Attitudes toward aging, social support and depression among older adults: Difference by urban and rural areas in China

Background: The specific impacts of attitudes toward aging on depressive symptoms have not been widely reported in previous studies in China. Objectives: The aim is to examine the associations between attitudes toward aging, perceived social support, and depressive symptoms among older adults stratified by rural and urban dwelling. Methods: This study used a cross-sectional data including 7209 participants, among which 64.6% were urban adults and 35.4% were rural adults. Several multiple liner regression models were used to analysis the data. Three social support types were analyzed as moderators of the relationship between the attitudes toward aging and depressive symptoms. Results: Positive attitudes toward aging (beta=-0.139, P <0.001), negative attitudes toward aging (beta=0.284, P <0.001) were significantly associated with lower depressive symptoms among older Chinese adults. Support from family (beta= -0.087, P <0.001), friends (beta= -0.047, P <0.01) and the government (beta= -0.035, P <0.01) were all significantly associated with urban older adults ' levels of depressive symptoms. Only family support (beta= -0.109, P <0.001) was associated with lower depressive symptoms among rural older adults '. In addition, family support buffered the effect of negative attitudes toward aging on depressive symptoms for all the older adults, while the moderation effects of support from friends and government only worked for urban elderly. Limitations: A cross-sectional design is limited to establish causal associations. Conclusions: Addressing depression among older adults should focus on improving attitudes toward aging and expanding the availability of social support. Moreover, deeper reforms are needed to address inequalities be-tween urban and rural areas in China.