Multiple Internet Divides and Mental Health Among Older Adults in China: A Nationally Representative Cross-Sectional Study (Preprint)

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Abstract
BACKGROUND Previous studies found that general internet use was associated with better mental health. However, there was little evidence about how this relationship would change across multiple subdimensions of internet divides and multiple subpopulations of older adults, particularly in low- and middle-income countries. OBJECTIVE This study examines the associations between multiple subdimensions of internet divides and mental health among older adults, as well as the potential moderating effects of rural/urban hukou status on these associations in China. METHODS We analyzed data from the 2018 China Longitudinal Aging Social Survey (CLASS), which provided a nationally representative sample of 11,418 participants aged 60 years and older. Multivariate linear regression models were used to analyze the associations of general internet use and three successive subdimensions (including access divide, support divide, and usage divide) with depressive symptoms (measured using the CES-D scale). The moderating roles of rural/urban hukou status were tested based on the interaction terms. RESULTS Among Chinese older adults, 18.3% (2,085/11,418) used the internet, with the proportion of rural participants (624/6,528, 9.6%) much lower than that of urban counterparts (1,461/4,890, 29.9%). After controlling for the confounders, older adults who used the internet reported significantly lower depressive symptom levels than non-users in China (β=-1.2; P<0.001). Further, access to internet devices, support for internet use from family, and using the internet for entertainment or as instruments were found to be significantly associated with a lower likelihood of suffering from depressive symptoms (P<0.05). Additionally, the associations between multidimensional internet divides and depressive symptoms were moderated by rural/urban hukou status, with these associations being significantly stronger among rural older people (P<0.1). CONCLUSIONS Lack of internet-enabled device access, technical support for internet use, and internet usage opportunities were the important barriers for Chinese older adults to take advantage of the internet in promoting mental health. Policy interventions targeting the access divide, support divide, and usage divide, respectively, should be taken to empower older adults, especially those with a rural hukou, for active engagement with the internet.

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