stronger for older adults who used the Internet less. The moderating effect of Internet use was significant for both males and females. However, among those who used the Internet more, the depression levels of socially isolated male participants were much lower than female participants.

Conclusions

Our results reveal the importance of considering Internet use in buffering the negative effects of social isolation and the associated health burdens for aging populations. Recommendations for service practice and future research are discussed.

The Effectiveness of Technology-Based Interventions for Reducing Loneliness in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: To systematically analyze the effectiveness of technology-based interventions for reducing loneliness in older adults.

Methods: We searched relevant electronic databases from inception to April 2021, which included Cochrane Library, PubMed, Web of Science, SpringerLink, EMBASE, CNKI, and Wanfang. The following criteria were used: (i) study design—randomized controlled trial (RCT) designs, (ii) people—older adults (aged ≥ 60 years), (iii) intervention—technology-based interventions in which a core component involved the use of technology to reduce loneliness in older adults; and (iv) outcome—reduction of loneliness level in terms of rating scale scores. Two reviewers independently identified eligible studies, extracted data, and assessed the risk of bias in the included studies. A third reviewer resolved any conflicts. The Cochrane Collaboration's bias assessment tool was used to evaluate the risk of bias for the included studies, and Review Manager 5.4 software was used for the meta-analysis. A random effects model was adopted to measure estimates of loneliness reduction, and standard mean differences (SMD) with a 95% confidence interval (CI) were calculated for each intervention-control contrast, and the I² statistic was applied to examine heterogeneity.

Results: A total of 391 participants from six RCTs were included in the review. Of these, three studies were rated as low-quality, and the remaining three were rated as moderate-quality studies. The meta-analysis showed that the evidence regarding the effects on loneliness of technology-based interventions compared with control groups was uncertain, and suggested that technology-based interventions resulted in little to no difference in loneliness reduction compared to control groups (SMD = −0.08, 95% CI −0.33 to 0.17, p = 0.53). Two types of technology-based interventions were identified: smartphone-based video calls and computer-based training with Internet usage. The subgroup analysis found low-quality evidence to support the effectiveness of both intervention types (SMD = −0.01, 95% CI −0.25 to 0.24, p = 0.95, and SMD = −0.38, 95% CI −0.19, 0.64, p = 0.47, respectively).

Conclusions: We found no current evidence to support that technology-based interventions were effective compared to different control conditions in reducing loneliness in older adults. This suggests that more research is needed to investigate the effects of technology-based interventions on loneliness in older adults.

Impact of Internet Use on Mental Health among Elderly Individuals: A Difference-in-Differences Study Based on 2016-2018 CFPS Data

The number of elderly Internet users has increased significantly in the past few years. However, the impact of Internet use on mental health remains unclear. In this study, we performed a difference-in-differences analysis using data from the 2016 and 2018 waves of the China Family Panel Studies (CFPS) to evaluate the impact of Internet usage on mental health among elderly individuals. A total of 5031 validated respondents were included to explore the relationship between Internet use and reduced levels of depression as well as improved life satisfaction among elderly individuals. The results showed that Internet use significantly reduced depression levels. Unexpectedly, Internet use was not found to improve life satisfaction. Moreover, discontinuing Internet use was not significantly associated with improvements in depression or life satisfaction. More research is needed to fully elucidate the relationship between Internet use and depression levels, as well as life satisfaction among elderly individuals.

The Relationship Between Internet Use and Mental Health Among Older Adults in China: The Mediating Role of Physical Exercise

Objective

Affected by internet applications, mental health among older adults has become an important public health issue in China. This study aimed to use cross-sectional data to explore how internet use affects mental health among older adults in China, along with the moderating role of physical exercise in the above relationship.

Methods

This study employed data from the Chinese General Social Survey (CGSS) conducted in 2017. In addition, OLS regression was adopted to explore the impacts of internet use on the mental health of older adults in China.

Results

Results from the cross-sectional data model showed that internet use had a statistically significant and positive correlation with the mental health of older adults. The regression result of the full sample showed that the regression coefficient of the influence of internet use on the mental health of the elderly was 0.114, which was significant at the 1% level. Furthermore, this study used mediating analysis to explore the possible underlying mechanism by which internet use influenced mental health status through physical exercise. Physical exercise played a mediating role in the relationship between internet use and mental health; the ratio of the indirect effect to total effect mediated was 0.272. It is important to note that the effect size of the indirect effect through physical exercise was quite large.

Conclusion

Our findings suggested that internet use was significantly associated with better mental health status for older Chinese residents, mediated by higher physical exercise frequency, which was consistent with China’s recent efforts to promote health governance with the “Internet Plus Exercise” campaign. Consequently, the government must encourage the development of more internet applications suitable for the elderly to increase their exercise frequency and ultimately improve their mental health. These results also provided insights for clinical solutions.

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Does digital technology reduce health disparity? Investigating difference of depression stemming from socioeconomic status among Chinese older adults

Background

Prior studies on health disparity have shown that socioeconomic status is critical to inequality of health outcomes such as depression. However, two questions await further investigation: whether disparity in depression correlated with socioeconomic status will become larger when depression becomes severer, and whether digital technology will reduce the disparity in depression correlated with socioeconomic status. Our study aims to answer the above two questions.

Methods

By using the dataset from China Health and Retirement Longitudinal Study 2015, we use quantile regression models to examine the association between socioeconomic status and depression across different quantiles, and test the moderating effect of digital technology.

Results

Our study obtains four key findings. First, the negative effects of socioeconomic status on depression present an increasing trend at high quantiles. Second, Internet usage exacerbates the disparity in depression associated with education level on average, but reduces this disparity associated with education level at high quantiles. Third, Internet usage reduces the disparity in depression associated with income on average and at high quantiles. Fourth, mobile phone ownership has almost no moderating effect on the relationship between socioeconomic status and depression.

Conclusions

Our findings suggest the potential use of digital technology in reducing disparity in depression correlated with socioeconomic status among middle-aged and aged individuals in developing countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02175-0.

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

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

Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS

China's rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New Rural Cooperative Medical System (NRCMS). NRCMS is a voluntary program, targeting rural residents with government subsidies and individual contribution. Using the two-stage residual inclusion approach (2SRI), we analyzed the impact of NRCMS on health-care service utilization and expenditure of rural older with chronic diseases by using the 2011 and 2013 China Health and Retirement Survey (CHARLS) data. The results showed NRCMS did not play an effective role on improving the medical services utilization of rural older with chronic diseases. Although NRCMS immediate reimbursement significantly reduced the outpatient service fee, the actual outpatient reimbursement is the opposite. In addition, NRCMS did not significantly decrease their hospitalization expense. Policy makers should pay attention to health management about chronic diseases in rural China, and some measures should be taken to deepen the medical security system reform and improve the public health service system.