{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:37:17Z","timestamp":1792600637566,"version":"4.5.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"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. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The mental health of the older adult in western rural areas is an area of growing concern. Mental health, as defined by the World Health Organization, encompasses emotional, psychological, and social well-being, affecting how individuals think, feel, and act. In this study, we operationalize mental health through four validated dimensions: depression (emotional well-being), anxiety (psychological stability), loneliness (social connectedness), and life satisfaction (overall subjective well-being), which together provide a comprehensive assessment of mental health status. Understanding their mental health status and associated factors is crucial for developing effective interventions and improving their quality of life. While social support has been established as both a preventive and prognostic factor for mental health in various populations, its specific role and mechanisms in western rural older adult populations require further investigation. However, limited research has comprehensively explored this topic, leaving gaps in knowledge regarding the complex interplay of various influencing factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted among 1,543 older adult individuals in western rural areas. The western rural areas in this study specifically refer to rural regions in Guizhou, Yunnan, and Sichuan provinces of China, characterized by mountainous terrain, ethnic diversity (including Yi, Miao, and other minority groups), lower economic development compared to eastern regions, and unique cultural practices such as traditional community support systems and intergenerational living arrangements. A multi-stage sampling strategy was employed to obtain a representative sample. Demographic information, health-related data, and mental health status were collected through face-to-face interviews. Structured questionnaires were used to gather details on age, gender, education, marital status, household income, chronic disease status, and living arrangements. Social support was measured using the Social Support Rating Scale (SSRS), which includes three dimensions: objective support (actual received support), subjective support (perceived support), and support utilization. The total score ranges from 12\u201366, with higher scores indicating better social support. Scores were categorized as low (\u226422), moderate (23\u201344), and high (\u226545) based on established cut-offs. Four validated scales, namely the Geriatric Depression Scale (GDS-15), Generalized Anxiety Disorder Scale (GAD-7), UCLA Loneliness Scale, and Life Satisfaction Scale, were utilized to assess depression, anxiety, loneliness, and life satisfaction, respectively. These four scales have been extensively validated as comprehensive measures of mental health in older adult populations, with meta-analyses demonstrating their collective ability to capture 85\u201390% of mental health variance in older adults. Univariate analysis, multivariate logistic regression, and mediational analysis were performed to explore the relationships between different factors and mental health outcomes. To provide a comprehensive understanding of mental health burden, we also analyzed participants with multiple mental health symptoms (defined as having \u22653 of the four assessed conditions: depression, anxiety, loneliness, and low life satisfaction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 30.3% of the older adult were at risk of depression, 26.0% had anxiety symptoms, 32.5% experienced loneliness, and 40.1% were satisfied with their lives. Additionally, 18.7% of participants had multiple mental health symptoms (\u22653 conditions), with this group showing significantly lower social support scores (mean 28.4\u202f\u00b1\u202f7.2) compared to those with fewer symptoms (mean 38.6\u202f\u00b1\u202f8.9, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Subgroup analysis showed that age, gender, education level, and income were significantly associated with mental health. Older adult individuals aged 70\u201379 and \u226580 had higher rates of depression, anxiety, and loneliness, while those aged 60\u201369 had a relatively higher life satisfaction. Females had higher depression and anxiety rates than males. The illiterate group had elevated rates of negative mental health outcomes, and the high-income group had a higher life satisfaction rate. Multivariate logistic regression identified age \u226570\u202fyears, female gender, illiteracy, low income (\u22641,000 yuan\/month), \u22653 chronic diseases, living alone, low social support, and no healthcare insurance as significant risk factors for depression. Similar patterns were observed for the multiple mental health symptoms group, with low social support showing the strongest association (AOR\u202f=\u202f3.42, 95% CI: 2.51\u20134.66, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Marital status (widowed), religious engagement, and employment status did not significantly influence depression. Mediational analysis, conducted using the Baron and Kenny approach and Sobel test, revealed that social support played a crucial mediating role in the relationship between some factors and depression. Notably, the mediating effects of social support in western rural areas were significantly stronger than those reported in eastern rural areas (indirect effect 0.60 vs. 0.35 for chronic diseases, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01), suggesting that the mountainous geography and dispersed settlement patterns in western regions amplify the importance of social networks for mental health maintenance. The indirect effects were calculated as the product of the coefficients for the path from the independent variable to the mediator and from the mediator to the outcome, with statistical significance tested using bootstrapping methods (1,000 iterations).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The mental health status of the older adult in western rural areas varies significantly among different subgroups. Multiple factors are associated with their mental health, and social support has a mediating effect. The unique geographical isolation and cultural context of western rural areas create distinct mental health challenges that differ from other rural regions in China, requiring culturally-adapted, community-based interventions that leverage traditional support systems while addressing modern healthcare access barriers. Our findings align with the broader health promotion literature while providing specific insights for this population. Community-based interventions, such as community therapy groups, peer support networks, and culturally adapted social engagement programs, should be prioritized to enhance social support and improve mental health outcomes. These findings provide important insights for the development of targeted mental health interventions and policies to enhance the well-being of this vulnerable population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1612600","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T04:12:01Z","timestamp":1752639121000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Investigation and analysis of mental health status of the older adult in western rural areas"],"prefix":"10.3389","volume":"13","author":[{"given":"Shuai","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangfu","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xudong","family":"Rui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1328","DOI":"10.2105\/AJPH.2020.305782","article-title":"Rural population health and aging: toward a multilevel and multidimensional research agenda for the 2020s","volume":"110","author":"Jensen","year":"2020","journal-title":"Am J Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1186\/1471-2458-12-287","article-title":"Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study","volume":"12","author":"Lou","year":"2012","journal-title":"BMC Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4817","DOI":"10.3390\/ijerph17134817","article-title":"The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults","volume":"17","author":"An","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.maturitas.2019.09.004","article-title":"Gender, mental health and ageing","volume":"129","author":"Kiely","year":"2019","journal-title":"Maturitas"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1016\/S0140-6736(22)01546-X","article-title":"The path to healthy ageing in China: a Peking University-lancet commission","volume":"400","author":"Chen","year":"2022","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s10880-024-10022-8","article-title":"Mental health education and utilization among patients with vestibular disorders","volume":"32","author":"Kostelnik","year":"2025","journal-title":"J Clin Psychol Med Settings"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1080\/1744666X.2024.2412771","article-title":"The burden of mental health issues in Beh\u00e7et's disease: implications for patient quality of life","volume":"21","author":"Teixeira","year":"2025","journal-title":"Expert Rev Clin Immunol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1007\/s10597-024-01349-5","article-title":"The meaning of social support for mental health service-users: the case managers' perspective","volume":"61","author":"Fitzgerald","year":"2025","journal-title":"Community Ment Health J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1007\/s40520-022-02079-y","article-title":"Characteristics of community-based exercise programs for community-dwelling older adults in rural\/regional areas: a scoping review","volume":"34","author":"Fien","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"801307","DOI":"10.3389\/fpubh.2021.801307","article-title":"Social engagement and urban-rural disparity in self-management behaviors: study of middle-aged and older Chinese hypertension patients","volume":"9","author":"Lu","year":"2022","journal-title":"Front Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1002\/gps.2821","article-title":"The prevalence of depressive symptoms among the older in China: a meta-analysis","volume":"27","author":"Zhang","year":"2021","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/camh.12501","article-title":"Review: mental health impacts of the COVID-19 pandemic on children and youth\u2014a systematic review","volume":"27","author":"Samji","year":"2022","journal-title":"Child Adolesc Ment Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"5212","DOI":"10.19082\/5212","article-title":"The correlation of social support with mental health: a meta-analysis","volume":"9","author":"Harandi","year":"2017","journal-title":"Electron Physician"},{"key":"ref14","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":"ref15","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1080\/13607863.2012.660622","article-title":"Effects of acculturation and social network support on depression among elderly Korean immigrants","volume":"16","author":"Kim","year":"2012","journal-title":"Aging Ment Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1186\/s12889-025-22186-5","article-title":"Housing inequalities and health outcomes among migrant and refugee populations in high-income countries: a mixed-methods systematic review","volume":"25","author":"Rana","year":"2025","journal-title":"BMC Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"102743","DOI":"10.1016\/j.healthplace.2022.102743","article-title":"Income-related health inequality in urban China (1991-2015): the role of homeownership and housing conditions","volume":"73","author":"Nie","year":"2022","journal-title":"Health Place"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1007\/s11606-013-2484-3","article-title":"Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities","volume":"28","author":"Wells","year":"2013","journal-title":"J Gen Intern Med."},{"key":"ref19","first-page":"389","article-title":"Prevalencia de problemas de salud mental y su asociaci\u00f3n con variables socioecon\u00f3micas, de trabajo y salud: resultados de la Encuesta Nacional de Salud de Espa\u00f1a [Prevalence of mental health problems and their association with socioeconomic, work and health variables: Findings from the Spain National Health Survey]","volume":"22","author":"Bones Rocha","year":"2010","journal-title":"Psicothema."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1016\/j.archger.2012.04.002","article-title":"Effects of a program to prevent social isolation on loneliness, depression, and subjective well-being of older adults: a randomized trial among older migrants in Japan","volume":"55","author":"Saito","year":"2012","journal-title":"Arch Gerontol Geriatr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1332\/175795921X16459587898770","article-title":"Developmental relationships between socio-economic disadvantage and mental health across the first 30 years of life","volume":"13","author":"O'Connor","year":"2022","journal-title":"Longit Life Course Stud"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1037\/dev0000117","article-title":"Age differences in loneliness from late adolescence to oldest old age","volume":"52","author":"Luhmann","year":"2016","journal-title":"Dev Psychol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3934","DOI":"10.1002\/cncr.31668","article-title":"The relationship between household income and patient-reported symptom distress and quality of life in children with advanced cancer: a report from the PediQUEST study","volume":"124","author":"Ilowite","year":"2018","journal-title":"Cancer"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1007\/s42414-023-0002-2","article-title":"Social determinants of health among older adults with dementia in urban and rural areas","volume":"10","author":"Bartley","year":"2023","journal-title":"J Prev Alzheimers Dis"},{"key":"ref25","first-page":"98","article-title":"The theoretical basis and research application of social support rating scale","volume":"4","author":"Xiao","year":"1994","journal-title":"J Clin Psychiatry"},{"key":"ref26","first-page":"1","article-title":"Investigation of reliability and validity of the social support scale","volume":"31","author":"Liu","year":"2008","journal-title":"J Xinjiang Med Univ"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1037\/\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"879","DOI":"10.3758\/brm.40.3.879","article-title":"Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav Res Methods"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1001\/archpsyc.62.6.617","article-title":"Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"Kessler","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1186\/1471-2458-11-647","article-title":"Interventions targeting social isolation in older people: a systematic review","volume":"11","author":"Dickens","year":"2011","journal-title":"BMC Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2618","DOI":"10.1001\/jama.2016.19102","article-title":"Effect of a primary care-based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial","volume":"316","author":"Chibanda","year":"2016","journal-title":"JAMA"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1016\/S0140-6736(10)61508-5","article-title":"Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial","volume":"376","author":"Patel","year":"2010","journal-title":"Lancet"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1177\/0898264315591003","article-title":"Understanding rural-urban differences in depressive symptoms among older adults in China","volume":"28","author":"Li","year":"2016","journal-title":"J Aging Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.labeco.2015.11.003","article-title":"Non-contributory pensions","volume":"38","author":"Galiani","year":"2016","journal-title":"Labour Econ"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s12888-015-0537-3","article-title":"Expanding care for perinatal women with depression (EXPONATE): study protocol for a randomized controlled trial of an intervention package for perinatal depression in primary care","volume":"15","author":"Gureje","year":"2015","journal-title":"BMC Psychiatry"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1146\/annurev-publhealth-032315-021402","article-title":"Mediation analysis: a practitioner's guide","volume":"37","author":"Vander Weele","year":"2016","journal-title":"Annu Rev Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"112518","DOI":"10.1016\/j.socscimed.2019.112518","article-title":"Melancholy or mahjong? Diversity, frequency, type, and rural-urban divide of social participation and depression in middle- and old-aged Chinese: a fixed-effects analysis","volume":"238","author":"Wang","year":"2019","journal-title":"Soc Sci Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1017\/S1041610213001701","article-title":"Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China","volume":"26","author":"Chen","year":"2014","journal-title":"Int Psychogeriatr"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.socscimed.2014.09.028","article-title":"Depressive symptoms and SES among the mid-aged and elderly in China: evidence from the China health and retirement longitudinal study national baseline","volume":"120","author":"Lei","year":"2014","journal-title":"Soc Sci Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.archger.2013.07.016","article-title":"A meta-analysis of the prevalence of depressive symptoms in Chinese older adults","volume":"58","author":"Li","year":"2014","journal-title":"Arch Gerontol Geriatr"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1017\/S0033291708003164","article-title":"Prevalence and sociodemographic correlates of depression in an elderly population living with family members in Beijing, China","volume":"38","author":"Ma","year":"2008","journal-title":"Psychol Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/j.ssresearch.2015.05.013","article-title":"Seclusion, decision-making power, and gender disparities in adult health: examining hypertension in India","volume":"53","author":"Stroope","year":"2015","journal-title":"Soc Sci Res"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e0301542","DOI":"10.1371\/journal.pone.0301542","article-title":"Multilevel negative binomial analysis of factors associated with numbers of antenatal care contacts in low and middle income countries: findings from 59 nationally representative datasets","volume":"19","author":"Alem","year":"2024","journal-title":"PLoS One"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12888-015-0458-1","article-title":"Reliability and validity of the center for epidemiologic studies depression scale (CES-D) among suicide attempters and comparison residents in rural China","volume":"15","author":"Yang","year":"2015","journal-title":"BMC Psychiatry"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1186\/s12884-022-04588-0","article-title":"Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy","volume":"22","author":"Rahman","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"CD013779","DOI":"10.1002\/14651858.CD013779","article-title":"Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review","volume":"11","author":"Pollock","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1002\/gps.2721","article-title":"Prevalence and correlates of depressive symptoms in Chinese older adults: a population-based study","volume":"27","author":"Yu","year":"2012","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1016\/S2215-0366(23)00193-1","article-title":"Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries","volume":"10","author":"McGrath","year":"2023","journal-title":"Lancet Psychiatry"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1111\/papr.12203","article-title":"Dealing with symptoms and issues of hospitalized patients with cancer in Indonesia: the role of families, nurses, and physicians","volume":"15","author":"Effendy","year":"2015","journal-title":"Pain Pract"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1111\/j.1447-0594.2009.00563.x","article-title":"Health and aging in a Chinese population: urban and rural disparities","volume":"10","author":"Dong","year":"2010","journal-title":"Geriatr Gerontol Int"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"117140","DOI":"10.1016\/j.socscimed.2024.117140","article-title":"Educational mismatch and mental health: evidence from China","volume":"356","author":"Xu","year":"2024","journal-title":"Soc Sci Med"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"115128","DOI":"10.1016\/j.psychres.2023.115128","article-title":"Associations between antenatal education program and mental health outcomes in Taiwan: a population-based cohort study","volume":"322","author":"Chen","year":"2023","journal-title":"Psychiatry Res"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1007\/s12035-020-02249-x","article-title":"Impact of COVID-19 in the mental health in elderly: psychological and biological updates","volume":"58","author":"Grolli","year":"2021","journal-title":"Mol Neurobiol"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1177\/14604582221075561","article-title":"Application and implementation of telehealth services designed for the elderly population during the COVID-19 pandemic: a systematic review","volume":"28","author":"Haimi","year":"2022","journal-title":"Health Informatics J"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1016\/S0140-6736(13)60221-4","article-title":"Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990-2010: a systematic review and analysis","volume":"381","author":"Chan","year":"2013","journal-title":"Lancet"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"240","DOI":"10.11622\/smedj.2018052","article-title":"Approach to frailty in the elderly in primary care and the community","volume":"59","author":"Chen","year":"2018","journal-title":"Singapore Med J"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"141","DOI":"10.14283\/jfa.2020.61","article-title":"Physical functional assessment in older adults","volume":"10","author":"Patrizio","year":"2021","journal-title":"J Frailty Aging"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"1726","DOI":"10.3390\/ijerph20031726","article-title":"Differences in physical activity, sedentary behavior, and mental health of the older population in South Korea based on marital status and gender","volume":"20","author":"Park","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"S256","DOI":"10.1093\/geronb\/61.5.S256","article-title":"Intergenerational transfers and living arrangements of older people in rural China: consequences for psychological well-being","volume":"61","author":"Silverstein","year":"2006","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"11989","DOI":"10.3390\/ijerph182211989","article-title":"Can the development of religious and cultural tourism build a sustainable and friendly life and leisure environment for the elderly and promote physical and mental health?","volume":"18","author":"Lin","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"NP2232","DOI":"10.1177\/1010539512472362","article-title":"The quality of life and mortality risk of elderly people in rural China: the role of family support","volume":"27","author":"Liu","year":"2015","journal-title":"Asia Pac J Public Health"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/S2215-0366(18)30511-X","article-title":"Prevalence of mental disorders in China: a cross-sectional epidemiological study","volume":"6","author":"Huang","year":"2019","journal-title":"Lancet Psychiatry."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.apnu.2016.09.015","article-title":"Social support moderates the effects of self-esteem and depression on quality of life among Chinese rural elderly in nursing homes","volume":"31","author":"Sun","year":"2017","journal-title":"Arch Psychiatr Nurs"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s10823-007-9037-3","article-title":"Childlessness, psychological well-being, and life satisfaction among the elderly in China","volume":"22","author":"Zhang","year":"2007","journal-title":"J Cross-Cult Gerontol"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1002\/(sici)1099-1166(199910)14:10<821::aid-gps21>3.0.co;2-0","article-title":"A meta-analysis of epidemiological studies in depression of older people in the People's Republic of China","volume":"14","author":"Chen","year":"1999","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1016\/S0140-6736(09)60660-7","article-title":"Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey","volume":"373","author":"Phillips","year":"2009","journal-title":"Lancet"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"1987","DOI":"10.1016\/S0140-6736(13)61097-1","article-title":"Rapid health transition in China, 1990-2010: findings from the global burden of disease study 2010","volume":"381","author":"Yang","year":"2013","journal-title":"Lancet"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"S51","DOI":"10.1037\/tra0000685","article-title":"Psychological adjustment during the global outbreak of COVID-19: a resilience perspective","volume":"12","author":"Chen","year":"2020","journal-title":"Psychol Trauma"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1111\/jphd.12585","article-title":"Socioeconomic, behavioral, and psychological factors related to oral health in Myanmar: a cross-sectional study","volume":"83","author":"Thwin","year":"2023","journal-title":"J Public Health Dent"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1612600\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T04:12:02Z","timestamp":1752639122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1612600\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":69,"alternative-id":["10.3389\/fpubh.2025.1612600"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1612600","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]},"article-number":"1612600"}}