THE EFFECTS OF SOCIAL INTEGRATION ON SELF-RATED HEALTH AMONG OLDER ADULTS IN URBAN CHINA

THE EFFECTS OF SOCIAL INTEGRATION ON SELF-RATED HEALTH AMONG OLDER ADULTS IN URBAN CHINA • Iris Chi, D.S.W. • Weiyu Mao, M.Phil., Ph.D. Candidate • 2012 Joint World Conference on Social Work and Social Development • July 11, 2012

BACKGROUND • Social integration has shown profound impact on physical health (Berkman, Glass, Brissette, & Seeman, 2000) • Berkman et al. (2000) theorized the causal process from social integration to health and the model has been tested predominantly in western contexts (e.g., Stephens, Alpass, Towers, & Stevenson, 2011; Zunzunegui et al., 2004) Health Outcome Pathway Psychosocial Mechanisms Social Networks Social-Structural Conditions 2

LITERATURE GAPS • Research on the relationship between social integration and health within the Chinese context is limited in terms of factors considered, sample representativeness, and examination of interrelationships among correlates(e.g., Cheng, Lee, Chan, Leung, & Lee, 2009; Gu, Feng, & Sautter, 2008; Wang, Chan, Ho, & Xiong, 2008) • The findings from studies conducted in the Chinese context were inconsistent 2

AGING POPULATION IN CHINA Figure 1 Population Aged 60 and Over: 1953 to 2050 SECTION TITLE | 2 5

OBJECTIVES • Guided by the social integration and health conceptual framework, we aim to: • Examine how social integration (social networks and community involvement ) influences self-rated health among older adults in urban China accounting for the social context • Understand the mediating role of depressive symptoms in the relationship between social integration and self-rated health 4

CONCEPTUAL FRAMEWORK Pathway Psychosocial Mechanisms Social-Structural Conditions Social Networks Health Outcome Gender Age Education Marital Status Economic Security Chronic Conditions ADLs IADLs • Family Network • Friend Network Community Involvement Depression Self-Rated Health 6

METHODS • Data: Nationally representative study “Sample Survey on Aged Population in Urban and Rural China in 2006”, collected by the China Research Center on Aging • Sampling method: Probability proportional to size • Sample: A subsample of adults aged 60 and older in urban China (N=8,018) • Analysis: Structural equation modeling with latent variables using Mplus5.1 6

KEY MEASUREMENTS • Self-rated health (DV) was assessed by a single question: • “Now, how do you assess your current health status?” • With a 5-point response set: 1= very bad, 2= bad, 3= so-so, 4= good, and 5= very good • Depressive symptoms (IV) were measured with the Chinese version of Geriatric Depression Scale (GDS) • A summated score with a range from 0 to 15 was used in the analysis 9

SOCIAL INTEGRATION MEASUREMENTS • Social networks were measured by 6-item Chinese version of Lubben Social Network Scale (Lubben et al., 2006) • 3-item on family networks; 3-item on friend networks • Scores for the family and friend subscales are an equally weighted sum of all three items, respectively, ranging from 0 to 15, Robust cut-off point is 6 • Community involvement was a summated score for the engagement in multiple (20) community activities, ranging from 0-19 10

SAMPLE CHARACTERISTICS

ESTIMATED MODEL WITH STANDARDIZED COEFFICIENTS • The model fit was acceptable (χ2 = 2352.09; df = 53; p = .000; CFI = .934; RMSEA = .074) ITEM 1 ITEM 2 ITEM 3 0.826 0.822 0.778 FAMILY NETWORKS -0.097 0.040 -0.283 COMMUNITY INVOLVEMENT -0.069 DEPRESSIVE SYMPTOMS SELF-RATED HEALTH 0.212 FRIEND NETWORKS -0.063 0.855 0.034 0.815 0.920 ITEM 4 ITEM 5 ITEM 6 14

RESULTS • Both social networks and community involvement influence self-rated health among older adults in urban China accounting for the social structural conditions (direct effect) • The effects of family network and friend network on self-rated health were fully mediated by depressive symptoms • The effects of community involvement on self-rated health was partially mediated by depressive symptoms 15

OTHER SIGNIFICANT FINDINGS • Gender, years of education, marital status, functional capacities, chronic disease status, and depressive symptoms were also significantly associated with self-rated health among older adults in urban China 15

CONCLUSIONS • The model by Berkman et al. (2000) seemed to be beneficial in understanding the process from social integration to health status among older adults in urban China • This study contributes to our knowledge base by examining the direct and indirect effects of social integration on self-rated health within the Chinese context 17

IMPLICATIONS • Protective effects of social integration on self-rated health among older adults in urban China were found • Interventions should also focus on preventing and reducing depressive symptoms besides strengthening and expanding social connections among older adults in order to improve health outcomes 17

LIMITATIONS • Cross-sectional design, unable to establish causal relationships between variables or rule out reverse causations • Self-rated health was measured by a single item on a 5-point scale and treating it as a continuous variable may be limited 16

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THE EFFECTS OF SOCIAL INTEGRATION ON SELF-RATED HEALTH AMONG OLDER ADULTS IN URBAN CHINA