Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study.

Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities (contribution -22.9%). Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.

Yuan L ，Jiang Q ，Liu Y ，Liu Y ，Du M ，Sun J ，Li M ... -  《JMIR Public Health and Surveillance》

Decomposition and comparative analysis of differences in depressive symptoms between urban and rural older adults: Evidence from a national survey.

Yuan L ，Xu Q ，Gui J ，Liu Y ，Lin F ，Zhao Z ，Sun J ... -  《-》

The prevalence of depressive symptoms and associated factors in countryside-dwelling older Chinese patients with hypertension.

To estimate the prevalence of depressive symptoms in older people with hypertension in rural areas of China and to clarify the predictors influencing depressive symptoms in these patients. Although many studies have described the prevalence of depressive symptoms in older people, these studies mainly focused on those in urban areas. Few studies explicitly clarify the depressive symptoms of older patients with hypertension in rural China. A cross-sectional design was adopted for the study. A convenience sampling method was used to recruit the participants. The data were collected by questionnaire survey from the medical outpatient department of five rural township hospitals in Jinzhong City of Shanxi Province, northern China. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-D, social support by the Social Support Rating Scale and activities of daily living by the Barthel Index. Nine hundred forty-two rural older people with hypertension participated in the study. Of those, 560 patients (59.4%) had no depressive symptoms and 382 (40.6%) had depressive symptoms. The total mean scores of Center for Epidemiologic Studies Depression Scale-D for the normal group were 8.45 ± 6.47, and 14.18 ± 5.91 for the group with depressive symptoms; the statistical difference was observed by comparing the mean scores of Center for Epidemiologic Studies Depression Scale-D between the two groups (t = 2.18, p = .027). The binary logistic regression showed that the presence of depressive symptoms for older rural participants with hypertension was associated with the following factors: female (odds ratio [OR] = 1.19, 95% CI 1.10-1.37), unmarried status (OR = 1.36, 95% CI 1.19-1.65), low household income (OR = 0.80, 95% CI 0.74-0.93), living alone (OR = 1.76, 95% CI 1.45-1.90), the presence of hypertension complications and comorbid chronic diseases (OR = 0.63, 95% CI 0.42-0.74; OR = 0.55, 95% CI 0.41-0.69), dependent activities of daily living status (OR = 1.47, 95% CI 1.36-1.64) and low social support (OR = 1.66, 95% CI 1.57-1.89). Depressive symptoms are common among older people with hypertension in rural China. The older patients with hypertension who are liable to have depressive symptoms warrant close attention from medical institutions and governments. The study explores the potential factors related to depressive symptoms, understanding of which can contribute to the development of effective measures to ameliorate depressive symptoms and improve the healthcare outcomes for rural older people with hypertension.

Ma C 《-》

Physical function, ADL, and depressive symptoms in Chinese elderly: Evidence from the CHARLS.

Depressive symptoms are a serious public health problem that affects the mental health of older adults. However, current knowledge of the association between ADL disability and physical dysfunction and depressive symptoms in Chinese adults is insufficient. We intend to analyze the association between physical function, ADL, and depressive symptoms in older Chinese adults. The data obtained from the China Health and Retirement Longitudinal Survey (2015 and 2018) (CHARLS). This includes 3,431 in 2015 and 3,258 in 2018 over the age of 60. Comparing 2015 and 2018 data, multivariate logistic regression models were used to explore the relationship between physical function, ADL, and depressive symptoms in urban and rural older adults, adjusting for sociodemographic factors associated with depression in older adults. The prevalence of depressive symptoms among older adults in China was 33.8 percent in 2015 and 50.6 percent in 2018. In baseline data from 2015 and 2018, residence, gender, marital status, drinking, physical function, ADL, and self-rated health were all found to be significantly associated with depressive symptoms in older adults. The differences in physical function, ADL and depressive symptoms among older adults in 2015 and 2018 were further analyzed based on urban and rural stratification. Both physical dysfunction and ADL disability were significantly associated with depressive symptoms in rural older adults in 2015 and 2018. And in urban areas, ADL was found to be significantly associated with depressive symptoms in urban older adults. Multivariate logistic regression analysis demonstrated that ADL disability was significantly associated with depressive symptoms among older adults in both urban and rural areas. Physical dysfunction was only significant in rural areas with depressive symptoms. The alpha level was instead set to 0.05 for all statistical tests. Rural, female, 60-70 years of age, primary school or below, married, non-smoking, non-drinking, physical dysfunction, ADL disability and self-rated poor health make-up a higher proportion of depressed older adults. ADL disability and physical dysfunction were more likely to be associated with depressive symptoms in rural Chinese older adults. Therefore, the physical and mental health of rural elderly should be of concern. The rural older adults should receive additional support from the government and society.

Yan Y ，Du Y ，Li X ，Ping W ，Chang Y ... -  《Frontiers in Public Health》

Decomposition analysis of the difference in depressive symptoms between urban and rural employed people in China: Unpaid work plays an important role.

Jiang Q ，Zhao Z ，Liu Y ，Wei Z ，Bing Y ，Zhang F ，Liu J ，Gao L ，Sun J ，Yuan L ... -  《-》