Prevalence and risk factors of depression in middle-aged and older adults in urban and rural areas in China: a cross-sectional study

BackgroundDespite substantial progress in the understanding of depression among middle-aged and older adults (aged 45 years or older), few data have been documented comparing rural and urban differentials in terms of prevalence and risk factors of depression. In this study, we aimed to investigate the prevalence and risk factors of depression among middle-aged and older people living in urban and rural areas of China.MethodsWe used data from the China Health and Retirement Longitudinal Study. We extracted community-level data from 2011 and individual-level data for depression status and other related variables, such as depressive risk factors, from 2015. We measured depression using the ten-item Center for Epidemiologic Studies-Depression Scale (CES-D), of which Cronbach's α reached 0·815. Participants who received a score of 10 or more were considered to be depressed. We used a multilevel logistic model in which participants were at level 1 and communities were at level 2. Variables at participant level included age (years), sleep duration (hours), instrumental activities of daily living (IADL), number of children, sex, smoking, drinking, living with spouse, education, area, disability, and chronic diseases. Variables at community level included having an activity centre in the community and pollution levels near the community.FindingsData for 450 communities and 13617 individuals were included, of whom 3295 lived in urban areas and 10322 lived in rural areas. The prevalence of depression was 670 (20·3%) of 3295 individuals in urban areas and 3281 (31·8%) of 10322 individuals in rural areas (p<0·05). For urban and rural middle-aged and older people, significant risk factors for depression (p<0·05) were being female, younger age, shorter sleeping time, higher IADL score, lower level of education, living in central or western China, physical disability, and having chronic diseases. For rural middle-aged and older people, having more children, smoking, not living with their spouses, and lack of community activity centres were significant risk factors (p<0·05).InterpretationThe prevalence of depression in middle-aged and older people differed, as did the factors related to depression in urban and rural older adults. These findings suggest that interventions for depression in middle-aged and older people should consider differences between urban and rural environments. Particular attention should also be given to the development of community activity centres for middle-aged and older adults, especially in rural areas.FundingNone.