Association among multimorbidity, physical disability and depression trajectories: a study of urban–rural differences in China

Abstract

Purpose The purpose of this study was to analyse the trajectories of depression in urban and rural areas, and to analyse the relationship among multimorbidity, disability and other variables and trajectories. Methods Data from the China Health and Retirement Longitudinal Study were used. A latent class growth model was used to characterise the trajectories of urban and rural depression symptoms. Chi-square test was used to test the differences in respondents’ characteristics among depression trajectories groups within urban and rural areas. The relationships among multimorbidity, disability and depression symptom trajectories were analysed via multinomial logistic regression. Results Urban and rural depression trajectories were divided into three categories. Respondents in urban areas were divided into rising, remaining-low and declining group, and those in rural areas were divided into rising, remaining-low and remaining-high group. The depression scores of respondents with multimorbidity were more likely to rise, and this result was similar for the disabled respondents. Respondents who need help on activities of daily living and instrumental activities of daily living in urban areas were more likely to decline in depression scores. In rural areas, however, the values were consistently high. In urban and rural areas, the relationships among marital status, education and age and depression trajectories were different. Conclusions The depression trajectories are different in urban and rural China. Improving the quality of medical services, promoting the distribution of rural social resources and implementing more recreational activities could be beneficial for the promotion of mental health in rural areas.

Impact of Multimorbidity on Symptoms of Depression, Anxiety, and Stress in Older Adults: Is There a Sex Difference?

“…Results from a longitudinal study have confirmed that multimorbidity increases the risk of mental health disorders among older individuals compared to those without a chronic disease ( Yan et al, 2021 ). Multiple linear regression analysis also showed that multimorbidity was positively associated with depression, anxiety, and stress symptoms in the current study.…”

Urban–Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

“…There are many family tragedies in the vast rural areas of China, particularly, in the economically underdeveloped regions, where older adults commit suicide, indicating the poor situation of older adults in rural areas (16). In 2018, the per capita disposable income of urban residents in China was CNY 39,251, and that of rural residents was CNY 14,617, which is a large gap (17). In addition, another study has documented the trends and gaps in health disparities between urban and rural areas (18).…”

Social Engagement and Urban–Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients

“…While urban residents showed better medication use (44)(45)(46), they were less likely to avoid tobacco and alcohol use. We attribute these differences to China's household registration system that was formally established in 1958, that is, the urban-rural segmentation has led to unfair distributions of resources (e.g., healthcare and cultural or educational resources) and different social relationships as well (4,5). While urban residents may benefit from better access to social welfare, healthcare, institutional social support, and medical information (4,47), rural residents benefit more from stronger social cohesion and close acquaintance networks.…”

“…The reduced disparity may also be the result of effective welfare policy (e.g., the communitybased hypertension management service of China's Equalization of Basic Public Health Services policy in 2009, new urbanization in 2014, and the rural revitalization strategy in 2017). Urban areas today have more voluntary or informal organizations than ever before to increase residents' participation in positive and beneficial social activities (5), including volunteering, to better connect with their community (2). Consequently, Chinese middle-aged and older urban residents tend to have more diverse and higher rates of social engagements than their rural counterparts (6); the influence of this resource to help patients adhere to self-monitoring, physical activity, and alcohol avoidance works in a similar fashion to the influence of close kinship and acquaintance networks in rural areas (2).…”

“…Intrinsically, self-management recognizes and seeks to foster patients' daily responsibility to maintain their wellbeing, by supporting from internal (e.g., family or friend support) and community resources (3). But, owing to the differences between China's urban and rural economic development and the household registration system design, there are wide variations in people's access to life opportunities and social service resources (e.g., healthcare and education) (4,5). This longstanding urbanrural disparity seems to mean that rural residents are less able to obtain valuable healthcare resources (e.g., correct health information and diversified healthcare services) to improve and maintain their self-management behaviors compared with urban residents (6).…”