Association between urbanicity and depressive symptoms among Chinese middle-aged and older adults

Yanhua Chen, Peicheng Wang, Qiaoyuan He, Jiming Zhu, Mika Kivimaki, Gill Livingston, Andrew Sommerlad
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Abstract

Background: Depression is a pressing public health issue and may be affected by multifaceted urban living, yet the specific urbanicity elements associated is unclear. Using a multidimensional urbanicity scale, we explored the association between urbanicity and its components with the risk of depressive symptoms. Methods: This study used data from four waves of the China Health and Retirement Longitudinal Study, including 12,515 participants aged ≥45 years at baseline in 2011 in 450 rural and urban communities, and 8,766 with 7 years of follow-up. Multilevel logistics regression and Cox proportional hazards regression models examined the cross-sectional and longitudinal associations between urbanicity and depressive symptoms. Results: Living in areas with the highest tertile of urbanicity was associated with a 61% lower risk of depressive symptoms cross-sectionally (odds ratio (OR): 0.39, 95% confidence interval (CI): 0.30-0.50) and 33% lower risk longitudinally (hazard ratio (HR): 0.67, 95% CI: 0.58-0.77) compared to those living in areas with the lowest tertile of urbanicity. Among components, higher population density (OR: 0.92, 95% CI: 0.87-0.97), better education (OR: 0.94, 95% CI: 0.89-0.99), transportation (OR: 0.95, 95% CI: 0.92-0.98), sanitation (OR: 0.96, 95% CI: 0.93-0.98) was associated with lower odds of depressive symptoms, while greater population educational and socioeconomic diversity (OR, 1.08; 95% CI, 1.03-1.13) had opposite effect. Better economic conditions (HR: 0.94, 95% CI: 0.90-0.98) and availability of social services (HR, 0.96; 95% CI, 0.93-0.99) were longitudinally associated with reduced risk of developing depressive symptoms during 7 years of follow-up. Additionally, differences in associated components were found between urban and rural residents and between midlife and older adults. Conclusions: Our findings underscore the complex links of urban living with depressive symptoms among middle-aged and older adults, highlighting the need to consider a multidimensional urbanicity perspective to understand the urbanicity-mental health nexus. Tailored urban planning policies should consider the associated urbanicity components, along with temporal effectiveness, urban-rural disparities, and age group differences.
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城市化与中国中老年人抑郁症状之间的关系
背景:抑郁症是一个紧迫的公共卫生问题,可能会受到城市生活多方面的影响,但与之相关的具体城市化要素尚不清楚。我们使用多维城市化量表,探讨了城市化及其组成部分与抑郁症状风险之间的关系:本研究使用了中国健康与退休纵向研究的四次波次数据,包括 2011 年在 450 个农村和城市社区基线年龄≥45 岁的 12,515 名参与者,以及随访 7 年的 8,766 名参与者。多层次物流回归和考克斯比例危险回归模型检验了城市化与抑郁症状之间的横截面和纵向关系:结果显示:与城市化程度最低的地区相比,生活在城市化程度最高的地区的人出现抑郁症状的风险横向降低了 61%(几率比 (OR):0.39,95% 置信区间 (CI):0.30-0.50),纵向降低了 33%(危险比 (HR):0.67,95% 置信区间 (CI):0.58-0.77)。在各组成部分中,较高的人口密度(OR:0.92,95% CI:0.87-0.97)、较好的教育(OR:0.94,95% CI:0.89-0.99)、交通(OR:0.95,95% CI:0.92-0.98)、卫生设施(OR:0.96,95% CI:0.93-0.98)与较低的抑郁症状几率相关,而较高的人口教育和社会经济多样性(OR,1.08;95% CI,1.03-1.13)则具有相反的效果。较好的经济条件(HR:0.94;95% CI:0.90-0.98)和社会服务的可用性(HR:0.96;95% CI:0.93-0.99)与 7 年随访期间抑郁症状发生风险的降低纵向相关。此外,城市居民和农村居民之间以及中年人和老年人之间的相关因素也存在差异:我们的研究结果强调了城市生活与中老年人抑郁症状之间的复杂联系,突出了从多维城市化角度来理解城市化与心理健康关系的必要性。有针对性的城市规划政策应考虑相关的城市性因素,以及时间有效性、城乡差异和年龄组差异。
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