Factors And Urban-rural Differences In Depressive Symptoms Among The Elderly

Objective: This study aims to understand the prevalence and characteristics of depressive symptoms among the elderly in China,explore the related factors of depressive symptoms in the elderly,and analyze the differences of depressive symptoms and influencing factors between urban and rural elderly in China,so as to provide reference and theoretical basis for the follow-up cohort study and the formulation of relevant intervention strategies.Methods: Data was from the China Health and Retirement Longitudinal Study in 2018,with the elderly ≥ 60 years old in China as the research object.Depressive symptoms were measured by the ten-item Centre for Epidemiologic Studies Depression Scale(CESD-10),with a total score of ≥12 being defined as having depressive symptoms.The independent variables involve six aspects: socio-demographic characteristics,physical health status,health-related behaviors,family factors,social factors,and satisfaction.SAS software was used for statistical description and single factor analysis.R software was used for Group Lasso screening variables and establishment and evaluation of the nomogram for predicting the risk of depressive symptoms in the elderly.The structural equation model was constructed and modified by AMOS software.Results: 1.A total of 8,339 elderly people were included,with a median CESD-10 score of 7(3,13),and 30.09% of the elderly(2509)had depressive symptoms.The prevalence of depressive symptoms in female elderly(37.09%)was higher than that of males(23.48%).The elderly in western region(36.21%)had a higher prevalence of depressive symptoms than the elderly in central region(30.81%)and eastern region(23.58%).The prevalence of depressive symptoms in the illiterate elderly(39.66%)was higher than that in the elderly with primary education(31.69%),and that in the elderly with primary education(31.69%)was higher than that in the elderly with junior high education or above(18.77%).2.Gender,regional location,urban and rural areas,education level,health self-assessment,pain,eyesight,physical function,disability,difficulty in daily living ability,social activities,high-intensity physical activity,sleep duration,stomach or Digestive system diseases,dibao households,financial assets,health satisfaction,life satisfaction,and marriage satisfaction were related to depressive symptoms in the elderly(p<0.05),which were used to construct a nomogram.3.The AUC for the nomogram model was 0.825(95%CI:0.813-0.836)in the training set and 0.826(95%CI: 0.809-0.843)in the test set;and calibration curves showed good consistency between actual and predicted risks by the nomogram in both training set and test set.4.The median CESD-10 scores of urban elderly and rural elderly were 6(3,11)and8(4,14)respectively,and the prevalence of depressive symptoms was 22.56%and 35.29% respectively.5.The results of the structural equation model showed that the total effects of socioeconomic status,poor physical health,low life satisfaction,sleep duration,and chronic diseases on depression were-0.398,0.532,0.243,-0.110,and 0.280,respectively,explaining 44.4% of the variation in depression.6.The analysis of the multi-group structural equation model found that the model was not invariant between the urban and rural elderly:(1)the socioeconomic status has no direct impact on chronic diseases among urban elderly(path coefficient was-0.004,p=0.844),while the socioeconomic status could reduce the risk of chronic diseases among rural elderly(path coefficient was-0.168,p<0.001);(2)socioeconomic status has a greater impact on poor physical health in rural elderly than in urban elderly(-0.497 vs.-0.388,p<0.05);(3)the direct influence of poor physical health status on depression among urban elderly was larger than that among rural elderly(0.460 vs 0.423,p<0.05).Conclusion: The prevalence of depressive symptoms in the elderly is relatively high,especially in women,rural elderly,and the elderly with low levels of education.It is necessary to strengthen the intervention of depressive symptoms in the elderly to reduce the burden of depressive symptoms in the elderly,so as to promote healthy aging.Depression is affected by many factors such as demographic characteristics,physical health,socioeconomic status,and social activities.The nomogram can visually display the influencing factors of depression in the elderly and has a good effect on predicting the risk of individual depression.It can be used to make depression screening tools to guide depression prevention and interventions.The influencing factors and effects of depression in the urban and rural elderly are different,and further research is needed to formulate targeted intervention measures.