Macro-level socioeconomic factors and mental health in midlife and older adults in China: a multilevel analysis

Objective: This study explores the associations between four macro-level factors-Economic Development (ED), Economic Inequality (EI), Governmental Willingness and capacities to invest in Public Health (GWPH) and Public Health-Related Infrastructures (PHRI)-and three mental health indicators: depressive symptoms, cognitive function and life satisfaction, among middle-aged and older adults in China.

Materials and methods: We obtained individual-level data from the Harmonised China Health and Retirement Longitudinal Survey (H-CHARLS) 2018 and acquired our provincial-level data from the Chinese Statistical Yearbook. Two-level linear mixed models are used to examine the associations. Supplementary analyses are carried out to test the robustness of the study.

Results: There are provincial variations in macro-level factors. Depressive symptoms and cognitive functions also vary across provinces, whereas life satisfaction does not. We find that ED contributes to better depressive status. EI contributes to worse cognitive functions and life dissatisfaction. GWPH and PHRI are not associated with mental health.

Conclusion: The study suggests that macro-level ED contributes to better depressive status. EI and potential systematic inequality lead to worsened cognitive functions and life dissatisfaction. It is too soon to generalise whether institutional factors like GWPH and PHRI are good or bad for mental health, but the current public health system in China does not adequately support mental and cognitive health.