Family economic disparities and the onset of depressive symptoms among middle-aged and elderly residents in urban and rural areas: A cross-sectional study based on CHARLS

Background: Comparisons in family economic differences and the risk of depression among middle-aged and older individuals in China have not been well investigated. Methods: This cross-sectional study included 10,884 participants aged 45 or older from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS) in 2020, with 73.56% aged 45-64 and 26.44% aged ≥65. We measured depressive symptoms using the 10-item Centre for Epidemiologic Studies Depression Scale (CES-D-10) with a cut-off score ≥ 10. Family economic status was estimated using family consumption per capita monthly. Log-binomial models with relative risks (RR) and 95% confidence intervals were used to estimate the relationship between family economic situation and depressive symptoms. Two-way interaction analyses provide insights into the associations between levels of consumption expenditure per capita with covariates and depression in both urban and rural households. Results: The prevalence of depression was higher in rural areas (42.74%) compared to urban areas (35.36%, P < 0.001). Significant differences were found in various factors between urban and rural areas, including monthly family consumption per capita, marital status, education level, chronic disease, age, self-reported health, satisfaction with children, social activities, and cigarette smoking (all P < 0.05). High household consumption per capita (Top 20%) was associated with depressive symptoms in both urban (aRR = 1.295, 95% CI: 1.091-1.538) and rural areas (aRR = 1.226, 95% CI: 1.127-1.335). Having a chronic disease increased the risk of depression in both urban and rural areas regardless of household consumption per capita. In urban areas, marital status and education level influenced the risk of depression, while in rural areas, health status, child satisfaction, and social activity were influential factors. Conclusions: Association between excessive consumption and depression in urban and rural areas. Healthcare and relevant support organizations in China should emphasize the importance of family economic status in depression among middle-aged and older adults in both urban and rural areas, and offer treatment and preventative strategies to all families.