Social Participation as a Moderator in Spousal Frailty Interdependence Among Chinese Middle-Aged and Older Couples.

Objectives: This study aimed to investigate the effects of transitioning into spousal caregiving, changes in social participation, and their interactions on depressive symptoms among community dwelling old adults over time. Methods: The samples included old adults who were non-caregivers at 2011 baseline of China Health and Retirement Longitudinal Study (CHARLS) and joined the follow-up surveys in 2013 and 2015. Generalized estimating equations (GEE) was used to analyze the effects of caregiving transitions (transitioning into low-intensity or high-intensity caregivers versus the non-caregivers) and changes in social engagement on the depressive symptoms over time. Results: The results showed that old adults who transitioned into spousal caregiving over a 4-year period reported more depressive symptoms than those remained non-caregivers. Old adults who continued or increased social participation reported fewer depressive symptoms than those without social participation. Individuals who continued social participation during the transitions into high-intensity caregiving showed less severe elevated depressive symptoms than their counterparts who did not engage in social participation. Conclusion: The results highlighted that continuous social participation might be a protective factor for old adults against negative psychological outcomes during the transition to high-intensive caregiving.

BackgroundWhile the relationship between internet usage and depression, and the mediating role of social participation in this association, has garnered significant attention, the COVID-19 pandemic has disrupted traditional forms of social participation. The extent to which this disruption has altered the association remains underexplored.ObjectiveThis study aims to examine the impact of internet usage on depressive symptoms among middle-aged and older adults and to assess how the mediating role of social participation differs before and during the COVID-19 pandemic.MethodsData for this study were sourced from the fourth wave (2018: 15,326 observations) and the fifth wave (2020: 15,758 observations) of the China Health and Retirement Longitudinal Study. A 2-way fixed-effects model incorporating an instrumental variable was employed to investigate the relationship between internet usage and depressive symptoms among middle-aged and older adults. Furthermore, a mediation effect model was applied following propensity score matching to assess changes in the mediating role of social participation on the relationship between internet usage and depressive symptoms before and during the pandemic, as well as to explore changes in 3 internet usage functions. Subgroup analyses based on age and urban-rural residence were performed to assess heterogeneity in this association.ResultsThe average Center for Epidemiological Studies Depression Scale (CESD-10) score among middle-aged and older Chinese people increased from 1.94 in 2018 to 1.98 in 2020. Internet usage was negatively associated with depressive symptoms (β=−.041; P<.01), with social participation serving as a partial mediator. The proportion of the mediating effect of social participation on the relationship between distinct internet usage functions and depression shifted during the pandemic: the social function declined from 12.55% in 2018 to 9.30% in 2020, while the informational and recreational function increased from 7.53% and 11.29% in 2018 to 8.85% and 16.37% in 2020, respectively. Both the total and indirect effects were statistically significant across subgroups, with a higher mediation proportion observed among rural residents and women than among urban residents and men.ConclusionsInternet usage was negatively associated with depressive symptoms among middle-aged and older adults. Despite a noticeable increase in depression scores in 2020 compared with 2018, the mediating effect of social participation diminished, while the direct effect of internet usage became more pronounced during the pandemic. These findings underscore the need to prioritize mental health recovery in this population, promote diverse forms of social participation, and leverage the internet’s potential to enhance social participation and mental well-being.

Background: This study aims to examine the impact of individual-level and community-based factors on popular social participation activities of Chinese middle-aged and older adults post-stroke. Methods: Sub-samples of survivors of stroke (2011: n = 413, 2013: n = 395, 2015: n = 441) recruited by the China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. Zero-inflated Poisson and multi-level logistic regression models were used to explore factors associated with social participation. Results: More than half of individuals (55.0%) had no social participation and 23.4% participated in multiple social activities. The most popular social activities that individuals participated in were interacting with friends (32.6%) and going to a community club to play table games (22.7%). Multiple individual-level factors were negatively related to social participation (e.g., depressive symptoms and multiple measures of functional limitations) while the allocation of an outdoor exercise facility in the community/village was positively associated with going to a community club to play table games. Conclusion: Stroke survivors are at high risk of limited social participation. Policymakers and other key stakeholders should consider community design among other potential solutions when identifying ways to link at-risk stroke survivors to both opportunities for rehabilitation (e.g., physical function) and social participation.

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 12165 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.

Through a longitudinal study, we explored the relationship between sensory impairments and depression in the elderly, and examined the mediating roles of daily activity capability and social participation within this relationship. Based on data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2015 and 2018, a total of 4,419 individuals aged 60 and above were selected as research participants. Sensory impairments (predictor variables) were assessed in 2015 through self-rated visual and hearing capabilities. Daily activity capability and social participation (mediator variables) were also assessed in 2015, with daily activities assessed using the Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and social participation assessed by the quantity of social activity participation. Depression status (outcome variable) was assessed in 2018 using the Center for Epidemiologic Studies Depression Scale (CESD-10). Statistical analysis was conducted using logistic regression and SPSS Macro PROCESS. First, there is a significant correlation between sensory impairments and an increased risk of depression among the elderly, including visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), all of which increase the likelihood of depression. Second, DSI indirectly affect depression through the cascading mediating effects of daily activity capability and social participation. Finally, in contrast to DSI, when there is only a single sensory impairment, either VI or HI, the cascading mediating effects of daily activity capability and social participation on depression are not statistically significant. The elderly population with dual sensory impairments requires continued attention to help these individuals adopt preventive measures to halt the onset and worsening of depression.

This study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors. The predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model's performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA). A total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631-0.707) and 0.635 (95% CI 0.573-0.698), respectively. Hosmer-Lemeshow test values were p = 0.588 and p = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance. The nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke.

Background/Purpose: Adverse childhood experiences (ACEs) have a significant impact on the developmental trajectory of healthy aging. The profound impact of ACEs on individuals may spill over to influence the informal social support and social participation (SP) of middle-aged and older adults. However, the precise influence of ACEs on SP and informal social support is not yet clear. Therefore, to fill the research gap, we examined the characteristics of different subgroups of ACEs and analyzed the effects of ACEs on SP and informal social support among middle-aged and older adults. Method: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2011 - 2018) and the 2014 Life History Survey (N=11070). Diverse aspects of SP frequency, informal social support, and ACEs were identified based on the CHARLS questionnaire items and ACEs were categorized using latent profile models. The fixed effects model was used to understand the impact of ACEs on SP and informal social support and to explore differences in ACE subgroups. Results: Three distinct subgroups of ACE were determined. It was found that in the group with excellent and good parental mental group, older adults with poorer parental mental health, lower quality family relationships, and better socioeconomic conditions were more likely to engage in SP with higher frequency (p &lt; 0.05). There was a clear correlation between ACEs and informal support (p &lt; 0.05), but no significant differences were found in the poor parental mental group. Conclusion/Discussion: In conclusion, the present study demonstrated that ACEs have an impact on SP and informal social support. To mitigate the adverse effects of ACEs, middle-aged and elderly individuals engage in SP and seek social support. As parents, it is crucial to take preventive measures during the child's formative years and particularly focus on mental health. Moreover, it is essential to pay attention to childhood SES and provide equal opportunities and resources to promote SP and development. This will ultimately improve mental and physical health in later life and foster healthy aging.

BackgroundArthritis primarily affects older people and is a prominent cause of their activity impairment. This study aimed to examine the mediating role of depressive symptoms in the relationship between social participation and activity impairment, as well as to determine whether sex moderated the mediating effect.MethodsA total of 2247 older patients with arthritis were included from the China Health and Retirement Longitudinal Study between 2015 and 2018. We first examined a simple mediation model where depressive symptoms were a mediator between social participation and activity impairment. Furthermore, sex was systematically integrated into the model as a moderator. The mediation model and moderated mediation model were analyzed using PROCESS macro.ResultsMediation analysis revealed that the association between social participation and activity impairment was partially mediated by depressive symptoms (B = -0.10, 95% CI = [-0.14, -0.06]) with intermediary effect of 28.6%. Moderated mediation analysis indicated that mediation model was moderated by sex. The indirect effect of social participation on activity impairment among female patients (B = -0.15, 95% CI = [-0.21, -0.09]) was stronger than male patients (B = -0.04, 95% CI = [-0.09, -0.01]).ConclusionSocial participation was the key protective factor associated with depressive symptoms and activity impairment among arthritis patients. Encouraging arthritis patients to social participation and improving the depressive symptoms might avoid activity impairment, especially for female patients.

Understanding the impacts of Internet use on senior Citizens’ social participation in China: Evidence from longitudinal panel data

This study aims to investigate the associations of caring for grandchildren and/or great-grandparents with depressive symptoms, as well as life satisfaction in Chinese grandparents, and analyze the moderating roles of urban-rural residence and social participation. A nationally representative sample of 2973 grandparents in families with great-grandparents and grandchildren were selected from the 2018 China Health and Retirement Longitudinal Study (CHARLS). The Center for Epidemiologic Studies Depression (CESD-10) and the single-item were used to measure depressive symptoms and life satisfaction. Social participation included participation in social and intellectual activities. The binary logistic regression model was employed to explore the relationship between caring and depressive symptoms, as well as life satisfaction in the whole participants, different urban-rural residence, and social participation groups, respectively. Caring was associated with depressive symptoms and life satisfaction (p < 0.05). A significant interaction existed between caring and urban-rural residence for depressive symptoms (interaction p = 0.029) and life satisfaction (interaction p = 0.027). Significant interactions were also found among caring, urban-rural residence, and social activities with depressive symptoms (interaction p = 0.025). In urban, caring for both was negatively related to depressive symptoms for the non-social activists, while in rural, caring for great-grandparents was positively associated with depressive symptoms for social activists (p < 0.05). Any new policy design related to preventing and reducing the possibility of mental disorders in Chinese grandparents should be tailored to heterogeneous subgroups who live in different rural-urban and social activities participation.

Hearing loss and depression in older adults are associated with a lower social participation rate. However, few studies have thoroughly analyzed the relationship between them. The data were obtained from the China Health and Retirement Longitudinal Study carried out in 2011, 2013 and 2015, and data from 24 306 participants ranging in age from 50 to 80 years were used in this study. Hearing loss, depression and social participation were assessed by self-reported hearing status, the 10-item Center for the Epidemiological Studies of Depression Short Form, and self-reported social participation activity types and frequency. The fixed effects logistic regression and random effects logistic regression were used to examine the relationship between hearing loss and social participation. The Sobel method was used to explore the relationship between hearing loss, depression and social participation. Compared with older adults without hearing loss, persons with hearing loss engaged in significantly fewer types of activities (β=-0.070, 95% CI -0.109, -0.031, P < 0.001) and at a lower frequency (β=-0.176, 95% CI -0.260, -0.093, P < 0.001). Depression significantly existed in the relationship between hearing loss and social participation as a mediating variable, and the percentage of indirect effects in this relationship were 16.5% and 20.8%. The findings of this study suggest that when facing an aging society, improving the hearing status of older adults should be considered by policymakers. More efforts should be made to help older adults cope with depression. Geriatr Gerontol Int 2022; 22: 529-535.

Social participation and health in middle-aged and older empty nesters: A study on gender differences

Physical activity and sleep duration as predictors of subsequent depression in older adults: Longitudinal evidence from the China health and retirement longitudinal study (CHARLS).

ObjectiveThe 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.MethodsWe 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).ConclusionA 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.

Frailty is a pervasive symptom among the older population, and social participation is a beneficial factor of late-life well-being. However, studies on the bidirectional association between social participation and frailty are limited. This study examined the cross-sectional and lagged associations of social participation and frailty. The analytic sample contained 6865 community-dwelling older adults, with 21,141 observations, from the first four waves (2011-2018) China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by the Frailty Index (FI). Social participation was measured by the accumulation of the frequencies of six social activities. Random intercept two-level models were used to analyse the concurrent and lagged association between social participation and frailty. The results showed significantly cross-sectional associations between higher levels of frailty and lower levels of social participation in the same wave. Moreover, there was a lagged association of social participation in the prior wave with the current frailty (b=-0.001, SE=0.001, p=0.028), and frailty in the prior wave with the current social participation (b=-0.634, SE=0.088, p < 0.001) even after adjusting for sociodemographic characteristics, and frailty or social participation in the prior wave. The bidirectional associations between social participation and frailty imply the necessity of enhancing social participation to prevent or slow the frailty progression, and improving the physical and social environment to reduce social participation restrictions imposed by frailty status.