Depression among older adults in China: Effects of urbanicity across the life course

The global prevalence of depression among older adults continues to increase alongside rapid urban development. Scant attention has been paid, however, to how exposure to urbanicity over the life course affects older adults’ depressive symptoms, particularly in China, which has undergone substantial recent urbanization. Using data from the China Health and Retirement Longitudinal Study (CHARLS) with its Life History Survey, this study adopts a life-course approach to examine the accumulative and sequenced effects of exposure to urbanicity from 1992 to 2018 on depressive symptoms among older adults, alongside the mediating roles of social relationships. Multilevel regression analysis, clustered at the city level, reveals that higher cumulative exposure to urbanicity is associated with reduced depressive symptoms, particularly with constant or increased exposure to higher levels of urbanicity during middle and older adulthood. This protective effect remains robust against the potential influence of health-selective migration but varies by sex and socioeconomic status. Relationships with friends and neighbors mediate the urbanicity–depression association, whereas cumulative urbanicity exposure is negatively associated with satisfaction with the parent–child relationship and aggregates depressive symptoms. These findings underscore the importance of employing the life-course approach to understand the interplay between health and place across the life span.