The Impacts of Depression and Chronic Diseases on the Health of Older Adults in China: Evidence in a System Equations Framework

Depression comorbid with chronic diseases is common, especially among the older adults. We examine the health of the older adults in China and its relationship with depression, alone or as a comorbidity with chronic diseases. The sample we study includes 10,307 individuals aged 45 or above from the 2011 national wave of the China Health and Retirement Longitudinal Study (CHARLS). Using factor analysis, we obtain three factors out of eight health measurements that capture multiple dimensions of health of an older adult, with which we construct health scores and use as outcome variables. The three factors obtained from the factor analysis can, respectively, be interpreted as ‘physical health’, ‘subjective health’ and ‘cognitive health’. We then apply a system equations approach to compare the disease effects. We find different chronic conditions are significantly associated with ‘physical health’ and ‘subjective health’ but not with ‘cognitive health’. While the key chronic diseases have similar adverse effects on the first two health factors (except for the respiratory diseases), depression impairs subjective and physical health scores to a greater degree than do any chronic diseases. Comorbid depression is significantly associated with a reduction in the physical health score of the older adults, particularly for those with depression and cardiovascular diseases. In light of the increasing burden of chronic diseases and the underfunding-undertreatment situation of depression, health insurance coverage for depression should be improved to provide a more integrated mental health system.