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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 230-238. doi: 10.19723/j.issn.1671-167X.2024.02.005

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Sequential mediating role of digital participation and health lifestyle in the relationship between socioeconomic status and depression of older adults

Huameng TANG1,Dianqi YUAN1,Mingxing WANG1,Hanbing YANG1,Chao GUO1,2,*()   

  1. 1. Institute of Population Research, Peking University, Beijing 100871, China
    2. APEC Health Science Academy (HeSAY), Peking University, Beijing 100871, China
  • Received:2023-06-21 Online:2024-04-18 Published:2024-04-10
  • Contact: Chao GUO E-mail:chaoguo@pku.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82103955);the Fundamental Research Funds for the Central Universities: Peking University Clinical Medicine Plus X-Young Scholars Project(7100604313)

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Abstract:

Objective: To explore the potential mechanisms of the relationship between socioeconomic status (SES) and depression of Chinese older adults through the mediating role of digital participation and health lifestyle. Methods: Using the nationally representative data from the China Family Panel Studies in 2020, 4 846 participants aged 60 years and older were analyzed in our study. We explored the potential mechanisms of the relationship between SES and depression of Chinese older adults in the digital era through a chain multiple mediating effects model. The KHB (The Karlson, Holm, and Breen) method was used to analyze the mediating role of digital participation and health lifestyle and the proportion of mediating effect between the two was also calculated. A series of robustness tests were further conducted and the fit of the model was checked by structural equation modeling. Results: The mean age of the 4 846 older adults included in this study was (68.20±5.07) years, 48.06% of whom were female and 51.94% were male. The KHB results showed that both digital participation and health lifestyle could mediate the relationship between SES and depression of older adults (P < 0.000 1) and the mediating role of health lifestyle accounted for a greater proportion than digital participation. And our study mainly found three potential pathways of SES and depression of older adults, including: (1) SES → digital participation → health lifestyle → depression, (2) SES → health lifestyle → depression, and (3) SES → depression. Structural equation modeling tests proved the overall fit of the model in this study. Conclusion: Our findings showed that in the digital age, in addition to the direct relationship between SES and depression of older adults, and the health lifestyle as a mediator between the relationship, there is also a sequential mediating role of digital participation and health lifestyle to reduce the risk of depression. The findings suggest that we should pay more attention to the probability of the digital divide exacerbating health inequalities and socioeconomic inequalities accumulation in the digital age and promote the co-progress of digital literacy and health literacy among older adults.

Key words: Sequential mediating effects, Depression, Aged, Health lifestyle, Digital divide

CLC Number: 

  • R749.4

Figure 1

Flowchart of samples"

Table 1

Conceptual basis of health lifestyles"

Health-related behaviors Questions from CFPS Healthy lifestyle factors③
Smoking Have you smoked in the past month? No smoking
Drinking Have you been drinking more than 3 times a week for the past month? Drinking less than 3 times a week
Sleeping How many minutes do you usually sleep for a nap?In general, how many hours of sleep per day, excluding the nap? (If divided into weekdays and rest-days, the average is calculated based on two rest-days a week) Sleep duration (including nighttime and nap) of more than 5 h and less than 10 h per day①
Exercising How often did you exercise in the past 12 months? (2020) Exercise more than 3 times a week②
Diet Whether consuming protein in the past week?Whether consuming fruits and vegetables in the past week? Dietary structure with protein and vitamins

Figure 2

The potential mechanisms of the relationship between SES and depression of Chinese older adults SES, socioeconomic status; X, the independent variable “social economic status”; Y, the dependent variable “depression status”; M1, the mediating variable “digital participation”; M2, the mediating variable “health lifestyle”; a1, a2, a3, b1, and b2, relationship between variables."

Table 2

Sociodemographic and health-related characteristics of older adults"

CharacteristicDigital participation (n=4 846)P value
No (n=3 756) Yes (n=1 090)
Covariates, n (%)
  Age group
    Aged 60 to 74 years 3 085 (82.14) 1 022 (93.76) < 0.000 1
    Aged 75 years and above 671 (17.86) 68 (6.24)
  Gender
    Female 1 869 (49.76) 460 (42.20) < 0.000 1
    Male 1 887 (50.24) 630 (57.80)
  Marriage status
    Not in marriage 672 (17.89) 135 (12.39) < 0.000 1
    In marriage 3 084 (82.11) 955 (87.61)
  Employment
    Employed 2 067 (55.03) 412 (37.80) 0.000 1
    Not 1 689 (44.97) 678 (62.20)
  Chronic disease
    No 2 636 (70.18) 765 (70.18) 0.999
    Yes 1 120 (29.82) 325 (29.82)
  Self-rated health
    Not good 1 690 (44.99) 373 (34.22) < 0.000 1
    Good 2 066 (55.01) 717 (65.78)
Independent variables
  Income, $\bar x \pm s$
    ln(In+1) 6.69±3.68 8.50±3.68 < 0.000 1
  Education, n (%)
    Primary school and below 2 470 (65.76) 245 (22.48) < 0.000 1
    Above primary school 1 286 (34.24) 845 (77.52)
  Living areas, n (%)
    Rural 2 111 (56.20) 306 (28.07) < 0.000 1
    Urban 1 645 (43.80) 784 (71.93)
Dependent variables, n (%)
    Depression 783 (20.85) 135 (12.39) < 0.000 1
    Healthy 2 973 (79.15) 955 (87.61)
Health lifestyle*
    Level, $\bar x \pm s$ 3.36±1.00 3.82±0.99 < 0.000 1

Table 3

Mediating role of digital participation and health lifestyle between SES and depression (regression analysis)"

ItemsDigital participation Health lifestyle Depression
OR 95%CI β 95%CI OR① 95%CI① OR② 95%CI②
SES
  Income 1.08*** 1.06-1.10 0.02*** 0.01-0.28 0.96*** 0.94-0.98 0.96*** 0.94-0.98
  Education 4.53*** 3.80-5.41 0.21*** 0.15-0.27 0.80* 0.67-0.96 0.89 0.74-1.07
  Living areas 2.06*** 1.73-2.46 0.26*** 0.20-0.31 0.64*** 0.55-0.76 0.70*** 0.59-0.83
Intermediary variables
  Digital participation 0.26*** 0.19-0.32 0.84 0.67-1.05
  Health lifestyle 0.77*** 0.70-0.83

Table 4

Mediating role of digital participation and health lifestyle between SES and depression (KHB)"

ItemsM1+M2 M1 M2
Income Education Living areas Income Education Living areas Income Education Living areas
Total effect 0.956*** 0.796* 0.639*** 0.956*** 0.799* 0.642*** 0.957*** 0.798* 0.641***
Direct effect 0.964*** 0.892 0.701*** 0.959*** 0.845 0.658*** 0.963*** 0.859 0.692***
Indirect effect 0.992*** 0.892*** 0.911*** 0.997* 0.945* 0.976* 0.994*** 0.929*** 0.926***
Mediation proportion/% M1: 4.40M2: 13.95 M1: 18.24M2: 31.73 M1: 4.04M2: 16.71 5.95 25.01 5.51 14.46 32.75 17.22

Figure 3

The mechanisms of the relationship between socioeconomic status and depression of Chinese older adults in the digital age"

Table 5

Mediating role of digital participation and health lifestyle between SES and depression: Robustness test (KHB)"

ItemsM1+M2 M1 M2
Income Education Living areas Income Education Living areas Income Education Living areas
Total effect 0.956*** 0.801* 0.640*** 0.956*** 0.799* 0.642*** 0.956*** 0.803* 0.642***
Direct effect 0.961*** 0.865 0.668*** 0.959*** 0.843 0.657*** 0.959*** 0.826* 0.657***
Indirect effect 0.995** 0.927** 0.957*** 0.997* 0.948* 0.977* 0.997* 0.972*** 0.977**
Mediation proportion/% M1: 5.37M2: 5.03 M1: 12.51M2: 21.98 M1: 4.72M2: 5.09 5.59 24.01 5.27 5.57 12.88 5.24

Table 6

Mediating role of digital participation and health lifestyle between SES and depression: Robustness test (SEM)"

ItemsDigital participation Health lifestyle Depression
β 95%CI β 95%CI β 95%CI
SES
  Income 0.047*** 0.019 to 0.075 0.088*** 0.061 to 0.114 -0.066*** -0.093 to -0.038
  Education 0.200*** 0.171 to 0.230 0.134*** 0.105 to 0.163 -0.029 -0.059 to 0.001
  Living areas 0.027 -0.003 to 0.057 0.139*** 0.111 to 0.167 -0.094*** -0.122 to -0.065
Intermediary variables
  Digital participation 0.059*** 0.032 to 0.086 0.017 -0.010 to 0.044
  Health lifestyle -0.113*** -0.141 to -0.085
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