Article Text

Download PDFPDF
Life course socioeconomic position and incidence of mid–late life depression in China and England: a comparative analysis of CHARLS and ELSA
  1. Milagros Ruiz1,
  2. Yaoyue Hu2,
  3. Pekka Martikainen2,3,4,
  4. Martin Bobak1
  1. 1 Research Department of Epidemiology and Public Health, University College London, London, UK
  2. 2 Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
  3. 3 Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  4. 4 Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Milagros Ruiz, Research Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK; m.a.ruiz{at}


Background Despite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is akin to that observed in Western societies. We compared incident risk of mid–late life depression by childhood and adulthood SEP in China and England, a country where mental health inequality is firmly established.

Methods Depression-free participants from the China Health and Retirement Longitudinal Study (N=8508) and the English Longitudinal Study of Ageing (N=6184) were studied over 4 years. Depressive symptoms were classified as incident cases using the Center for Epidemiologic Studies Depression Scale criteria. Associations between SEP (education, wealth, residence ownership and childhood/adolescent deprivation) and depression symptom onset were assessed using Cox proportional hazards models. In China, we also investigated children’s government employment status as a SEP marker.

Results Higher education and wealth predicted lower incidence of depression in both countries. The association with non-ownership of residence appeared stronger in England (HR 1.61, 95% CI 1.41 to 1.86) than in China (HR 1.11, 95% CI 0.95 to 1.29), while that with childhood/adolescent deprivation was stronger in China (HR 1.43, 95% CI 1.29 – 1.60) than in England (HR 1.33, 95% CI 0.92 to 1.92). Chinese adults whose children were employed in high-status government jobs, had lower rates of depression onset.

Conclusions Consistent findings from China and England demonstrate that SEP is a pervasive determinant of mid–late life depression in very diverse social contexts. Together with conventional measures of SEP, the SEP of children also affects the mental health of older Chinese.

  • ageing
  • china
  • depression
  • depressive symptoms
  • england
  • incidence
  • inequality
  • socioeconomic position

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • MR and YH are joint first authors.

  • Contributors MR and YH, as joint first authors, developed the harmonised variables for the article, did the scientific literature search, prepared the data for analysis, analysed the data, interpreted the results, and prepared the first and final drafts of the article. PM and MB made substantial contributions to the analysis and interpretation of data, and critically reviewed the first and final drafts of the article for important intellectual content. MB made substantial contributions to the conception and design of the study.

  • Funding MR, PM and MB are supported by a European Commission Horizon 2020 grant, 667661, as part of the Promoting Mental Wellbeing in the Ageing Population: Determinants, Policies and Interventions in European Cities (MINDMAP) research project. PM is also funded by the Academy of Finland (#1294861 and 1308247), the Strategic Research Council PROMEQ project (#303615) and the C-LIFE project funded by NordForsk (#75970).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was provided by the Ethical Review Committee of Peking University (IRB00001052-11015) and the London Multi-Centre Research Ethics Committee (MREC/01/2/91), respectively for the CHARLS and ELSA studies. All CHARLS and ELSA participants provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.