Multidimensional Internet Use, Social Participation, and Depression Among Middle-Aged and Elderly Chinese Individuals: Nationwide Cross-Sectional Study

Association Between Multidimensional Social Participation and Hypertension Among Middle-Aged and Older Adults in China: A Cross-Sectional Analysis From the China Health and Retirement Longitudinal Study

Hypertension is a significant public health issue, particularly among middle-aged and older adults. This study investigated the impact of multidimensional social participation, including its diversity and frequency, on hypertension in this population in China, with a focus on urban-rural differences. Using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), which included 12 165 participants aged 45 and older, social participation was categorized by diversity (e.g., voluntary activities, Mahjong, cards, chess, or other clubs) and frequency. Hypertension was determined based on self-reported diagnoses, medication use, and blood pressure measurements. Logistic regression analyses, adjusted for demographic and health-related factors, revealed that more diverse social participation was associated with lower hypertension rates (OR = 0.718, 95% CI = 0.612, 0.840). Participating more than once a week also correlated with reduced hypertension risk (OR = 0.877, 95% CI = 0.803, 0.958). Specific activities, such as volunteering, internet use, and Mahjong, were notably protective against hypertension. Subgroup analyses highlighted urban-rural disparities, with differing impacts of social participation observed. However, interaction analyses showed that urban-rural residency did not significantly modify the relationship between social participation and hypertension. These findings emphasize the role of social participation in mitigating hypertension risk among middle-aged and older Chinese adults, and underscore the need for targeted public health strategies to address urban-rural disparities and promote social participation.

Multidimensional health status and its impact on health care consumption behavior among elderly people with chronic diseases: evidence from CHARLS in China

Purpose

This study aims to provide a comprehensive understanding of the multidimensional health status of elderly individuals with chronic diseases in China and examine its impact on their healthcare consumption behavior.

Methods

A chi-square test was conducted to assess the variations in healthcare consumption behavior across different multidimensional health categories. Additionally, a logistic regression model was employed to identify the key determinants influencing healthcare consumption among elderly individuals with chronic diseases from a multidimensional health perspective.

Results

The chi-square test results indicated a statistically significant association between multidimensional health and healthcare consumption behavior (p < 0.05). Furthermore, the logistic regression analysis identified dyslipidemia, regular participation in social activities, and children's financial support (≥¥5,801 yuan per year) as significant contributors to healthcare consumption behavior among elderly individuals with chronic conditions (p < 0.05).

Conclusion

The findings of this study suggest that both physical and social health play a positive role in enhancing healthcare consumption behavior among elderly individuals with chronic diseases (p < 0.05). These results highlight the importance of targeted policy interventions that integrate physical health management and social engagement strategies to improve healthcare accessibility and utilization in this population.

Social isolation and depressive symptoms among older adults with different functional status in China: A latent class analysis

BACKGROUND

Social isolation is considered a risk factor for depression in older adults. Since there may be heterogeneity in the experience of social isolation, we aimed to investigate social isolation patterns and their association with depressive symptoms, for older adults with different functional status separately.

METHODS

This study used data from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS). A total of 8262 participants, defined as older adults aged 60 years and above, were included in the analysis, comprising 49.9 % (n = 4124) men and 50.1 % (n = 4138) women. Latent class analysis was conducted to identify social isolation patterns. Binary logistic regression was used to estimate the association between latent classes and depressive symptoms.

RESULTS

Two distinct classes were identified in participants with functional dependency and three classes were identified in participants without functional dependency. The severely isolated with minimal family and social contact group was associated with a higher risk of depressive symptoms in both subgroups (participants with functional dependency: OR = 1.319, 95%CI: 1.032-1.686; participants without functional dependency: OR = 1.537, 95%CI: 1.209-1.953). No difference was found in the risk of depressive symptoms between the moderately isolated with family contact group and the low isolated group among participants without functional dependency (OR = 1.020, 95%CI: 0.83-1.252).

CONCLUSION

Risk of depressive symptoms varies with different social isolation patterns among older people with different functional status.

Cardiac history and post-stroke depression association in Chinese stroke survivors: a cross sectional study

A substantial body of evidence indicates that stroke is a primary cause of death and disability on a global scale. The presence of post-stroke depression has been demonstrated to exert a substantial influence on the prognosis of stroke patients, underscoring the imperative for the identification and early prevention of post-stroke depression. The objective of this study was to examine the association between cardiac history and post-stroke depression (PSD) in Chinese stroke patients, with the aim of identifying high-risk groups, promoting early intervention strategies, and enhancing patient prognosis. This study was based on data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), which included 933 respondents with a history of stroke. Univariate and multivariate logistic regression analyses were used to assess the effects of cardiac history and other variables on post-stroke depression (PSD). The results indicated a correlation between cardiac history and post-stroke depression (PSD). In addition, the data showed that gender, activities of daily living (ADLs), cognitive functioning, and life satisfaction also had an effect on post-stroke depression (PSD). The findings presented here indicate that patients with a history of cardiac disease are more likely to develop post-stroke depression. This provides valuable insights into the clinical management of stroke patients and the prevention of post-stroke depression. The emotional health assessment of such patients should be emphasized in clinical management, and appropriate psychological support and interventions should be provided to improve their overall prognosis.

Knowledge, attitudes, and practices regarding intrinsic capacity in the elderly population: A cross-sectional study in Shanghai, China

To investigate the knowledge, attitudes, and practices (KAP) of the elderly population regarding their intrinsic capacity, as defined by the World Health Organization as a marker of healthy aging. A cross-sectional study was conducted at the Shanghai Traditional Chinese Medicine Hospital from July to November 2023. Participants' socio-demographic information and KAP scores were collected through a self-designed questionnaire. A total of 507 elderly individuals participated, with 53.25% being male and a mean age of 70.76 ± 7.63 years. The mean knowledge, attitude, and practice scores were 19.58 ± 8.85, 30.07 ± 4.81, and 34.71 ± 7.77, respectively. Pearson's correlation analysis showed significant positive correlations among the KAP scores (all P < 0.001). Multivariate logistic regression indicated that knowledge scores (OR = 1.127, P < 0.001), attitude scores (OR = 1.189, P < 0.001), and current employment status (OR = 2.759, P = 0.009) were associated with proactive practices. Structural equation modeling demonstrated that knowledge had a direct influence on attitude (β = 0.572, P < 0.001) and practice (β = 0.776, P < 0.001), while attitude directly impacted practice (β = 0.412, P < 0.001). The study reveals that the elderly lack knowledge but have positive attitudes and proactive behaviors about intrinsic capacity. Enhancing education and attitudes is vital for healthy aging and well-being.

Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study

BACKGROUND

Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied.

OBJECTIVE

The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China.

METHODS

A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire.

RESULTS

We observed a substantial increase in digital connectivity from 29.5% in 2015 to 59.8% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas.

CONCLUSIONS

This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity.

The association between digital technology use and depression among older people in China: a moderated mediation model

Objective

To investigate the association among multidimensional (Digital engagement, DE; Digital devices, DD; and Digital purpose, DP) digital technology use and depression in older Chinese, considering social participation as a mediator and physical activity level (PAL) as a moderator.

Methods

Data on 5,744 participants (aged≥60) were extracted from the China Health and Retirement Longitudinal Study 2020 dataset. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Logistic regression examined the association between digital technology use and depression. The PROCESS program's Model 4 evaluated the mediating role of social participation, while Model 7 assessed the moderating role of PAL.

Results

Digital technology use was negatively associated with depression (DE, OR= 0.722, 95%CI: 0.609, 0.858; DD, OR= 0.739, 95%CI: 0.634, 0.860; DP, OR= 0.916, 95%CI: 0.881, 0.952). Various dimensions of digital technology use exerted direct effects on depression scores of 85.87% (DE, OR= -0.638, 95%CI: -1.036, -0.240), 86.09% (DD, OR= -0.526, 95%CI: -0.844, -0.208), and 87.82% (DP, OR= -0.173, 95%CI: -0.259, -0.087), respectively, and social participation mediated 14.13%, 13.91%, 12.18%. PAL exerted a positive moderating effect on the first half path of mediation, especially with the vigorous PAL (DE, OR= 0.591, 95%CI: 0.230, 0.952; DD, OR= 0.515, 95%CI: 0.206, 0.824; DP, OR= 0.157, 95%CI: 0.075, 0.239).

Conclusions

Multidimensional digital technology use showed an association with depression in older adults. Promoting social participation through digital technology use is associated with lower depressive symptom scores, and vigorous PAL further strengthens this association, leading to improved mental health.

Community social capital and depressive symptoms among older adults relocated for poverty alleviation in Shanxi, China: a cross-sectional study

BACKGROUND

Depression is one of the most common mental health problems in older adults. Community social capital and depressive symptoms in older adults have been discussed in previous studies but remain limited. This study aims to explore the association between community social capital and depressive symptoms among older adults relocated for poverty alleviation in China.

METHODS

Through the multi-stage stratified sampling, 1882 relocated older adults (≥ 60) were surveyed in 24 resettlement sites in Shanxi Province, China. Community social capital was measured in civic participation, social cohesion, and reciprocity. Depressive symptoms were assessed by the 10-item CES-D scale.

RESULTS

There were 49.5% of relocated older adults reported significant depressive symptoms. We found that the relocated older adults who did not participate in leisure-time activities showed higher odds of reporting significant depressive symptoms compared to those who participated [Adjusted Odds Ratio (AOR) 1.360, 95% CI: 1.060 ~ 1.745], the relocated older adults who gave negative responses in community trust were more likely to report significant depressive symptoms compared to those who gave positive responses (AOR: 1.461, 95% CI: 1.126 ~ 1.896), and those who did not receive emotional support in their community showed 33.6% higher odds of reporting significant depressive symptoms (AOR: 1.336, 95% CI: 1.015 ~ 1.757) after controlling for all potential confounders.

CONCLUSIONS

Leisure-time activity participation, community trust, and receiving emotional support were associated with depressive symptoms of older adults relocated for poverty alleviation in Shanxi, China. Targeted interventions on community social capital for relocated older adults are needed for mental health promotion.

Effect of Inter-Generational Living Arrangement and Digital Exclusion on Unmet Healthcare Needs Among Older Adults: Findings From Two National Cohort Studies

AIM

To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.

DESIGN

A prospective cohort study. The study reporting is conformed to the STROBE checklist.

DATA SOURCES

This longitudinal study utilised data from the 2018-2020 waves of the United States-based Health and Retirement Study and the 2013-2015 waves of the China Health and Retirement Longitudinal Study.

METHODS

Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.

RESULTS

A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.

CONCLUSION

Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.

REPORTING METHOD

This study using the STROBE CHECKLIST for reporting guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY: By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.

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.

The impact of urban agglomeration planning on depression in older adults

Introduction

The residential environment significantly impacts the mental health of older adults. Urban agglomeration planning, while fostering regional economic development, also influences the psychological well-being of this demographic.

Methods

This study investigates the effects of urban agglomeration planning on depression levels in older adults, utilizing cohort data from the China Health and Retirement Longitudinal Study (CHARLS) and the multi-temporal double-difference-in-differences (DID) model.

Results

Our findings reveal that urban agglomeration planning alleviates depression by enhancing green spaces, improving air quality, and advancing digital infrastructure development. Moreover, these benefits are particularly pronounced among older females, residents of Central and Western regions, and those with lower educational attainment.

Conclusion

Based on our research findings, we recommend expediting the dissemination of urban agglomeration construction experiences to alleviate depression among older adults. In the implementation of policies, it is essential to consider objective conditions such as geographical location and educational level. The formulation of differentiated urban agglomeration planning to promote mental health among older adults.

The effect of internet use on depressive symptoms in older adults: based on the chain mediating role of physical exercise and self-rated health

Background

Depressive symptoms in older adults have been a major public health problem. Although many studies have suggested a potential relationship between Internet use and depressive symptoms, the underlying mechanisms of this relationship among older adults remain unclear. This study aimed to explore the multiple mediating effects of physical exercise and self-rated health on the relationship between Internet use and depressive symptoms in older adults.

Methods

Utilizing the 2020 data from the China Family Panel Studies (CFPS), we assessed the depressive status among the older population through the application of the Ambulatory Self-Rating Depression Scale. To validate the associations, we conducted a Pearson correlation analysis. Furthermore, we constructed a mediating effect model, which aimed to delve into the intricate pathways mediating the influence of Internet usage on depressive symptoms in the older adults. Additionally, we employed a latent class analysis to uncover the intricate heterogeneity of depression among older individuals who do not utilize the Internet, offering insights into the diverse manifestations of this condition.

Results

After controlling for age, sex, marital status, chronic disease, and education level, regression results showed that the use of the Internet had a significant direct effect on depressive symptoms in the older adults (β = -0.684, t = -4.318, p < 0.001). Physical exercise and self-rated health significantly affected depressive symptoms in the older adults (β = -0.176, t = -7.939, p < 0.001; β = -0.937, t = -18.681, p < 0.001). Mediating results showed that the mediating effect of physical exercise between Internet use and depressive symptoms in the older adults was -0.220 (95%CI: -0.2877--0.1598), and the mediating effect of self-rated health between Internet use and depressive symptoms in the older adults was -0.084 (95%CI: -0.1716--0.0008), and the chain mediation effect was -0.022 (95%CI: -0.0371--0.0076). The potential profile analysis of depressive symptoms in the older adults without using the Internet showed that they could be divided into three groups, namely, high loneliness-high depression group (7.4%), medium loneliness-moderate depression group (14.7%), and low loneliness-low depression group (77.9%).

Conclusion

Internet use can directly affect the depressive symptoms of the older adults, and can also indirectly affect the depressive symptoms of the older adults through physical exercise and self-rated health. The depressive symptoms of the older adults who do not use the Internet are heterogeneous and can be divided into three categories. With the popularization of the Internet, the use of the Internet should be promoted for the older adults, and the frequency of physical exercise should be enhanced to achieve physical and mental health.

Did internet usage reduce the impact of COVID-19 on the mental health of middle-aged and older adults? A difference-in-differences study based on CFPS data

Introduction

Mental health is the cornerstone of public health, especially where middle-aged and older adults during the COVID-19 pandemic were concerned. The impact of Internet usage on mental health in the time of the crisis still presents a mixed picture.

Methods

This study employs the PSM-DID method according to longitudinal data (CFPS) to explore whether Internet usage reduced the impact of COVID-19 on the mental health of middle-aged and older adults.

Results

The results reveal that Internet use improves the mental health of middle-aged and older adults during the pandemic in China, but that the impact varies between urban and rural residents. Furthermore, the moderator effects model shows that people's perceptions of the Internet have an impact upon the length of time spent online and its consequent effect on mental health.

Discussion

These findings suggested that Internet use had a significant effect on alleviating the levels of depression in middle-aged and older adults. Greater marginal gains may be realized by enhancing the digital capacity of and narrowing the digital divide that exists among rural residents. The enhancement of digital capacity and proper guidance in digital education should be taken into consideration where the mental health of middle-aged and older adults is at issue.

Medical service satisfaction and depression among middle-aged and older Chinese adults: moderating role of distinct Internet-using patterns

BACKGROUND

Patient satisfaction is a powerful predictor of an individual's mental health, according to previous research. However, there has not been a thorough study on the relationship between depression and overall medical service satisfaction (OMSS) in middle-aged and older adults. Moreover, little is known about how different Internet-using patterns affect this relationship.

METHODS

We selected 4,523 participants from the China Family Panel Studies (CFPS) 2020 dataset who were aged 45 and older. The relationship between OMSS and depression was examined using logistic regression analysis, distinct Internet-using patterns were investigated using latent class analysis, and the moderating effects of these patterns were examined using SPSS PROCESS macro analysis.

RESULTS

The results showed OMSS was negatively related to depression in middle-aged and older adults (β = -0.181, p < 0.001). For skilled Internet users, there was a significant positive moderating effect (β = -0.272, SE = 0.096, p < 0.01), for unskilled users, there was a significant negative moderating effect (β = 0.497, SE = 0.156, p < 0.01). Yet, there is no moderating effect of a controlled Internet-using pattern on the correlation between OMSS and depression.

CONCLUSIONS

This study highlights the potential value of improving medical service satisfaction in reducing depressive symptoms in middle-aged and older adults. Additionally, in order to maximize the benefits of healthcare for mental health, the study suggests that Internet-using patterns could be a significant area for intervention.

Latent transition of social participation and its effects on depression among older adults in China: A National Longitudinal Study

OBJECTIVES

As populations age, the issue of social participation among older adults has gained prominence. Studies indicate variability in social participation trajectories among this demographic, yet the transition patterns and their effects on depression remain unclear. This longitudinal study aims to explore the latent classes and transition patterns in social participation among older adults and to evaluate their effects on depression.

METHODS

Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014 (T1) and 2018 (T2) were analyzed, including 2293 older adults. Latent class analysis (LCA) and latent transition analysis (LTA) were employed to identify latent classes of social participation at T1 and T2, as well as the transition probabilities between these classes. Multinomial logistic regression was used to examine predictors of transitions, and depression levels at T2 were compared across transition patterns.

RESULTS

The LCA results supported a 3-class model labeled as low, moderate, and high social participation. The probabilities of remaining stable and transitioning to other classes were similar across the three classes (ranging from 0.50 to 0.54). Age, gender, and other baseline characteristics emerged as significant predictors of transition patterns. Older adults experiencing positive transitions exhibited reduced depression compared to those in their original class over time, while those with negative transitions showed increased depression.

CONCLUSIONS

This research prompts a deep understanding of social participation dynamics in older adults and their effects on depression. Identifying social participation classes and transition patterns could inform interventions to enhance social participation and reduce depression among older adults.

Impact of social, familial and personal factors on depressive symptoms in middle-aged and older adults from the national CHARLS cohort

BACKGROUND

This study aimed to evaluate whether social, familial and personal factors can predict incident and prevalent depressive symptoms in Chinese adults aged ≥ 45 years using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Study subjects without depressive symptoms from CHARLS at baseline were enrolled. Depressive symptoms were defined by the 10-item Center for Epidemiologic Studies Depression Scale. Statistical adjustment, subgroup exploration and unmeasured confounding assessment were undertaken to derive reliable estimates.

RESULTS

1681 (27.04%) of 6215 subjects who had no depressive symptoms in 2011, suffered one or more depressive symptoms in 2018. Multivariate analyses showed that number of grandchildren (odds ratio [95% confidence interval]: 1.06 [1.02, 1.10]), social activity score (0.95 [0.91, 0.98]), instrumental activities of daily living (IADL) (1.35 [1.11, 1.65]) and number of comorbidities (1.16 [1.10, 1.22]) were independently and significantly associated with the presence of incident depressive symptoms. Further categorization revealed significance for social activity score (odds ratio [95% confidence interval]: 0.78 [0.69, 0.89] and 0.71 [0.53, 0.95] for 1-5 and > 5 vs. 0), IADL (1.35 [1.11, 1.65] for yes vs. no) and number of comorbidities (1.38 [1.20, 1.58], 1.44 [1.16, 1.81] and 2.42 [1.54, 3.80] for 1-2, 3-4 and > 4 vs. 0) associated with incident depressive symptoms. Restricting analysis to wave IV data in 2018 observed significant association of number of grandchildren, social activity score, IADL and number of comorbidities with prevalent depressive symptoms.

CONCLUSIONS

The present study findings support the marked contribution of social activity score, IADL and number of comorbidities to incident and prevalent depressive symptoms in Chinese middle-aged and older adults.

Identifying the subgroups of depression trajectories among the middle-aged and older Chinese individuals with chronic diseases: an 8-year follow-up study based on CHARLS

Background

Prior studies have demonstrated a prevalent occurrence of depression among the middle-aged and older Chinese individuals with chronic diseases. Nevertheless, there is limited research on the specific subgroups of depression trajectories within this population and the factors influencing these subgroups.

Objective

To explore the changing trajectory and influencing factors of depression in the middle-aged and older individuals with chronic disease in China, and provide the data reference for the health management of the older adult population in China.

Methods

A longitudinal cohort study was conducted using the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, 2018, and 2020. A total of 2,178 participants with complete data were included. The level of depression was evaluated using the Center for Epidemiologic Studies Depression Scale (CESD-10). The Latent Class Mixed Models (LCMM) were employed to estimate trajectories of depressive symptoms. The Kruskal-Wallis H test and the Pearson χ 2 test were used to determine the significant factors affecting trajectory grouping. Subsequently, the multinomial logistic regression model was utilized to perform a multifactorial analysis of the variables impacting the trajectory subgroup of change in depressive symptoms.

Results

The LCMM-analysis revealed three distinct subgroups of depression trajectories: the "Low stable group" comprising 36.7% of the sample, the "Medium growth group" comprising 34.4% of the sample, and the "High growth group" comprising 28.9% of the sample. Among the baseline characteristics of different depression trajectory subgroups, there were significant differences in gender, residence, education, marital status, social activity participation, number of chronic diseases, smoking status, BMI, midday napping (minutes) and nighttime sleep duration (hours). Through multiple logistic regression analysis, our findings demonstrate that among the middle-aged and older Chinese individuals with chronic diseases, the following individuals should be the key groups for the prevention and treatment of depressive symptoms: Those who are young, female, residing in rural areas, having primary school education and below, being single, not participating in social activities, suffering from multiple chronic diseases, and having shorter naps and sleeping at night.

Conclusion

There is heterogeneity in the subgroups of depression trajectories among the Chinese middle-aged and older individuals with chronic diseases. The focus should be on the distinct characteristics of various trajectories of depression within the realm of health management.

Triple digital divide and depressive symptoms among middle-aged and older Chinese adults: a disparity analysis

Background

The triple digital divide refers to the lack of internet access, use and knowledge among specific populations. In China, middle-aged and older adults and those living in rural areas or various regions of the country are more likely to have limited internet access and skills and, thus, have less accessibility to internet services. Few longitudinal studies have explored the association between the digital divide and the progression of depressive symptoms among middle-aged and older Chinese adults. Significantly, none of the existing studies have estimated this long-term relationship from a disparity perspective.

Aims

This study investigates the association between the triple digital divide and depressive symptom trajectories among middle-aged and older adults in China during a 10-year follow-up period from 2011 to 2020.

Methods

The sample for this secondary analysis comprises 3019 urban and 10 427 rural respondents selected from the China Health and Retirement Longitudinal Study baseline survey in 2011. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Employing longitudinal mixed-effects models, this study explored the association between the triple digital divide and depressive symptom trajectories among middle-aged and older Chinese adults by examining gender, rural-urban and regional disparities in this relationship.

Results

Our findings revealed a significant association between the triple digital divide and increasing trajectories of depressive symptoms, showing significant disparities based on gender, rural-urban dwelling and regional location. Notably, for both male and female participants who resided in urban areas or the central region of the country, their ability to use the internet, coupled with enhanced internet skills and greater access to internet services, was found to have a mitigating effect on the increasing trajectories of depressive symptoms.

Conclusions

To alleviate some of the confounding influences on the trajectory of depression in middle-aged and older adults, policymakers in China should continue to prioritise the development of internet technology, foster easy access to the internet to ensure it is 'elder-friendly', provide internet skill training platforms for this population and broaden access to various internet services appropriate for them. Additionally, the implementation of tailored interventions to address depression, especially targeting the more vulnerable cohorts, such as middle-aged and older women, those residing in rural areas and the western regions, is crucial. Such tailored approaches are essential for addressing the disparities and challenges associated with the triple digital divide.

Does Helping Others Always Benefit Health? Longitudinal Evidence on the Relationship between Helping Behavior and Depression: The Mediating Role of Life Satisfaction and the Moderating Effect of IADL

Background

This study aims to explore whether helping behavior is always beneficial for alleviating depression or if there is a "moderation is the key" effect.

Materials and Methods

This study focused on a sample of 7,436 participants from the China Health and Retirement Longitudinal Study (CHARLS). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to identify the presence of depression. Linear mixed model and Quasi-Bayesian estimation methods were used to explore the mediating role of life satisfaction in the relationship between helping behavior and depression, as well as the moderating effects of the instrumental activity of daily living (IADL). Additionally, we employed the Johnson-Neyman technique to visualize the moderating effect of IADL.

Results

Helping behavior shows a negative correlation with depression (B = -0.170, p = 0.020), where life satisfaction fully mediates this relationship (effect = -0.055, 95% confidence interval = -0.088 to -0.022). Moreover, the association between helping behavior and life satisfaction is moderated by IADL (B = -0.047, p < 0.001). Specifically, when IADL is below 0.56, helping behavior positively impacts life satisfaction. In contrast, when IADL exceeds 1.99, helping behavior has a detrimental effect on life satisfaction.

Conclusions

This study highlights the significant positive impact of helping behavior on depression alleviation, which is achieved by increasing life satisfaction. Notably, although helping behavior has positive effects on individuals, not everyone can benefit directly from it. Only those without functional limitations are more likely to experience the benefits of such behavior. Therefore, when policymakers and researchers develop strategies to encourage individuals in helping behavior to combat depression, they should consider two key approaches. First, life satisfaction should be used as an important indicator in the treatment of depression, allowing for timely adjustments to ensure the effectiveness and individualization of treatment plans. Second, the principle of "moderation is the key" should be prioritized, ensuring that helping behavior can maximize its benefits and help individuals emerge from the shadows of depression.

Relationship between social participation and depressive symptoms in patients with multimorbidity: the chained mediating role of cognitive function and activities of daily living

OBJECTIVE

The potential mechanisms linking social participation and depressive symptoms in Chinese individuals with multimorbidity are not yet fully understood. This study aims to explore how cognitive function and activities of daily living (ADLs) mediate the relationship between social participation and depressive symptoms in individuals with multimorbidity.

METHODS

We selected 3782 participants with multimorbidity from the 2018 China Health and Retirement Longitudinal Study. Data related to social participation, cognitive function, ADLs, and depressive symptoms were extracted. Regression and Bootstrap analyses were used to explore the sequential mediating effects of social participation, cognitive function, ADLs, and depressive symptoms.

RESULTS

(1) There was a significant correlation between social participation, cognitive function, activities of daily living, and depressive symptoms (p < 0.01). (2) Social participation directly affected depressive symptoms (β = -0.205, p < 0.05). (3) Cognitive function (β = -0.070, p < 0.01) and activities of daily living (β = -0.058, p < 0.01) played separate mediating roles in the effect of social participation on depressive symptoms. (4) Cognitive function and activities of daily living had a chain-mediated role in the relationship between social participation and depressive symptoms in patients with multimorbidity (β = -0.020, p < 0.01).

CONCLUSION

A chained mediating effect was found between cognitive function, ADLs, social participation, and depressive symptoms in patients with multimorbidity. Social participation was found to improve the cognitive function of patients with multimorbidity, which in turn enhanced their daily life activities and ultimately alleviated their depressive symptoms.

Internet use and frailty in middle-aged and older adults: findings from developed and developing countries

BACKGROUND

With increasing trend of internet use in all age groups, whether internet use can prevent frailty in middle-aged and older adults remains unclear.

METHODS

Five cohorts, including Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Aging (ELSA), and Mexican Health and Aging Study (MHAS), were used in this study. Internet use, social isolation, and frailty status was assessed using similar questions. The Generalized estimating equations models, random effects meta-analysis, COX regression, and mediation analysis were utilized.

RESULTS

In the multicohort study, a total of 155,695 participants were included in main analysis. The proportion of internet use was varied across countries, ranging from 5.56% in China (CHARLS) to 83.46% in Denmark (SHARE). According to the generalized estimating equations models and meta-analysis, internet use was inversely associated with frailty, with the pooled ORs (95%CIs) of 0.72 (0.67,0.79). The COX regression also showed that participants with internet use had a lower risk of frailty incidence. Additionally, the association was partially mediated by social isolation and slightly pronounced in participants aged 65 and over, male, not working for payment, not married or partnered, not smoking, drinking, and not co-residence with children.

CONCLUSIONS

Our findings highlight the important role of internet use in preventing frailty and recommend more engagements in social communication and activities to avoid social isolation among middle-aged and older adults.

Effects of mobile Internet use on the health of middle-aged and older adults: evidences from China health and retirement longitudinal study

The rapid development of digital technology has radically changed people's lives. Simultaneously, as the population is rapidly aging, academic research is focusing on the use of Internet technology to improve middle-aged and older people's health, particularly owing to the popularity of mobile networks, which has further increased the population's accessibility to the Internet. However, related studies have not yet reached a consensus. Herein, empirical analysis of the influence of mobile Internet use on the subjective health and chronic disease status of individuals in their Middle Ages and above was conducted utilizing ordered logit, propensity score matching (PSM), and ordered probit models with data from the 2020 China Health and Retirement Longitudinal Study. The study aimed to provide a theoretical basis and reference for exploring technological advances to empower the development of a healthy Chinese population and to advance the process of healthy aging. The health of middle-aged and older adults mobile Internet users was greatly improved, according to our findings. Further, the use of mobile Internet by these persons resulted in improvements to both their self-assessed health and the state of their chronic diseases. As per the findings of the heterogeneity analysis, the impact of mobile Internet use was shown to be more pronounced on the well-being of middle-aged persons aged 45-60 years compared to those aged ≥ 60 years. Further, the endogeneity test revealed that the PSM model could better eliminate bias in sample selection. The results suggest that the estimates are more robust after eliminating endogeneity, and that failure to disentangle sample selectivity bias would overestimate not only the facilitating effect of mobile Internet use on the self-assessed health impacts of middle-aged and older adults, but also the ameliorating effect of mobile Internet use on the chronic diseases of middle-aged and older adults. The results of the mechanistic analysis suggest that social engagement is an important mediating mechanism between mobile Internet use and the health of middle-aged and older adults. This implies that mobile Internet use increases opportunities for social participation among middle-aged and older adults, thereby improving their health.

Analysis of factors associated with depressive symptoms in stroke patients based on a national cross-sectional study

Post-stroke depression is commonly experienced by stroke survivors and has a significant negative impact on the physical, cognitive, and social functioning of those affected. This study aims to investigate the prevalence of depressive symptoms and their associated factors in Chinese stroke patients. Research samples were selected from the China Health and Retirement Longitudinal Study 2018 survey. Depression was evaluated using the 10-item Center for Epidemiological Studies Depression Scale, with a score ≥ 10 defined as depression. Univariate and multivariable analyses were performed to examine the associations of depressive symptoms with demographics, family relationships, health status, and lifestyle. A total of 963 stroke patients were included and 57.8% of them had depressive symptoms. Depressive symptoms were significantly associated with female sex (OR 1.762, 95% CI 1.235-2.514), lower education level (non-formal education: OR 2.148, 95% CI 1.235-3.737, primary to secondary school education: OR 1.964, 95% CI 1.272-3.033), dissatisfaction with spouse (OR 1.912, 95% CI 1.075-3.401), dissatisfaction with life (OR 1.779, 95% CI 1.080-2.931), dissatisfaction with health (OR 1.592, 95% CI 1.138-2.226), pain (OR 1.392, 95% CI 1.005-1.928) and abnormal sleep (OR 1.557, 95% CI 1.126-2.152). The findings suggest the need for regular depression screening and evaluation after a stroke, and that a well-functioning support system, effective health management, and lifestyle modifications could potentially improve the mental state of stroke patients.

Urban-rural disparities in depressive symptoms and related factors among offspring of advanced maternal mothers: A national cross-sectional study in China

BACKGROUND

Urbanization remains an important factor affecting the mental health of people. Currently, there is insufficient research on depression among the offspring of women who have children at an advanced maternal age (AMA). The objective of this study is to investigate the urban and rural disparities in depressive symptoms among the offspring of AMA and related influencing factors.

METHODS

In this study, a total of 1273 offspring born to AMA were selected from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS) database. The questionnaire used in the study included demographic information and the Center for Epidemiologic Studies Depression Scale (CESD). Chi-square tests and logistic regression analysis were employed to examine the urban-rural differences.

RESULTS

The likelihood of developing depressive symptoms of the offspring of AMA in rural areas was 1.633 times higher (AOR = 1.633; 95%CI: 1.211-2.202) compared to their urban counterparts. Several factors including gender, education, marital status, disability, chronic diseases, and sleep duration showed a linkage with depression among rural based offspring of AMA. For the urban offspring of AMA, only disability and sleep duration exhibited a significant association with depressive symptoms.

LIMITATIONS

This study cannot establish a causal relationship between depressive symptoms and the influencing factors for the offspring of AMA. Age range and variables of the respondents needs further consideration.

CONCLUSIONS

This study has brought to light the elevated risk of depressive symptoms among rural-based offspring of AMA. Thus, emphasizing the urgent need for targeted interventions and measures to address the negative impact.

Analysis of health risk factors for older adults living alone in China and establishment and evaluation of a nomogram prediction model

Objective

To understand the health status of older adults living alone in China and analyze the influencing factors, so as to provide reference for improving the health status of older adults living alone.

Methods

Based on CGSS data from China General Social Survey (2017), the influencing factors of health status of older adults living alone were analyzed by unconditional Logistic regression, and the R software was used to develop a nomogram for predicting the risk of self-assessed unhealthy adverse outcomes.

Results

Gender, annual income, mandarin listening level and participation in medical insurance were the influencing factors of self-rated health of older adults living alone. Age and annual income are the influencing factors of physiological health. Annual income and Internet use were influential factors for mental health. C-Statistic of nomogram prediction model was 0.645. The calibration curve showed that goodness of fit test (χ2 = 58.09, p < 0.001), and the overall prediction ability of the model was good.

Conclusion

The health status of older adults living alone in the home-based older adults care is worrying, and it is affected by various factors. We should pay more attention to older adults living alone, improve the ability of listening and distinguishing mandarin and the use of health information platforms for older adults living alone, and further implement medical insurance policies and health services. Announcing the solution to promote healthy home-based care for older adults living alone.

The Effect of Social Media Forwarding on Subjective Well-Being in Chinese Older Adults: A Moderated Mediation Model

Purpose

In the intersection of the aging and information era, the development of digital aging significantly influences the well-being of older individuals. Given the divergent findings in various studies exploring the effects of social media use on mental health, this study specifically examined the impact of forwarding, a prevalent social media behavior among older individuals, focusing on the effects of use intensity on their subjective well-being (SWB) and the specific mechanisms involved.

Materials and Methods

A total of 323 Chinese older adults completed the questionnaire. SPSS along with Hayes Process Models 4 and 7 was employed to test the hypotheses.

Results

The results indicated that social media forwarding intensity significantly and positively predicted SWB of older adults. This association was partially mediated by perceived social support (PSS) and self-esteem. Gender served as a moderator, highlighting that the positive predictive effects of forwarding intensity on PSS and self-esteem were more pronounced for older men than for older women. Further, the findings confirmed the existence of the moderated mediating effect such that the impact of forwarding on SWB was mediated through both PSS and self-esteem for older men, while, for older women, it was solely mediated by PSS.

Conclusion

This study revealed the positive impact of forwarding, a user-friendly social media function, on the well-being of older adults and elucidated the specific mechanisms through a moderated mediation model. In light of these findings, we propose customizing the development of age-friendly social media functions to address the diverse psychological needs of older adults, taking into account gender differences. These findings may offer valuable insights for constructing digital age-friendly platforms and fostering active aging development.

Gender differences in geriatric depressive symptoms in urban China: the role of ADL and sensory and communication abilities

OBJECTIVES

ADL and Sensory and Communication Abilities are important indicators of the quality of life of the elderly which are significant determinants of health, particularly in developing countries. The present cross-sectional study investigated effect of ADL and Sensory and Communication Abilities on depressive symptoms, as well as the the role of gender in these effects.

DESIGN

This is a cross-sectional study.

SETTING

A nationally representative cross-sectional survey among the Chinese population aged 60 years and over.

PARTICIPANTS

A total of 163296 females and 148724 males aged 65 and over in 2019 in urban China.

OUTCOME MEASURES

Prevalence, risk factors and gender differences in geriatric depressive symptoms among urban elderly.

RESULTS

Approximately 95.69% of the participants had depressive symptoms according to the CESD-10, with no statistically significant gender difference of 52.15% in females and 47.85% in males. Logistic regression findings suggest that geriatric depressive symptoms are significantly associated with the lack of eldercare (OR=2.427, female; OR=1.426, male), living alone(OR= 1.430, female; OR= 1.179, male), ADL dysfunction (OR=1.528, female; OR=1.246, male), and impaired sensory and communication ability (OR=1.338, female; OR=1.185, male) among both female and male participants. Remarkably, geriatric depressive symptoms are only significantly associated with age (≥75, OR = 1.327), marital status (unmarried, OR=1.598), the number of children (no children, OR=2.271), and the living arrangement (living alone, OR= 1.430) among female participants.

CONCLUSION

Significant gender differences in these associations were found for living alone, ADL dysfunction and impaired sensory and communication ability. Moreover, the study emphasized that the gender difference exists in terms of geriatric depression in urban China. Females are more likely to experience depressive than males with the same circumstances.

Flattening the biological age curve by improving metabolic health: to taurine or not to taurine, that' s the question

The aging population is an important issue around the world especially in developed countries. Although medical advances have substantially extended life span, the same cannot be said for the duration of health span. We are seeing increasing numbers of elderly people who are frail and/or have multiple chronic conditions; all of these can affect the quality of life of the elderly population as well as increase the burden on the healthcare system. Aging is mechanistically related to common medical conditions such as diabetes mellitus, ischemic heart disease, cognitive decline, and frailty. A recently accepted concept termed 'Accelerated Biological Aging' can be diagnosed when a person's biological age-as measured by biomarkers of DNA methylation-is older than their corresponding chronological age. Taurine, a conditionally essential amino acid, has received much attention in the past few years. A substantial number of animal studies have provided a strong scientific foundation suggesting that this amino acid can improve cellular and metabolic health, including blood glucose control, so much that it has been labelled one of the 'longevity amino acids'. In this review article, we propose the rationale that an adequately powered randomized-controlled-trial (RCT) is needed to confirm whether taurine can meaningfully improve metabolic and microbiome health, and biological age. This trial should incorporate certain elements in order to provide the much-needed evidence to guide doctors, and also the community at large, to determine whether this promising and inexpensive amino acid is useful in improving human metabolic health.