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Does money relieve depression? Evidence from social pension expansions in China

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Abstract

We estimate the impact of pension enrollment on mental well-being using China's New Rural Pension Scheme (NRPS), the largest existing pension program in the world. Since its launch in 2009, more than 400 million Chinese have enrolled in the NRPS. We first describe plausible pathways through which pension may affect mental health. We then use the national sample of China Family Panel Studies (CFPS) to examine the effect of pension enrollment on mental health, as measured by CES-D and self-reported depressive symptoms. To overcome the endogeneity of pension enrollment or of income change on mental health, we exploit geographic variation in pension program implementation. Results indicate modest to large reductions in depressive symptoms due to pension enrollment; this effect is more pronounced among individuals eligible to claim pension income, among populations with more financial constraints, and among those with worse baseline mental health. Our findings hold for a rich set of robustness checks and falsification tests.

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... As the most common and serious mental disorder, the incidence of depression increased by 18.4% between 2005 and 2015, depressive disorders led to more than 50 million Years Lived Disability (YLD) in 2015, accounting for 7.5% of all YLDs, and more than 80% of this non-fatal disease burden occurred in LMICs [12]. Moreover, depression occurs at a higher level among elderly persons, and prevalence of depression at older ages has been increasing as a result of global population aging [12,13]. ...
... A study in Mexico revealed that a social pension program significantly decreased the depression score by 12% and improved mental health of the beneficiaries [32]. Two recent studies on the NRSPI program in China both found that the NRSPI pensions significantly improved mental health of rural elderly by decreasing the depression score or depressive symptoms [13,33]. ...
... They also did not analyze the impact of pension income on the rate of depressive symptoms, which may be more important to assess the seriousness of depression. Chen et al. [13] used cross-sectional data in 2012 to examine the effects of pension enrollment and income on mental health, which makes it difficult to control individual effects and to analyze long-term impact of pension income. In addition, Cheng et al. [33] and Chen et al. [13] mainly assessed the impact of pension income on mental health of rural elderly, but failed to describe mental health production within the context of the NRSPI pensions and to discuss regional differences of the impact of pension income. ...
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The causal effect of public pensions on the mental wellbeing of the elderly in lower and middle-income countries deserves further investigation. This paper first constructed a theoretical framework for the impact of New Rural Society Pension Insurance pensions in China on the mental wellbeing of the rural elderly, and described potential channels through which pension income may affect mental wellbeing. We then used the fixed effect model and the instrument variable approach to estimate the casual effects of pension income on the mental wellbeing of the rural elderly. The results reveal that pension income improves mental wellbeing by relieving depression of the rural elderly; however, the beneficial effects of pension income are very limited. Pension income has no beneficial effects on the mental health of the rural elderly in the east region, whereas it slightly relieves depression of those in the middle and west regions. We also found that pension income produces small improvements in the mental health of older females, elderly persons living independently, and those with relatively poor economic conditions.
... In addition to depressive symptoms (DiMaria-Ghalili & Amella, 2005;FAO et al., 2019;Souter & Keller, 2002), food consumption patterns can affect the use of health services and medication as well as the ability to perform basic activities of daily living (ADLs) (Jensen & Richter, 2004). Income availability can also help reduce anxiety and other depressive symptoms associated with the lack of income in old age Chen, Wang, & Busch, 2019;Lu & Shelley, 2019;Salinas-Rodríguez, Torres-Pereda, Manrique-Espinoza, Moreno-Tamayo, & Téllez-Rojo Solís, 2014). ...
... A study of China used two-stage least squares equations to examine changes in mental health status and depressive symptoms for people enrolled in the New Rural Pension Scheme (NRPS) (Chen et al., 2019)-a non-contributory pension and matching contributions program. Chen et al. (2019) used the CES-D Scale as a continuous scale to assess mental health status and as a binary variable with a cutoff at 15 points (of 60) to assess depressive symptoms. The authors used the 2012 wave and NRPS duration as an instrumental variable for pension enrollment status and pension income. ...
... The authors used the 2012 wave and NRPS duration as an instrumental variable for pension enrollment status and pension income. They found pension enrollment produced a moderate-to-large decrease in depressive symptoms among people age 60 and older, with this reduction being larger for those with relatively worse mental health, lower educational attainment, and lower income (Chen et al., 2019). Lu and Shelley's (2019) analysis of the 2012/2013 HRS partner surveys also assessed the effects of supplemental income programs (i.e., non-contributory cash transfers provided by the government) and social security programs (i.e., a definedcontribution system in which the government, the employer, and the worker contribute to the retirement account) on depressive symptoms of older adults. ...
Chapter
The world’s population is aging rapidly, with the proportion of persons age 60 and older in the total population expected to increase from 12% in 2015 to 22% by 2050 (World Health Organization, 2017). Similarly, in Mexico, the proportion of persons age 60 and older is expected to increase from 11.0% in 2019 to 22.6% by the year 2050 (The World Bank, n.d.).
... However, the replacement of children's support with public benefits may also have negative consequences for older individuals' SWB because it contradicts the social norm of filial piety. Focusing on the impacts of new rural pension in China, several studies have estimated the effects of pension benefits and demonstrated their positive impact on the financial and SWB of older adults (Chen and Wang 2016;Huang and Zhang 2016;Zhang et al. 2014). Yet, a research gap remains with respect to linking these effects of pension receipt to changes in intergenerational transfers. ...
... Huang and Zhang (2016) also found that pension receipt increases household income, food expenditure, and participation in health care. As to mental wellbeing and health, previous research confirms that pension receipt coincides with higher life satisfaction and decreases depressive moods of older adults (Chen and Wang 2016;Zhang et al. 2014). Furthermore, Huang and Zhang (2016) show that mortality of older adults who are eligible to receive the pension dropped one year after the launch of the NRSPS. ...
... First-difference models focus only on the change in the dependent variable from one time-point to another, whereas level-effects and stable characteristics, for example emerging from the composition of the sample, are controlled for. These models are a robust method to eliminate the unobserved timeinvariant heterogeneity and reversed causation issue, which instrumental variable (IV) estimations or regression discontinuity (RD) based on cross-sectional data cannot fully reduce (Chen and Wang 2016;Zhang et al. 2014). Hence, first-difference models are suitable for our purposes to examine whether a change in pension receipt actually leads to a change in individuals' behavior or wellbeing, controlling for individuals' stable characteristics and traits (Allison 2009;Brüderl and Ludwig 2014). ...
Article
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With the introduction of the New Rural Social Pension Scheme (NRSPS), pension coverage in rural China has increased substantially during the last decade. We investigate how the new public pension benefits influence intergenerational transfers and subjective well-being of older adults in rural China using panel data from the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study (CHARLS). The results of our first-difference regression models show that receiving a public pension goes along with an increase in intergenerational financial support and has a positive impact on the subjective well-being of older adults in rural China. Our analysis represents one of the first studies examining the effects of the introduction of the NRSPS from a longitudinal perspective. The results demonstrate that public pension benefits as a form of institutional financial support are beneficial to the well-being of older adults, while they do not hinder intergenerational exchange.
... Research shows that there is a relationship between health and income (10). The New Rural Pension Scheme is a main source of income for the elderly in rural China. ...
... = 0.90) and less likely to be depressed (OR = 0.75) than people without pension. These outcomes are in agreement with recent evidence that show that pension enrollment significantly relieves depression (10). Table 1 Group B shows the regression outcomes found by using monthly pension income as an explanatory variable. ...
... The New Rural Pension Scheme is a system in which rural elderly participate voluntarily. This scheme can improve a sense of selfactualization (10), and the promotion of spiritual comfort may lead to less serious depression, especially for vulnerable groups. The impact of pension enrollment and pension benefits on psychological health was even greater among rural elderly without chronic diseases. ...
Article
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Objectives: This study was designed to explore the effect of the New Rural Pension Scheme on depressive symptoms or medical costs induced by depression. Methods: We used the Logit, OLS and 2SLS models to explore the impact of the pension on depression and medical costs. We also adopt the method of quantile regression and discontinuity regression to verify the causal relationship between the New Rural Pension Scheme and depression or medical costs induced by depression of the rural elderly. Results: We have found that the New Rural Pension Scheme decreases depressive symptoms of elderly in rural China (OR = 0.90), and the medical costs induced by depressive symptoms by 4.6%. Regression discontinuity results showed that pension significantly reduced the depressive symptoms (depression) and the medical expenditure caused by depressive symptoms (depression) by using parametric and non-parametric methods, and performing a placebo test. The mediating effect results showed that pension may improve mental health by increasing confidence about the future. Conclusion: We demonstrate that the pension significantly decreased both mental health problems and the medical expenses due to depressive symptoms and depression of elderly in rural China. Therefore, our results suggest that the Chinese government should perfect the New Rural Pension Scheme to eliminate barriers to mental health resources, especially for the rural elderly.
... As an important part of the social pension system of China, the NRP is designed and implemented by the government, with the aim to improve the welfare of the elderly in rural areas. Most of the existing studies have focused on the effects of the NRP on the elderly, such as their physical health, consumption, and subjective welfare [97][98][99][100]. For example, several studies have reported a positive causal relationship between the NRP and the physical health level of the elderly and its influencing mechanisms [101,102]. ...
... For example, several studies have reported a positive causal relationship between the NRP and the physical health level of the elderly and its influencing mechanisms [101,102]. Other studies have found that the NRP increased the probability of the elderly receiving daily care and spiritual comfort [103], which further helped to reduce their depression [99]. ...
Article
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Research purpose: This study aimed to explore the effect of China's New Rural Pension (NRP) on the physical and mental health of rural children from the perspective of intergenerational care, and to examine whether family childcare types and the child's gender affect the relationships between social pensions and the physical and mental health of rural children. Methods: We used data from the 2016 China Family Panel Studies (CFPS) of the China Social Science Survey Center, a nationally representative sample at the individual, family, and county levels from 25 provinces (cities and districts) in China. A total of 2142 sets of valid samples of children, the elderly, family economic and social conditions, and basic family information were retained after data screening. The regression discontinuity (RD) method was employed for the statistical analyses. Results: The NRP had a significant effect on both the mental health (β = -2.818, p < 0.1) and physical health (β = -2.214, p < 0.1) of rural children. This effect varied with the family childcare type and child's gender. Conclusions: We reveal a positive effect of the NRP on the physical and mental health of rural children. Therefore, the establishment of a social pension system may be used as an effective approach to enhance the health of rural children. The impact of the NRP on the physical and mental health of children differs with the family childcare type and their gender, which should be taken into consideration when using social pensions to enhance child health.
... Rural residents who were aged 60 or above when the scheme was implemented are entitled to enjoy benefits without having contributed anything to the program. The basic pension benefit is 55 yuan per month per person (or around $8), which is over 30% of rural household income per capita among rural residents aged 60 or above (Chen et al., 2019;Huang & Zhang, Forthcoming). The governments subsidize all basic pension benefits. ...
... The governments subsidize all basic pension benefits. A rising literature demonstrates that the launch of NRPP significantly improves physical and health of the rural elderly (Chen et al., 2019;Cheng et al., 2018), reduces mortality rates, and increases household income and food expenditure for recipients (Huang & Zhang, Forthcoming). We extend this line of research by considering the political consequences of the NRPP. ...
Article
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Do social welfare benefits enhance political legitimacy in nondemocracies? Conventional wisdom treats material interest as being the central mechanism underpinning widespread political attitudes, but social welfare is not always effective in garnering political support in nondemocracies. Using a regression discontinuity design, we find that even though receiving social welfare benefits has significantly improved individuals' well‐being, their political support in different levels of government have not significantly grown. We demonstrate that the null effect of social welfare on political support can be partially explained by individuals' exposure to political violence before. Social welfare benefits yield a backsliding effect on local government support when individuals were exposed to high revolutionary intensity.
... Focusing on pension income, which is one of the main sources of household income for the retired population, Chen et al. found that pension enrolment and pension income were significantly associated with a reduction in CESD scores among Chinese older adults, controlling for other socioeconomic factors and health status [43]. ...
... Based on a quasi-natural experiment, Reeves et al. also found that the reduction in housing benefits significantly increased the prevalence of depression for low-income UK households [38]. Additionally, the association between pension income and depressive symptoms in older adults were more pronounced among lower-income groups [43]. More broadly, the income-depression relationship might be influenced by the economic status of the regions where households live. ...
Article
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Financial stress has been proposed as an economic determinant of depression. However, there is little systematic analysis of different dimensions of financial stress and their association with depression. This paper reports a systematic review of 40 observational studies quantifying the relationship between various measures of financial stress and depression outcomes in adults. Most of the reviewed studies show that financial stress is positively associated with depression. A positive association between financial stress and depression is found in both high-income and low-and middle-income countries, but is generally stronger among populations with low income or wealth. In addition to the “social causation” pathway, other pathways such as “psychological stress” and “social selection” can also explain the effects of financial stress on depression. More longitudinal research would be useful to investigate the causal relationship and mechanisms linking different dimensions of financial stress and depression. Furthermore, exploration of effects in subgroups could help target interventions to break the cycle of financial stress and depression.
... Social pension insurance is considered one of the major social security programs to improve the well-being and quality of life of the elderly (Chen et al., 2019;Galiani et al., 2016;Lalive & Parrotta, 2017). Evidence has also shown that social pension income can also relax household budget constraints and have intra-household spillover effects beyond older adults, such as household consumption and savings, living arrangements, intergenerational economic support, and migration of young adults (Eggleston et al., 2018;Kabeer & Waddington, 2015). ...
... According to a report from the Ministry of Human Resources and Social Security of China, the per capita NRPS pension was 125 RMB yuan per month in 2018, approximately 10% of the per capita disposable income in rural areas. Although the amount of NRPS pensions is relatively low compared to the old-age pension scheme in other countries such as South Africa and Mexico, past research has shown that the NRPS has significant effects on household economic status and elderly well-being (Chen et al., 2019;Zheng et al., 2020b). The current study adds to this literature by investigating the educational consequences of the NRPS policy. ...
Article
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Social pension programs are a popular policy instrument to improve the well-being of the elderly and their households. However, evidence regarding the intra-household spillover effect of social pensions on children’s education remains limited. Using data from the China Family Panel Studies (CFPS), this study empirically examined the associations between the cash transfers from the New Rural Pension Scheme (NRPS) for the eligible older adults and children’s educational outcomes in rural China. The results showed that the NRPS had significant intra-household spillover effects on children’s school enrollment and literacy skills. The findings were robust to a suite of robustness checks. Further, the associations of the NRPS with children’s educational outcomes were stronger for children who were boys, at a younger age, left behind by parents, and lived in economically disadvantaged families. We explored the potential mechanisms and found that the increase of childcare from grandparents and parents, accompanied by the improvement of physical and mental health, as well as learning behaviors of children, were the main possible channels behind the relationships between the NRPS and children’s schooling outcomes. Our findings shed new light on the effects of social pensions in rural China and provide insights on the policy improvement for the human capital development of disadvantaged children in developing countries like China.
... Even though most studies supported a positive correlation between pension scheme and mental health (27,28,30), there were still many questions left unanswered. Firstly, nearly all the literature assumed that the effect of pension on mental health is the same irrelevant of the state of pension, i.e., as a contributor or pensioner (31), but this assumption could be challenged, because the impact of paying premiums and receiving proceeds won't be the same for an ordinary person, even if this person is considered as "under coverage." ...
Article
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As China experiences rapid aging, the mental health of older rural adults has become a major public health concern. Among other social insurance programs, the New Rural Social Pension (NRSP) scheme was established to replace part of the income for old-age rural residents in China. This article employs survey data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018 to investigate the impact of a pension on depression in middle-aged and old residents. Our results show that the pension scheme not only reduces the depressive symptoms of the rural residents but keeps down the prevalence rate of depression. Among the subscribers of the pension scheme, the pensioners benefit more from enrolling in the pension scheme than the contributors in terms of depression alleviation. The impact of pension on depression displays heterogeneity; female residents, residents in central China, and/or those from lower income households are found to be positively affected. It is also confirmed that a pension scheme contributes to easing depression via reduced labor supply, better family support, and more consumption expenditure. JEL Classification: H55, I18, I38.
... It is necessary to understand existing beliefs, including those about recovery, in order to challenge misunderstandings and move towards a deeper understanding of mental health and mental illness within the community. Thirdly, practical interventions which focus on strengthening family and community relationships and enabling people with mental health problems to access education and employment opportunities have already been shown to have positive effects on mental health (Lund et al., 2011;Petersen et al., 2016;Chen et al., 2019;Drosos and Theodoroulakis, 2019;Hall et al., 2019). These findings suggest that they are likely to have an added benefit of strengthening social inclusion, as family and community members perceive these as signs that the person is recovering, leading to greater acceptance. ...
Article
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Qualitative comparative analysis (QCA) is a relatively new method that examines causal complexity. Its use in mental health research is nascent. In low-income and fragile settings, with weak mental health service provision, identifying pathways of recovery from psychological distress can inform the appropriate deployment of scarce community and public resources. This paper examines the use of QCA to identify predictors of recovery in Sierra Leone. Our study explored lay perceptions of the signs of recovery from psychological distress caused by such events as the loss of a family member, severe sickness, and loss of a relationship. The data drew upon 75 interviews with women and men, across four districts of Sierra Leone, who described the signs of recovery from psychological distress they have observed in one person known to them. The truth table generated through QCA software indicated two signs of recovery— work/study and healthy relations—to be the most prevalent across different combinations of predictive factors. Further analysis of the truth table and sub-set relations suggested that work/study and healthy relations frequently served as sufficient conditions for reported recovery from distress to occur. QCA provided a means to identify sufficient predictive factors for recovery from psychological distress to occur. The findings suggest that to enable recovery from psychological distress, support needs to be broad and bring together services that will enable individuals to improve their social and relational wellbeing. Responses to distress need to involve a wide range of community-based stakeholders who will help individuals to engage in constructive activity and strengthen relations with their family members, friends, and the broader community. QCA is potentially well-positioned to unpack complexity in mental health research.
... To identify the probability of being a high contributor, we use community-level, heterogeneous years of introducing NRSP and construct the community-level duration of the NRSP program as the difference between the survey year and the year when the NRSP started in local communities. Previous studies have used county-level duration of the NRSP program as an instrument for individual participation probability (Chen, Wang and Busch, 2019;Cheng et al., 2018a,b;Shu, 2018). The assumption is that the longer the program has been in place, the more likely people will participate and will contribute at a higher level to their pensions after a build-up of knowledge about the program and trust in the local governments. ...
... Although many studies used household consumption as a socioeconomic factor, it may be partially overlapped with our independent variable. Given that studies indicate pension as a significant financial factor that influences older adults' mental health [50,51], the logarithm of yearly total pension income (continuous variable) was controlled to specifically test the effect of intergenerational financial support. Previous studies have shown that a significant factor of mental health is health status [52]. ...
Article
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Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons' mental health.
... In addition, Western countries also tend to have better social security and pension systems, while Eastern countries tend to have lower pension coverage, as in South Korea, where only 28% of all elderly people receive a basic old-age pension (40,69). Pension coverage can improve mental health (70,71), and low pension coverage might be one of the reasons for the negative impact of retirement on mental health in Eastern developed countries. There is relatively less evidence from developing countries, and more relevant empirical studies are needed in developing countries in the future. ...
Article
The purpose of this study was to collect the evidence of the relationship between retirement and depression through meta-analysis, and further analyze the heterogeneity of results. The quality of the studies was rated based on ten predefined criteria. We searched articles published between 1980 and 2020 and a total of 25 longitudinal studies were included in the meta-analysis. The meta-analysis results showed that retirement was associated with more depressive symptoms (d =0.044, 95%CI 0.008 to 0.080). The association of involuntary retirement (d = 0.180, 95%CI 0.061 to 0.299) with more depressive symptoms was stronger than voluntary retirement (d = 0.086, 95%CI -0.018 to 0.190) and regulatory retirement (d = 0.009, 95%CI -0.079 to 0.097). Retirement was significantly associated with more depressive symptoms in eastern developed countries (d = 0.126, 95%CI 0.041 to 0.210), and the association was stronger than that in western developed countries (d = 0.016, 95%CI -0.023 to 0.055). These findings suggest that the transition to retirement was associated with higher risk of depression and this association varied by the type of retirement and country. Further empirical studies need to explore the mechanism of retirement and depression and whether such association was linked with socio-economic position.
... Summing up the scores of the 20 items yields a total CES-D score, with higher scores indicting more severe depressive symptoms. The CES-D has been used in multiple studies of depressive symptoms in Chinese adult and adolescent populations [49,50]. Cronbach's alpha of the current sample was 0.86. ...
Article
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PurposeSelf-harm in adolescents is prevalent and is the most significant predictor of future self-harm and suicide. Longitudinal data on the incidence and predictors of repeat self-harm in the general population of adolescents are limited. This study investigated 1-year incidence and psychosocial predictors of repeat self-harm in Chinese adolescents.Methods Shandong Adolescent Behavior and Health Cohort is a longitudinal study of behavior and health in adolescents in Shandong Province, China. Of 7072 participants who were assessed in 2015 and again 1 year later in 2016, 1879 reported a history of self-harm at the baseline survey and were included for this analysis. A self-administered structured questionnaire was used to assess behavioral and emotional problems, sleep, life stress, previous history of self-harm and suicidal thought, and family factors at baseline and self-harm at 1-year follow-up.ResultsMean age of the sample was 14.86 (SD 1.36) years and 54.6% were female. At 1-year follow-up, 22.1% participants engaged in repeat self-harm. Multiple logistic regression analyses showed that female gender (OR 1.45, 95% CI 1.11–1.89), alcohol use (OR 1.95, 95% CI 1.48–2.57), frequent nightmares (OR 1.61, 95% CI 1.14–2.28), elevated depression score (OR 1.59, 95% CI 1.05–2.42), and prior suicidal thought (OR 1.79, 95% CI 1.37–2.34) were independently and significantly associated with an increased risk of repeat self-harm.Conclusion More than one in five Chinese adolescents who had a history of self-harm engaged in self-harm at 1-year follow-up. Multiple psychosocial factors including female gender, alcohol use, frequent nightmares, depression, and prior suicidal thought appeared to be significant predictors of repeat self-harm. Our findings highlight the importance of comprehensive psychosocial assessment and intervention of repeat self-harm in adolescents.
... The second was equal to 1 (0 otherwise) if the respondent participates in any of the following social activities: interacting with a friend; playing Mahjong, chess, or cards; going to a community club or sporting event; participating in a social group or other club type, belonging to a community-related organization or engaging in voluntary or charity work; and/or attending an educational or training course. Because receiving pension benefits contributes to health both directly (through, for example, better diet, lack of stress, ability to pay for housing) [66] and indirectly through healthcare utilization (e.g., inpatient/outpatient visits, preventive care) [67], we also included a binary variable for whether the respondent is currently receiving any type of nondisability pension (1 = yes, 0 = no). Lastly, given China's diverse physical geography and its major rural-urban divide in health outcomes [2,61,68], we added in a province dummy to capture possible geographic heterogeneity and a control for current residence location (1 = rural, 0 = urban). ...
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Background: Although prior research on the housing-health linkage suggested that those with poor housing conditions are more likely to report poor health, it is dominated by Western studies and offers little evidence on the housing-health relation in China. Scarce is empirical evidence on the potentially detrimental impact of either qualitative or quantitative housing poverty on health outcomes, especially for seniors in China. This paper aims to fill this void by using data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) to provide a comprehensive analysis of the demographic, socioeconomic, and behavioral factors that contribute to changes in healthy aging among Chinese adults aged 60 and over. Methods: Data collected from 8839 adults aged 60 and over in the 2011 and 2015 CHARLS (3732 in 2011 and 5107 in 2015) were used. We first used six blood-based biomarkers to construct a composite measure of the Chinese Healthy Aging Index (CHAI, ranging from 0 (healthiest) to 12 (unhealthiest)) and then assessed the psychometric properties of the CHAI score, including acceptability, internal consistency, convergent validity, discriminative validity and precision. In addition, we employed both mean-based Blinder-Oaxaca and unconditional quantile regression decomposition to decompose the change in healthy aging within the 2011-2015 period. Results: We overall identified a decrease in CHAI score from 5.69 in 2011 to 5.20 in 2015, which implies an improvement in healthy aging during this period. Our linear decomposition revealed that dependent on the type of measure used (whether quality, quantity, or combined quality-quantity), housing poverty explained 4-8% of the differences in CHAI score. Our distributional decompositions also highlighted an important role for housing poverty in the change in healthy aging, accounting for approximately 7-23% of the explained portion. Within this latter, the relative contribution of housing quantity and quality poverty was more pronounced at the median and upper end of the CHAI distribution. We also found household expenditure to be significantly associated with healthy aging among older Chinese adults and made the largest contribution to the improvement in healthy aging over time. Conclusions: The association between housing poverty and CHAI is independent of household expenditure. Regardless of type, housing poverty is positively associated with a decrease in healthy aging. Thus, improved housing conditions boost healthy aging, and housing amelioration initiatives may offer the most effective solution for augmenting healthy aging in China. Improvement of flush toilets and the access to potable water and a separate kitchen require particular attention. Since high-density congested housing has a negative impact on healthy aging, more attention can also be paid to improvements in the available space for older people. Especially at an institutional level, the government may extend the housing policy from a homeownership scheme to a housing upgrading scheme by improving housing conditions.
... From the demand side, although a social safety net has been well established for urban Chinese residents, a similar program has been rolled out only recently with limited pension benefits for rural residents (Chen et al. 2019). As a result, rural Chinese older adults rely more heavily on their adult children for support. ...
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Caring for grandchildren provides grandparents an opportunity to sustain an active lifestyle and remain socially engaged in older age. Studies have examined the association between providing care to grandchildren and grandparents’ cognitive function. However, these studies had several limitations and yielded mixed findings. Using data from the China Health and Retirement Longitudinal Study, this study examined the longitudinal association between caregiving and cognitive functioning in grandparents aged 50–75 years. Grandparents’ caregiving status and cognitive functioning were assessed in 2011, 2013, and 2015. Random-effects and fixed-effects regression models were estimated and compared. The full sample (20,000 + person-year observations) was divided into four subgroups to examine gender and rural–urban variations. Being a part-time noncoresident caregiver was associated with higher scores on episodic memory for grandfathers but not for grandmothers. Compared with their noncaregiving counterparts, rural part-time multigenerational caregiving grandmothers had significantly better mental intactness and global cognitive functioning, while rural full-time noncoresident caregiving grandmothers had significantly better episodic memory. Caregiving status was not associated with any cognitive measure among urban grandmothers. Taken together, these findings suggest that Chinese grandparents enjoy cognitive benefits from providing casual or intensive care to grandchildren, but these benefits vary substantially by gender and rural–urban status.
... Several studies have found positive effects of social pensions on depressive symptoms and well-being (Chen et al., 2019;Cheng et al., 2018;Galiani et al., 2016;Kollamparambil & Etinzock, 2019;Salinas-Rodríguez et al., 2014;Schatz et al., 2012). Although in Colombia it seems that the country's social pension has a number of positive effects on a number of other socioeconomic characteristics and behaviors, various reasons may help to explain the absence of a significant effect on depression. ...
Article
Background Many low- and middle-income countries have introduced social pensions to alleviate extreme poverty and improve the well-being of older individuals. However, evidence remains inconclusive about the potential effects of such programs on mental health, social and health behaviors. Method Data for individuals ≥60 years came from the nationally representative Encuesta Nacional de Salud, Bienestar y Envejeciamiento (SABE) survey in Colombia 2015 (N=9,456). We used propensity score matching (PSM) to estimate the association between the country’s social pension program (Colombia Mayor) with depression, self-rated health, food insecurity, alcohol consumption, social participation and labor force participation. Results Results show that receiving the program does not significantly affect the likelihood of suffering from depression or self-rated health among either men or women. However, receiving the program is associated with significant reductions in the likelihood of experiencing food insecurity and significant increases in the likelihood of participating socially. Among women, receiving the program is associated with significant reduction in the likelihood of participating in the labor force. Discussion The absence of a measurable effect on depression and self-rated health may be explained, at least partly, by the program’s comparatively small cash benefit and the sharing of resources with other family members. Policymakers should assess possibilities to maximize the health and social benefits of social pensions.
... To simplify the problem in question, this study considers one or two breakpoints, and reports the results for two breakpoints if both are significant. To avoid reverse causation and omitted variable bias, we followed the suggestion of Cheng et al. [65] and Chen et al. [66], and took pension duration as an instrumental variable for pension income. This was calculated as the time between the survey year and the year the participant begin to receive the pension. ...
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Background The proportion of people aged 60 years or over is growing faster than other age groups. Traditionally, retirement has been considered as both a loss to the labour market and an additional economic burden on the nation. More recently, it is widely accepted that retired people can still contribute to society in many ways, though the extent of their contributions will depend heavily on their state of health. In this context, a significant practical issue is how to encourage older people to use the health services they need. This study aims to evaluate the effects of pensions on older adults’ health service utilization, and estimate the level of pension required to influence such utilization. Methods Using data from a nationally representative sample survey, the China Health and Retirement Longitudinal Study, we adopted a fuzzy regression discontinuity design and undertook segmented regression analysis. Results It was found that a pension did encourage low-income people to use both outpatient (OR = 1.219, 95% 1.018–1.460) and inpatient services (OR = 1.269, 95% 1.020–1.579); but also encouraged both low- and high-income people to choose self-treatment, specifically over-the-counter (OR = 1.208, 95% 1.037–1.407; OR = 1.206, 95% 1.024–1.419; respectively) and traditional Chinese medicines (OR = 1.452, 95% 1.094–1.932; OR = 1.456, 95% 1.079–1.955; respectively). However, receiving a pension had no effect on the frequency of outpatient and inpatient service use. Breakpoints for a pension to promote health service utilization were mainly located in the range 55–95 CNY (7.1–12.3 EUR or 8.0–13.8 USD). Conclusions A pension was found to have mixed effects on health service utilization for different income groups. Our study enriches existing evidence on the impact of pensions on healthcare-seeking behaviour and can be helpful in policy design and the formulation of improved models relating to pensions and healthcare utilisation.
... Using China Health and Retirement Longitudinal Study (CHARLS), one study showed that pension income was directly and negatively related to depressive symptoms in rural China. Using the national sample of China Family Panel Studies (CFPS), another study found pension enrollment in rural China generated moderate to severe reductions in depressive symptoms, and such a beneficial effect was more pronounced among older adults than younger cohorts [32]. ...
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This study aimed to investigate the relations between pensions and depressive symptoms of Chinese older people, and whether intergenerational support mediated such association. Secondary data was drawn from Chinese Longitudinal Aging Social Survey (CLASS) 2014 (N = 6687). Depressive symptoms were measured by 12-item version of the Centre for Epidemiological Studies Depression scale (CES-D). Intergenerational support was measured by financial, instrumental, and emotional support. About 80.1% of the participants had pension and the mean score of depressive symptoms of the participants was 17.10 (SD = 4.35) with a range from 12 to 36. The results from hierarchical linear regression revealed that there was significantly association between pensions and lower levels of depressive symptoms (B = −0.645, p < 0.000). Findings of mediation analyses also indicated that financial support from adult children played a mediating role between pensions and depressive symptoms (B = −0.039, 95% CI [−0.064, −0.018], z = −3.082, p = 0.002). Findings from this study enrich our theoretical and practical understanding of the roles of intergenerational support, and offer implications for social insurance policy, social work, and family support interventions for Chinese older adults.
... While unrecoverable and ongoing economic difficulties are a chronic stressor [33], a regular and stable income stream can be a positive influence. This alleviation effect is more evident in vulnerable groups such as females, low-educated households [34], low-income households, and the chronically ill [35]. In other words, the positive effect of the BOP benefit might be crystallized in vulnerable beneficiaries who have limited access to other economic resources. ...
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Objectives: The purpose of this study was to investigate the association between the Basic Old-Age Pension (BOP), which is a noncontributory pension, and depression in BOP beneficiaries in Korea. Methods: We used the second and third waves (2007-2008) of the Korea Welfare Panel Study to identify the effect of the BOP on mental health in the year of its introduction. The Center for Epidemiological Studies-Depression Scale, applied in a Korean context, was used to evaluate mental health. To analyze the effect of the BOP, a difference-in-difference approach was used in analyses of all subjects and subgroups. Results: For this study population of 760 adults, the BOP did not have a statistically significant relationship with depression in its beneficiaries. After controlling for type of household, the BOP was still not associated with lower reporting of depression, either in single-beneficiary or double-beneficiary households, in the year of the benefit. Conclusions: The BOP policy had no significant relationship with the level of depression among recipients. However, this should not be interpreted as implying that income subsidy programs for older adults, such as the BOP, do not affect mental health, considering the importance of economic hardship in this population and the program's socioeconomic effects.
... In this scale, which ranges from 0 to 9 symptoms, the ineligible population report 3.89 symptoms on average, while the program produces a 0.61 point reduction in symptoms. Positive effects of NCP programs on psychological well-being have previously been found by Salinas-Rodriguez et al. (2014) and Galiani et al. (2016) in Mexico, Chen et al. (2019) in China, and Bando et al. (2020) in Peru. A key difference between our study and Bando et al. (2020) is that while they look at the overall program effects, we assess the differential effects by the exposure time to the program, the access to health care facilities, and gender. ...
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This paper exploits the discontinuity around a welfare index of eligibility to assess the heterogeneous health impacts of Peru's social pension program Pension 65, which focuses on elderly poor individuals. The heterogeneity is analysed with regards to the treatment exposure (short vs long run), the accessibility to health care infrastructure (near vs distant facilities), and gender. Overall, we find improvements in anaemia, mortality risk markers, cognitive functioning, mental health, and self-reported health among eligible individuals; yet there is an increase in the risk of obesity among women, as well as an increase in reported chronic diseases. The program improves the quality of nutrition and health care access, but reduces the frequency or intensity of physical activities. About half of the effects on the analysed outcomes persist in the longer run and living in a district with good access to facilities stands out as the most relevant characteristic enhancing the beneficial program effects. Overall thus, the resulting health benefits in areas of under-nutrition are at most modestly compensated by deterioration in over-nutrition related conditions. As the program evolves further, policymakers need to confront the challenge of continuing to ensure the health benefits in terms of reducing nutritional deficits and the lack of health infrastructure while avoiding potential undesirable side effects in terms of over-nutrition in a geographically diverse country like Peru.
... 9 It should be noted that the sample survey in wave 2012 took place from July 2012 through March 2013. Considering that the temporal variation, we follow previous studies on NRPS program evaluation (Cheng et al. 2018a(Cheng et al. , 2018bChen, Wang, and Busch 2019;Bradley, Chen, and Tang 2020), and generate a discrete variable measuring the length of time the NRPS program has been implemented in the county at the time of the survey. For over one month but less than one year, variable equals 1; over one year but less than two years, variable equals 2; over two years, variable equals 3. ...
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Although farmland transfer is a radical solution to the problem of sustainable development of the land rental market in China, there is insufficient research that attempted to quantitatively explore the determinants of land transfer behaviour, particularly the effects of enrolment in public pension programs. In this paper, we examine how enrolment in the recently established and expanded New Rural Pension Scheme (NRPS) can affect land transfer decisions among the age-eligible and age-ineligible rural residents. Specifically, our study employs balanced panel data from the first two waves of the China Family Panel Studies (CFPS) in the year 2010 and 2012. It reveals that, although the enrolment in the public pension system increases the scale of farmland transfer among age-eligible people, this effect is not shown among age-ineligible members. Moreover, for households with members over the age of 60, the positive income effects are concentrated among farmers from low-income family; for other groups, the heterogeneous outcomes are insignificant. These estimates may offer insights for the dynamic adjustments of the public pensions for the elderly population and for enhancing the vitality of land transfer in rural China.
... Income, which in this study was defined as the sum of wages and pension funds, was found to be the most important sociodemographic factor in CGD-Risk. Previous studies have identified a causal link between China's National Rural Pension Scheme (NRPS) and improvements to mental health among rural elderly 36 . Our study reinforces that income is a risk factor more broadly across China's elderly population as the partial dependence plots showed that CGD-Risk predicted low-income earners to be at higher risk This preprint research paper has not been peer reviewed. ...
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Background. The prevalence of depression among China’s elderly is high, but stigma surrounding mental illness and a shortage of psychiatrists limit the widespread screening, diagnosis, and treatment of geriatric depression. We sought to develop a screening model using easy-to-obtain and minimally sensitive predictors to identify elderly Chinese with depressive symptoms (depression hereafter) for referral to mental health services. Methods. Using nationally representative survey data, we developed and externally validated the Chinese Geriatric Depression Risk calculator (CGD-Risk). CGD-Risk, a gradient boosting machine learning model, was evaluated based on discrimination (Concordance (C) statistic), calibration, and net benefit through a decision curve analysis. We externally validated a simplified version of CGD-Risk, conducted a sensitivity analysis on a cohort of middle-aged Chinese, and performed a sub-group analysis on four cohort subsets from three data sets. Predictor importance and partial dependence plots were created to enhance interpretability. Findings. A total of 5681 elderly Chinese were included in the development data and 12373 in the external validation data. CGD-Risk showed good discrimination during internal validation (C: 0·81, 95% CI 0·79 to 0·84) and external validation (C: 0·77, 95% CI: 0·76, 0·78). Compared to an alternative screening strategy and given a prediction cutoff of 0·4, CGD-Risk would correctly identify 17·8 more elderly with depression per 100 people screened. Interpretation. CGD-Risk is a clinically viable tool for identifying elderly Chinese at high risk of depression that shows superior performance compared to alternative screening strategies. The use of minimally sensitive predictors means CGD-Risk could help reduce the depression detection gap in China while circumventing issues of response bias from stigma surrounding emotional openness
... Compared with ordinary older people who are disabled due to disability, they need family support and care, and need professional long-term care services [29]. Receiving pensions can effectively reduce the risk of depression in the elderly [30], and, at the same time, the elderly can obtain wages other than pensions, which also promotes mental health. In addition, this study also found that the risk of depression in the elderly without partners and living alone was 30.1% higher than that of the elderly with a partner and living together. ...
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(1) Background: To explore the relationship between health status, social security status, and the occurrence of depression in older adults and provide a basis for mental health care services for the elderly population; (2) Methods: This study used the 2018 China Health and Senior Care Tracking Survey (CHARLS) data to select 8383 older people aged over 60 years old as the research subjects. The two-category Logistic model was used to analyze the research problem; (3) Results: Older adults with depressive tendencies accounted for 34.1% of the total older adults. The incidence of depression among female older adults reached 41.51%. The risk of depression in the elderly population was 40.3% lower in males than in females (OR = 0.597, 95% CI: 0.539–0.662). Self-rated health status, physical disability, and receipt of pensions affected the incidence of depression in older adults (all p < 0.05); (4) Conclusions: Focus on and intervene in the mental status of elderly females and disabled elderly people. Provide mental and economic support and mental health care services to the elderly at the family and social levels. Promote the healthy development of the mental health of the elderly and promote active aging.
... Building a new pattern of social pension with the coordination of community pension and family pension, will alleviate the current social pension pressure and solve the prominent contradictions in pension. The social pension with the community as the main body is often manifested in the pension mode paid by the beneficiaries [1]. The community plays an intermediary role, responsible for the communication and coordination between the pension claimants and social service organizations in the community, and providing life care and spiritual comfort to the elderly group. ...
Article
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Social pension is a new supporting method for the elderly from family to society. Its solutions integrate many kinds of social services in the community and the surrounding areas, which can effectively make up for the deficiencies of various existing pension models. Although the exploration of the community pension model has been continuously deepened, the problem of population aging is becoming increasingly intractable. There are also some problems in the community socialized pension, causing a vigorous discussion on its feasibility and consciousness. In this context, this work investigated the feasibility and consciousness of community social endowment. Based on the discussion of community pension consciousness, the feasibility and effective way of community endowment were analyzed, which can promote the construction of social pension service system and provide corresponding theoretical and practical guidance for social pension practice.
... For example, Chinese older adults with children had better mental health than those without children (Wu & Penning, 2019). Receiving a pension was related to decreased depression and increased life satisfaction (Chen et al., 2019;Lu & Shelley, 2021). Self-rated health also had a significant impact on depression (Peleg & Nudelman, 2021). ...
Article
Adverse childhood experiences (ACEs) have negative impacts on individuals' subjective well-being (SWB) in later life. This article investigates the relationships between the ACEs and SWB of Chinese older adults and examines how elder abuse victimization mediates the pathways in these relationships. We used retrospective cross-sectional survey data collected in Beijing, China, in 2019. The study sample consists of 1002 older adults aged 65 years and over. The survey measured individual types, number, and various categories of ACEs of older adults and their elder abuse victimization experiences, along with their SWB (i.e. depression and life satisfaction). We tested the potential mediating role of elder abuse victimization in the relationships between ACEs and SWB. After controlling for socio-demographic factors and self-rated health, the results suggest a full mediating effect of elder abuse on the relationship between both several individual types and multiple categories of ACEs (i.e. childhood victimization, the family's economic difficulties, and a family member's episodes of illness) and depression, in addition to a partial mediating effect of elder abuse between number of ACEs and depression. A full mediating effect of elder abuse was found in regard to the relationship between a family's economic difficulties and life satisfaction. This study provides evidence for a long-term impact of ACEs on the SWB of older adults in China. In analyzing and understanding elder abuse victimization as a pathway linking ACEs and SWB, we stress the importance of the prevention of interpersonal violence across the life course. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2040427 .
... Table 5 also reports the parameters associated with control variables from estimates of the baseline regression (equation (1)). Consistent with Blanchflower and Oswald (2004) and Chen et al. (2019), we find that SWB is U-shaped in age with lowest life satisfaction occurring in middle age. Consistent with , SWB is higher among respondents who are married, employed, healthier, and exercise frequently. ...
Research
Using data taken from the China Family Panel Studies (CFPS), which covers more than 33,000 individuals over the period 2010-2018, we estimate the extent to which inflation relates to subjective well-being (SWB). We find, firstly, that people tend to adapt to reference inflation levels, which do not affect SWB. Secondly, the deviations of inflation from the reference level are negatively associated with SWB. Thirdly, the negative impact of unexpected inflation on SWB is weaker, the higher the economic growth. Our findings suggest that, in China, inflation-stabilizing policies would potentially benefit citizens’ SWB. In a more general case, the well-being cost of inflation varies in different regional economic growth and historical inflation contexts. Thus, to be more effective, economic policies should be tailored to the regional growth and inflation environment rather than being nationwide.
... Wang also found that receiving care from one's offspring and the quality of one's intergenerational relationships influence the SWB of older adults (25). Chen assessed the impact of monetary support from one's children, demonstrating that these benefits have positive effects on the economic status and SWB of older adults (27). A study by Giles concerning intergenerational support among migrants found that, in China, rural-based older adults with migrant children receive less support than those who did not have migrated children in the form of both income and inkind instrumental care (24). ...
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Background: In China, as domestic urbanization progresses and immigration expands, an increasing number of older people are choosing to follow their migrant children to new cities. Such people are referred to as "migrant elderly following children." However, few studies have explored the subjective well-being of these older adults. The present study aims to investigate the factors that influence the subjective well-being of this population of older adults. Methods: This cross-sectional study was conducted among 656 older migrants who had followed their children to Jinan, Shandong Province, China. Multistage cluster random sampling was used. Binary logistic regression analyses were performed to explore, the relationships between intergenerational support, social integration, and subjective well-being. Results: Overall, 96.3% of the older migrants showed good subjective well-being. Analysis of intergenerational support showed that those who had a female child (odds ratio [OR] = 0.401, 95% confidence interval [95%CI]: 0.180, 0.893) and those whose children had terrible conjugal relationships (OR = 0.223, 95% CI: 0.099, 0.504) were less likely to have better subjective well-being. Analysis of social integration showed that migrants who liked their current city (OR = 5.358, 95%CI: 1. 631, 17.599) and those who had a basic understanding of the local dialect (OR = 2.869, 95%CI: 1.203, 6.843) were more likely to have good subjective well-being. Migrants who had used in-patient service in the past year (OR = 0.216, 95%CI: 0.094, 0.497) were more likely to have poor subjective well-being. Conclusion: Intergenerational support and social integration are positively associated with the subjective well-being of migrant elderly following children in China. Efforts should be made, including the creation of specialized policies, to improve the family atmosphere of such migrants and their integration into their new cities, as this would contribute to improving their subjective well-being.
... Instrument-based methods for policy research use instrumental variables (IV) analysis [45,148,149]. IV can also be implemented as fuzzy regression discontinuity [150][151][152], or DID, the latter if the instrument is defined as an indicator for the jurisdictions and times with the policy [153]. Instrumentbased methods require the assumption that the instrument (e.g., the discontinuity indicator or the policy adoption indicator) is unrelated to the health outcomes that people in the sample would have experienced under alternative values of Mediatoroutcome confounders Fig. 3 Directed acyclic graph and required assumptions for evaluating causality via the front door criterion Legend: In the absence of a randomized trial, causality is typically evaluated via one of two approaches: fulfilling the backdoor criterion (i.e., controlling for confounders) or using an instrumental variable. ...
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Purposeof Review Epidemiologic research on the health effects of social policies is growing rapidly because of the potentially large impact of these policies on population health and health equity. We describe key methodological challenges faced in this nascent field and promising tools to enhance the validity of future studies. Recent Findings In epidemiologic studies of social policies, causal identification is most commonly pursued through confounder-control but use of instrument-based approaches is increasing. Researchers face challenges measuring relevant policy exposures; addressing confounding and positivity violations arising from co-occurring policies and time-varying confounders; deriving precise effect estimates; and quantifying and accounting for interference. Promising tools to address these challenges can enhance both internal validity (randomization, front door criterion for causal identification, new estimators that address interference and practical positivity violations) and external validity (data-driven methods for evaluating heterogeneous treatment effects; methods for transporting and generalizing effect estimates to new populations). Summary Common threats to validity in epidemiologic research play out in distinctive ways in research on the health effects of social policies. This is an active area of methodologic development, with ongoing advances to support causal inferences and produce policy-relevant findings. Researchers must navigate the tension between research questions of greatest interest and research questions that can be answered most accurately and precisely with the data at hand. Additional work is needed to facilitate integration of modern epidemiologic methods with econometric tools for policy evaluation and to increase the size and measurement quality of datasets.
... For example, food insecurity was identified as one of the key stressors in a study in Zambia [35]. Another example is the elderly in China whose depressive symptoms were connected to their limited social pension [36]. Poverty has consistently been found to be associated with increased sexual and gender-based violence in contexts including Sierra Leone [30,37,38]. ...
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Purpose Growing evidence demonstrates that daily stressors such as family violence, unemployment, and living conditions play an important part in causing psychological distress. This paper investigates the impact of distressing events and day-to-day living conditions on psychological distress in the fragile context of Sierra Leone. Methods A cross-sectional survey was conducted with 904 adults (454 men, 450 women) in 5 districts of Sierra Leone. The survey questionnaire comprised the Sierra Leone Psychological Distress scale and measures of demographic variables and personal characteristics, current life circumstances and potentially distressing events. Results Multiple regression results identified three factors to be the greatest contributors to psychological distress: family conflict (β = 0.185, p < 0.001) and inability to afford basic needs (β = 0.175, p < 0.001). Gender differences were evident: factors predicting men’s psychological distress included severe sickness or injury (β = 0.203, p < 0.001) and being unable to afford basic needs (β = 0.190, p < 0.001); for women, predicting factors were family conflict (β = 0.212, p < 0.001), perceived poor health (β = 0.192, p < 0.001) and inability to afford basic needs (β = 0.190, p < 0.001). Conclusion Initiatives to promote good mental health and psychosocial wellbeing in Sierra Leone should focus on enhancing income-generating and employment opportunities, promoting access to education, and strengthening family relationships.
Article
Do better material conditions improve well-being and mental health? Or does any positive relationship merely reflect that well-being promotes economic success? We compare winners and losers from a large Ethiopian housing lottery in a preregistered analysis. Winners gain access to better housing, experience a substantial increase in wealth, and report higher levels of overall life satisfaction and lower levels of financial distress. However, we find no average effects of winning on psychological distress. Our results suggest that not all aspects of well-being and mental health are equally sensitive to economic conditions.
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Religiosity is important for religious people to maintain their subjective well-being (SWB). We propose a dual-path effect hypothesis to explore different working mechanisms of religious faith and practice on benefiting people's SWB. Religious faith can promote SWB mainly via an intrinsic meaning-making path although religious practice can promote SWB via both an intrinsic meaning-making path and an extrinsic capital-accumulating path. If the dual-path effect hypothesis stands, then the role of religious practice in influencing SWB should be partly substituted by good economic status, but the role of religious faith should not. Then, only the effect of religious practice would be moderated by wealth. Results show that people's individual income and national GDP have significant moderating effects on the relationship between religious practice and SWB, but they had no moderating effect on the association between religious faith and SWB, indicating wealth could be an alternative source of accumulating capital and social resources between religious practice and SWB. Results provide important evidence for the dual-path effect hypothesis. The findings uniquely contribute to the literature of religiosity, SWB, and their connections with wealth. Implications for future research are also discussed.
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A growing body of empirical research seeks to quantify the causal effects of social policies on health by exploiting variation in the timing of policy changes across places. However, multiple social policies are often adopted simultaneously or in close succession in the same locations, creating clustering which must be handled analytically for valid inferences. Although this is a substantial methodological challenge for studies aiming to isolate social policy effects, yet systematic assessments of available analytic solutions and tradeoffs among approaches are lacking. We designated eight analytic solutions prior researchers have adopted, including efforts to disentangle individual policy effects and efforts to estimate the joint effects of clustered policies. We leveraged an existing systematic review of social policies and health to evaluate how often policy clustering is identified as a threat to validity and how often each analytic solution is applied in practice. Of the 55 studies, only 17 (31%) reported checking for any clustered policies, and 36 (67%) used at least one approach that helps address clustered policies. The most common approaches were adjusting for clustered policies, defining the outcome on subpopulations likely to be affected by the policy of interest but not other clustered policies, and selecting a less-correlated measure of policy exposure were the most common approaches. Systematically assessing policy clustering and applying analytic solutions when necessary would strengthen future studies on the health effects of social policies. Adequate reporting on these analytic decisions would facilitate evaluating validity and interpreting study findings.
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Background: The proportion of people aged 60 years or over is growing faster than other age groups. Traditionally, retirement has been considered as both a loss to the labour market and an additional economic burden on the nation. More recently, it is widely accepted that retired people can still contribute to society in many ways, though the extent of their contributions will depend heavily on their state of health. In this context, a significant practical issue is how to encourage older people to use the health services they need. This study aims to evaluate the effects of pensions on older adults’ health service utilization, and estimate the level of pension required to influence such utilization. Methods: Using data from a nationally representative sample survey, the China Health and Retirement Longitudinal Study, we adopted a fuzzy regression discontinuity design and undertook segmented regression analysis. Results: It was found that a pension did encourage low-income people to use both outpatient (OR = 1.219, 95% 1.018-1.460) and inpatient services (OR = 1.269, 95% 1.020-1.579); but also encouraged both low- and high-income people to choose self-treatment, specifically over-the-counter (OR = 1.208, 95% 1.037-1.407; OR = 1.206, 95% 1.024-1.419; respectively) and traditional Chinese medicines (OR = 1.452, 95% 1.094-1.932; OR = 1.456, 95% 1.079-1.955; respectively). However, receiving a pension had no effect on the frequency of outpatient and inpatient service use. Breakpoints for a pension to promote health service utilization were mainly located in the range 55-95 CNY (7.1-12.3 EUR or 8.0-13.8 USD). Conclusions: A pension was found to have mixed effects on health service utilization for different income groups. Our study enriches existing evidence on the impact of pensions on healthcare-seeking behaviour and can be helpful in policy design and the formulation of improved models relating to pensions and healthcare utilisation.
Article
Using data from two waves of the China Health and Retirement Longitudinal Study ( N ≈ 5,500), this study used latent class analysis to identify tangible support patterns among Chinese older adults based on types and sources of support. Furthermore, multivariate regression was used to examine the stress-buffering roles of tangible support patterns in the relationships between two stressors (i.e., poor health and functional dependence) and older adults’ subjective well-being (i.e., depressive symptoms and life satisfaction). We found four distinct tangible support patterns (i.e., semitraditional, traditional, formal financial-spousal instrumental, and restricted) among Chinese older adults. Poor health and functional dependence were significantly associated with lower subjective well-being. The moderating role of support differed significantly by patterns. Two patterns, formal financial-spousal instrumental and restricted, mitigated or reversed the negative relationships between both stressors and older adults’ subjective well-being. In addition, the traditional Chinese support pattern reduced the positive relationship between poor health and depressive symptoms. Implications for the well-being of the Chinese older adult population are discussed.
Article
This study aimed to investigate gender convergence or divergence among older adults in China, a Confucian society with strong persistence of gender role differentiation. We examined how multiple stressors influence depression simultaneously, with gender comparison approach. The data were drawn from the China Longitudinal Aging Social Survey study (N = 8,097). Results indicated that older women reported significantly higher levels of depression than men, yet overall depressive symptoms showed many gender similarities. Surprisingly, our analyses supported the hypothesis of gender convergence in stressors predicting late-life depression. Recommendations for practice and further research priorities based on findings are discussed.
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伴随着中国居民医疗费用的快速增长,仅依靠医疗保险并不足以缓解过重的居民医疗负担。本文发现,作为一项保障中国农村老年居民收入的社保制度,新农保反倒可以显著缓解医疗负担。本文采用中国健康与养老追踪2015年调查数据,利用老年人超过60岁才可以领取养老金这一自然实验,使用断点回归方法考察了领取养老金对医疗负担的因果效应。结果显示,获得新农保可以显著减少自负医疗费用在收入中的比例,并显著降低灾难性医疗支出发生的概率。在此基础上,本文通过建立理论模型讨论了为什么在缓解医疗负担上,养老保险做到了医疗保险做不到的事:因为医保待遇的提高,会由于道德风险而并不能有效降低自负医疗费用;而养老保险可以通过收入效应来缓解医疗负担。这一解释也得到了样本数据和数值模拟的验证。最后,从更一般的社会总福利视角来看,医疗保险虽然在缓解医疗负担上效果不明显,但其强大的共济性可以很大程度上提升社会总福利。 With the rapid growth of medical expenses of Chinese residents, relying on medical insurance alone is not enough to alleviate the excessive health care spending burden. However, as a social security system that guarantees the income of elderly rural residents in China, the New Rural Pension Scheme(NRPS) can significantly reduce the health care spending burden. In this paper, we used the policy rule that only those people who are over 60 years old can receive pension as the nature experiment, and explored the causal effect of receiving pensions on the health care spending burden by using regression discontinuity design method with CHARLS 2015 data. Our research found that receiving pension benefits can significantly reduce the proportion of out-of-pocket spending in income and the probability of catastrophic health expenditure. Furthermore, we used a theoretical model to discuss why pension insurance can alleviate the burden but medical insurance cannot. The reason is that due to increasing the reimbursement of the medical insurance, the by-product moral hazard will lead to even higher the health care spending, while pension can alleviate the burden through the income effect. This explanation is also supported by some suggestive evidence from both the empirical data and the numerical simulation. Finally, from the perspective of the social welfare, we find that although medical insurance is not effective in alleviating the medical burden, its strong mutual aid can dramatically improve the total social welfare.
Article
Background Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age, or HIV infection) are a social protection intervention addressing a key social determinant of health (income) in low‐ and middle‐income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided only if recipients follow prescribed behaviours, e.g. use a health service or attend school) is unknown. Objectives To assess the effects of UCTs on health services use and health outcomes in children and adults in LMICs. Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure, and to compare the effects of UCTs versus CCTs. Search methods For this update, we searched 15 electronic academic databases, including CENTRAL, MEDLINE and EconLit, in September 2021. We also searched four electronic grey literature databases, websites of key organisations and reference lists of previous systematic reviews, key journals and included study records. Selection criteria We included both parallel‐group and cluster‐randomised controlled trials (C‐RCTs), quasi‐RCTs, cohort studies, controlled before‐and‐after studies (CBAs), and interrupted time series studies of UCT interventions in children (0 to 17 years) and adults (≥ 18 years) in LMICs. Comparison groups received either no UCT, a smaller UCT or a CCT. Our primary outcomes were any health services use or health outcome. Data collection and analysis Two review authors independently screened potentially relevant records for inclusion, extracted data and assessed the risk of bias. We obtained missing data from study authors if feasible. For C‐RCTs, we generally calculated risk ratios for dichotomous outcomes from crude frequency measures in approximately correct analyses. Meta‐analyses applied the inverse variance or Mantel‐Haenszel method using a random‐effects model. Where meta‐analysis was impossible, we synthesised results using vote counting based on effect direction. We assessed the certainty of the evidence using GRADE. Main results We included 34 studies (25 studies of 20 C‐RCTs, six CBAs, and three cohort studies) involving 1,140,385 participants (45,538 children, 1,094,847 adults) and 50,095 households in Africa, the Americas and South‐East Asia in our meta‐analyses and narrative syntheses. These analysed 29 independent data sets. The 24 UCTs identified, including one basic universal income intervention, were pilot or established government programmes or research experiments. The cash value was equivalent to 1.3% to 81.9% of the annualised gross domestic product per capita. All studies compared a UCT with no UCT; three studies also compared a UCT with a CCT. Most studies carried an overall high risk of bias (i.e. often selection or performance bias, or both). Most studies were funded by national governments or international organisations, or both. Throughout the review, we use the words 'probably' to indicate moderate‐certainty evidence, 'may/maybe' for low‐certainty evidence, and 'uncertain' for very low‐certainty evidence. Health services use We assumed greater use of any health services to be beneficial. UCTs may not have impacted the likelihood of having used any health service in the previous 1 to 12 months, when participants were followed up between 12 and 24 months into the intervention (risk ratio (RR) 1.04, 95% confidence interval (CI) 1.00 to 1.09; I2 = 2%; 5 C‐RCTs, 4972 participants; low‐certainty evidence). Health outcomes At one to two years, UCTs probably led to a clinically meaningful, very large reduction in the likelihood of having had any illness in the previous two weeks to three months (RR 0.79, 95% CI 0.67 to 0.92; I2 = 53%; 6 C‐RCTs, 9367 participants; moderate‐certainty evidence). UCTs may have increased the likelihood of having been food secure over the previous month, at 13 to 36 months into the intervention (RR 1.25, 95% CI 1.09 to 1.45; I2 = 85%; 5 C‐RCTs, 2687 participants; low‐certainty evidence). UCTs may have increased participants' level of dietary diversity over the previous week, when assessed with the Household Dietary Diversity Score and followed up 24 months into the intervention (mean difference (MD) 0.59 food categories, 95% CI 0.18 to 1.01; I2 = 79%; 4 C‐RCTs, 9347 participants; low‐certainty evidence). Despite several studies providing relevant evidence, the effects of UCTs on the likelihood of being moderately stunted and on the level of depression remain uncertain. We found no study on the effect of UCTs on mortality risk. Social determinants of health UCTs probably led to a clinically meaningful, moderate increase in the likelihood of currently attending school, when assessed at 12 to 24 months into the intervention (RR 1.06, 95% CI 1.04 to 1.09; I2 = 0%; 8 C‐RCTs, 7136 participants; moderate‐certainty evidence). UCTs may have reduced the likelihood of households being extremely poor, at 12 to 36 months into the intervention (RR 0.92, 95% CI 0.87 to 0.97; I2 = 63%; 6 C‐RCTs, 3805 participants; low‐certainty evidence). The evidence was uncertain for whether UCTs impacted livestock ownership, participation in labour, and parenting quality. Healthcare expenditure Evidence from eight cluster‐RCTs on healthcare expenditure was too inconsistent to be combined in a meta‐analysis, but it suggested that UCTs may have increased the amount of money spent on health care at 7 to 36 months into the intervention (low‐certainty evidence). Equity, harms and comparison with CCTs The effects of UCTs on health equity (or unfair and remedial health inequalities) were very uncertain. We did not identify any harms from UCTs. Three cluster‐RCTs compared UCTs versus CCTs with regard to the likelihood of having used any health services or had any illness, or the level of dietary diversity, but evidence was limited to one study per outcome and was very uncertain for all three. Authors' conclusions This body of evidence suggests that unconditional cash transfers (UCTs) may not impact a summary measure of health service use in children and adults in LMICs. However, UCTs probably or may improve some health outcomes (i.e. the likelihood of having had any illness, the likelihood of having been food secure, and the level of dietary diversity), two social determinants of health (i.e. the likelihoods of attending school and being extremely poor), and healthcare expenditure. The evidence on the relative effectiveness of UCTs and CCTs remains very uncertain.
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Cash transfers (CTs) are increasingly recognized as a scalable intervention to alleviate financial hardship. A large body of evidence evaluates the impact of CTs on subjective well-being (SWB) and mental health (MH) in low- and middle-income countries. We undertook a systematic review, quality appraisal and meta-analysis of 45 studies examining the impact of CTs on self-reported SWB and MH outcomes, covering a sample of 116,999 individuals. After an average follow-up time of two years, we find that CTs have a small but statistically significant positive effect on both SWB (Cohen’s d = 0.13, 95% confidence interval (CI) 0.09, 0.18) and MH (d = 0.07, 95% CI 0.05, 0.09) among recipients. CT value, both relative to previous income and in absolute terms, is a strong predictor of the effect size. Based on this review and the large body of existing research demonstrating a positive impact of CTs on other outcomes (for example, health and income), there is evidence to suggest that CTs improve lives. To enable comparisons of the relative efficacy of CTs to improve MH and SWB, future research should meta-analyse the effects of alternative interventions in similar contexts.
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Prior literature has documented a positive association between income and cognitive function at older ages; however, the extent to which this association represents causal effects is unknown. In this study, we use an exogenous change in Social Security income due to amendments to the Social Security Act in the 1970s to identify the causal impact of Social Security income on cognitive function of elderly individuals. We find that higher benefits led to significant improvements in cognitive function and that these improvements in cognition were clinically meaningful. Our results suggest that interventions even at advanced ages can slow the rate of decline in cognitive function. © 2016 American Society of Health Economists and Massachusetts Institute of Technology.
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We use British panel data to determine the exogenous impact of income on a number of individual health outcomes: general health status, mental health, physical health problems, and health behaviours (drinking and smoking). Lottery winnings allow us to make causal statements regarding the effect of income on health, as the amount won by winners is largely exogenous. Positive income shocks have no significant effect on self-assessed overall health, but a significant positive effect on mental health. This result seems paradoxical on two levels. First, there is a well-known gradient in health status in cross-sectional data, and second, general health should partly reflect mental health, so that we may expect both variables to move in the same direction. We propose a solution to the first apparent paradox by underlining the endogeneity of income. For the second, we show that lottery winnings are also associated with more smoking and social drinking. General health will reflect both mental health and the effect of these behaviours and so may not improve following a positive income shock.
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China launched a new rural pension scheme (hereafter NRPS) for rural residents in 2009, now covering almost all counties with over 400 million people enrolled. This implementation of the largest social pension program in the world offers a unique setting for studying the economics of intergenerational relationships during development, given the rapidity of China’s population aging, traditions of filial piety and co-residence, decreasing number of children, and dearth of formal social security, at a relatively low income level. We draw on rich household surveys from two provinces at distinct development stages – impoverished Guizhou and relatively well-off Shandong – to better understand heterogeneity in the impact of pension benefits. Employing a fuzzy regression discontinuity design, we find that around the pension eligibility age cut-off, the NRPS significantly reduces intergenerational co-residence, especially between elderly parents and their adults sons; promotes pensioners’ healthcare service consumption; and weakens (but does not supplant) non-pecuniary and pecuniary transfers across three generations. These effects are much larger in less developed Guizhou province.
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Given concerns about the depletion of the Social Security Trust Fund, policymakers are considering several proposals to improve the financial sustainability of the program, including some that would lower benefits over time. The extent to which reductions in Social Security benefits impact individual health and well-being is not well understood. Using data from a nationally representative survey of older adults, we examine the impact of changes in Social Security income on a broad range of elderly health outcomes, including cognitive function, depression, disability and self-rated health. Prior literature has documented a positive association between income and health. However, this association may reflect unmeasured confounders that are correlated with both income and health (e.g. childhood environment) or may reflect the impact of health on income. To address these concerns and to identify the causal impact of income on health, we employ an instrumental variables strategy based on changes in Social Security income due to amendments to the Social Security Act in the 1970s. We discuss the implications of our findings for aging populations and for public policy.
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China's fast economic growth in the past decades is accompanied by a rapid epidemiological transition from communicable to non-communicable diseases (NCDs). An important yet often neglected NCD is mental disorder, which accounts for 14% of global disease burden but has been paid relatively little research attention in China. This paper uses a nationally representative dataset to investigate the prevalence and correlates of depression and depressive symptoms among the adult population in China. Our results indicate that the prevalence rate of depression, estimated with the Center for Epidemiologic Studies Depression Scale (CES-D), is high (37.9% for depressive symptoms and 4.1% for depression) and unevenly distributed across regions and subpopulations. Specifically, women, older people and those who live in the central/western and rural areas are more likely to be depressed. We also find significant socioeconomic gradients in mental health: higher education and income levels are associated with lower likelihood of depression, especially among the lower socioeconomic groups. Our results indicate the urgent need for depression prevention and treatment in China (particularly in the economically less developed regions) through the expansion of primary mental health care resources and a reduction of socioeconomic inequalities.
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Background: Although self-stigma is found to have adverse effects on the lives of persons with mental illness, little is known on the self-stigma of these individuals in Chinese societies. Objective: This research study explores the prevalence rate and predicting factors of self-stigma of consumers in two Chinese cities, Hong Kong and Guangzhou. Methods: A cross-sectional research design is adopted which involves a random sample of 266 consumers from Hong Kong and a convenient sample of 208 consumers from Guangzhou. These individuals have been assessed in terms of their self-stigma, recovery, self-esteem and quality of life by using standardized assessment scales. Results: In all, 38.3% of the Hong Kong participants and 49.5% of the Guangzhou participants report to have self-stigma. Also, self-stigma is found to be negatively related to self-esteem and quality of life. A logistic regression analysis shows that hope and well-being are predicting factors of self-stigma. Conclusion: Self-stigma is found to be higher in Guangzhou, probably due to the influence of traditional cultural values. Also, as hope and well-being are found to be predicting factors of self-stigma, suitable recovery-orientated interventions that facilitate hope and well-being should be developed so as to reduce self-stigma of consumers in Chinese societies.
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China launched a pension program for rural residents in 2009, now covering more than 300 million Chinese. This program offers a unique setting for studying the ageing population, given the rapidity of China’s population ageing, traditions of filial piety and co-residence, decreasing number of children, and dearth of formal social security, at a relatively low income level . This paper examines whether receipt of the old-age pension payment equips elderly parents and their adult children to live apart and whether parents substitute children’s time involved in instrumental support to them with service consumption. Employing a regression discontinuity design to a primary longitudinal survey conducted in Guizhou province of China, this paper overcomes challenges in the literature that households eligible for pension payment might be systematically different from ineligible households and that it is difficult to separate the effect of pension from that of age or cohort heterogeneity. Around the pension eligibility age cut-off, results reveal large and significant reduction in intergenerational co-residence of the extended family and increase in service consumption among elderly parents.
Article
Improvements in health have become expected in wealthy countries. But both within and between countries there are substantial inequalities in health that have remained despite overall improvements. In some cases, these inequalities have become even more clearly visible. While universal access to high quality, affordable medical care is a social goal that should have high priority, it alone will not eliminate social inequalities in mortality rates. Inequalities in health are not limited to worse health among the poor. A gradient runs across society, in combination with the close link between income inequalities and health which indicates that relative deprivation is an important determinant of health inequalities. Providing more people with fulfilling jobs, adequate compensation, and social environments that foster good relationships may be of crucial importance in reducing inequalities in health. -from Author
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Mental health is a key component of overall wellbeing and mental disorders are relatively common, including among older adults. Yet the causal effect of income on mental health status among older adults is poorly understood. This paper considers the effects of a major source of transfer income, Social Security retirement benefits, on the mental health of older adults. The Social Security benefit "Notch" is as a large, permanent, and exogenous shock to Social Security income in retirement. The "Notch" is used to identify the causal effect of Social Security income on mental health among older ages using data from the AHEAD cohort of the Health and Retirement Study. We find that increases in Social Security income significantly improve mental health status and the likelihood of a psychiatric diagnosis for women, but not for men. The effects of income on mental health for older women are statistically significant and meaningful in magnitude. While this is one of the only studies to use plausibly exogenous variation in household income to identify the effect of income on mental health, a limitation of this work is that the results only directly pertain to lower-education households. Public policy proposals that alter retirement benefits for the elderly may have important effects on the mental health of older adults.
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China's New Rural Pension Program (NRPP) has rapidly expanded since its implementation in 2009, and by the end of 2010 had reached a coverage rate of 24 percent. Empirical evidence, however, shows that rural residents, especially those who are younger, lack incentives to participate. If they do participate, they tend to choose plans with the lowest payment standard. Through calculations and simulations under various scenarios, we demonstrate that the current design of the rural pension program is itself a disincentive. Proper return rate for individual account funds is essential, and would not only encourage participation, but also enable a high replacement rate and relieve the current system's fiscal burden.
Article
We examine the prevalence of depressive symptoms among the mid-aged and elderly in China and examine relationships between depression and current SES factors such as gender, age, education and income (per capita expenditures). In addition, we explore associations of depressive symptoms with measures of early childhood health, recent family deaths and current chronic health conditions. We use data from the China Health and Retirement Longitudinal Study (CHARLS) national baseline, fielded in 2011/12, which contains the ten question version of the Center for Epidemiologic Studies-Depression scale (CES-D) for 17,343 respondents aged 45 and older. We fill a major gap by using the CHARLS data to explore the general patterns of depression and risk factors among the Chinese elderly nationwide, which has never been possible before. We find that depressive symptoms are significantly associated with own education and per capita expenditure, and the associations are robust to the inclusion of highly disaggregated community fixed effects and to the addition of several other risk factors. Factors such as good general health during childhood are negatively associated with later depression. There exist strong gender differences, with females having higher depression scores. Being a recent widow or widower is associated with more depressive symptoms, as is having a series of chronic health problems, notably having moderate or severe pain, disability or problems with measures of physical functioning. Adding the chronic health problems to the specification greatly reduces the SES associations with depressive symptoms, suggesting that part of the pathways behind these associations are through these chronic health factors.
Article
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among 1,206 well older adults (aged 65–98 yrs). The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D. The CESD-10 showed an expected positive correlation with poorer health status scores and a strong negative correlation with positive affect. Retest correlations for the CESD-10 were comparable to those in other studies. The CESD-10 was administered again after 12 mo. Data were based on 80% of the original sample. Scores were stable with strong correlation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The growth of South African state-provided social security is traced from its origins in British colonialism, through the consolidation under apartheid of racially discriminatory benefits mainly to protect white interests, to the present time of political change when there is a rapid move towards racial parity. It is a difficult system to understand, because of the fragmentation created by apartheid: benefits are delivered through 17 separate “governments”, geographically different from each other, using different information systems and, until recently, characterized by secrecy regarding information. This paper is based on interviews conducted in all administrations in 1991, and it focuses on the state social pensions and grants for elderly people, disabled people, child and family care, and poor relief. Major problems with the system are those of access, racial discrimination, inefficiency, corruption, and the way in which the means test is implemented. Does the social security system have a role to play in addressing the inequality and poverty produced by apartheid? In rural areas most beneficiaries live in three-generational families, and the benefit is consumed by the household. It is suggested that its potential is greatly underestimated, and rather than being seen as an expensive burden, the social security system should be enthusiastically embraced. It is already in place; it can relatively easily be made more efficient.
Article
We study the demand for household water connections in urban Morocco, and the effect of such connections on household welfare. In the northern city of Tangiers, among homeowners without a private connection to the city's water grid, a random subset was offered a simplified procedure to purchase a household connection on credit (at a zero percent interest rate). Take-up was high, at 69%. Because all households in our sample had access to the water grid through free public taps (often located fairly close to their homes), household connections did not lead to any improvement in the quality of the water households consumed; and despite significant increase in the quantity of water consumed, we find no change in the incidence of waterborne illnesses. Nevertheless, we find that households are willing to pay a substantial amount of money to have a private tap at home. Being connected generates important time gains, which are used for leisure and social activities, rather than productive activities. Because water is often a source of tension between households, household connections improve social integration and reduce conflict. Overall, within 6 months, self-reported well-being improved substantially among households in the treatment group, despite the financial cost of the connection. Our results suggest that facilitating access to credit for households to finance lump sum quality-of-life investments can significantly increase welfare, even if those investments do not result in income or health gains.