The effect of subjective social status on health-related quality of life decline in urban Chinese older adults: a four-year longitudinal study from Hong Kong

Friends, neighbors, country, and respect: Status ladders and health behaviors in the United States

Efforts to understand the relationship between socioeconomic status (SES) and health have expanded beyond traditional indicators of education, income, occupation, and wealth to individuals' own reports of where they stand. This more contemporary approach has enjoyed considerable success, in that self-reported SES standing, often measured on a ladder representing the entire U.S. socioeconomic hierarchy, is associated strongly with health even when traditional SES indicators are controlled. However, disparities in self-rated health across ladder measures typically are not assessed with regard to health behavior disparities. Here, we draw on two US national probability samples assessing diverse ladder reference groups, as well as a new ladder asking people to report how much respect, honor, or esteem they receive from other people. Respect or honor offers a distinct potential to measure social influence across circles of recognition. We find that U.S.-based ladder status is related to smoking currently or ever and to days of exercise. While friend, neighbor, and respect-based ladders do not relate to health behaviors net of U.S. ladder standing, they show relationships to ever smoking and physical activity, and self-rated health, in their own right. Physical activity accounts for 12-18% of self-rated health disparities by friend, neighbor, or country ladder status. Smoking and drinking do not robustly contribute to ladder-based disparities in self-rated health. Contrasting what is typically found for traditional SES measures, physical activity merits further research, as does the receipt of respect or honor. That status ladder health disparities go largely unexplained by behaviors suggests the potential roles of non-behavioral pathways including inflammation, hopelessness, or classism.

Perceived social position, active engagement with life, and depressive symptoms among older adults

RATIONALE

Despite the existing literature on the relationship between perceived social position (PSP) and depressive symptoms, there remain gaps in our understanding, particularly regarding the potential for asymmetric effects of increases and decreases in PSP and the underlying mechanisms involved.

OBJECTIVE

This study aims to examine whether increases and decreases in PSP are differentially associated with depressive symptoms and to explore the potential mediating role of active engagement with life in these associations.

METHODS

This study utilized data from the Korean Longitudinal Study of Aging (KLoSA), collected between 2008 and 2018, involving a sample of 3506 individuals aged 65 or older. Asymmetric fixed effects (FE) models were employed, which enable the estimation of differential effects for increases and decreases in PSP, while accounting for unobserved individual-level heterogeneity. To assess the mediating role of active engagement in life, Sobel mediation tests were conducted.

RESULTS

The asymmetric FE estimates revealed a stronger association between decreases in PSP and increases in depressive symptoms compared to the association between increases in PSP and decreases in depressive symptoms. The Sobel mediation tests indicated that formal social activities had the most substantial mediating effect, explaining 14% and 9% of the total effect mediated for increased and decreased PSP and depressive symptoms, respectively. Leisure/hobby activities explained 10% and 4% of the total effect mediated for increased and decreased PSP and depressive symptoms, respectively.

CONCLUSION

This study provides evidence that increases and decreases in PSP have differential effects on depressive symptoms among older adults in Korea. Policy interventions aimed at improving the psychological well-being of older adults should prioritize efforts to both enhance PSP and minimize declines, as the latter can have a stronger negative impact on depressive symptoms. Active engagement in life may serve as a potential pathway for achieving the desired effects.