Socioeconomic Status and Depressive Symptoms Among Older Adults in Shanghai,China: The Mediating Roles of Activities of Daily Living and Loneliness

Abstract

Objectives

To investigate the impact of socioeconomic status (SES) on depressive symptoms in Chinese older adults, focusing on the mediating roles of activities of daily living (ADL) and loneliness.

Methods

645 participants aged 60 years old and above from Shanghai, China, were included in the analysis. SES was measured by assessing participant’s annual income, educational attainment and occupation, ADL Scale, UCLA Loneliness Scale, and Depression, Anxiety, and Stress Scale were used to measure physical limitations, loneliness, and depressive symptoms, respectively.

Results

We found that the direct effect of SES on depressive symptoms was not significant. However, both ADL and loneliness had respective and serial mediating effects in this relationship. The findings suggest that ADL and loneliness play important roles in shaping the mental health of Chinese older adults.

Conclusions

The study highlights the need to conduct interventions targeting maintaining ADL capabilities and reducing loneliness for older adults with lower SES.

Keywords

socioeconomic status activities of daily living loneliness depressive symptoms Chinese older adults

Get full access to this article

View all access options for this article.

References

Alao

Nur

Fivian

Shankar

Kadiyala

Harris-Fry

(2021). Economic inequality in malnutrition: A global systematic review and meta-analysis. BMJ Global Health, 6(12), Article e006906. https://doi.org/10.1136/bmjgh-2021-006906

Alsubheen

S. A.

Oliveira

Habash

Goldstein

Brooks

(2023). Systematic review of psychometric properties and cross-cultural adaptation of the university of California and Los Angeles loneliness scale in adults. Current Psychology, 42, 11819–11833. https://doi.org/10.1007/s12144-021-02494-w

Antony

M. M.

Bieling

P. J.

Cox

B. J.

Enns

M. W.

Swinson

R. P.

(1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181. https://doi.org/10.1037/1040-3590.10.2.176

Backe

I. F.

Patil

G. G.

Nes

R. B.

Clench-Aas

(2018). The relationship between physical functional limitations, and psychological distress: Considering a possible mediating role of pain, social support and sense of mastery. SSM - Population Health, 22(4), 153–163. https://doi.org/10.1016/j.ssmph.2017.12.005

Barman

Rahut

D. B.

Mishra

(2024). Mediating role of social disengagement and loneliness in the nexus between functional health and mental well-being in older individuals. Scientific Reports, 14(1), Article 16232. https://doi.org/10.1038/s41598-024-66919-9

Cai

Jin

Liu

Zhang

Ungvari

G. S.

Tang

Y. L.

C. H.

X. H.

Xiang

Y. T.

(2023). Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys. Asian Journal of Psychiatry, 80, Article 103417. https://doi.org/10.1016/j.ajp.2022.103417

Cao

C. H.

Liao

X. L.

Jiang

X. Y.

X. D.

Chen

I. H.

Lin

C. Y.

(2023). Psychometric evaluation of the depression, anxiety, and stress scale-21 (DASS-21) among Chinese primary and middle school teachers. BMC Psychology, 11(1), 209. https://doi.org/10.1186/s40359-023-01242-y

Cheah

Y. K.

Syed Anera

S. N.

Omar

M. A.

Abd Manaf

N. H.

Idris

Z. Z.

(2024). Age, education and depression among older adults: The mediating role of physical activity. Clinical Gerontologist, 26(1), 1–13. https://doi.org/10.1080/07317115.2024.2371612

Chen

I. H.

Chen

C. Y.

Liao

X. L.

Chen

X. M.

Zheng

Tsai

Y. C.

Lin

C. Y.

Griffiths

M. D.

Pakpour

A. H.

(2023). Psychometric properties of the depression, anxiety, and stress scale (DASS-21) among different Chinese populations: A cross-sectional and longitudinal analysis. Acta Psychologica (Amst), 240(1), Article 104042. https://doi.org/10.1016/j.actpsy.2023.104042

10.

Cheval

Maltagliati

Saoudi

Fessler

Farajzadeh

Sieber

Cullati

Boisgontier

M. P.

(2023). Physical activity mediates the effect of education on mental health trajectories in older age. Journal of Affective Disorders, 1(336), 64–73. https://doi.org/10.1016/j.jad.2023.05.052

11.

Chiu

H. C.

Hsieh

Y. H.

Mau

L. W.

Lee

M. L.

(2005). Associations between socio-economic status measures and functional change among older people in Taiwan. Ageing and Society, 25(3), 377–395. https://doi.org/10.1017/S0144686X05003478

12.

Dannefer

(2003). Cumulative advantage/disadvantage and the life course: Cross-fertilizing age and social science theory. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58(6), S327–S337. https://doi.org/10.1093/geronb/58.6.S327

13.

Darin-Mattsson

Fors

Kåreholt

(2017). Different indicators of socioeconomic status and their relative importance as determinants of health in old age. International Journal for Equity in Health, 16(1), 173. https://doi.org/10.1186/s12939-017-0670-3

14.

Domènech-Abella

Mundó

Leonardi

Chatterji

Tobiasz-Adamczyk

Koskinen

Ayuso-Mateos

J. L.

Haro

J. M.

(2018). The association between socioeconomic status and depression among older adults in Finland, Poland and Spain: A comparative cross-sectional study of distinct measures and pathways. Journal of Affective Disorders, 241, 311–318. https://doi.org/10.1016/j.jad.2018.08.077

15.

Feng

Zhen

Duncan

P. W.

Purser

J. L.

(2013). Trends in ADL and IADL disability in community-dwelling older adults in shanghai, China, 1998–2008. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 68(3), 476–485. https://doi.org/10.1093/geronb/gbt012

16.

Feng

Zhou

Chen

Yin

(2021). The relationship between depressive symptoms and activity of daily living disability among the elderly: Results from the china health and retirement longitudinal study (CHARLS). Public Health, 198, 75–81. https://doi.org/10.1016/j.puhe.2021.06.023

17.

Ferrari

A. J.

Charlson

F. J.

Norman

R. E.

Patten

S. B.

Freedman

Murray

C. J.

Vos

Whiteford

H. A.

(2013). Burden of depressive disorders by country, sex, age, and year: Findings from the global burden of disease study 2010. PLoS Medicine, 10(11), Article e1001547. https://doi.org/10.1371/journal.pmed.1001547

18.

GBD 2019 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. https://doi.org/10.1016/S2215-0366(21)00395-3

19.

GBD 2019 Diseases and Injuries Collaborators . (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the global burden of disease study 2019. Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9

20.

Gong

Xie

Luo

(2010). Psychometric properties of the Chinese versions of DASS-21 in Chinese college students. Chinese Journal of Clinical Psychology, 18(4), 443–446.

21.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach: The Guilford Press.

22.

Hays

R. D.

Dimatteo

M. R.

(1987). A short-form measure of loneliness. Journal of Personality Assessment, 51(1), 69–81. https://doi.org/10.1207/s15327752jpa5101_6

23.

Zhao

Luo

Yang

(2022). Prevalence of depression in older adults: A systematic review and meta-analysis. Psychiatry Research, 311, Article 114511. https://doi.org/10.1016/j.psychres.2022.114511

24.

Hussenoeder

F. S.

Jentzsch

Matschinger

Hinz

Kilian

Riedel-Heller

S. G.

Conrad

(2020). Depression and quality of life in old age: A closer look. European Journal of Ageing, 18(1), 75–83. https://doi.org/10.1007/s10433-020-00573-8

25.

Kara

David

J. L.

Iain

A. L.

Sandeep

Mohammed

U. K.

Erin

M. M.

Kenneth

M. L.

(2010). Depression among older adults in the United States and England. American Journal of Geriatric Psychiatry, 18(11), 1036–1044. https://doi.org/10.1097/JGP.0b013e3181dba6d2

26.

Katz

Ford

A. B.

Moskowitz

R. W.

Jackson

B. A.

Jaffe

M. W.

(1963). Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185(12), 914–919. https://doi.org/10.1001/jama.1963.03060120024016

27.

Kumar

B. P. R.

Dudala

S. R.

Rao

A. R.

(2012). Kuppuswamy’s social-economic status scale – A revision of economic parameter for 2012. International Journal of Research & Development of Health, 1(1), 2–4.

28.

Lee

S. L.

Pearce

Ajnakina

Johnson

Lewis

Mann

Pitman

Solmi

Sommerlad

Steptoe

Tymoszuk

Lewis

(2021). The association between loneliness and depressive symptoms among adults aged 50 years and older: A 12-year population-based cohort study. The Lancet. Psychiatry, 8(1), 48–57. https://doi.org/10.1016/S2215-0366(20)30383-7

29.

Lei

Sun

Strauss

Zhang

Zhao

(2014). Depressive symptoms and SES among the mid-aged and elderly in China: Evidence from the China health and retirement longitudinal study national baseline. Social Science & Medicine, 120, 224–232. https://doi.org/10.1016/j.socscimed.2014.09.028

30.

Liu

Wang

(2022). Socioeconomic status and ADL disability of the older adults: Cumulative health effects, social outcomes and impact mechanisms. PLoS One, 10(17): Article e0262808. doi: https://doi.org/10.1371/journal.pone.0262808

31.

Maier

Riedel-Heller

S. G.

Pabst

Luppa

(2021). Risk factors and protective factors of depression in older people 65+. A systematic review. PLoS One, 16(5), Article e0251326. https://doi.org/10.1371/journal.pone.0251326

32.

McMaughan

D. J.

Oloruntoba

Smith

M. L.

(2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 18(8), 231. https://doi.org/10.3389/fpubh.2020.00231

33.

National Bureau of Statistics of China . (2023). Statistical communiqué of the people’s Republic of China on the 2022 national economic and social development. https://www.stats.gov.cn/english/PressRelease/202302/t20230227_1918979.html (Accessed 2 September 2024).

34.

Parajuli

Berish

Jao

Y. L.

(2019). Chronic conditions and depressive symptoms in older adults: The mediating role of functional limitations. Aging & Mental Health, 25(2), 243–249. https://doi.org/10.1080/13607863.2019.1693971

35.

Patel

Burns

J. K.

Dhingra

Tarver

Kohr

Lund

(2018). Income inequality and depression: A systematic review and meta-analysis of the association and a scoping review of mechanisms. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 17(1), 76–89. https://doi.org/10.1002/wps.20492

36.

Pinquart

Sorensen

(2001). Influences on loneliness in older adults: A Meta analysis. Basic and Applied Social Psychology, 23(4), 245–266. https://doi.org/10.1207/S15324834BASP2304_2

37.

Sánchez-Moreno

Gallardo-Peralta

Barrón López de Roda

Rivera Álvarez

J. M.

(2024). Socioeconomic status, loneliness, and depression among older adults: A cross-sectional study in Spain. BMC Geriatrics, 24(1), 361. https://doi.org/10.1186/s12877-024-04978-3

38.

Sato

Tsuji

Ueno

Watanabe

Ide

Kondo

(2024). Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan gerontological evaluation study. International Journal of Geriatric Psychiatry, 39(2), Article e6069. https://doi.org/10.1002/gps.6069

39.

Scharf

Phillipson

Smith

A. E.

(2005). Social exclusion of older people in deprived urban communities of England. European Journal of Ageing, 2(2), 76–87. https://doi.org/10.1007/s10433-005-0025-6

40.

Scher

Nepomnyaschy

Amano

(2023). Comparison of cognitive and physical decline as predictors of depression among older adults. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 42(3), 387–398. https://doi.org/10.1177/07334648221139255

41.

Solar

Irwin

(2010). A conceptual framework for action on the social determinants of health. Social determinants of health discussion paper 2 (policy and practice): World Health Organization.

42.

Song

Lee

Jun

Lee

Yoon

(2017). The effects of employment on depression among older adults: Mediating role of self-esteem. Innovation in Aging, 1(Suppl 1), 1233. https://doi.org/10.1093/geroni/igx004.4476

43.

Taylor

Nguyen

Chatters

(2018). Social isolation, depression, and psychological distress among older adults. Journal of Aging and Health, 30(2), 229–246. https://doi.org/10.1177/0898264316673511

44.

United Nations Population Division . (2019). World population prospects 2019: Volume II: Demographic profiles. United Nations. https://population.un.org/wpp/Publications/Files/WPP2019_Volume-II-Demographic-Profiles.pdf (Accessed 4 September 2024).

45.

Van As

B. A. L.

Imbimbo

Franceschi

Menesini

Nocentini

(2022). The longitudinal association between loneliness and depressive symptoms in the elderly: A systematic review. International Psychogeriatrics, 34(7), 657–669. https://doi.org/10.1017/S1041610221000399

46.

Wang

Shi

H. S.

Geng

F. L.

Zou

L. Q.

Tan

S. P.

Wang

Neumann

D. L.

Shum

D. H. K.

Chan

R. C. K.

(2016). Cross-cultural validation of the depression anxiety stress Scale–21 in China. Psychological Assessment, 28(5), e88–e100. https://doi.org/10.1037/pas0000207

47.

Wang

Chen

Liu

(2024). Prevalence of depression and its influencing factors in Chinese older population: A meta-analysis. Chinese General Practice Journal, 1(2), 77–83. https://doi.org/10.1016/j.cgpj.2024.04.001

48.

Wang

Liu

Yang

Chen

Wang

Liu

(2024). The associations of socioeconomic status, social activities, and loneliness with depressive symptoms in adults aged 50 years and older across 24 countries: Findings from five prospective cohort studies. The Lancet. Healthy Longevity, 5(9), Article 100618. https://doi.org/10.1016/j.lanhl.2024.07.001

49.

WHO . (2023). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults (Assessed 4 September 2024).

50.

Wormald

A. D.

McCallion

McCarron

(2019). The antecedents of loneliness in older people with an intellectual disability. Research in Developmental Disabilities, 85, 116–130. https://doi.org/10.1016/j.ridd.2018.11.009

51.

Yao

(2008). Psychometric analysis of the short-form UCLA loneliness scale (ULS-8) in Taiwanese undergraduate students. Personality and Individual Differences, 44(8), 1762–1771. https://doi.org/10.1016/j.paid.2008.02.003

52.

Xiao

Shi

Xue

Zheng

Zhang

Chang

Lin

Zhang

(2022). The relationship between activities of daily living and psychological distress among Chinese older adults: A serial multiple mediation model. Journal of Affective Disorders, 300(1), 462–468. https://doi.org/10.1016/j.jad.2021.12.069

53.

Qiu

Hahne

Zhao

(2018). Psychometric properties of the short-form UCLA loneliness scale (ULS-8) among Chinese adolescents. Medicine, 97(38), Article e12373. https://doi.org/10.1097/MD.0000000000012373

54.

Yang

George

L. K.

(2005). Functional disability, disability transitions, and depressive symptoms in late life. Journal of Aging and Health, 17(3), 263–292. https://doi.org/10.1177/0898264305276295

55.

Zenebe

Akele

W/Selassie

Necho

(2021). Prevalence and determinants of depression among old age: A systematic review and meta-analysis. Annals of General Psychiatry, 20(1), 55. https://doi.org/10.1186/s12991-021-00375-x

56.

Zimmer

Amornsirisomboon

(2001). Socioeconomic status and health among older adults in Thailand: An examination using multiple indicators. Social Science & Medicine, 52(8), 1297–1311. https://doi.org/10.1016/S0277-9536(00)00232-X