Gender Differences in Depression Prevalence, Influencing Factors, Life Satisfaction, and Network Structure Among Middle-Aged and Older Adults in China: A National Survey

Background: The prevalence of depression is high in China especially among older adults. This study aimed to explore the gender differences in depression prevalence, influencing factors, network structure, and their relationship with life satisfaction among middle-aged and older adults in China. Methods: This was a cross-sectional study based on the data from the fifth wave (2020) of the China Health and Retirement Longitudinal Study (CHARLS). We performed network analyses and applied expected influence (EI) to identify the most central symptoms. Results: A total of 15,834 middle-aged and older adults were included in this study. The prevalence of depression among women was (45.5%, 95% CI [44.4%, 46.6%]), which was significantly higher than men (29.1%; 95% CI [28.1%, 30.1%]). In both women and men, older age (OR = 1.006), living in village areas (OR = 1.7), having a job (OR = 1.2), activities of daily living (ADL) limitations (OR = 2.2), and experiencing pain (OR = 1.8) were significantly associated with a higher risk for depression. Additionally, being married (OR = 0.7) and having better perceived health status (e.g. good vs. normal: OR = 0.5; poor vs. normal: OR = 2.2) were associated with a lower risk of depression across both genders. Moreover, network comparison of depressive symptoms by gender found that the most central symptom across gender groups was similar. Center for Epidemiologic Studies Depression Scale (CESD)-3 (“Feeling depressed”; corresponding to the item “I felt depressed” from the 10-item, CESD-10; EI value = 1.079) was the most central symptom in the depression network for both genders, while CESD-8 (“Lack of happiness”; corresponding to the item “I felt happy” from the CESD-10, reverse scored; average edge weight (AEW) = −0.15) had the strongest negative correlation with life satisfaction. Conclusion: In this study of middle-aged and older adults, women were more likely to have depression than men. The results identified influential symptoms which should be prioritized to promote emotional well-being and enhance life satisfaction in this population. There is a critical need to develop gender-sensitive mental health strategies and public health interventions aimed at alleviating the burden of depression among older adults in China.