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Urban-Rural Differences in the Longitudinal Relationship between Activity of Daily Living and Depression in Older Adults: Analysis of Multiple Group Parallel Process Latent Growth Model
Li Guangming, Yang Dong
Journal of Psychological Science ›› 2026, Vol. 49 ›› Issue (2) : 366-378.
PDF(1513 KB)
PDF(1513 KB)
Urban-Rural Differences in the Longitudinal Relationship between Activity of Daily Living and Depression in Older Adults: Analysis of Multiple Group Parallel Process Latent Growth Model
Depression and disability are two major health problems faced by older adults in China. Some studies have found that depression in older adults is associated with cognitive impairment and disability, and can significantly reduce their quality of life and increase suicidal tendencies and risk of death. However, there are some limitations in exploring the relationship between depression and activity of daily living (ADL) in older adults. First, there is a lack of vertical exploration of the relationship between depression and ADL. As the research data is cross-sectional, it is impossible to reveal the dynamic relationship between depression and ADL for their development in older adults. Second, there are few longitudinal studies exploring the relationship between body mass index (BMI) and depression in older adults. Third, there is less attention paid to the differences between urban older adults and rural older adults, as well as the interaction between gender and urban/rural. Fourth, there has been no research on the relationship between the depression and ADL for multiple-group parallel process latent growth model (MGPP-LGM), which appears insufficient.
In view of the lack of longitudinal relationship between the depression and ADL in urban-rural older adults in China, this study aimed to examine the urban-rural differences in the longitudinal relationship between the depression and ADL using the MGPP-LGM, which would help to specifically interfere with ADL and depression in older adults. Three-wave longitudinal data over 4 years (2011, 2013, 2015) were derived from the China Health and Retirement Longitudinal Study (CHARLS). This study had 5,757 participants, including 4,602 rural and 1,155 urban older adults aged 60 years old and above. The MGPP-LGM was used to gauge urban-rural differences in the longitudinal relationship between depression and ADL in older adults and to examine the effect of covariates. We also explored the effects of time-invariant (e.g., age, nationality, gender, and educational level) and time-varying covariates (e.g., body mass index and social activity participation) on the relationship between the depression and ADL.
The results are as follows. First, the ADL of older adults in urban and rural areas showed a significant linear decline over time. For older adults in urban and rural areas, their depression level showed a trend of "first decreasing and then increasing", and only rural older adults show a significant change trend, but the urban older adults had no significant change in depression. Secondly, under the condition of controlling covariates, there was a significant difference between the initial ADL and depression of urban-rural older adults. There was a significant positive correlation between the depression and ADL for urban-rural older adults. For older adults with impaired initial ADL, the initial depression level of rural older adults was higher than that of urban older adults, and the psychological health of rural older adults was more worthy of attention. Third, male, younger, and more educated rural older adults had better initial ADL, but there were no significant differences in the initial ADL of urban older adults in terms of gender, age, and education level. Male and older adults with relatively higher levels of education in urban and rural areas had lower initial levels of depression, but there was inconsistency in the "education level" that affects depression in older adults between urban area and rural area. Finally, social activity participation and BMI had a dynamic impact on the ADL and depression of older adults in urban and rural areas, with a greater impact on rural older adults than urban older adults. Participating in social activities can significantly reduce the level of depression in older adults. Maintaining suitable BMI in geriatric period can benefit their physical and mental health. In view of the backward economic development in rural areas in China, the intervention of the health status of rural older adults in the future needs particular attention.
older adults / depression / activities of daily living / multiple group parallel process latent growth model / urban-rural differences
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The China Health and Retirement Longitudinal Study (CHARLS) is a nationally representative longitudinal survey of persons in China 45 years of age or older and their spouses, including assessments of social, economic, and health circumstances of community-residents. CHARLS examines health and economic adjustments to rapid ageing of the population in China. The national baseline survey for the study was conducted between June 2011 and March 2012 and involved 17 708 respondents. CHARLS respondents are followed every 2 years, using a face-to-face computer-assisted personal interview (CAPI). Physical measurements are made at every 2-year follow-up, and blood sample collection is done once in every two follow-up periods. A pilot survey for CHARLS was conducted in two provinces of China in 2008, on 2685 individuals, who were resurveyed in 2012. To ensure the adoption of best practices and international comparability of results, CHARLS was harmonized with leading international research studies in the Health and Retirement Study (HRS) model. Requests for collaborations should be directed to Dr Yaohui Zhao (yhzhao@nsd.edu.cn). All data in CHARLS are maintained at the National School of Development of Peking University and will be accessible to researchers around the world at the study website. The 2008 pilot data for CHARLS are available at: http://charls.ccer.edu.cn/charls/. National baseline data for the study are expected to be released in January 2013.
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