Liao Ziyin, Zhou Rui, Huang Jingwei, Wang Qing, Xu Jiajing
Dong Fureng Economic and Social Development School, Wuhan University, Wuhan, China.
Department of the Sixth Health Care, The Second Medical Center, Chinese PLA General Hospital, Beijing, China.
Front Public Health. 2025 Apr 25;13:1583822. doi: 10.3389/fpubh.2025.1583822. eCollection 2025.
According to the latest research by the World Health Organization (WHO), the disease burden caused by depression has risen to the second place in the world, and will rise to the first place by 2030. Currently, there are approximately 90 million individuals with depression in China, with rural middle-aged and older adults facing higher risks due to factors such as weak economic foundations and poor health. This study empirically examines the effect of basic medical insurance in reducing depression scores (measured by the CES-D scale) among rural middle-aged and older adults and validates its underlying mechanisms.
Using panel data from the China Family Panel Studies (CFPS) in 2012 and 2018, this study constructs a two-way fixed effects model to analyze the relationship between basic medical insurance and depression scores. Heterogeneity analysis was conducted through grouped regression, while robustness checks were performed using panel Probit regression and Quantile regression. Additionally, moderation and mediation effect models were employed to analyze the mechanisms through which basic medical insurance reduces depression scores in this population.
The study finds that basic medical insurance has a positive effect on reducing depression scores among rural middle-aged and older adults. Grouped regression results reveal heterogeneity across subgroups, with weaker improvement effects observed among subgroups aged over 60, females, and those with spouses. By introducing an interaction term between insurance enrollment and chronic disease status into the baseline model, the study identifies a moderating effect of chronic disease on the depression-reducing impact of basic medical insurance. Mediation analysis using the three-step method and bootstrap approach demonstrates that household income per capita partially mediates this effect. Robustness checks support the main findings, and quantile regression indicates that the effect of basic medical insurance is most pronounced among individuals with mild depression or near-threshold depression scores.
The research contributes to explaining the dynamic relationship between basic medical insurance and depression among rural middle-aged and older adults, enriching theoretical studies on the impact of basic medical insurance on mental health in this population. The findings hold significant theoretical implications.
根据世界卫生组织（WHO）的最新研究，抑郁症所造成的疾病负担已升至全球第二位，并将于2030年升至首位。目前，中国约有9000万抑郁症患者，农村中老年人群因经济基础薄弱、健康状况不佳等因素面临更高风险。本研究实证检验了基本医疗保险对降低农村中老年人群抑郁得分（以CES-D量表衡量）的效果，并验证其潜在机制。
本研究使用2012年和2018年中国家庭追踪调查（CFPS）的面板数据，构建双向固定效应模型来分析基本医疗保险与抑郁得分之间的关系。通过分组回归进行异质性分析，同时使用面板Probit回归和分位数回归进行稳健性检验。此外，采用调节效应和中介效应模型来分析基本医疗保险降低该人群抑郁得分的机制。
研究发现，基本医疗保险对降低农村中老年人群的抑郁得分有积极作用。分组回归结果显示各亚组存在异质性，60岁以上亚组、女性亚组以及有配偶亚组的改善效果较弱。通过在基线模型中引入参保与慢性病状况的交互项，研究确定了慢性病对基本医疗保险降低抑郁影响的调节作用。使用三步法和Bootstrap方法的中介分析表明，人均家庭收入部分中介了这一效应。稳健性检验支持主要研究结果，分位数回归表明基本医疗保险的效果在轻度抑郁或接近临界抑郁得分的个体中最为显著。
该研究有助于解释基本医疗保险与农村中老年人群抑郁症之间动态关系，丰富了关于基本医疗保险对该人群心理健康影响的理论研究。研究结果具有重要的理论意义。
