Urbanization and depressive symptoms among middle-aged and older adults in China

Abstract Background: As a health transition, urbanization plays an important role in individuals’ health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.Methods: Using the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.Results: Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR=1.19, 95% CI=1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR=0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.Conclusions: Planned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact on depressive symptoms from disadvantaged early life conditions, but it cannot completely eliminate the gap between urbanized rural people and urban non-migrants.