Melancholy or mahjong? Diversity, frequency, type, and rural-urban divide of social participation and depression in middle- and old-aged Chinese: A fixed-effects analysis

Zhuo Chen,Zhiguo Zhang,Yongjie Zhou,Xiang Wu,Lining Shen,Ruoxi Wang

doi:10.1016/j.socscimed.2019.112518

Abstract

The potential benefit of social participation (SP) to one's mental health has been widely acknowledged. Nevertheless, the specific type and amount of SP that is associated with improved depressive symptoms in middle- and old-aged Chinese awaits further investigation. This study aimed to understand the patterns of depression and SP by comparing urban vs rural China, and according to which, measure the associations between changes in SP and that in depressive symptoms. A total of 10,988 community residents aged 45 years and above were selected from wave 1 (2011), wave 2 (2013), and wave 4 (2015) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. The fixed-effects analysis was used to explore the association between the changes in diversity, frequency, and type of SP and the changes in depressive symptoms. The results indicated that rural respondents suffered from a significantly higher risk of depression and took less SP than their urban counterparts. Transitioning from no SP to 1 or more types of SP or to a once a week or higher frequency was associated with a decline in depressive symptoms. For urban respondents, playing mah-jong or cards and joining sports or social clubs predicted a decline in depressive symptoms. For rural residents, interacting with friends regularly was associated with fewer depressive symptoms. In conclusion, more diverse and higher frequency of SP was associated with better mental health, while the social significance of SP varied across different types of SP and between rural and urban areas.

Highlights

China, one of the low- and middle-income countries (LMICs) (World Bank, 2018), accounts for nearly 18%of the global population, and roughly 17% of the global disease burden of mental disorders (Liu & Page, 2016)
(69.30%); were affected by at least one type of non-communicable diseases (NCD) (69.55%); and suffered from lower-body constraints. Compared with those residing in urban areas, rural respondents held lower education level (6.49% with senior high school and above education in rural respondents vs. 18.28% in urban counterparts) and poorer household financial situation (6250 RMB vs 16971 RMB), and kept working (83.73% vs 60.21%)
Except living near child(ren) and numbers of types of NCDs, all covariates were significantly associated with the variety and frequency of social participation (SP)

Summary

Introduction

One of the low- and middle-income countries (LMICs) (World Bank, 2018), accounts for nearly 18%of the global population, and roughly 17% of the global disease burden of mental disorders (Liu & Page, 2016). One of the low- and middle-income countries (LMICs) (World Bank, 2018), accounts for nearly 18%. China is experiencing rapid population ageing (Wang & Chen, 2014). Over million residents were 65 years or above in 2011, whilst the figure was projected to reach 400 million by 2050 (Fang et al, 2015). Addressing this daunting challenge to China is critical to the global improvement of mental health as well. Similar to other LMICs, China suffers greatly from insufficient professional resources on the supply side. There are less than 8.75 mental health workers per

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