title: Social Engagement and Depressive Symptoms among the Elderly in China: A Mixed-method Research
Creators: name: Li, Jining
Publisher: name: University of Liverpool Repository
Year: 2030

description: Background: As China transitions into an aging society, depression poses a significant burden on both the elderly population and the healthcare system in China. Existing research indicates that social engagement is potentially an important protective factor for depression. Social engagement may help to combat feelings of loneliness, create an elderly friendly environment, and promote healthy aging. Nevertheless, the extent to which social engagement mitigates depression or mediates socioeconomic mental health inequalities among the Chinese elderly remains unclear. By employing both quantitative and qualitative methodologies, this thesis aims to investigate the relationship between social engagement and depressive symptoms among the elderly in China.

Methods: I undertook evidence synthesis, novel analyses of existing representative secondary data from China, along with semi-structured interviews, to investigate the effect of social engagement on depression. The first study presents a systematic review that explores empirical evidence on the socio-economic risk factors of depression among the elderly in China. Using the Chinese Health and Retirement Longitudinal Study, the second study investigates the relationship between social engagement and depressive symptoms, as well as how social engagement mediates the effects of social class on depressive symptoms among Chinese elderly. The third study uses thematic analysis of semi-structured interviews to represent the lived experience of aging among China's urban population, capturing the elderly’s perceptions of social engagement as well as the opportunities and barriers to practicing it.

Results: Higher socioeconomic status, higher educational status, better financial status, better housing conditions, active social engagement, more social support and better neighbourhood conditions are generally associated with a lower risk of depression among the elderly in China. Higher frequencies of social engagement are associated with decreased risk of depression within the Chinese elderly population. Specifically, respondents engaged in social activities almost daily were 15% less likely to develop depression than those never engaged in social activities. However, I did not observe strong evidence of social engagement mediating the relationship between social class and depression. The thematic analysis revealed a range of factors that facilitate or hinder social engagement. The facilitating factors include financial security, availability of free time, heightened health awareness, as well as the existence of organized recreational activities, community amenities, and a well-developed urban infrastructure. The barriers to social engagement include physical limitations, pre-existing health conditions, shrinking social networks, formal and informal constraints such as institutional ageism and low digital literacy.

Conclusion: This thesis contributes valuable insights to examine the possible causal relationship between social engagement and depression. However, there is no clear evidence of social engagement mediating between social class and depression. Moreover, this thesis presents the lived experience of social engagement among the Chinese elderly, revealing their capacity to mitigate negative psychological states and pursuit of healthy aging through social engagement. These findings may provide much needed evidence for the development of targeted interventions and policies for the elderly population, to enhance healthy aging by promoting social engagement as a preventive measure against depression. Interventions aimed at promoting social engagement may play a pivotal role in reducing depression among the elderly. However, to maximize the effectiveness, these interventions need to address the barriers and make use of facilitators identified in my qualitative work, such as providing accessible community resources, organizing recreational activities, and creating meaningful social connections, with additional support for elderly who have physical limitations. To effectively address health inequalities in mental health among the elderly, it is likely to require interventions more than encouraging social engagement, for example, measures to mitigate the underlying socioeconomic inequalities.