Digital Exclusion and Depressive Symptoms among Older People: Findings from Five Aging Cohort Studies across 24 Countries.

Abstract

Background: Digital exclusion is a global issue that disproportionately affects older individuals especially in low- and middle-income nations. However, there is a wide gap in current research regarding the impact of digital exclusion on the mental health of older adults in both high-income and low- and middle-income countries. Methods: We analyzed data from 5 longitudinal cohorts: the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). These cohorts consisted of nationwide samples from 24 countries. Digital exclusion was defined as the self-reported lack of access to the internet. Depressive symptoms were assessed using comparable scales across all cohorts. We used generalized estimating equation models, fitting a Poisson model, to investigate the association between the digital exclusion and depressive symptoms. We adjusted for the causal directed acyclic graph (DAG) minimal sufficient adjustment set (MSAS), which includes gender, age, retirement status, education, household wealth, social activities, and weekly contact with their children. Results: During the study period (2010-2018), 122,242 participants underwent up to 5 rounds of follow-up. Digital exclusion varied greatly across countries, ranging from 21.1% in Denmark to 96.9% in China. The crude model revealed a significant association between digital exclusion and depressive symptoms. This association remained statistically significant in the MSAS-adjusted model across all cohorts: HRS [incidence rate ratio (IRR), 1.37; 95% confidence interval (CI), 1.28 to 1.47], ELSA (IRR, 1.32; 95% CI, 1.23 to 1.41), SHARE (IRR, 1.30; 95% CI, 1.27 to 1.33), CHARLS (IRR, 1.62; 95% CI, 1.38 to 1.91), and MHAS (IRR, 1.31; 95% CI, 1.26 to 1.37); all Ps < 0.001. Notably, this association was consistently stronger in individuals living in lower wealth quintile households across all 5 cohorts and among those who do not regularly interact with their children, except for ELSA. Conclusions: Digital exclusion is globally widespread among older adults. Older individuals who are digitally excluded are at a higher risk of developing depressive symptoms, particularly those with limited communication with their offspring and individuals living in lower wealth quintile households. Prioritizing the provision of internet access to older populations may help reduce the risks of depression symptoms, especially among vulnerable groups with limited familial support and with lower income.