{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:14:02Z","timestamp":1771481642520,"version":"3.50.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Aging anxiety is not only a critical practical issue for understanding the psychology of middle-aged and older adults, but also a key pathway for improving their health levels, optimizing aging policies, and achieving active and healthy aging. Existing research has insufficiently addressed the pathways and heterogeneity through which aging anxiety impacts health. This study aims to reveal the effects of aging anxiety on the health of middle-aged and older adults, its underlying mechanisms, and the differences in its impact across various groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Drawing on large-scale data from the 2021 China General Social Survey (CGSS), this study first employs a logistic regression model to analyze the impact of aging anxiety on the health of middle-aged and older adults. Then, we employ structural equation modeling to examine the mediating roles of psychological pessimism, sleep disturbance, and loss of self-efficacy in this relationship. Subsequently, a moderation analysis examines the buffering effects of six factors\u2014including social participation and social support\u2014on the relationship between aging anxiety and health outcomes. Finally, heterogeneity analysis explores variations in aging anxiety impacts across different groups defined by income, household registration status, education level, and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher aging anxiety is significantly associated with poorer self-rated health among middle-aged and older adults (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.271). Mediation analyses suggest that this association may be partially mediated by psychological pessimism, sleep disturbance, and loss of self-efficacy. Psychological pessimism accounts for 26.53% of the total indirect effect, sleep disturbance for 8.21%, and loss of self-efficacy for 27.22%. Moderation analyses indicate that social participation, social support, social capital, healthcare utilization, insurance coverage, and digital technology use attenuate the negative association between aging anxiety and health. Heterogeneity analyses further show that the negative association is stronger among low-income, rural, less-educated, and older respondents.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings highlight the potential value of a multidimensional coping framework to address aging-related concerns and support healthy aging. Such efforts may include fostering more positive perceptions of aging, strengthening psychologically informed and behaviorally oriented supports (e.g., pessimism reduction, sleep management, and self-efficacy enhancement), improving social and institutional resource support systems, and prioritizing targeted strategies for vulnerable and older populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1782428","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:23:12Z","timestamp":1771478592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["How aging anxiety relates to self-rated health in middle-aged and older adults: the role of psychological pathways"],"prefix":"10.3389","volume":"17","author":[{"given":"YuXin","family":"Zhou","sequence":"first","affiliation":[{"name":"School of Marxism, Xi'an Jiaotong University","place":["Xi'an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DanDan","family":"Chen","sequence":"additional","affiliation":[{"name":"Business School, University of International Business and Economics","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Dong","sequence":"additional","affiliation":[{"name":"School of Public Health, Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MengHan","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Humanities and Management, Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YiFan","family":"Li","sequence":"additional","affiliation":[{"name":"Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1377305","DOI":"10.3389\/fpubh.2024.1377305","article-title":"Mechanism of the impacts of older adults social participation on their health","volume":"12","author":"Ai","year":"2024","journal-title":"Front. 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Health Psychol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jad.2021.04.077","article-title":"Aging anxiety, loneliness, and depressive symptoms among middle-aged adults: the moderating role of ageism","volume":"290","author":"Bergman","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1007\/s11205-021-02692-w","article-title":"Does unpaid caregiving erode working hours among middle-aged Chinese adults?","volume":"157","author":"Chai","year":"2021","journal-title":"Soc. Indic. Res."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1111\/jan.15509","article-title":"The impact of social capital on successful ageing of empty nesters: a cross-sectional study","volume":"79","author":"Chang","year":"2023","journal-title":"J. Adv. Nurs."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1093\/geronb\/gbaa043","article-title":"Overlooked and underestimated: experiences of ageism in young, middle-aged, and older adults","volume":"76","author":"Chasteen","year":"2021","journal-title":"J. Gerontol.: Ser. B"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"7886","DOI":"10.3390\/su16187886","article-title":"Disparities in environmental behavior from urban\u2013rural perspectives: how socioeconomic status structures influence residents\u2019 environmental actions\u2014based on the 2021 China general social survey data","volume":"16","author":"Cheng","year":"2024","journal-title":"Sustainability"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101860","DOI":"10.1016\/j.eclinm.2023.101860","article-title":"Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis","volume":"57","author":"Chowdhury","year":"2023","journal-title":"EClinicalMedicine"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol. Bull."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3259","DOI":"10.3390\/ijerph20043259","article-title":"Socioeconomic, behavioural, and social health correlates of optimism and pessimism in older men and women: a cross-sectional study","volume":"20","author":"Craig","year":"2023","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.gerinurse.2023.10.013","article-title":"The role of self-efficacy and self-care agency as mediating factors in the link between health literacy and health-promoting lifestyle among older adults post COVID-19 era: a multiple mediator model","volume":"54","author":"Du","year":"2023","journal-title":"Geriatr. Nurs."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1186\/s12889-024-18895-y","article-title":"A cohort study of self-perception of ageing and all-cause mortality among older adults in China: a multiple mediators analysis","volume":"24","author":"Gao","year":"2024","journal-title":"BMC Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.1017\/SJP.2025.9","article-title":"Self-perceptions of aging and distress in middle-aged and older adults: the role of perceived control and pleasant activities","volume":"28","author":"Garc\u00eda-Garc\u00eda","year":"2025","journal-title":"Span. J. Psychol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1017\/S0144686X23000570","article-title":"Revisiting the social construction of old age","volume":"45","author":"Gilleard","year":"2025","journal-title":"Ageing Soc."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"89","DOI":"10.2307\/2137237","article-title":"Self-efficacy and health behavior among older adults","volume":"34","author":"Grembowski","year":"1993","journal-title":"J. Health Soc. Behav."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"14368","DOI":"10.1007\/s12144-022-02727-6","article-title":"Influence of social participation and support on self-rated health among Chinese older adults: mediating role of coping strategies","volume":"42","author":"Jiang","year":"2023","journal-title":"Curr. Psychol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1146\/annurev-soc-031021-121020","article-title":"The social construction of age: concepts and measurement","volume":"49","author":"Johfre","year":"2023","journal-title":"Annu. Rev. Sociol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.4069\/kjwhn.2017.23.3.181","article-title":"Impacts of health perception, aging anxiety and perception of successful aging on health promotion behavior of late middle-aged women","volume":"23","author":"Lee","year":"2017","journal-title":"Korean J. Women Health Nurs."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12939-022-01623-6","article-title":"The influence of medical insurance on the use of basic public health services for the floating population: the mediating effect of social integration","volume":"21","author":"Li","year":"2022","journal-title":"Int. J. 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Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1186\/s12889-020-08650-4","article-title":"Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China","volume":"20","author":"Ma","year":"2020","journal-title":"BMC Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"689","DOI":"10.2147\/PRBM.S508795","article-title":"Association between social capital and anxiety among older adults in China: a cross-sectional study","volume":"18","author":"Meng","year":"2025","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s12913-022-07529-x","article-title":"Health anxiety is an important driver of healthcare use","volume":"22","author":"Norbye","year":"2022","journal-title":"BMC Health Serv. 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Res."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1017\/S1041610213001798","article-title":"Measuring anxiety about aging across the adult lifespan","volume":"26","author":"Sargent-Cox","year":"2014","journal-title":"Int. Psychogeriatr."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"512","DOI":"10.3389\/fpubh.2020.00512","article-title":"Using Anderson's model of health service utilization to assess the use of HIV testing services by sexually active men in Ghana","volume":"8","author":"Seidu","year":"2020","journal-title":"Front. Public Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1177\/0193945921989017","article-title":"Self-perception of aging among older adults and participation in prevention","volume":"43","author":"Silva-Smith","year":"2021","journal-title":"West. J. Nurs. Res."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1043072","DOI":"10.3389\/fpubh.2022.1043072","article-title":"The effect of equalization of public health services on the health China\u2019s migrant population: evidence from 2018 China migrants dynamic survey","volume":"10","author":"Su","year":"2023","journal-title":"Front. Public Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"818930","DOI":"10.3389\/fpubh.2021.818930","article-title":"The promotional effect of health education on the medical service utilization of migrants: evidence from China","volume":"9","author":"Tian","year":"2022","journal-title":"Front. Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"19861","DOI":"10.1038\/s41598-024-69992-2","article-title":"Air pollution, health status and public awareness of environmental problems in China","volume":"14","author":"Wang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"503","DOI":"10.12114\/j.issn.1007-9572.2020.00.409","article-title":"Path analysis of influencing factors of medication compliance in elderly hypertensive patients in the community","volume":"24","author":"Wang","year":"2021","journal-title":"Chin. Gen. Pract."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/1471-2458-13-320","article-title":"The relationship between self-rated health and objective health status: a population-based study","volume":"13","author":"Wu","year":"2013","journal-title":"BMC Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.dr.2017.08.002","article-title":"How do views on aging affect health outcomes in adulthood and late life? Explanations for an established connection","volume":"46","author":"Wurm","year":"2017","journal-title":"Dev. Rev."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1037\/a0032845","article-title":"How do negative self-perceptions of aging become a self-fulfilling prophecy?","volume":"28","author":"Wurm","year":"2013","journal-title":"Psychol. Aging"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"20041","DOI":"10.1007\/s12144-024-05796-x","article-title":"Social participation and subjective well-being among older adults in China: the mediation effect of media use","volume":"43","author":"Yang","year":"2024","journal-title":"Curr. Psychol."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1602284","DOI":"10.3389\/fpsyg.2025.1602284","article-title":"Why does aging anxiety emerge? A study on the influence of socioeconomic status","volume":"16","author":"Yang","year":"2025","journal-title":"Front. Psychol."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1180024","DOI":"10.3389\/fpubh.2023.1180024","article-title":"The impact of pension insurance types on the health of older adults in China: a study based on the 2018 CHARLS data","volume":"11","author":"Yang","year":"2023","journal-title":"Front. Public Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"677643","DOI":"10.3389\/fpubh.2021.677643","article-title":"Internet use, life satisfaction, and subjective well-being among the elderly: evidence from 2017 China general social survey","volume":"9","author":"Yang","year":"2021","journal-title":"Front. Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"104015","DOI":"10.1016\/j.archger.2020.104015","article-title":"Anxiety about aging, resilience and health status among Chinese older adults: findings from Honolulu and Wuhan","volume":"88","author":"Zhang","year":"2020","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"11411","DOI":"10.3390\/ijerph191811411","article-title":"The relationship between social support and anxiety among rural older people in elderly caring social organizations: a cross-sectional study","volume":"19","author":"Zhao","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1186\/s12889-024-18269-4","article-title":"The impact of internet use on health among older adults in China: a nationally representative study","volume":"24","author":"Zhou","year":"2024","journal-title":"BMC Public Health"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1093\/her\/cyac020","article-title":"Does public health education improve migrant workers\u2019 health status in China? Evidence from China migrants dynamic survey","volume":"37","author":"Zhu","year":"2022","journal-title":"Health Educ. 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