Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity
Abstract Background Little is known about the association between catastrophic health expenditure (CHE) and mental health in elderly population and its potential moderators. This study examined the relationship between CHE and depressive symptoms in Chinese older persons and its difference between g...
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BMC
2025-04-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05887-9 |
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| author | Siwei Sun Xuechun Wang Na Guo Peipei Li Ruoxi Ding Dawei Zhu |
| author_facet | Siwei Sun Xuechun Wang Na Guo Peipei Li Ruoxi Ding Dawei Zhu |
| author_sort | Siwei Sun |
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| description | Abstract Background Little is known about the association between catastrophic health expenditure (CHE) and mental health in elderly population and its potential moderators. This study examined the relationship between CHE and depressive symptoms in Chinese older persons and its difference between groups of different income level and social activity engagement. Methods We employed data from the 4 waves (2011, 2013, 2015, and 2018, N = 15,406) of the China Health and Retirement Longitudinal Study (CHARLS). A linear mixed model was used to examine the association between depressive symptoms and CHE, and interaction terms were involved in the model to examine the moderating role of social activity and income levels. Results Significant correlations have been shown between CHE and depressive symptoms(coefficient = 0.363, P < 0.05), such association was more pronounced in socially inactive (P = 0.034, Difference = 0.37, interaction terms (social activity*CHE: -1.189) or low-income seniors (P < 0.001, Difference = 0.77, interaction terms (medium income*CHE: -0.594, P < 0.05, high income*CHE: -0.667, P < 0.01), and especially in socially inactive and low-income seniors (P < 0.001, Difference = 0.93, interaction terms (high income*CHE*social acitivity: 1.132, P < 0.05). Even after increasing the threshold of CHE to 20% and 25%, similar pattern was observed. Conclusions This study suggest a positive association between CHE event and depressive symptoms, as well as the protective effect of advantaged financial status and engagement of social activity. Our finding provide empirical evidence to call for urgent action for government and public health authorities, to address the high medical expenditure, psychological stress among elderly, especially for low-income households or elderly living alone. |
| format | Article |
| id | doaj-art-5f5cd764b6ee4518a2c9cc20ea00a9a2 |
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| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj-art-5f5cd764b6ee4518a2c9cc20ea00a9a22025-08-20T02:17:13ZengBMCBMC Geriatrics1471-23182025-04-0125111110.1186/s12877-025-05887-9Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activitySiwei Sun0Xuechun Wang1Na Guo2Peipei Li3Ruoxi Ding4Dawei Zhu5Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital)Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital)China Population and Development Research CenterShandong Institute of Brain Science and Brain-inspired Research, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical SciencesPeking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital)Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking UniversityAbstract Background Little is known about the association between catastrophic health expenditure (CHE) and mental health in elderly population and its potential moderators. This study examined the relationship between CHE and depressive symptoms in Chinese older persons and its difference between groups of different income level and social activity engagement. Methods We employed data from the 4 waves (2011, 2013, 2015, and 2018, N = 15,406) of the China Health and Retirement Longitudinal Study (CHARLS). A linear mixed model was used to examine the association between depressive symptoms and CHE, and interaction terms were involved in the model to examine the moderating role of social activity and income levels. Results Significant correlations have been shown between CHE and depressive symptoms(coefficient = 0.363, P < 0.05), such association was more pronounced in socially inactive (P = 0.034, Difference = 0.37, interaction terms (social activity*CHE: -1.189) or low-income seniors (P < 0.001, Difference = 0.77, interaction terms (medium income*CHE: -0.594, P < 0.05, high income*CHE: -0.667, P < 0.01), and especially in socially inactive and low-income seniors (P < 0.001, Difference = 0.93, interaction terms (high income*CHE*social acitivity: 1.132, P < 0.05). Even after increasing the threshold of CHE to 20% and 25%, similar pattern was observed. Conclusions This study suggest a positive association between CHE event and depressive symptoms, as well as the protective effect of advantaged financial status and engagement of social activity. Our finding provide empirical evidence to call for urgent action for government and public health authorities, to address the high medical expenditure, psychological stress among elderly, especially for low-income households or elderly living alone.https://doi.org/10.1186/s12877-025-05887-9Depressive symptoms, catastrophic health expenditureIncomeLongitudinal studySocial activity |
| spellingShingle | Siwei Sun Xuechun Wang Na Guo Peipei Li Ruoxi Ding Dawei Zhu Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity BMC Geriatrics Depressive symptoms, catastrophic health expenditure Income Longitudinal study Social activity |
| title | Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity |
| title_full | Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity |
| title_fullStr | Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity |
| title_full_unstemmed | Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity |
| title_short | Association between catastrophic health expenditure and mental health among elderly in China: the potential role of income and social activity |
| title_sort | association between catastrophic health expenditure and mental health among elderly in china the potential role of income and social activity |
| topic | Depressive symptoms, catastrophic health expenditure Income Longitudinal study Social activity |
| url | https://doi.org/10.1186/s12877-025-05887-9 |
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