Functional disability, including basic activities of daily living (BADL) and instrumental activities of daily living (IADL), is associated with depressive symptoms in older adults. This study aimed to examine the functional disability and urban-rural differences in depressive symptoms among older adults in China, thereby providing empirical evidence for policies that promote mental health equity across urban and rural areas. The data for this study was derived from the China Health and Retirement Longitudinal Survey 2020. Following the exclusion of participants under 60 years old or with missing data, 9,241 older adults were included in the analysis. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to measure depressive symptoms in older adults (scores ranging from 0 to 30). Bivariate analyses were used to examine characteristic differences between urban and rural older adults. Multivariate linear regression models were employed to analyze the association between functional disability and depressive symptoms among urban and rural older adults. The linear Oaxaca-Blinder decomposition was used to quantify the contribution of functional disability to differences in depressive symptoms between urban and rural older adults, and robustness was tested by a Fairlie decomposition. Significant differences in depressive symptoms were observed between urban and rural older adults. Both BADL and IADL were risk factors influencing depressive symptoms in the elderly. The Oaxaca-Blinder decomposition results showed that the explained and unexplained portions were 39.677% and 60.323%, respectively. BADL accounted for 8.3% and IADL for 6.7% of the urban–rural differences in depressive symptoms. Furthermore, age, gender, education, health status, chronic diseases, pain, sleep duration, and social activity also contributed to differences in depressive symptoms between urban and rural older adults. Depressive symptom scores were higher among rural older adults relative to urban older adults. Targeted psychological care for rural elderly individuals with functional disability should be prioritized to reduce the mental health gap between urban and rural older adults.
Zhao et al. (Sat,) studied this question.