Frontiers in public health · 2026
Beyond access: usage variety, instrumental support, and later-life depression in a prospective study of Chinese older adults.
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Hou Ningyi, Chen Tianyuan, Yu Zhixian
Аннотация
INTRODUCTION: The digital divide is treated as a social determinant of later-life mental health, yet most evidence is cross-sectional and cannot separate its prospective effect from contemporaneous confounding. We examined which facets prospectively predict depression in older adults, and through what pathway.
METHODS: We analyzed three waves (2018, 2020, 2023) of the China Longitudinal Aging Social Survey. Four 2020 divide indicators (access, proficiency, usage variety, outcomes) predicted 2023 CES-D-9 symptoms, adjusting for baseline symptoms and covariates; the 2018-2020 interval provided an earlier-window replication. Half-longitudinal (Cole-Maxwell) mediation tested four social-connection mediators, moderated by hukou, living arrangement, and gender.
RESULTS: After adjustment for baseline depression, only the usage-variety divide-a narrower range of online activity-predicted higher subsequent depressive symptoms (b = 0.069, 95% CI 0.008-0.131). Of four mediators, only instrumental support mediated this association (indirect 0.019, bootstrap 95% CI 0.010-0.033), replicating in the 2018-2020 window (indirect 0.014, bias-corrected 95% CI 0.005-0.028). The pathway was stronger among urban and co-resident adults, with baseline instrumental support far higher in urban than rural areas (difference 0.82, p < 0.001), consistent with resource multiplication rather than substitution.
DISCUSSION: Conditioning on baseline depression, only the usage-variety divide-not access, proficiency, or outcomes-is prospectively associated with later depressive symptoms (chiefly as a stable between-person difference); this association was statistically mediated by lower instrumental support. Because the mediated association was stronger in resource-rich subgroups, the pattern is more consistent with resource multiplication than with substitution. Translating digital inclusion into mental-health gains may require broadening use while strengthening instrumental-support infrastructure, especially in rural settings.
METHODS: We analyzed three waves (2018, 2020, 2023) of the China Longitudinal Aging Social Survey. Four 2020 divide indicators (access, proficiency, usage variety, outcomes) predicted 2023 CES-D-9 symptoms, adjusting for baseline symptoms and covariates; the 2018-2020 interval provided an earlier-window replication. Half-longitudinal (Cole-Maxwell) mediation tested four social-connection mediators, moderated by hukou, living arrangement, and gender.
RESULTS: After adjustment for baseline depression, only the usage-variety divide-a narrower range of online activity-predicted higher subsequent depressive symptoms (b = 0.069, 95% CI 0.008-0.131). Of four mediators, only instrumental support mediated this association (indirect 0.019, bootstrap 95% CI 0.010-0.033), replicating in the 2018-2020 window (indirect 0.014, bias-corrected 95% CI 0.005-0.028). The pathway was stronger among urban and co-resident adults, with baseline instrumental support far higher in urban than rural areas (difference 0.82, p < 0.001), consistent with resource multiplication rather than substitution.
DISCUSSION: Conditioning on baseline depression, only the usage-variety divide-not access, proficiency, or outcomes-is prospectively associated with later depressive symptoms (chiefly as a stable between-person difference); this association was statistically mediated by lower instrumental support. Because the mediated association was stronger in resource-rich subgroups, the pattern is more consistent with resource multiplication than with substitution. Translating digital inclusion into mental-health gains may require broadening use while strengthening instrumental-support infrastructure, especially in rural settings.