The Role of Community Factors in Predicting Depressive Symptoms in Chinese Workers: A Rural-Urban Longitudinal Study | BMC Public Health

The prevalence of depressive symptoms has increased in recent decades worldwide [1]. A study using the China Family Panel Studies (CFPS), which covers 40,000 respondents from 25 Chinese provinces, found that the rate of depressive symptoms reached 37.86% [1]. Depression poses serious social challenges given its close relationship to disability, disease burden, physical well-being, human capital accumulation, medical costs and economic loss. [1,2,3]. Moreover, the regional disparity of depressive symptoms in China is remarkable: in rural areas, the prevalence of depressive symptoms is 41.21%, much higher than the rate in urban areas of 31.49%. [1]. Additionally, urban residents are 3.1% less likely to have depressive symptoms than rural residents [1]. Therefore, there is a need to examine disparities in depressive symptoms between rural and urban settings and related factors.

Theoretical frame

Field theory [4] provides a framework for examining the factors that influence an individual in social situations [5]. It posits that human behavior results from the interaction between the individual and the total environment (terrain). The interaction between individuals and the surrounding environment influences mental health in two ways: (1) the reconstruction of personal living space and (2) the formation of community-related factors that affect mental health. an individual. [6]. Community factors can influence individual mental health through structural factors (eg, community resources) and relational factors (eg, community relationships). Rural and urban communities showed differences in structural and relational dimensions [6]. Thus, both community factors and urban-rural differences in community factors are examined in this study.

Individual factors of depressive symptoms

The existing literature has highlighted a range of demographic and socioeconomic factors on depressive symptoms. Low income, low education and unemployment have been linked to depressive symptoms [7,8,9]while more pronounced depressive symptoms tend to be more common in women and younger people [10,11,12]. The influence of education on depressive symptoms is mixed, as the literature indicates that both educated and relatively less educated people experience depressive symptoms [8]. More and more research is interested in discovering the influence of the environment on the depressive symptoms of workers.

Community Factors of Depressive Symptoms

Community cohesion

Current findings related to community cohesion and depressive symptoms are mixed and limited. Previous research has indicated that older Chinese population with strong community cohesion report fewer depressive symptoms [13, 14]. However, Yamaguchi, Inoue, Shinozaki, Saito, Takagi, Kondo, and Kondo [15] pointed out that community cohesion was not associated with depressive symptoms. Similarly, Haseda et al. [16] also found that the influence of community cohesion on depressive symptoms was not significant.

Compatible network size

Previous research has shown that participants with higher social support, particularly support from friends and neighbors [17] reported fewer depressive symptoms [8, 18]. Analyzing data from a national survey in Australia, Werner-Seidler et al. [19] found that people who interacted with friends less than once a month were 2.19 times more likely to have depressive symptoms, and those without family support were 3.47 times more likely to have depressive symptoms .

Predictable community threat

People’s perception of the community shapes their understanding of community risk [20]. More than 50% of men think their community is at risk, and less than half of women share similar perceptions [21]. Arthur et al. [22] found that people with higher perceived community insecurity are more prone to unhealthy illness. However, Moore et al. [23] found that when a person feels safer in the community, their depressive symptoms are less present. Similarly, Flórez et al. [24] reported that the more a person perceives safety in their neighborhood, the less they are in psychological distress.

Medical insurance coverage

Medical insurance coverage is considered a community factor because it is essentially the product of inequalities in medical benefit coverage between rural and urban China [25,26,27]. Previous studies have highlighted the positive effect of medical insurance coverage on health outcomes, including relief from depressive symptoms [28]. Also, Chiu & Yang [29] demonstrated a significant relationship between the level of medical insurance and psychological conditions. Additionally, Tang et al. [30] reported that urban elderly in China with higher medical insurance coverage reported significantly fewer depressive symptoms than rural elderly.

Existing research has hinted at the significant influence of community factors on people’s depressive symptoms. However, empirical research related to the influence of community factors on depressive symptoms among Chinese workers is scarce. The first research question of this study is to identify the impact of different community factors on depressive symptoms in this Chinese working population.

Urban-rural differences in community factors

German sociologist Tonnies [31] mentions the difference between community and society in his book “Community and Society”. According to him, the traditional countryside is the typical representative of the community, and the market town is the representative of society. According to Tonnies, rural “communities” and urban “societies” have completely different organizational foundations and characters. In urban “society”, relationships between people are based on individual independence, personal reason, contracts and laws. In rural “communities”, people are based on shared history, traditions, beliefs, customs and trust, forming an interpersonal relationship with intimacy, mutual trust and vigilance. Community in this article refers to various social associations and social groups consisting of people living in a specific place and a regional living community consisting of multiple social activities. [32]. This regional living community includes both rural regional living communities (rural communities) and urban regional living communities (urban communities). Urban communities are like what Tonnies calls “society,” while rural communities are like “communities.”

Compared to their urban counterparts, rural residents are more willing to help each other, even financially. They also tend to perceive greater community cohesion and a larger support network size. [33, 34]. On the other hand, urban residents are generally more likely to report predictable community threats such as public safety and environmental pollution than rural residents. [35].

In addition, China’s urban-rural division system leads to differences in the management and quality of social services between urban and rural communities. [36]. In the late 1950s, the “Regulations of the People’s Republic of China on Household Registration” was promulgated and implemented. It marked the emergence of a dual system of urban-rural division in China, which remains influential to this day. [37]. According to the household registration system (hukou), each citizen is assigned to agricultural (rural) or non-agricultural (urban) groups based on where they and their parents were born. hukou status [38, 39]. It’s hard to change Hukou rural to urban status [39, 40]. As a determinant of privilege, the hukou affects the socio-economic well-being of Chinese citizens [40]leading to disparities in economic development, access to medical services, education and employment opportunities, pensions and mental health outcomes between urban and rural areas [38, 41,42,43,44]. For example, health care and medical insurance coverage is better in urban communities than in rural communities [45]. Most of the urban workforce participates in the Urban Employees Basic Medical Insurance (UEBMI). In contrast, the rural workforce is generally covered by the New Rural Cooperative Medical System (NRCMS). UEBMI is better off than NRCMS in terms of reimbursement thresholds and reimbursement ratios. In China, the overall level of medical benefit coverage ranked from top to bottom is the Government Employee Health System, UEBMI, Urban Resident Basic Medical Insurance (URBMI), NRCMS [6].

Previous studies have examined urban-rural differences in community cohesion, support network size, predictable community threat, and medical insurance coverage among Chinese workers. However, they mainly used cross-sectional data. Additionally, existing research has not examined the long-term influence of community factors on depressive symptoms. Longitudinal studies are needed to shed light on the roles of different community factors in rural and urban contexts. Thus, this study fills the gap and identifies which community factors affect depressive symptoms in the working population between urban and rural workers.

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