The Association between Urbanization and Depression among the Middle-Aged and Elderly: A Longitudinal Study in China

Abstract

Urbanization has been and will continue to be the mainstream trend of global population movement, including China. Depression is the most common mental disorders and the leading factor of disabilities. However, the impacts of urbanization on the depression occurrence are still unclear. This paper analyzed the data from 3 waves of the China Health and Retirement Longitudinal Study (CHARLS) with sample size as 8510 adults representing the middle aged and elderly group in China. Depression was identified and measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Urbanization level was measured by population density, GDP per capita and secondary/tertiary industry as percentage to GDP in the China City Statistical Yearbook. The fixed effect regression model was used to explore the association between the changes of urbanization and depression. As result, depression is closely related to the urbanization, protective effects are found for 3 indicators above: The depression prevalence decreases while urbanization level increases (from lowest urbanization level to the highest: P < 0.01). Among the 10 depression symptoms, “Bothered”, “Reduced energy leading to diminished activity” and “Hopelessness” are the most significantly improved with urbanization. The impact of urbanization on residents’ mental health is a long-term, multi-factor interaction. Therefore we need to fully consider all possible influencing factors, and longer follow-up study to verify.

Social support and depressive symptoms among physicians in tertiary hospitals in China: a cross-sectional study

“…In the present study, the prevalence of depressive symptoms among physicians was 42.2% (male: 40.1%; female: 44.8%), which was higher than the Chinese general population (12.6%) [ 30 ]. Using the same measurement of depressive symptoms as in our study, the prevalence of depressive symptoms was 33.08% among older adults [ 31 ] and was 28.1% among adolescents [ 32 ] in China. Despite the differences in participants’ age, gender, and place of residence, when compared to the Chinese general population, our results showed that the prevalence of depressive symptoms among physicians in tertiary hospitals is significantly higher.…”

Comparison of Depressive Symptoms and Its Influencing Factors among the Elderly in Urban and Rural Areas: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

“…In the second stage, three communities (rural administrative villages or urban resident committees) were randomly chose using the PPS method from a sampling frame containing all communities in the county-level units. In the third stage, to create a sampling frame, using the software developed by the CHARLS team which utilized Google Earth map images, all dwelling units in a community were listed following an extensive mapping and listing operation, and then a certain number of dwelling units were randomly chose [ 39 , 40 , 41 , 42 , 43 ]. All data collected in CHARLS are maintained by the Institute of Social Science Survey of Peking University and have been publicly released on the CHARLS website ( , accessed on 28 December 2020).…”

“…Gan et al’s study (1075 elderly people aged 65 years and over) indicated that the prevalence rate of the urban elderly (23.5%) was lower than that of the rural elderly (31.9%) [ 38 ]. He and Zhao et al studied the association of Chinese drifting elderly intergeneration support satisfaction with expectation in Shanghai, China, and found that the urban and rural elderly have received different intergenerational support which had a very important impact on depression, especially for the drifting elderly [ 39 , 40 , 41 ].…”

Prevalence of Major Depressive Disorder Among Adults in China: A Systematic Review and Meta-Analysis

“…This is consistent with results from the previous meta-analysis of MDD prevalence in China (point prevalence: 2.0% [95% CI: 1.2–2.9%] in rural areas, and 1.7% [95% CI: 0.8–2.7%] in urban areas) ( 20 ). Epidemiological studies have consistently found that urbanization level is negatively associated with the risk of depression ( 80 , 81 ). However, some studies in other countries such as in the United States ( 82 ), Canada ( 83 ), the Netherlands ( 84 ), and Malaysia ( 85 ) found that urban residents had a higher risk developing depression compared to their rural counterparts.…”