Restricted accessReview articleFirst published online 2025
Gender Differences in Depression Prevalence,Influencing Factors,Life Satisfaction,and Network Structure Among Middle-Aged and Older Adults in China: A National Survey
The prevalence of depression is high in China especially among older adults. This study aimed to explore the gender differences in depression prevalence, influencing factors, network structure, and their relationship with life satisfaction among middle-aged and older adults in China.
Methods:
This was a cross-sectional study based on the data from the fifth wave (2020) of the China Health and Retirement Longitudinal Study (CHARLS). We performed network analyses and applied expected influence (EI) to identify the most central symptoms.
Results:
A total of 15,834 middle-aged and older adults were included in this study. The prevalence of depression among women was (45.5%, 95% CI [44.4%, 46.6%]), which was significantly higher than men (29.1%; 95% CI [28.1%, 30.1%]). In both women and men, older age (OR = 1.006), living in village areas (OR = 1.7), having a job (OR = 1.2), activities of daily living (ADL) limitations (OR = 2.2), and experiencing pain (OR = 1.8) were significantly associated with a higher risk for depression. Additionally, being married (OR = 0.7) and having better perceived health status (e.g. good vs. normal: OR = 0.5; poor vs. normal: OR = 2.2) were associated with a lower risk of depression across both genders. Moreover, network comparison of depressive symptoms by gender found that the most central symptom across gender groups was similar. Center for Epidemiologic Studies Depression Scale (CESD)-3 (“Feeling depressed”; corresponding to the item “I felt depressed” from the 10-item, CESD-10; EI value = 1.079) was the most central symptom in the depression network for both genders, while CESD-8 (“Lack of happiness”; corresponding to the item “I felt happy” from the CESD-10, reverse scored; average edge weight (AEW) = −0.15) had the strongest negative correlation with life satisfaction.
Conclusion:
In this study of middle-aged and older adults, women were more likely to have depression than men. The results identified influential symptoms which should be prioritized to promote emotional well-being and enhance life satisfaction in this population. There is a critical need to develop gender-sensitive mental health strategies and public health interventions aimed at alleviating the burden of depression among older adults in China.
AdamsT. R.RabinL. A.Da SilvaV. G.KatzM. J.FogelJ.LiptonR. B. (2016). Social support buffers the impact of depressive symptoms on life satisfaction in old age. Clinical Gerontologist, 39(2), 139–157.
2.
AkifA.QusarM. S.IslamM. R. (2024). The impact of chronic diseases on mental health: An overview and recommendations for Care Programs. Current Psychiatry Reports, 26(7), 394–404.
3.
AmtmannD.KimJ.ChungH.BamerA. M.AskewR. L.WuS.CookK. F.JohnsonK. L. (2014). Comparing CESD-10, PHQ-9, and PROMIS depression instruments in individuals with multiple sclerosis. Rehabilitation Psychology, 59(2), 220–229.
4.
AnH.-Y.ChenW.WangC.-W.YangH.-F.HuangW.-T.FanS.-Y. (2020). The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults. International Journal of Environmental Research and Public Health, 17(13), Article 4817.
5.
AndersenE. M.MalmgrenJ. A.CarterW. B.PatrickD. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. American Journal of Preventive Medicine, 10(2), 77–84.
6.
BianZ.XuR.ShangB.LvF.SunW.LiQ.GongY.LuoC. (2024). Associations between anxiety, depression, and personal mastery in community-dwelling older adults: A network-based analysis. BMC Psychiatry, 24(1), Article 192.
7.
BorsboomD. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13.
8.
BringmannL. F.ElmerT.EpskampS.KrauseR. W.SchochD.WichersM.WigmanJ. T. W.SnippeE. (2019). What do centrality measures measure in psychological networks?Journal of Abnormal Psychology, 128(8), Article 892.
9.
CarlehedG.KatzJ.NordinS. (2017). Somatic symptoms of anxiety and depression: A population-based study. Mental Health & Prevention, 6, 57–62.
10.
CHARLS. (2024). The China Health and Retirement Longitudinal Study (CHARLS). Retrieved August 5, 2024, from https://charls.pku.edu.cn
11.
CheckleyS. (1996). The neuroendocrinology of depression. International Review of Psychiatry, 8(4), 373–378.
12.
ChenH. J.MuiA. C. (2014). Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China. International Psychogeriatrics, 26(1), 49–57.
13.
ChenP.SunH.-L.ZhangL.FengY.ShaS.SuZ.CheungT.WongK. K.UngvariG. S.JacksonT.ZhangQ.XiangY. T. (2024). Inter-relationships of depression and insomnia symptoms with life satisfaction in stroke and stroke-free older adults: Findings from the Health and Retirement Study based on network analysis and propensity score matching. Journal of Affective Disorders, 356, 568–576.
14.
ChenY.HicksA.WhileA. E. (2014). Quality of life and related factors: A questionnaire survey of older people living alone in Mainland China. Quality of Life Research, 23(5), 1593–1602.
15.
ChengY.FangY.ZhengJ.GuanS.WangM.HongW. (2024). The burden of depression, anxiety and schizophrenia among the older population in ageing and aged countries: An analysis of the Global Burden of Disease Study 2019. General Psychiatry, 37(1), Article e101078.
16.
CramerA. O.WaldorpL. J.Van Der MaasH. L.BorsboomD. (2010). Complex realities require complex theories: Refining and extending the network approach to mental disorders. Behavioral and Brain Sciences, 33(2–3), Article 178.
17.
de OliveiraP. B. F.DornellesT. M.GosmannN. P.CamozzatoA. (2023). Efficacy of Telemedicine interventions for depression and anxiety in older people: A systematic review and Meta-Analysis. International Journal of Geriatric Psychiatry, 38(5), Article e5920.
18.
DienerE.ChanM. Y. (2011). Happy people live longer: Subjective well-being contributes to health and longevity. Applied Psychology-Health and Well Being, 3(1), 1–43.
19.
EpskampS.BorsboomD.FriedE. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50, 195–212.
20.
EpskampS.CramerA. O.WaldorpL. J.SchmittmannV. D.BorsboomD. (2012). qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48, 1–18.
21.
Fernández-NiñoJ. A.Bonilla-TinocoL. J.Manrique-EspinozaB. S.Romero-MartínezM.Sosa-OrtizA. L. (2018). Work status, retirement, and depression in older adults: An analysis of six countries based on the Study on Global Ageing and Adult Health (SAGE). SSM-Population Health, 6, 1–8.
22.
FiskeA.WetherellJ. L.GatzM. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5(1), 363–389.
23.
GaoQ.PrinaM.HuangY.LiuZ.RozanovaJ.MaystonR. (2025). “I don’t want to make trouble”: Emotional distress, disconnection, and loneliness among older people in China. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 80(6), Article gbaf068.
24.
GBD Mental Disorders Collaborators. (2022). Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry, 9(2), 137–150.
25.
Gómez-RubioV. (2017). ggplot2-elegant graphics for data analysis. Journal of Statistical Software, 77, 1–3.
26.
GongJ. Q.WangG. W.WangY. F.ChenX. X.ChenY. F.MengQ. Q.YangP.YaoY.ZhaoY. (2022). Nowcasting and forecasting the care needs of the older population in China: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS). Lancet Public Health, 7(12), E1005–E1013.
27.
GuoM.ChiI.SilversteinM. (2017). Intergenerational support and depression among Chinese older adults: Do gender and widowhood make a difference?Ageing & Society, 37(4), 695–724.
28.
HaJ. Y.ParkH. J. (2022). Effect of life satisfaction on depression among childless married couples: A cross-sectional study. International Journal of Environmental Research and Public Health, 19(4), Article 14.
29.
HarerimanaB.ForchukC.O’ReganT. (2019). The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review. International Journal of Mental Health Nursing, 28(3), 657–670.
30.
HeX. Q.HuangX. Y.HuangC. J. (2024). Social participation and life satisfaction among middle-aged and elderly people in China: the mediating role of depression and the moderating role of relative income. Current Psychology, 43(34), 27521–2733.
31.
HofmannS. G.CurtissJ.McNallyR. J. (2016). A complex network perspective on clinical science. Perspectives on Psychological Science, 11(5), 597–605.
32.
HollonS. D.StewartM. O.StrunkD. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57(1), 285–315.
33.
HungM.VossM. W.BounsangaJ.GraffT.BirminghamW. C. (2019). Assessing spousal support and health in an aging population: Support and strain amidst changing social dynamics. Social Work in Health Care, 58(4), 345–367.
34.
JanssenN. P.GuineauM. G.LucassenP.HendriksG.-J.IkaniN. (2024). Depressive symptomatology in older adults treated with behavioral activation: A network perspective. Journal of Affective Disorders, 352, 445–453.
35.
JiangC. H.ZhuF.QinT. T. (2020). Relationships between chronic diseases and depression among middle-aged and elderly people in China: A prospective study from CHARLS. Current Medical Science, 40(5), 858–870.
36.
JonesP. (2022). Networktools: Tools for identifying important nodes in networks (1.5. 0): R-CRAN.
37.
JonesP.JonesM. P. (2018). Package ‘networktools’: CRAN-R.
38.
LabakaA.Goñi-BalentziagaO.LebeñaA.Pérez-TejadaJ. (2018). Biological sex differences in depression: A systematic review. Biological Research for Nursing, 20(4), 383–392.
39.
LiA.WangD.LinS.ChuM.HuangS.LeeC.-Y.ChiangY. C. (2021). Depression and life satisfaction among middle-aged and older adults: Mediation effect of functional disability. Frontiers in Psychology, 12, Article 755220.
40.
LiD.ZhangD.-j.ShaoJ.-j.QiX.-d.TianL. (2014). A meta-analysis of the prevalence of depressive symptoms in Chinese older adults. Archives of Gerontology and Geriatrics, 58(1), 1–9.
41.
LiH. J.LiuX. L.ZhengQ. Y.ZengS. Y.LuoX. F. (2022). Gender differences and determinants of late-life depression in China: A cross-sectional study based on CHARLS. Journal of Affective Disorders, 309, 178–185.
42.
LiJ. S.LinS.YanX.PeiL.WangZ. (2022). Adverse childhood experiences and trajectories of ADL disability among middle-aged and older adults in China: Findings from the CHARLS Cohort Study. Journal of Nutrition Health & Aging, 26(12), 1034–1041.
43.
LiJ. S.MaW. J. (2017). Prevalence and influencing factors of depression symptom among middle-aged and elderly people in China. (in Chinese). Chinese Journal of Public Health, 33(2), 177–181.
44.
LiQ. G.CenW. J.YangT.TaoS. R. (2024). Association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China: The mediation effect of activities of daily living (ADL) disability. BMC Psychiatry, 24(1), Article 13.
45.
LinH. Y.JinM. D.LiuQ.DuY.FuJ. Z.SunC. Q.MaF.LiW.LiuH.ZhangX.ZhuY. (2021). Gender-specific prevalence and influencing factors of depression in elderly in rural China: A cross-sectional study. Journal of Affective Disorders, 288, 99–106.
46.
LinY.ZhuT.ZhangX.ZengZ. (2024). Trends in the prevalence of social isolation among middle and older adults in China from 2011 to 2018: The China Health and Retirement Longitudinal Study. BMC Public Health, 24(1), Article 339.
47.
LiuH.GuoL.FengZ. (2024). Social participation, attitudes towards ageing and depressive symptoms among Chinese older adults. Ageing & Society, 44(2), 269–281.
48.
McInerneyA. M.LindekildeN.NouwenA.SchmitzN.DeschênesS. S. (2022). Diabetes distress, depressive symptoms, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity. Diabetes Care, 45(8), 1715–1723.
49.
NakamuraH.ManagiS. (2020). Effects of subjective and objective city evaluation on life satisfaction in Japan. Journal of Cleaner Production, 256, Article 9.
50.
NiX. L.SuH. B.LvY.LiR. Q.ChenC.ZhangD.YangZ.SunL.ZhouQ. (2022). The major risk factor for depression in the Chinese middle-aged and elderly population: A cross-sectional study. Frontiers in Psychiatry, 13, Article 11.
51.
OliverM. I.PearsonN.CoeN.GunnellD. (2005). Help-seeking behaviour in men and women with common mental health problems: Cross-sectional study. The British Journal of Psychiatry, 186(4), 297–301.
52.
ParkerG.FletcherK.PatersonA.AndersonJ.HongM. (2014). Gender differences in depression severity and symptoms across depressive sub-types. Journal of Affective Disorders, 167, 351–357.
53.
PashaH.OmidvarS.FaramarziM.BakhtiariA. (2023). Depression, anxiety, stress, and PTSD symptoms during the first and second COVID-19 waves: A comparison of elderly, middle-aged, and young people in Iran. BMC Psychiatry, 23(1), Article 10.
54.
PiccinelliM.WilkinsonG. (2000). Gender differences in depression: Critical review. The British Journal of Psychiatry, 177(6), 486–492.
55.
PutoG.RepkaI.GniadekA. (2024). Gender differences in the quantitative and qualitative assessment of chronic pain among older people. Frontiers in Public Health, 12, Article 1344381.
56.
R Core Team. (2022). R: A Language and Environment for Statistical Computing. Foundation for Statistical Computing.
57.
RennB. N.AreánP. A. (2017). Psychosocial treatment options for major depressive disorder in older adults. Current Treatment Options in Psychiatry, 4(1), 1–12.
58.
Ribeiro-GonçalvesJ. A.JesusJ. C.CostaP. A.LealI. (2024). Sexual stigma and mental health of LGB older adults: A systematic scoping review. Sexuality Research and Social Policy, 22(1), 467–489.
59.
RobinaughD. J.MillnerA. J.McNallyR. J. (2016). Identifying highly influential nodes in the complicated grief network. Journal of Abnormal Psychology, 125(6), Article 747.
60.
RomansS. E.TyasJ.CohenM. M.SilverstoneT. (2007). Gender differences in the symptoms of major depressive disorder. The Journal of nervous and mental disease, 195(11), 905–911.
61.
SeoB. K.HwangI. H.SunY.ChenJ. (2022). Homeownership, depression, and life satisfaction in China: The gender and urban-rural disparities. International Journal of Environmental Research and Public Health, 19(22), Article 14833.
62.
ShenL. W.XuX. Q.YueS. W.YinS. (2024). A predictive model for depression in Chinese middle-aged and elderly people with physical disabilities. BMC Psychiatry, 24(1), Article 13.
63.
SiahpushM.SpittalM.SinghG. K. (2008). Happiness and life satisfaction prospectively predict self-rated health, physical health, and the presence of limiting, long-term health conditions. American Journal of Health Promotion, 23(1), 18–26.
64.
SilversteinB. (1999). Gender difference in the prevalence of clinical depression: The role played by depression associated with somatic symptoms. American Journal of Psychiatry, 156(3), 480–482.
65.
SongY. P.QianL.SuiJ.GreinerR.LiX. M.GreenshawA. J.LiuY. S.CaoB. (2023). Prediction of depression onset risk among middle-aged and elderly adults using machine learning and Canadian Longitudinal Study on Aging cohort. Journal of Affective Disorders, 339, 52–57.
66.
SunH.-L.ChenP.BaiW.ZhangL.FengY.SuZ., et al. (2024). Prevalence and network structure of depression, insomnia and suicidality among mental health professionals who recovered from COVID-19: a national survey in China. Translational psychiatry, 14(1), 227.
67.
TangT.JiangJ.TangX. (2021). Prevalence of depressive symptoms among older adults in mainland China: A systematic review and meta-analysis. Journal of Affective Disorders, 293, 379–390.
68.
World Health Organization. (2017). Depression and other common mental disorders: Global health estimates.
69.
YangY.ZhangD.-Y.LiY.-L.ZhangM.WangP.-H.LiuX.-H.GeL. N.LinW. X.XuY.ZhangY. L.LiF.J. (2022). Prevalence, correlates, and network analysis of Internet addiction symptoms among Chinese pregnant and postpartum women. Journal of Affective Disorders, 298, 126–133.
70.
YouR. J.LiW. J.NiL. H.PengB. (2023). Study on the trajectory of depression among middle-aged and elderly disabled people in China: Based on group-based trajectory model. SSM-Population Health, 24, Article 8.
71.
ZhangY.CuiY.LiY.LuH.HuangH.SuiJ.GuoZ.MiaoD. (2024). Network analysis of depressive and anxiety symptoms in older Chinese adults with diabetes mellitus. Frontiers in Psychiatry, 15, Article 1328857.
72.
ZhaoY. H.HuY. S.SmithJ. P.StraussJ.YangG. H. (2014). Cohort Profile: The China Health and Retirement Longitudinal Study (CHARLS). International Journal of Epidemiology, 43(1), 61–68.
73.
ZhaoY.-J.StraussJ.YangG.GilesJ.HuP.HuY.LeiX.ParkA.SmithJ. P.WangY. (2013). China health and retirement longitudinal study–2011–2012 national baseline users’ guide. Beijing: National School of Development, Peking University, 2, 1–56.
74.
ZhaoY.-J.ZhangL.FengY.ShaS.LamM. I.SuZ.CheungT.UngvariG. S.JacksonT. (2023). Prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic: A network perspective. Frontiers in Psychiatry, 14, Article 1139742.
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