Relationship between neighbourhood social participation and depression among older adults: A longitudinal study in China

Neighborhood Qualities Are Related to Better Mental Health, Quality of Life, and Loneliness Over 6 Years: Pathways Through Social Engagement and Social Support to Aging Well

BACKGROUND AND OBJECTIVES

Growing research evidence supports the importance of neighborhoods for the well-being of older people. The aim of this study was to investigate key pathways (social engagement and social support) through which neighborhood qualities (accessibility, safety, and social cohesion) may affect older people's mental well-being (mental health, quality of life, and loneliness) over 6 years.

RESEARCH DESIGN AND METHODS

A structural equation model was used to test the model while controlling for individual limitations such as physical health and socioeconomic status. The population sample included 2,750 New Zealanders over the age of 55 (M = 65.64 ± 6.30) years who responded to Health, Work and Retirement (HWR) longitudinal surveys in 2016 and 2022.

RESULTS

The results showed that greater neighborhood accessibility to important facilities in 2016 predicted better mental health and quality of life and less loneliness in 2022 through provision of social support. Neighborhood social cohesion predicted social engagement, which was related to higher social support predicting better mental health and quality of life and less loneliness in 2022.

DISCUSSION AND IMPLICATIONS

These findings confirm a body of research highlighting the importance of neighborhood qualities and show the socially oriented pathways through which neighborhoods support aging well. These findings have direct implications for the development of social policy that focuses on the development of housing situations to support healthy aging.

Community-Based Group Exercises and Depression Prevention Among Middle-Aged and Older Adults in China: A Longitudinal Analysis

Physical activity and social support are recognized as contributing to preventing depression. Community-based group exercises are activities that combines both functions. Fewer studies have examined the association between community-based group exercises and the depression severity of middle-aged and older adults. In this study, we were trying to estimate such correlation and explore the potential mechanisms. Data from the China Longitudinal Study of Health and Retirement was analyzed (N = 17,481). Participation in community-based group exercises and depression severity were self-reported by the surveyed middle-aged and older adults. The ordered probit model was used to analyze the association between participation in community-based group exercises and depression severity. Compared with middle-aged and older adults who did not participate in community-based group exercises, those who engaged in such activities exhibited improved depression severity in the current year (coefficient = 0.229, p < 0.01) and two years later (coefficient = 0.199, p < 0.01). The relationship was more pronounced among women. Improved physical fitness and more frequent visits to neighbors and relatives for social support are potential mechanisms. In addition to medical interventions, social support and physical fitness are effective strategies for depression prevention. Policymakers could enhance the mental health of middle-aged and older adults, particularly among women, by encouraging participation in community-based group exercises. This is particularly important in rapidly ageing societies.

Depressive symptoms among middle-aged and older adults in China: The interaction of physical activity and sleep duration

BACKGROUND

Previous research on the interaction of physical activity and sleep on depressive symptoms was mostly cross-sectional or conducted with children or young adults. This study examines the main and interactive associations of physical activity and sleep duration with depressive symptoms over a 3-year period among middle-aged and older Chinese adults.

METHODS

Data from 4269 Chinese adults aged 45 or older from the China Health and Retirement Longitudinal Study (CHARLS) were used. Physical activity was categorized as inadequate (<600 MET), adequate (600-8000 MET), and extremely high (>8000 MET). Sleep was classified as inadequate (<6 hours), adequate (6-9 hours), and excessive (>9 hours). The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms.

RESULTS

Inadequate sleep was linked to greater increases in depressive symptoms over 3years. A significant interaction between baseline physical activity and sleep duration in predicting depressive symptoms at the 3-year follow-up showed that inadequate sleep, when combined with either inadequate or extremely high physical activity, was associated with higher depressive symptoms at the 3-year follow-up. In middle-aged subgroups, for people with either inadequate physical activity or an extremely high level of physical activity, inadequate sleep was associated with higher CES-D score compared to adequate sleep; for older adults, only inadequate sleep was associated with a higher follow-up CES-D score.

CONCLUSION

Physical activity and sleep interactively impacted depressive symptoms, suggesting future personalized interventions that simultaneously target physical activity and sleep. Adequate sleep was associated with lower levels of future depressive symptoms in people with inadequate or extremely high physical activity.

Social participation classification and activities in association with health outcomes among older adults: Results from a scoping review

AIMS

The aim of this study is to summarize the characteristics of social participation classification and examine the association between activities and health outcomes among older adults.

DESIGN

Scoping review.

DATA SOURCES

Eight databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Embase, ProQuest, Psychological Information Database, PubMed, Scopus and Web of Science) were searched. Reference lists of relevant social participation reviews were also considered.

METHODS

This study applied a five-stage methodological framework. A narrative synthesis summarized social participation classification and activities and their associations with health outcomes among older adults (≥65 years) living at home, in the community or in nursing residences.

RESULTS

Forty-two articles published between 1975 and 2022 were selected. Four classification criteria of social participation were extracted and summarized from these studies. Based on the depth and breadth of social interactions, this review proposed a four-level classification schema. A lower risk of mortality and less visual impairment were associated with participation in level-one, level-three or level-four activities, whereas less depression, less pain and better cognitive function were linked to participation in level-three or level-four activities.

CONCLUSION

Future studies should provide a clear definition, establish classification criteria for participation and properly select activity forms while considering both subjective and objective dimensions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results could provide data for designing targeted social participation interventions to improve specific health outcomes among older adults.

IMPACT

This review could help researchers examine the role of social participation activities in specific health outcomes. Moreover, a proposed classification of social participation activities would benefit researchers and community nurses in discerning the similarities and differences among activities.

REPORTING METHOD

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A case for the use of deep learning algorithms for individual and population level assessments of mental health disorders: Predicting depression among China's elderly

BACKGROUND

With the continuous advancement of age in China, attention should be paid to the mental well-being of the elderly population. The present study uses a novel machine learning (ML) method on a large representative elderly database in China as a sample to predict the risk factors of depression in the elderly population from both holistic and individual level.

METHODS

A total of participants met the inclusion criteria from the fourth waves of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed with ML algorithms. The level of depression was assessed by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10).

RESULTS

The current study found top 5 factors that were important for predicting depression in the elderly population in China, including average sleep time, gender, age, social activities and nap time during the day. The results also provide reliable diagnostic likelihood at the individual level to support clinicians identify the most impactful factors contributing to patient depression. Our findings also suggested that activities such as interacting with friends and play ma-Jong, chess or join community clubs may have a positive collaborative effect for elderly's mental health.

CONCLUSIONS

Holistic approaches are an effective method of deriving and interpreting sophisticated models of mental health in elderly populations. More detailed information about a patient's demographics, medical history, sleeping patterns and social/leisure activities can help to inform policy and treatment interventions on a population and individual level. Large scale surveys such as CHARLS are effective methods for testing the most accurate models, however, further research using professional clinical input could further advance the field.

The impact of internet device diversity on depressive symptoms among middle-aged and older adults in China: A cross-lagged model of social participation as the mediating role

BACKGROUND

Depressive symptoms is more prevalent in middle-aged and older populations, and the development of Internet technology has brought new challenges and opportunities for the mental health of this group. This study aims to explore the bidirectional relationship between Internet device diversity and levels of depressive symptoms through longitudinal data analysis, as well as investigate the mediating role of social participation.

METHODS

Data for the analysis was retrieved from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, 2018, and 2020, which included 9259 middle-aged and older adults. The sum of the number of devices mentioned by each participant was calculated to assess the diversity of internet device use, a weighted total score of how frequently and to what extent individuals had participated in various social activities in the past month was calculated to measure the social engagement, and the Center for Epidemiological Studies Depression Scale was used to calculate depressive symptoms. A cross-lagged mediation model and bivariate correlation analysis were employed to examine the longitudinal relationships among depressive symptoms, internet device diversity, and social participation. Age, gender, highest education level, marital status, drinking status, smoking history, self-rated health, sleep duration, and chronic health conditions were adjusted as covariates.

RESULTS

The results from the three waves of longitudinal data revealed mutual predictive relationships among internet device diversity, social participation, and depressive symptoms. The mediating effect was significant (β = -0.612, 95 % CI -0.796 to -0.429), with significant gender differences observed. Furthermore, our findings indicated that social participation functioned as a protective factor against depressive symptoms, and the association between social participation and depressive symptoms was not a straightforward linear relationship. This suggests that participation in social activities (either high or low) is associated with a lower risk of depressive symptoms compared to no social participation, with no gender differences.

CONCLUSIONS

This study suggests that there is a relationship between internet device diversity and lower levels of depressive symptoms among middle-aged and older adults in China. Social participation mediates the relationship between internet device diversity and depressive symptoms, and different levels of social engagement have different effects on depressive symptoms. It is recommended to increase support for social participation among middle-aged and older adults, strengthen structural social capital, and better leverage the use of the internet to reduce depressive symptoms levels and promote the physical and mental well-being of this population.

Contribution of social activity participation to the relationship between sensory impairment, physical performance and cognitive decline: a longitudinal study in China

Objectives

This study examined the impact of sensory impairment (hearing and/or vision) combined with poor physical performance on cognitive decline and assessed whether social activity participation mediated this relationship.

Methods

Multilevel models were used to explore the relationships between sensory impairment, physical performance, their combination, and cognitive decline. A multilevel mediation model analyzed the mediating effect of social activity participation. The study included 10,149 adults aged 45 and older (mean age 53.84) from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS). The exposure variable, body function (BF), was categorized into six groups based on sensory impairment and physical performance. Cognitive function was measured using an adapted Chinese Mini-Mental State Examination (MMSE).

Results

Compared to BF group 1 (normal physical performance without sensory impairment), individuals in BF group 4 (low physical performance without sensory impairment) (β = -0.670, P < 0.001), BF group 5 (low physical performance with single sensory impairment) (β = -1.029, P < 0.001), and BF group 6 (low physical performance with dual sensory impairment) (β = -1.630, P < 0.001) showed worse cognitive function. Only BF group 4 (β = -0.670, P < 0.001) had a faster cognitive decline. Mediation analysis revealed a significant indirect effect of social activity participation on cognitive function in BF group 4 (β = -0.03, P < 0.01, mediation proportion: 4.32%).

Conclusion

The combined effect of sensory impairment and low physical performance on cognitive decline may be accumulative, and social activity participation could mitigate this effect. Prioritizing social activity participation is crucial for health professionals and policymakers.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Association between Internet use and depression among older adults in China: the chain-mediating role of volunteer activity participation and friend network

Background

Depression is a significant burden on individuals and society, which requires our attention and action. As the aging wave collides with digitalization, further research is needed to understand how internet use relates to depression in older adults. This study aimed to investigate whether volunteer activity participation and friend networks played a chain mediating role in this relationship from the perspective of the socioemotional selectivity theory.

Method

This study's data was derived from the 2018 China Longitudinal Aging Social Survey (CLASS), comprising 5,558 samples. The study employed the OLS model for benchmark regression and multiple robust check methods, including altering variable settings and utilizing the instrumental variable model. In addition, the generalized structural equation model (GSEM) was used to analyze the mechanism.

Result

Using the internet was significantly associated with reduced depression in older adults (coefficient = -0.9321, p < 0.001). The instrumental variable model confirmed this reduction (coefficient = -0.9200, p < 0.001). Moreover, we found that there were three indirect pathways of Internet use on depression among older adults: the mediating role of volunteer activity participation (all p-values <0.001), the mediating role of friend network (all p-values <0.001), and the chain mediating role of both factors (all p-values <0.001).

Conclusion

Based on the research findings, we suggest mobilizing tech-savvy older adults to assist others in adopting digital technology and using the internet. We also suggest that the government could assist in creating older adult-friendly communities. Social workers could collaborate with tech-savvy older adults to organize various voluntary activities, encouraging more senior citizens to participate. In addition, we recommend that the community should consider the form of activities to help older adults make friends first rather than solely focusing on voluntary activities.

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.

Social activities and depressive symptoms among migrant middle-aged and older adults in China: a network analysis

Background

This study investigated the central symptom within the depression network and examined the relationship between social activities and depressive symptoms among migrant middle-aged and older adults in China.

Methods

We analyzed data from 1,926 migrants aged 45 and older, derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Using network analysis, we identified the central depressive symptom and assessed the association between various social activities and depressive symptoms.

Results

Network analysis revealed that depressed mood was the most central symptom. Regarding mitigation of depressive symptoms, informal social activities predominantly influenced positive emotions and somatic symptoms. Formal activities were mainly revealed through positive emotions. Solitary activities were manifested primarily through positive emotions and somatic symptoms. In addition, informal and solitary activities showed a stronger correlation with the alleviation of depressive symptoms compared to formal activities.

Conclusion

The findings underscore the importance of addressing depressed mood in treating depression among migrant middle-aged and older adults. Recognizing the differential impacts of various social activities can aid in the development of customized prevention and intervention strategies aimed at enhancing the mental well-being of this demographic in China.

Individual-level community-based social capital and depressive symptoms among older adults in urban China: the moderating effects of socioeconomic status

OBJECTIVES

This study aimed to examine the moderating role of socioeconomic status in the association between community-based social capital-based on individual-level cognitive and structural social capital-and depressive symptoms among older adults in urban China.

METHODS

Data were collected in 2020 through a community survey of 800 respondents aged 60 years and older living in Shijiazhuang and Tianjin. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Multiple-group analyses were conducted to analyze the data.

RESULTS

Measurement models of cognitive social capital and structural social capital were established. Measurement invariance was established across different socioeconomic groups. Additionally, socioeconomic status significantly moderated the association between social capital and depressive symptoms. The association between cognitive social capital and depressive symptoms was statistically significant among respondents with relatively low incomes and high levels of education, whereas the association between structural social capital and depressive symptoms was significant only among those with relatively high incomes.

CONCLUSION

Future social capital policies and interventions should adopt different strategies to provide services to older adults from different socioeconomic backgrounds. Furthermore, educational programs should promote the effects of cognitive social capital on depressive symptoms later in life.

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.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

An analysis of the influencing factors of depression in older adults under the home care model

Objectives

To explore and analyze the influencing factors of depression in older adults living at home, so as to propose suggestions for improving the quality of older adults living at home.

Methods

We conducted a cross-sectional study on 498 older adults living at home based on questionnaire survey on the general information, daily living ability, health status, and care perception (including self-care, care for cohabitants, and care for non-cohabitants) of older adults living at home, as well as their willingness to help each other, and analyzed the influencing factors of depression among older adults living at home.

Results

The results showed a willingness to help older adults, self-care, and total activities of daily living (ADL), health status was an influential factor for depression in older adults (p < 0.05).

Conclusion

It aims to take targeted measures, such as encouraging older adults at home to actively participate in mutual assistance activities for older adults and care for themselves, so as to prevent and reduce the occurrence of depression in older adults.

Association between internet use and depressive symptoms among older adults: mediating role of daytime napping and moderating role of productive engagement

OBJECTIVES

This study investigated the mediating role of daytime napping in the relationship between internet use and depressive symptoms among older adults. Further the moderating effect of productive engagement was assessed on the linkage between internet use and depressive symptoms.

METHODS

We surveyed 956 Chinese community-dwelling older adults. Respondents reported their internet use for different purposes (social, informational, and instrumental use), rated their levels of depressive symptoms and of daytime napping, and reported different types of/overall productive engagement. We conducted mediation and moderation analyses to test the potential pathways of associations among those factors.

RESULTS

Daytime napping mediated the association between social and informational internet use and depressive symptoms. Family caregiving, sporting activities, and overall productive engagement each moderated the relationship between internet use and depressive symptoms.

CONCLUSION

Internet use can increase the risk of depressive symptoms in older adults by increasing daytime napping. However, the benefits of internet use can be particularly salient for those who have a low level of productive engagement. The findings have implications for policies and practices that are designed to help older adults access the internet to enhance well-being.

Examining the Pathways from General Trust Through Social Connectedness to Subjective Wellbeing

The broad conceptualisation of wellbeing has allowed researchers to establish subjective wellbeing as a valid indicator of social development. However, changing social patterns, norms, and values suggest changes in how social determinants may predict subjective wellbeing. The current analysis tests a serial mediation hypothesis in which social participation and social resources mediate the effect of general trust on subjective wellbeing.

Data from 8725 participants were pooled from the German part of the European Social Survey (ESS) Wave 10. Structural models were estimated to access the path from general trust to subjective wellbeing (SWB). Three separate mediation analyses were performed to test (1) the indirect effect of general trust on SWB through social participation, (2) through social resources and (3) through social participation and social resources. A full-mediation model reveals the direct and indirect paths predicting SWB through general trust, social participation, and social resources. Gender, age, education, and household size were included as control variables.

The full-mediation model suggests significant results for direct paths from general trust to social participation, social resources, and SWB. Direct paths from social participation to social resources and SWB were also significant. However, the path from social resources to SWB became non-significant.

Results highlight general trust as a critical predictor of SWB. The finding that social participation is significant while social resources are not significant in a mediation model suggests that social participation directly affects wellbeing, independent of the effect of social resources. This highlights the importance of social participation in promoting wellbeing.

Dual trajectories of depression and social participation among Chinese older adults

OBJECTIVES

This study aimed to investigate the dual trajectories of social participation (SP) and depression among older adults, and explore common factors that may influence both trajectories.

METHODS

The study utilized data from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). The dual-trajectory model was employed to estimate the dual trajectories of SP and depression.

RESULTS

This study identified two SP and three depression trajectories. The results revealed that the reciprocal relationship between SP and depression trajectories is confirmed in all sub-groups of the dual trajectories. Our study identified six distinct sub-groups of individuals based on their SP and depression trajectories and some commen risk factors of SP and depression trajectories.

CONCLUSIONS

Related intervention policies should consider the dual trajectories of SP and depression and focus on subgroups with high vulnerability, such as high depression but low SP. Additionally, attention should be given to addressing the common risk factors that underlie these trajectories.

Social activities and long-term depressive-symptoms trajectories among middle-aged and older adults in China: a population-based cohort study

Background

The association between social activities and depressive symptoms remains unclear. This study aimed to explore the relationship between social activities at baseline and the long-term depressive-symptoms trajectories among a cohort of middle-aged and older adults in China.

Methods

This study included 13,258 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms across four waves from 2011 to 2018 were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Four types of social activities were assessed at baseline by self-report: (1) interacting with friends; (2) playing Mahjong, chess, and cards or attending a community club; (3) providing help to family, friends, or neighbors; and (4) attending a sporting or social event or club. Group-based trajectory modeling (GBTM) was used to map depressive-symptoms trajectories during the follow-up period.

Results

Not interacting with friends at baseline was associated with an increased risk of increasing (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.03, 1.41) and severe-stable (aOR: 1.35, 95% CI: 1.10, 1.65) depressive-symptoms trajectories. Participants who did not play Mahjong, cards, or chess and did not attend a sporting or social event or club at baseline were more likely to have mild-stable, decreasing, increasing, and severe-stable depressive-symptoms trajectories.

Conclusion

Social activities play an important role in long-term depressive-symptoms trajectories in middle-aged and older Chinese adults. Interacting with friends, attending sports, or social clubs may prevent depressive symptoms.

The impact of neighborhood mental health on the mental health of older adults

BACKGROUND

In this article, we use cross-sectional data obtained from the 2018 China Health and Aging Tracking Survey (CHARLS) to examine the impact of neighborhood mental health at the community level on the mental health of older adults aged 60 years and older.

METHODS

NMH is the average mental health of older adults in the same community, excluding the older adults themselves. The explained variable mental health in this paper was measured using the simple CES-D depression scale. The mediating variables were social connectedness, social participation and social inclusion, and the instrumental variables were physical exercise and amusement. regression analysis was conducted using OLS regression models, two-stage least squares (IV-2SLS) instrumental variables to address the two-way causality of NMH and MH, and KHB decomposition was used to investigate the effect mechanism.

RESULTS

Baseline regressions showed that the neighborhood mental health effect positively influenced the mental health of older adults (Coef. = 0.356, 95% CI 0.315,0.397). The neighborhood mental health effect estimated by IV-2SLS (Coef. = 0.251, 95% CI 0.096,0.405) was higher than the OLS regression, indicating endogeneity. The mediated effects of KHB showed total (Coef. = 0.356, 95% CI 0.314,0.398), direct (Coef. = 0.281, 95% CI 0.232,0.330), and indirect effects (Coef. = 0.075, 95% CI 0.049,0.101). While the total effect was 1.266 times higher than the direct effect, 21.03% of the total effect came from mediating variables.

CONCLUSIONS

First, the neighborhood mental health effect has a positive impact on the mental health of older adults, but there are heterogeneous differences based on gender, age, and place of residence. Second, the results of the IV-2SLS estimation showed that the effect of the neighborhood mental health effect was underestimated if endogenous problems were not controlled for. Third, the effect of neighborhood mental health on older adults' mental health was tested to be stable. Moreover, social connectedness, social participation, and social interaction are important mediating mechanisms for the effect of neighborhood mental health on older adults' mental health. This study provides new perspectives and ideas for an in-depth understanding of the mental health of older adults in the context of social transformation in China.

Economic development, weak ties, and depression: Evidence from China

OBJECTIVES

Weak ties are becoming mainstream in daily relationships and play an essential role in the improvement of individuals' mental health. Despite growing concerns on depression, inclusion of weak ties is limited. To address the gap, this study empirically shed light on the role of weak ties on individual depression in the context of economic development.

METHOD

A cross-sectional study was conducted based on 2018 China Health and Retirement Longitudinal Study (CHARLS) with a sample of 16,545 individuals. A moderated mediation model is constructed to evaluate the impact of economic development (GDP) on the degrees of depression, the mediating effect of weak ties, and the moderating effect of residents' residence types (living in urban or rural areas).

RESULTS

Economic development exerts a significant direct impact on depression (β=-1.027, p<0.001). Weak ties are significantly negatively correlated with depression (β=-0.574, p<0.001), and act as a mediator between economic development and local individual depression. In addition, the residence type plays a moderating role between economic development and weak ties (β=0.193, p<0.001). That is, living in urban areas would introduce the higher the level of weak ties.

CONCLUSIONS

Higher economic development is largely conducive to alleviating the degrees of depression, weak ties play a mediating role in economic development and depression, and residence types have a positive moderating effect on the economic development and weak ties.

Association of spouse's health status with the onset of depressive symptoms in partner: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

This study aimed to evaluate the associations between the multidimensional health status of one spouse and the onset of depressive symptoms in partner, and whether the associations differed by gender and residence.

METHODS

We analyzed data from 2401 females and their husbands (scenario 1), and 2830 males and their wives (scenario 2) who participated in the 2011/2012 and 2015 waves of China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Multidimensional health indicators included mobility disability, activities of daily living disability, frailty, global cognition, depressive symptoms, comorbidity, and self-reported health. Principal component analysis was used to construct a composite health indicator reflecting overall health status that was then categorized into three groups (poor, moderate, and excellent). Logistic regression models were performed.

RESULTS

We observed strong associations of spouse's health status with the onset of depressive symptoms in partner. For instance, females whose husbands had poor overall health status reported more depressive symptoms than those having husbands with excellent overall health after four years (OR: 1.75; 95 % CI: 1.35, 2.26). These associations were statistically significant in rural females and urban males, but surprisingly disappeared in rural males and urban females.

LIMITATIONS

No exact timing of depressive symptoms onset.

CONCLUSIONS

In Chinese middle-aged and older adults, spouse's health status is associated with depressive symptoms in partner and the associations vary by gender and residence. The findings underscore the importance of considering partner's health status to manage one spouse's mental health.

The correlation analysis of WeChat usage and depression among the middle-aged and elderly in China: the mediating role of social participation

BACKGROUND

We aimed to explore the association between WeChat usage and depression in the Chinese middle-aged and elderly and the role of social participation.

METHODS

Data were obtained from China Health and Retirement Longitudinal Study (CHARLS) of 2018. The dependent variable was depressive symptoms, measured with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). We used the propensity score matching (PSM) to match the WeChat users with the non-WeChat users. Correlations between WeChat usage and depressive symptoms were verified by using logistic regression and linear regression, and the mediating role of social participation was verified by using stepwise regression and KHB method.

RESULTS

Four thousand five hundred forty-five samples were ultimately matched for analysis in this study. After including all control variables, results of logistic regression showed that WeChat usage was significantly associated with a lower prevalence of depression (aOR:0.701,95% CI: 0.605-0.812). And the results of linear regression showed that WeChat usage was associated with lower levels of depression which was significant (p < 0.001). The results of the stepwise regression and the KHB method showed a mediating role of social participation in WeChat usage and depressive symptoms. Among the four types of social participation, the mediating effect of recreational activities was significant, while the mediating effects of voluntary activities, cultural activities, and other activities were not significant. Meanwhile, the effect of WeChat usage on depression and the mediating effect of social participation were heterogeneous because of differences in age and gender.

CONCLUSION

Social participation partly mediated the effect between WeChat usage and depression in middle-aged and older adults. Among the four types of social participation, only recreational activities had a mediating effect. Encouraging more active social participation and other types of social activities should be considered to improve the mental health of the middle-aged and older adults in China through social media usage.

Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study

Nursing home residents' well-being is often proxy-rated in studies, and few studies have explored the association between resident-rated person-centered climate, garden greenery, and resident-rated well-being. A cross-sectional study was conducted. Questionnaire data from a convenient sample of 470 nursing home residents in a city in Southeast China in 2021 were analyzed using multiple linear regressions, with block-wise models. The instruments used were the Person-centered Climate Questionnaire-Patient version, the Nursing Home Greenery Index, and, for well-being, the EuroQol-Visual Analogue Scale, the Life Satisfaction Questionnaire, and the 9-item Patient Health Questionnaire (depression symptoms). In the unadjusted models, the person-centered climate was positively associated with general health (β 0.29, p < 0.001), person-centered climate and greenery with life satisfaction (β 0.39, and 0.18; both p < 0.001), and negatively with depression (β -0.28, and β -0.23, both p < 0.001). After adjusting for personal and nursing home characteristics, the associations between person-centered climate, greenery, and well-being remained statistically significant. The three models explained 36%, 35%, and 21% of the variance in general health, life satisfaction, and depression, respectively. This study provides knowledge on person-centered climate in long-term care and the access to greenery.

The Relationship between Social Participation and Subjective Well-Being among Older People in the Chinese Culture Context: The Mediating Effect of Reciprocity Beliefs

It is demonstrated that the subjective well-being (SWB) of older people greatly relies on their social participation. However, there are few studies on reciprocity beliefs as a mediating mechanism between social participation and SWB. In this study, 297 participants aged 60 and over in Chengdu, Sichuan Province, China, completed a questionnaire of social participation, reciprocity beliefs, and SWB. We used multiple linear regression and mediation analyses to verify the mediating effect of reciprocity beliefs. Results showed that social participation was positively relative to SWB and reciprocity beliefs, and reciprocity beliefs played an intermediary role in social participation and SWB. These findings suggest the importance of social participation for SWB, with reciprocity beliefs (behaviors) playing a positive mediating role, particularly in China. In conclusion, analysis of the mediating effect of reciprocity beliefs provides us with knowledge that could help in achieving a healthy old age. Additionally, this study opens up new perspectives of research.

Self-reported visual impairment and depression of middle-aged and older adults: The chain-mediating effects of internet use and social participation

Background

Visual impairment (VI) is a strong predictor of depression in middle-aged and older adults. However, the underlying mechanisms and pathways have not been well characterized. The purpose of this study was to determine whether Internet use and social participation mediate the effects of self-reported VI on depression.

Methods

The study used the fourth wave of cross-sectional data from the China Health and Retirement Longitudinal Study, including 19,766 Chinese adults. Depression was assessed according to the CES-D 10 International Scale. Logistic regression models were used to examine the relationship between self-reported VI and depression. While adjusting for relevant covariates, the PROCESS macro (model nos. 6 and 91) was used to assess the chain-mediating effects of Internet use and social participation.

Results

A total of 17,433 respondents were included in this study. The CES-D 10 results showed that 7,327 middle-aged and older adults had depressive symptoms, of whom 39.5% were male and 10.2% were ≥75 years old. 32.1% of respondents self-reported VI. Regression analysis showed a positive association between VI and depression, while Internet use and social participation had a negative predictive effect on depression. In the mediation analysis, the social participation pathway contributed the most to the total effect, accounting for 52.69% of it. The proportion of Internet use is 37.72%. When these two mediators were considered together in the full model, they accounted for 9.58% of the total effect of VI on depression.

Conclusion

Internet use and social participation were important mediators that mitigated the effects of VI on depression. Combined with previous evidence, online activities such as e-health and m-health can effectively promote disease monitoring and diagnosis, and various offline social participation activities can also play a role in regulating emotions. Therefore, Internet use and social participation factors may serve as relevant entry points for the development of intervention programs that may further improve the mental health of the visually impaired.

Formal volunteering and depressive symptoms among Community-Dwelling older adults in China: A longitudinal cross-level analysis

The role of formal volunteering in mental health promotion among older adults in China has been widely discussed during recent decades. However, the relationship connecting mental health with cross-level interaction (i.e., average levels of participation in the community vs. individual participation) is still unclear. This paper examined the effects of cross-level formal volunteering on depressive symptoms among older adults living in China. Using two waves of the China Longitudinal Aging Social Survey, a sample of 3128 Chinese older adults was surveyed in 2014 and 2016. Depressive symptoms were measured using the abbreviated CES-D-9. Individual fixed-effects ordinary least squares regression models assessed the associations between individual- and community-level formal volunteering and depressive symptoms in urban and rural areas separately. We found that in the urban sample, formal volunteering activities were negatively associated with depressive symptoms at the individual level (β = -0.49, SE = 0.22, p < 0.05). Higher community-level formal volunteering was positively associated with depressive symptoms (β = 2.82, SE = 1.42, p < 0.05). When adding interactions between individual and community levels, engagement in individual-level formal volunteering was associated with lower rates of depressive symptoms as community volunteering participation levels increased (β = -3.07, SE = 1.07, p < 0.01). High community-level volunteering participation was detrimental for non-volunteers. In rural areas, neither community- nor individual-level formal volunteering was associated with changes in depressive symptoms. The current findings demonstrate formal volunteering may not always benefit mental health for all. The effects may depend on the community context and individual choices. Social policies aimed to promote mental health through formal volunteering need to be tailored according to the specific community social environment.

Impacts of psychological resources, social network support and community support on social participation of older adults in China: Variations by different health-risk groups

Social participation comprises comprehensive interactions between individual health and relevant environmental characteristics, which play an increasingly important role in promoting older adults' health and quality of life. Although many studies have examined impacts of various factors on the social participation of older adults, some internal mechanisms between health characteristics and environmental characteristics have not been revealed. This study aimed to examine the moderating effects of health characteristics on the relationships among psychological resources, social network support, community support and social participation of Chinese older adults. Based on some key health indicators, this study used the two-step cluster algorithm to divide the participants aged over 60 years from the Chinese Longitudinal Aging Social Survey in 2016 (N = 8669) into low (47.2%), moderate (33.8%) and high (18%) health risk groups. A multiple-group structural equation model was then built to examine the effects of psychological resources, social network support and community support on social participation across the three groups. The results suggested that with the increase in health risks, the contributions of psychological resources and community support to social participation decreased from 28.6% to 23.7% and from 61.5% to 50.7%, respectively, while that of social network support increased from 9.9% to 25.6%. These variations suggest that individual health has a significant moderating effect on the psychological and social compensating mechanisms of the social participation among Chinese older adults.

Social Disconnectedness and Mental Health Problems During the COVID-19 Pandemic in China: A Moderated Mediation Model

Objectives: This study aimed to examine the mediating effect of perceived isolation and the moderating effect of COVID-19 related concerns in the relationship between social disconnectedness and mental health problems during the COVID-19 pandemic in China.

Methods: A cross-sectional online survey of 11,682 Chinese residents were conducted during the COVID-19 outbreak. Conditional process analysis was performed to test the mediating effect of perceived isolation and the moderating effect of COVID-19 related concerns.

Results: Social disconnectedness was positively related to mental health problems, and perceived isolation significantly mediated their relationship. COVID-19 related concerns exacerbated the direct link between social disconnectedness and mental health problems as well as the indirect link via perceived isolation.

Conclusion: Social disconnectedness was a key predictor of mental health problems during the COVID-19 outbreak. The direct and indirect effects of social disconnectedness on mental health problems were stronger for respondents who had more COVID-19 related concerns. Understanding the underlying mechanisms by which social disconnectedness is related to mental health problems has important practical implications for the prevention of mental health problems during the COVID-19 pandemic.

Neighborhood Environment and Depressive Symptoms among Chinese Older Immigrants in the U.S.: The Mediation Effects of Coping Resources

BACKGROUND AND OBJECTIVES

Studies have shown that neighborhood environment shapes older Americans' aging experience and health. However, it remains largely unknown whether and how neighborhood environment influences the wellbeing of older Asian Immigrants. Guided by the neighborhood stress process model, this study aims to investigate 1) the associations between neighborhood environmental stressors and depression among Chinese older immigrants, and 2) the potential mediation effects of intrapersonal (sense of mastery, sense of hopefulness) and interpersonal coping (social engagement) resources in such associations.

RESEARCH DESIGN AND METHODS

This study analyzed data collected from 2,801 Chinese older immigrants in the greater Chicago area. Structural equation modeling (SEM) with bootstrap resampling was used to fit path models on neighborhood environmental stressor, intra- and interpersonal coping resources, and depression.

RESULTS

Findings showed that neighborhood social disintegration and physical disorder were associated with more depressive symptoms directly and indirectly via lower intra- and inter-personal coping resources. Specifically, older immigrants living in neighborhoods with greater social disintegration reported lower sense of mastery and social engagement, which in turn were associated with more depressive symptoms (partial mediation). Older immigrants living in neighborhoods with greater physical disorder reported lower sense of hopefulness and mastery, which subsequently were associated with more depressive symptoms (full mediation).

DISCUSSION AND IMPLICATIONS

The findings showed that neighborhood environmental stressors are risk factors for mental health of older Chinese immigrants and coping resources may serve as pathways of the associations. The implications for future research and practice were discussed.

Association between depression and motoric cognitive risk syndrome among community-dwelling older adults in China: A 4-year prospective cohort study

BACKGROUND AND PURPOSE

Depression can lead to a wide range of adverse health outcomes, including dementia. However, evidence supporting the relationship between depression and motoric cognitive risk syndrome (MCR), a pre-dementia syndrome, remains lacking. This study aimed to examine the association between depression and MCR among community-dwelling Chinese older adults.

METHODS

Data were taken from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Depression was defined by a Center for Epidemiological Studies Depression Scale (CES-D) score ≥10. MCR was defined as subjective cognitive complaints and objective slow gait speed. Multivariate logistic regression analyses were conducted to examine the cross-sectional and longitudinal associations between depression and MCR at baseline and a 4-year follow-up period for the sample population and gender groups.

RESULTS

The prevalence of MCR was higher in participants with depression than in those without depression at baseline (12.2% vs. 8.9%; p = 0.001). Participants with depression at baseline had a higher 4-year incidence of MCR than those without depression (14.8% vs. 8.7%; p < 0.001). Both cross-sectional analysis (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13-1.75) and prospective analysis (OR 1.95, 95% CI 1.56-2.44) demonstrated that depression was significantly associated with MCR. These associations were consistent across different gender groups and stronger among female individuals.

CONCLUSIONS

Depression is an independent risk factor for MCR among community-dwelling Chinese older adults. Special attention should be paid to the care of older people with depression to reduce the occurrence of MCR and even dementia.

Effect of socioeconomic status on the physical and mental health of the elderly: the mediating effect of social participation

BACKGROUND

Previous studies have demonstrated the effect of socioeconomic status on the health status of the elderly. Nevertheless, the specific dimensions of the effect and the mechanism await further investigation. In this study, socioeconomic status was divided into three dimensions and we used social participation as the mediation variable to investigate the specific path of effect.

METHODS

Using the 2018 Waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, a total of 10,197 effective samples of the elderly over 65 years old were screened out. Socioeconomic status included income, education level, and main occupation before retirement. The physical health and mental health of the elderly was measured by the Instrumental Activities of Daily Living Scale and the Minimum Mental State Examination, respectively. The social participation of the elderly was the mediation variable, including group exercise, organized social activities and interacting with friends. Omnibus mediation effect analysis was adopted to examine the mediation effect and mediation analysis was completed using the SPSS PROCESS program.

RESULTS

First, the results showed that when the income gap between the elderly reached a certain level, there was a significant difference in health status. Significant differences existed in health status amongst with different education levels. There was no sufficient evidence to show that occupation has a significant effect on the physical health. But when the dependent variable was mental health, the effect was significant. Second, group exercise mediated 64.11% (a_ib = 0.24, 95% CI [0.17,0.3]) and up to 20.44% (a_ib = 0.12, 95% CI [0.07,0.17]) of the disparity in physical and mental health due to income gap, respectively. And it could mediate the effect up to 56.30% (a_ib = 0.62, 95% CI [0.52,0.73]) and 17.87% (a_ib = 0.50, 95% CI [0.4,0.61]) of education on physical and mental health status, respectively. The proportion of relative mediation effect of occupation was up to 28.74% (a_ib = 0.19, 95% CI [0.13,0.25]) on mental health. Interacting with friends mediated only on the path that the education affected the health status of the elderly. The proportion was up to 33.72% (a_ib = 0.29, 95% CI [0.16,0.44]). The relative mediation effect of organized social activities on the health gap caused by income or education level gap was significant at some levels. The proportion was up to 21.20% (a_ib = 0.33, 95% CI [0.26,0.4]).

CONCLUSION

The SES of the elderly including relatively large income gap, different education levels and occupational categories could indeed have a significant effect on health status of the elderly, and the reason why this effect existed could be partly explained by the mediation effect of social participation. Policymakers should pay more attention to the social participation of the elderly.

Less Social Participation Is Associated With a Higher Risk of Depressive Symptoms Among Chinese Older Adults: A Community-Based Longitudinal Prospective Cohort Study

OBJECTIVE

We aimed to examine the association between social participation and depressive symptoms among Chinese older people aged 65 years or above to supplement limited studies in China on this topic.

METHODS

This community-based longitudinal prospective cohort study used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, baseline in 2014 and a follow-up in 2018). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Social participation was assessed using a composite index by considering the frequency for the two types of social activity: organized social activities and informal activities. Pearson's χ2 test was used to correlate the characteristics of participants with social participation or depressive symptoms. Log-binomial regression models were used to assess the association between social participation and the risk of depressive symptoms.

RESULTS

The incidence of depressive symptoms was 28.8% among 2,200 participants in 2018 after a 4-year follow-up. Participants with no social participation (32.6%), organized social activities (30.6%), or informal social activities (31.2%) were more likely to have depressive symptoms. After the adjustment of demographic factors, socioeconomic status, lifestyle habits, and health status, in comparison with older people who often engaged in social participation, organized social activities, and informal social activities, the risk of depressive symptoms was 45% [adjusted risk ratio (aRR): 1.45, 95% CI: 1.16-1.82], 42% (aRR: 1.45, 95% CI: 1.02-2.00), and 29% (aRR: 1.29, 95% CI: 1.02-1.99) higher among older people with no social participation and who never engaged in organized social activities and informal social activities, respectively.

CONCLUSIONS

This study showed that the lack of social participation, including organized social activities and informal social activities, was associated with a higher risk of depressive symptoms after 4 years among older adults in China. Our findings shed lights into the feasibility of promoting social participation to reduce the risk of depressive symptoms and promote longevity and healthy aging among older adults.

Participation Predicts Cognitive Functioning in Older Adults Using the PART-O Transformed Scores Systems

Participation has been shown to be a protective factor for cognition in older adults, but instruments to assess it are limited. The main objective was to determine the validity of two scoring systems (direct vs transformed) for the Participation Assessment with Recombined Tools-Objective (PART-O) by applying structural equation modeling to the relationship between the subscales and the cognitive functions, in a sample of 245 people over 60 years of age. The transformed scores model showed stronger relationships and larger explained variance in overall participation (55.4% vs 37.4%), especially in the Social Relations subscale (31.4% vs 14.6%). Participation was a direct predictor of cognitive functions in both models. Age and depression inversely influenced participation in the transformed scores model. The proposed score transformation for the PART-O provides a more appropriate measurement of the older adults' participation. Participation has a mediating role in the relationship between cognition and both age and depression.

Productive engagement, sleep-wake disturbances, and loneliness: SEM analysis of depressive symptoms of community-dwelling Chinese elders

OBJECTIVES

This study set out to examine the bidirectional relationship between loneliness and productive engagement, delineate the association between different dimensions of productive engagement and depression, and explore the potential mediating effect of sleep-wake disturbances in the relationship between loneliness and/or productive engagement and depression.

METHOD

Data from a total of 4427 older adults in China were included in the analysis. Factor analysis was conducted to explore a set of discrete dimensions of productive engagement (recreational activities, group artistic and learning activities, sportive activities, paid work, volunteering, and family caregiving). Structural equation modeling was used to assess the potential relationships between loneliness, multidimensional productive engagement, sleep-wake disturbances, and depression.

RESULTS

All dimensions of productive engagement were found to be negatively associated with loneliness, except for paid work which was associated with elevated level of self-reported loneliness. Sleep-wake disturbances mediated the relationship between leisure activities and depression but this was not significantly related to other forms of productive engagement. The direct effect of productive engagement on depression varied, in that leisure activities and family caregiving were negatively associated with depressive symptoms, while doing paid work was positively associated with depressive symptoms. Volunteering was not significantly related to depressive symptoms.

DISCUSSION

This study makes an important contribution to the research on the relationship between loneliness, productive engagement, sleep-wake disturbances, and depression, by distinguishing the different effects of different dimensions of productive engagement. The findings provide a robust stimulus for intervention programs and other forms of social work practice seeking to mitigate depressive symptoms in older adults.

Social participation and quality of life among patients with neuromyelitis optica spectrum disorders: The mediating effects of depression

BACKGROUND

Depression is one of the most common and important symptoms of patients with neuromyelitis optica spectrum disorders. Depression is an important aspect of mental health which would be expected to affect a person's social participation. Studies have shown that depression and social participation are independent predictors of health-related quality of life. Depression especially affects its mental component and social participation especially affects its physical aspects. This study was designed to explore to what extent depression may regulate the relationship between social participation and quality of life.

METHODS

A convenience sample of 138 discharged patients with neuromyelitis optica spectrum disorders were surveyed. They were asked about their demographic characteristics and disease-related information. Their ability in the activities of daily living was quantified using the Barthel Index. The 36-item short-form health survey, the Beck Depression Inventory and the Impact on Participation and Autonomy questionnaire were also administered. Univariate analysis and Pearson correlations were used to test for any significant relationships between the variables and quality of life. The mediating effect of depression on the association between social participation and life quality was examined using structural equation modeling.

RESULTS

The structural equation models provided an excellent fit for the data. Social participation and the physical aspects of life quality were found to be strongly associated. And depression was of course strongly related to the mental aspects. Depression was not a mediator in the significant relationship between social participation and the physical aspects of life quality, but depression was found to be a strong and significant meditator in the association between social participation and the mental aspects of life quality.

CONCLUSION

These findings help to clarify the direct and indirect effects of depression and social participation on the life quality of patients with neuromyelitis optica spectrum disorders. While helping and encouraging patients to actively participate in social life should be supplemented by monitoring them for signs of depression and providing appropriate treatment.

Three-year effects of neighborhood social network intervention on mental and physical health of older adults

OBJECTIVES

Although neighborhood is considered to be a crucial source of social network to promote health among older adults, current findings are mostly derived from observational study designs. This study examined whether participations in event-based community programs could increase neighborhood social network and whether such increase could lead to desirable changes in mental and physical health among older adults.

METHOD

This study employed quasi-experimental design. A baseline questionnaire survey was sent to residents of Tsurukabuto community aged 60 years or more (n = 1769); 1,068 responded. Community events were implemented approximately once a month for three years. Then, a three-year follow-up survey questionnaire was sent to the respondents of the baseline survey. The total number of respondents in the latter survey was 662; of the total, 173 participated in the intervention. Strong and weak ties with neighbors, mental well-being (Ikigai-9), health-related quality of life (HRQOL), and instrumental activity of daily living (IADL) were measured in the surveys.

RESULTS

The path analysis revealed that intervention participation was significantly associated with changes in strong ties (standardized path coefficient = 0.12) and changes in strong ties were associated with those in Ikigai-9 scores (standardized path coefficient = 0.15). The total and indirect effects of intervention participation on Ikigai-9 scores were significant. Significant intervention effects were not observed for HRQOL and IADL scores.

CONCLUSION

This study found that participation in our event-based intervention could indirectly and positively influence older adults' mental well-being through their strong ties with their neighbors.

The Impact of Leisure Activities on the Mental Health of Older Adults: The Mediating Effect of Social Support and Perceived Stress

As the aging continues, China has become the country with the largest older population. In order to ensure the well-being of older adults in their later years, the whole society is increasingly concerned about the mental health of older adults. In 2019, we conduct a questionnaire survey in Shaanxi Province. Stratified random sampling is used to select three representative cities, and 677 samples are selected from the survey results for research. By using the structural equation model, we aim to reveal the mechanism of leisure activities' influence on mental health of the older adults and verify whether social support and perceived stress play a mediating role. The study finds that the older adults' leisure activities have no significant direct impact on mental health. Social support has a significant mediating effect between leisure activities and mental health of the older adults. Leisure activities indirectly affect the mental health of the older adults through social support, and participation in leisure activities can improve the social support of the older adults, thus improving the mental health level of the older adults. Perceived stress plays a significant mediating role between leisure activities and mental health of the older adults. By participating in leisure activities, the perceived stress of the older adults will be reduced, thus improving their mental health. Social support and perceived stress play a sufficient mediating role in the influence of leisure activities on mental health.

Neighborhood-Based Social Capital and Depressive Symptoms among Adults: Evidence from Guangzhou, China

This study examined the association between neighborhood-based social capital (NSC) and depressive symptoms in the context of urban neighborhoods in China, with special attention given to the association heterogeneity across socioeconomic groups. Drawing on cross-sectional data collected from 39 neighborhoods in Guangzhou, this research demonstrated that adults’ depressive symptoms were higher among those with lower cognitive (trustworthiness, reciprocity, and cohesion within a neighborhood) and structural (social network and participation) dimensions of NSC. Further analysis showed that the negative association between NSC and depressive symptoms was significantly heterogeneous across socioeconomic groups. Specifically, this negative relationship was more prominent in the lower socioeconomic classes than in the upper socioeconomic classes, indicating that the lower accumulation of NSC among disadvantaged groups may aggravate depression unequally across social classes. In addition, the negative association between social participation and depressive symptoms was stronger for people who are older or unemployed. The findings of this study not only provide new evidence concerning the significance of the beneficial effects of NSC in the Chinese context, but also, more importantly, highlight that NSC plays a crucial role in creating mental health inequality across social classes. Thus, the relevant social interventions including fostering neighborhood relationships and social activities should be carefully tailored against the backdrop of community building during the urbanization process. The implications of our study for urban governance to promote healthy cities are discussed.

Factors Associated with Post-Stroke Depression in Chinese Stroke Survivors

OBJECTIVES

To explore the relationship between participation self-efficacy, sociodemographic and clinical characteristics, and post-stroke depression in stroke survivors and provide insights into the development of rehabilitation programmes.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted with 336 participants recruited from five hospitals in Kunming, China. Measures included the Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES-C), Geriatric Depression Scale (GDS), modified Barthel Index, Rivermead Mobility Index (RMI), Reintegration to Normal Living Index (RNLI), and the Social Support Questionnaire (SSQ6). Logistic regression analyses were performed using SPSS 25.0.

RESULTS

Nearly half (44.6%) of the sample was found to have depression. The mean participation self-efficacy score of stroke survivors with depression was significantly lower than that of those without depression. Logistic regression analyses suggested that participation self-efficacy is a constant and major factor negatively associated with depression, with every 10-pt increase in the PS-SES-C score associated with decreased odds of depression (p<0.001). Other features associated with depression prevalence to varying degrees included education level, marital status, pre-morbid financial role in family, stroke symptom severity, history of heart disease, frequency of stroke, lesion side, stroke type, and use of assistive aids.

CONCLUSIONS

Participation self-efficacy is negatively associated with depression in stroke survivors. Rehabilitation programmes might consider incorporating interventions aimed at boosting participation self-efficacy in order to promote positive recovery outcomes among survivors.

Sport and Recreational Physical Activities Attenuate the Predictive Association of Multimorbidity With Increased Geriatric Depressive Symptoms: A 14-Year Follow-Up Study of Community-Dwelling Older Adults

Multimorbidity is associated with increased depression risks. Little research examines how physical exercise moderates this association. From an existing cohort of community-dwelling older adults in Hong Kong recruited in 2001-2003, the authors included participants who were successfully interviewed after 14 years (2015-2017). Geriatric depressive symptoms were used as the primary outcome and measured by the 15-item Geriatric Depression Scale, while multimorbidity was operationalized using a list of 19 conditions. Subscores of the Physical Activity Scale for the Elderly measuring light, moderate, and strenuous sport/recreational activities were included as moderators. In total, 1,056 participants were included, of whom 50.7% were multimorbid. Multimorbidity was associated with 12% more geriatric depressive symptoms, but strenuous physical activities were associated with a smaller risk elevation only among multimorbid patients (adjusted relative risk = 0.99, 95% confidence interval [0.98, 0.99]; p = .001). In conclusion, strenuous sport and recreational activities may attenuate the association between multimorbidity and geriatric depressive symptoms.

Influence of Subjective/Objective Status and Possible Pathways of Young Migrants' Life Satisfaction and Psychological Distress in China

Young migrants have been the major migrant labor force in urban China. But they may be more vulnerable in quality of life and mental health than other groups, due to their personal characteristic and some social/community policies or management measures. It highlights the need to focus on psychological wellbeing and probe driving and reinforcing factors that influence their mental health. This study aimed to investigate the influence of subjective/objective status and possible pathways of young migrants' life satisfaction and psychological distress. Data on 9838 young migrants in the China Migrants Dynamic Survey were analyzed by LISREL 8.8. A total of 94.03% migrated for jobs or business. Subjective status, including subjective socioeconomic status, social adaptation, and psychological integration, had positive effects on life satisfaction, whereas social adaptation and psychological integration negatively affected psychological distress. Objective status, including objective socioeconomic status and health insurance, had adverse effects on life satisfaction, whereas they positively affected psychological distress. Social participation and city belonging had only significant positive mediating roles on life satisfaction. It is essential to increase social adaptation and decrease integration stress according to younger internal migrants' practical needs. It is also necessary to enhance community/social resources and activities in the context of developing sustainability in the community to assist in mental health promotion.

Age-friendly neighbourhoods and depression among older people in China: Evidence from China Family Panel Studies

BACKGROUND

Older population with depression symptoms reached about 64 million in China. Under the World Health Organization's (WHO) age-friendly communities framework, this study explored relationships between neighbourhood environment characteristics and depressive symptoms among community-dwelling older adults in China.

METHODS

Data were obtained from the China Family Panel Studies (CFPS), a national multi-stage probability sample in China. The final analytic sample comprised 5,641 older adults in China. Neighbourhood environment characteristics were measured in three ways: objective facilities, interviewers' evaluation, and respondents' own perceptions on the neighbourhood environment. Depressive symptoms were measured by the 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Multilevel regression models were applied.

RESULTS

Neighbourhoods with more exercise and recreational facilities, better interviewers' evaluations, and better objective respondents' perceptions on neighbourhood environment at a neighbourhood level were significantly negatively associated with depressive symptoms, but these association were influenced by respondents' demographic characteristics, socioeconomic status and respondents' own perceptions of neighbourhood environment at the individual level. On the other hand, respondents' subjective positive perceptions of neighbourhood environment at the individual level were also significantly negatively associated with depressive symptoms.

LIMITATIONS

The actual conditions of affordability, accessibility and utilization of public facilities and social services within neighbourhoods were not known.

CONCLUSIONS

This research extended the current knowledge of the associations between neighbourhoods and mental health among older adults, to promote ageing in place in China. Great importance should be attached to the improvement of both physical and social aspects of the neighbourhoods to develop age-friendly communities.

Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults

This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among 1643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty was associated with disability, comorbidity, depression, and cognitive decline. Less social participation was associated with limitations in instrumental activities of daily living (IADLs), depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than prefrail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults.

Difference of depression between widowed and non-widowed older people in China: A network analysis approach

BACKGROUND

In this study, the difference of depression network structures between the widowed and non-widowed older people and the associations of family capital, neighborhood cohesion, and neighborhood built environment with depressive symptoms were explored by using network analysis.

METHODS

This study fitted network models to two subsamples extracted from a nationally representative and cross-sectional data from China Family Panel Studies (CFPS). Depressive symptom levels and the effect of the three possible influencing factors related on depression were compared.

RESULTS

The network structures of depression across the widowed and the non-widowed older people were different to some extent but significantly associated with one another. Neighborhood cohesion were significantly related to severe depressive symptoms in both subsamples. Neighborhood built environment mattered for the non-widowed older people, but not for their counterparts. Family capital also functioned in a different way for the two subsamples.

LIMITATIONS

Investigation was carried out using cross-sectional data, and changes in contents could alter the network structure. In addition, grief-related variables were not included. New studies replicating the current findings with a wider range of contents, multiple time points and a larger sample are warranted.

CONCLUSIONS

This study added evidence to a growing body of literature on depressive symptom patterns for the widowed older people and their counterparts. Tailored service and treatment could be developed for the widowed and non-widowed older people based on their features of depression. The contextual factors including family, neighborhood, and physical environment could be taken into account when considering their association with depressive symptoms.

Willingness to engage in and current status of social participation among Chinese merchant sailors

China has the largest population of sailors in the world, but little is known of their social participation. This study examined Chinese merchant sailors' social participation using a nationwide survey. Across 12 Chinese provinces, 7,296 merchant sailors completed the questionnaire on sailor' willingness to engage in and status of social participation. The results showed that most Chinese merchant sailors were willing to participate in social affairs, but few of them reported having joined relevant social organizations, over half of sailors reported never having participated in public affairs, and half of them chose to ignore when they faced with an obvious mistake in shipping-related information in the media. Most of sailors reported unknowing the role of the labor union related to Chinese seafarers and NGO related to navigation well, and their evaluation of these organizations were mostly negative. Chinese merchant sailors reported higher expectations of services in terms of protection of rights, providing information and technology, and providing employment opportunity. We conclude that Chinese merchant sailors have willingness to social participation although the reality is not positive and discuss implications for improving the social participation of Chinese merchant sailors.

The Association between Urbanization and Depression among the Middle-Aged and Elderly: A Longitudinal Study in China

Urbanization has been and will continue to be the mainstream trend of global population movement, including China. Depression is the most common mental disorders and the leading factor of disabilities. However, the impacts of urbanization on the depression occurrence are still unclear. This paper analyzed the data from 3 waves of the China Health and Retirement Longitudinal Study (CHARLS) with sample size as 8510 adults representing the middle aged and elderly group in China. Depression was identified and measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Urbanization level was measured by population density, GDP per capita and secondary/tertiary industry as percentage to GDP in the China City Statistical Yearbook. The fixed effect regression model was used to explore the association between the changes of urbanization and depression. As result, depression is closely related to the urbanization, protective effects are found for 3 indicators above: The depression prevalence decreases while urbanization level increases (from lowest urbanization level to the highest: P < 0.01). Among the 10 depression symptoms, "Bothered", "Reduced energy leading to diminished activity" and "Hopelessness" are the most significantly improved with urbanization. The impact of urbanization on residents' mental health is a long-term, multi-factor interaction. Therefore we need to fully consider all possible influencing factors, and longer follow-up study to verify.

Social change and birth cohort decrease in social support for older adults in China: A cross-temporal meta-analysis, 1994-2018

Social support not only plays an important role in the physical and mental health of the elderly people but also constitutes an essential resource for healthy ageing. With the rapid economic and social development during the last 40 years in China, the acceleration of urbanisation, and the disintegration of traditional extended families, the social support that Chinese older adults receive may be declining, leading to deterioration in quality of life for the rapidly ageing population. Cross-temporal meta-analysis was employed to investigate changes in older Chinese adults' social support from 1994 to 2018. One hundred and thirty-six studies (N = 82,722; age ≥ 60) that used the social support rating scale (SSRS) were analysed. Additionally, social support scores were correlated with social indicators to explore the relationship between social support and the environment of social development. Results show that social support scores decreased by 5.09 and 0.73 standard deviations over the past 24 years. Correlation with social indicators suggests that a decrease in social connectedness and an increase in economic imbalance may be responsible for the reduction in social support.

Exploring the health-relevant poverty line: a study using the data of 663,000 individuals in Japan

Background

Income poverty is known to be associated with poor health outcomes. However, the poverty line, which is used to calculate the poverty rate, is arbitrarily set without specific reference to health. This study explored the health-relevant poverty line to understand poverty in terms of population health.

Methods

Using repeated cross-sectional data from approximately 663,000 individuals obtained from 11 waves of nationwide population surveys conducted in Japan from 1986 to 2016, we used two methods to calculate a health-relevant poverty line: (1) We searched for a poverty line that maximized the proportion-weighted relative underperformance in health among individuals whose income was below the poverty line (Method I). (2) We searched for a poverty line that maximized the likelihood of the logistic regression model to explain poverty in terms of health using a binary variable for below-the-poverty-line income (Method II). For both methods, we considered five health outcomes: Poor/fair and poor self-rated health, subjective symptoms, problems with daily life activities, and psychological distress, along with covariates.

Results

Methods I and II indicated that the health-relevant poverty line should be drawn, respectively, at 72–86% and 67–69% of median income; this level is somewhat higher than the conventional 50% or 60%.

Conclusions

The results suggest that there is a risk that the conventionally defined poverty line may underestimate poverty in terms of population health.