Associations between home- and community-based services (HCBSs) and depressive symptoms in older adults: a nationally representative cross-sectional survey in China

Abstract Background There is growingevidence in Europe and America that Home- and community-based services (HCBSs) are widely used for older people (aged ≥ 60 years). To date, however, no published evidence has discussed the correlation between HCBSs and depressive symptoms in older adults in China. Objective This cross-sectional survey aimed toexamine the relationship between HCBSs and depressive symptoms in older people. In addition, this study explored the relationship between internet use and depression risk in the older population at the individual and provincial levels and in rural and urban subgroups. Methods The survey of CHARLS used a multistage probability-proportional-to-size (PPS) sampling technique. Province-level socioeconomic characteristics were merged with microdata for respondents over 60 years of age from the 2020 China Health and Retirement Longitudinal Study (CHARLS 2020) Wave 5 (n = 10,036) by the author. The respondents were asked whether they used the HCBSs. Depression was assessed using the 10-item Centre for Epidemiologic Studies Depression Scale(CES-D 10). The chi-square test was used to explore whether HCBSs were related to mental health status. A binary logistic regression model was used to determine this association further after controlling for confounding factors. Results Overall, 24.8% (2155/8692) of the participants used HCBSs. Regression analyses revealed that older adults who utilized HCBSs (OR = 0.486, 95% CI: 0.404–0.585, P < .001) had a lower risk of depressive symptoms than those who did not utilize HCBSs and older adults who were female (P = .001), single (P < .001), illiterate (P < .001), living in rural areas (P < .001), without retirement pensions (P < .001), with health insurance (P < .001) and with very poor Self-rated Health Index (SRH) (P < .001) had a greater risk of depressive symptoms. For province-level characteristics, older adults living in provinces with the number of beds in medical institutions per 10,000 persons in the second quartile were more likely to suffer from depressive symptoms, while there is no effect between depression and gross domestic product (GDP). Conclusions HCBSs had a positive effect on depression of older adults who lived in rural. However, the rate of HCBS usage remains low among older Chinese people. Therefore, the HCBS penetration rate should be a priority, especially in rural areas.