Social participation and depressive symptoms among Chinese older adults: A study on rural–urban differences

Highlights

• Urban-rural differences exist in the association between social participation and depression in China.

• Participation in paid work was negatively associated with depression for both urban and rural older adults.

• Participation in political activities or voluntary activities was negatively associated with depression only for urban older adults.

• Social participation contributed more benefits for the mental health of urban older adults than for their rural counterparts.

Abstract

Background

Although studies conducted in developed countries have reported a negative relationship between social participation and depressive symptoms, few studies have examined rural–urban differences in the relationship between participation in various types of social activities and depressive symptoms among Chinese older adults.

Objectives

This study examined the association between participation in paid work, political, and voluntary activities and depressive symptoms among Chinese older adults in urban and rural areas.

Methods

Data were obtained from the China Longitudinal Ageing Social Survey conducted in 2014, and bivariate linear regression and multivariable linear regression analyses were conducted.

Results

The prevalence of depressive symptoms was significantly higher among older adults residing in rural areas than among older adults in urban areas. Participation in paid work activities was significantly associated with fewer depressive symptoms among older adults in urban and rural areas, whereas participation in political or voluntary activities was negatively associated with depressive symptoms only among older adults in urban areas. Older adults who participated in two or three types of activities (paid work, political, and voluntary activities) tended to have fewer depressive symptoms both in urban and rural areas.

Limitations

Because this study comprised a cross-sectional design, causality could not be established between social participation and depressive symptoms.

Conclusions

Social participation plays a protective role against depressive symptoms among Chinese older adults, especially among those in urban areas. Urban-rural differences exist between participation in different types of social activities and depression symptoms.

Introduction

China is experiencing rapid population ageing. In 2010, 13.26% of its total population was aged 60 years or older (National Bureau of Statistics of China, 2011), with this figure expected to reach 35% by 2050 (Beard et al., 2012). As the ageing population roaring, major diseases of older people, including chronic non-communicable diseases and mental disorders, have attracted research and service attention (Fang et al., 2015). Depression has become a major concern because it is closely associated with numerous undesirable consequences, such as disability, a decline in cognitive function, functional impairment, and mortality (Steffens et al., 2006).

A number of risk factors for depression have been identified, which can generally be classified into (a) socio-demographic characteristics, such as being women, older age, low education level, and low income (Guerra et al., 2016); (b) social participation, such as not frequently engaging in cognitive and social activities (Glass et al., 2006); (c) health conditions, such as functional disability and having chronic diseases (Glass et al., 2006); and (d) environmental factors, such as having few living facilities, and little social support (Zhang et al., 2016).

Social participation refers to involvement in social activities, including paid work, volunteering, mutual-help activities and so on (Hsu, 2007, Glass et al., 2006). Active participation in social activities is beneficial for improving mental health, such as reducing depressive symptoms, and improving life satisfaction (Bai et al., 2017a, Bai et al., 2017b, Chi et al., 2011, Croezen et al., 2015, Lou et al., 2013). However, few studies have investigated the joint effect of the type and number of social activities on mental health (Hao, 2008). Moreover, related studies on Chinese older adults have mostly examined residents in Hong Kong, Taiwan, and the United States (Chi et al., 2011, Lou et al., 2013). Few studies have investigated how social participation affects the mental health of older adults from mainland China and potential urban-rural disparities. Due to the large economic disparity between urban and rural areas in China, the environment and conditions of social activities for older adults as well as their motivation and levels of participation could differ between urban and rural areas. The present study examined the associations between three common types of social activities (paid work, political activities, and voluntary activities) and depressive symptoms among Chinese older adults in urban and rural areas. Compared to some other social activities that require participation in formal organizations, these three activities are easier for urban and rural older adults to participate in.

Several studies have found that, compared with older adults in Western societies, Chinese older adults have a relatively low rate of social participation (Lin, 2017, Zhang et al., 2015). Moreover, the engagement rates in different social activities vary. Results from the 2011 China Health and Retirement Longitudinal Survey showed that the participation rate of older adults in voluntary activities was only 5.1% (Lin, 2017). The findings of the China General Social Survey revealed that the engagement rate of older adults in political activities was 57.2% in 2010 (Dong, 2016). Moreover, approximately 30% of Chinese older adults still participate in paid work (Chen, 2013).

Under the long-lasting urban-rural structure in China, the gap between urban and rural areas has widened in terms of the economy, social welfare, medical services, employment and infrastructure (Chow and Bai, 2011). Consequently, unequal opportunities and differences have developed between the social participation levels of urban and rural older adults. Most urban older adults participate in social activities out of interest or for self-actualization. Moreover, they have plenty of choices because public facilities, community services, and voluntary or informal organizations are considerably more developed and accessible than are those in rual areas (Chen and Lu, 2007, Zhang, 2009). Conversely, a lack of infrastructure and community services limits the options available to rural older adults for participating in social activities. Consequently, most rural older audlts do not show as much diversity in their life-style as their urban counterparts (Zhang, 2009). Due to these urban-rural disparities, considerable differences have been identified in the levels of participation in paid work and political activities. Compared with rural older adults, urban older adults participate in more diverse forms of political activities and are less likely to engage in paid work (Chen, 2013, Dong, 2016).

Moreover, a substantial urban-rural gap has been identified in the levels of participation in paid work. The retirement pension system in China is dual-pathway, which means the big difference of pension policies between the rural and urban areas of China. Although urban retirees may choose to work or engage in public services, rural older adults, most of whom have been engaged in agricultural activities and are not subject to a mandatory retirement age, work as long as their health permits (Pang et al., 2004). According to a previous study in China, found that the employment rate of urban older adults was only 5%, whereas that of rural older adults was 40% (Chen, 2013). This difference may be due to deficiencies in the formal pension available in rural areas. According to the National Human Resources and Social Security Department, the average monthly pension of urban residents was approximatedly 1400 RMB (approximately US$221.4) in 2010,¹ whereas the average monthly benefit level of the pension for rural residents was 86 RMB (approximately US$13.6) in the same year (Hua, 2013), which was insufficient to cover basic expenses (Tao, 2016).

As for political activities, rural older adults have a higher than or at least an equal participation rate compared with their urban counterparts (Dong, 2016, Lin, 2017). Voting in local elections is a common political activity in rural and urban China (Chen, 2000, Dong, 2016, Duckett and Wang, 2013). Political activities, which are one of the few social activities accessible in rural area, have a high participation rate among older adults. These activities are mainly in voting-related, and are organized by local governments (Dong, 2016). As for other forms of political activities, such as offering suggestions or reporting problems to the government and reading political news, the participation rate of rural older adults is lower than that of urban older adults (Dong, 2016).

In contrast to paid work and political activities, voluntary activities require little economic investment or physical effort and are easy to access both in rural and urban areas. Studies have found no significant difference in the participation in voluntary activities between urban and rural areas. Older adults' participation in voluntary activities, such as taking care of peers, serving as peacemakers among neighbors, and companying those living alone, is similar in rural and urban areas in China, approximately 4% and 5%, respectively (Lin, 2017).

Activity theory is often used to explain the association between social participation and mental health among older adults. It suggests that older adults who maintain an active lifestyle are likely to sustain a positive self-concept and improve their self-esteem, thereby contributing to good mental health in later life (Hao, 2008, Lemon et al., 1972). Researchers have also employed role accumulation theory to explain the relationship between participation in multiple activities and mental health outcomes (Hao, 2008, Moen et al., 1992). According to this theory, a high number of role identities indicates a wide range of resources and support, which promote positive mental health outcomes (Adelmann, 1994, Hao, 2008). Multiple role occupancy can help older adults maintain a certain level of social participation (Morgan, 1988). Based on activity theory and role accumulation theory, participating in social activities and the number of activities participate in are both crucial to older adults’ mental health (Hao,2008).

Empirical findings on the effects of various types of social activities on depressive symptoms are inconsistent. Although a few studies revealed that engaging in paid work has protect effects against depression (Chaaya et al., 2010), some other studies have found that particpation in paid work later in life can induce depressive symtoms (Hong et al., 2009). With regard to political activities, political participation was positively associated with depressive symptoms in Europeans (Croezen et al., 2015), but negatively linked with depression among Chinese older immigrants (Kim et al., 2013). Under the same political system in urban and rural areas in China, political participation is a legitimate channel and opportunity for civic engagement (Chen, 2000), which may enhance a person's sense of ownership, thereby reducing depressive symptoms. Regarding voluntary activities, studies have demonstrated the effectiveness of volunteering in reducing depressive symptoms, especially for older adults (Croezen et al., 2015, Musick and Wilson, 2003), but other studies have reported non-significant associations (Croezen et al., 2015). Although volunteering is predictive of few depressive symptoms among urban older adults (Li et al., 2013), the situation for rural older adults remains understudied. Moreover, whether there are rural-urban differences in the relationship between participation in voluntary activities and depressive symptoms remains unclear.

In addition to examining the relationship between depression and participation in social activities, studies have examined how the number of social activities and the frequency of participaion in social activities affect depression. Consistent with activity theory and role accumulation theory, an emerging theme in empirical findings is that participation in a high number of social activities and a high frequency of engagement are associated with low levels of depressive symptoms (Croezen et al., 2015, Glass et al., 2006, Lou et al., 2013, Zhang et al., 2016). The 2014 Chinese Longitudinal Healthy Longevity Study showed that most Chinese older adults participated in multiple social activities (Hu et al., 2017). Whether role accumulation theory is valid for both rural and urban older adults in China is unclear.

Based on activity theory, role accumulation theory, and the presented empirical findings, this study examined the respective influence of participation in paid work, political activities, and voluntary activities on depressive symptoms in China. In addition, we examined the influence of multiple participation in paid work, political, and voluntary activities on depressive symptoms in Chinese older adults. This study also examined whether there were according differences between urban and rural older adults.