Depression among older adults living in China: a multilevel, multimethod investigation

Introduction With the rapid ageing of China’s population, depression among older adults has become a major public health concern, and general hospitals are a primary source of care for this group. However, the population patterns of depressive symptoms, their links to healthcare utilisation, and the conditions under which they are recognised in routine nursing practice remain insufficiently understood. Against this background, the aim of this thesis is to provide an integrated understanding of depressive symptoms among older adults in China, particularly regarding inpatient care in general hospitals. Methods This thesis employed a multiple methods design with three interrelated studies: Phase 1) An integrative review of the prevalence and correlates of depression and depressive symptoms among older adults in China. Phase 2) Secondary analysis of cross-sectional data from the China Health and Retirement Longitudinal Study using Bayesian structural equation modelling to assess direct and indirect associations between depressive symptoms and inpatient healthcare utilisation. Phase 3) Qualitative descriptive exploration, using focus group interviews with nurses in a tertiary general hospital in China, to examine how they recognise, interpret and respond to depression in older patients. An interpretive synthesis was then used to integrate evidence across the three studies. Results Phase 1 indicated that depressive symptoms among older adults in China were common and were associated with multiple biopsychosocial factors. Phase 2 showed that links between depressive symptoms in older persons (n = 7,777) and inpatient utilisation were mainly indirect via physical health and functional status. Phase 3 found that nurses’ (n = 48) recognition of depressive symptoms in routine care was fragmented and constrained by knowledge gaps and organisational conditions. Drawing on findings from all three phases, the thesis proposed the Recognition-Misalignment-Recognition (RMR) framework. Conclusion The findings indicate that depressive symptoms among older adults occupy a position of low visibility and structural misalignment across care needs, service use and clinical responses in general hospitals. Depressive symptoms enter professional view mainly through physical and functional problems and become linked to inpatient healthcare utilisation along these routes, while psychological needs are rarely embedded in routine assessment, documentation and referral, and are perceived only intermittently and in a fragmented way in nursing practice. On this basis, the thesis proposes the RMR framework as a process-oriented explanatory lens to organise initial recognition, structural misalignment and subsequent recognition of depressive symptoms within general hospital care, and to provide a basis for strengthening visibility and support for depression among older adults in general hospital.

Grantor dc:publisher

University College Cork

Year dc:date.issued

2026

Author dc:creator

• Wu, Yue

Advisors dc:contributor.advisor

• Cornally, Nicola
• O' Donovan, Aine
• Wills, Teresa
• Kilty, Caroline

• Depression
• Older adults
• China
• Healthcare utilisation
• Nurses

Statement dc:rights

• © 2026, Yue Wu.

Licence dc:rights.uri

• https://creativecommons.org/licenses/by-nc-nd/4.0/

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10468/18906

OAI identifier oai:identifier

oai:cora.ucc.ie:10468/18906