Association between social activity participation and rural-urban difference in depressive symptoms among middle-aged and older adults in China: a Fairlie decomposition analysis

BACKGROUND: Rural-urban difference in depressive symptoms is a manifestation of health inequality. This study aimed to analyze the association between offline and online activity participation and depressive symptoms among middle-aged and older adults in China and to measure the contribution of activity participation to the rural-urban gap. METHODS: Data was obtained from the China Health and Retirement Longitudinal Study (CHARLS, wave 5, 2020). In total, 14,592 participants (≥ 45 years old) were analyzed. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Offline activities were all binary variables, including social interaction, recreational activity, helpful activity, and leisure exercise. Online activities were all binary variables, including online chatting, watching news, watching videos, and playing games. Logistic regression was used to clarify the association between offline and online activity participation and depressive symptoms among middle-aged and older adults in urban and rural areas in China, and the Fairlie decomposition analysis was used to calculate the contribution of offline and online activity participation to the rural-urban gap in the prevalence of depressive symptoms. RESULTS: Rural residents had a higher prevalence of depressive symptoms than urban residents (42.25% and 29.66%, respectively). Logistic regression results showed that leisure exercise in offline activity (OR = 0.790, 95%CI: 0.636–0.981) was negatively associated with depressive symptoms among urban residents, and recreational activity in offline activity (OR = 0.825, 95%CI: 0.723–0.941) was negatively associated with depressive symptoms among rural residents. Online activities of watching news (ORurban=0.762, 95%CI: 0.635–0.915; ORrural=0.831, 95%CI: 0.713–0.969) and playing games (ORurban=0.627, 95%CI: 0.474–0.828; ORrural=0.681, 95%CI: 0.502–0.925) were negatively associated with depressive symptoms among both urban and rural residents. The Fairlie decomposition analysis showed that the total difference in the prevalence of depressive symptoms between rural and urban residents was 12.59%, of which 63.46% can be explained by some observed factors (offline activity participation: 2.79%, online activity participation: 12.68%, endowment insurance: 13.81%, monthly family expenditure: 12.25%, medical insurance: 10.46%, education level: 9.60%, and so on). The differences in offline and online activity participation accounted for 4.39% and 20.00% of the explained portion of the rural-urban gap in the prevalence of depressive symptoms, respectively. CONCLUSIONS: There was a significant rural-urban difference in depressive symptoms among middle-aged and older adults in China. Offline and online activities were significantly associated with lower depressive symptoms in both urban and rural residents, and contributed a relatively higher explanation to the rural-urban gap. Personalized interventions are needed to improve residents’ depressive symptoms, and more efforts are required to promote mental health equality in urban and rural areas.