The Relationship between Rural to Urban Migration in China and Risk of Depression in Later Life: An Investigation of Life Course Effects

Abstract

Background: In the Chinese context, living in urban areas with an urban Hukou is associated with socioeconomic advantage. This study investigates how migration into urban areas in China is associated with risk of depression in later life by focusing on the timing and the type (rural-urban residence and/or Hukou status) of migration. Methods: We use sequence analysis to identify migration trajectories in the China Health and Retirement Longitudinal Study. Then we estimate how and why these trajectories are associated with risk of depression at older ages. Findings: We found strong associations between migration over the life course and depression in later life. The timing of migration appears to play an important role. In-situ urbanisation is associated with lower depression scores in later life, and these effects appear to be greater for in-situ urbanisation occurring in middle age compared with young adulthood. Forced urban-rural migration is also associated with improved later life mental wellbeing. Formal social protection, particularly having a private pension, contributes substantially to the mental health advantage of social groups with an urban Hukou. Informal familial support only explains small differences. Interpretation: Having an urban Hukou origin has an independent protective role in shaping mental wellbeing in later life in China, potentially in part due to the entitlement to a private pension attached to this status. When informal support has weakened in contemporary China, enhanced formal social protection in the form of adequate pensions should be put in place to mitigate structural inequalities associated with migration in old age. Funding Statement: The authors stated that none exist. Declaration of Interests: The authors declared that none exist. Ethics Approval Statement: The Ethics Review Committee of Peking University granted ethical approval for the study. All the participants provided signed, informed consent at the time of participation.