Sun Siwei, Wang Xuechun, Guo Na, Li Peipei, Ding Ruoxi, Zhu Dawei
Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbeilu No.51, Beijing, 100191, China.
China Population and Development Research Center, Beijing, China.
BMC Geriatr. 2025 Apr 8;25(1):231. doi: 10.1186/s12877-025-05887-9.
Little is known about the association between catastrophic health expenditure (CHE) and mental health in elderly population and its potential moderators. This study examined the relationship between CHE and depressive symptoms in Chinese older persons and its difference between groups of different income level and social activity engagement.
We employed data from the 4 waves (2011, 2013, 2015, and 2018, N = 15,406) of the China Health and Retirement Longitudinal Study (CHARLS). A linear mixed model was used to examine the association between depressive symptoms and CHE, and interaction terms were involved in the model to examine the moderating role of social activity and income levels.
Significant correlations have been shown between CHE and depressive symptoms(coefficient = 0.363, P < 0.05), such association was more pronounced in socially inactive (P = 0.034, Difference = 0.37, interaction terms (social activityCHE: -1.189) or low-income seniors (P < 0.001, Difference = 0.77, interaction terms (medium incomeCHE: -0.594, P < 0.05, high incomeCHE: -0.667, P < 0.01), and especially in socially inactive and low-income seniors (P < 0.001, Difference = 0.93, interaction terms (high incomeCHE*social acitivity: 1.132, P < 0.05). Even after increasing the threshold of CHE to 20% and 25%, similar pattern was observed.
This study suggest a positive association between CHE event and depressive symptoms, as well as the protective effect of advantaged financial status and engagement of social activity. Our finding provide empirical evidence to call for urgent action for government and public health authorities, to address the high medical expenditure, psychological stress among elderly, especially for low-income households or elderly living alone.
关于灾难性卫生支出（CHE）与老年人群心理健康之间的关联及其潜在调节因素，人们了解甚少。本研究探讨了中国老年人中CHE与抑郁症状之间的关系，以及不同收入水平和社会活动参与组之间的差异。
我们使用了中国健康与养老追踪调查（CHARLS）4轮（2011年、2013年、2015年和2018年，N = 15406）的数据。采用线性混合模型来检验抑郁症状与CHE之间的关联，并在模型中纳入交互项以检验社会活动和收入水平的调节作用。
CHE与抑郁症状之间存在显著相关性（系数 = 0.363，P < 0.05），这种关联在社会活动不活跃的人群中更为明显（P = 0.034，差异 = 0.37，交互项（社会活动CHE：-1.189））或低收入老年人中（P < 0.001，差异 = 0.77，交互项（中等收入CHE：-0.594，P < 0.05，高收入CHE：-0.667，P < 0.01）），尤其是在社会活动不活跃且低收入的老年人中（P < 0.001，差异 = 0.93，交互项（高收入CHE*社会活动：1.132，P < 0.05））。即使将CHE的阈值提高到20%和25%，也观察到类似模式。
本研究表明CHE事件与抑郁症状之间存在正相关，以及有利的财务状况和社会活动参与的保护作用。我们的研究结果提供了实证证据，呼吁政府和公共卫生当局采取紧急行动，以解决老年人的高额医疗支出、心理压力问题，特别是针对低收入家庭或独居老年人。
