Socioeconomic Position and Depression in Older Adults: Roles of Digital Participation and Lifestyle

Background

In the digital era, digital inequality poses new challenges to mental health disparities among older adults. The pathways through which socioeconomic position (SEP) shapes mental health remain unclear. This study aims to provide empirical evidence to promote mental health equity among older adults in England.

Methods

This study explored the mechanisms linking SEP to depressive symptoms through digital participation and healthy lifestyle among 2,433 core members aged 60+ from Waves 9 (2018-2019), 10 (2020-2021), and 11 (2023-2024) of the English Longitudinal Study of Ageing (ELSA). SEP was constructed as latent variable based on income, wealth, occupation and education. Healthy lifestyle included smoking, physical activity, sleep duration and diet. Structural Equation Modelling explored sequential mediation pathways, adjusting for gender, age, marital status, and chronic disease.

Results

The study included 56% of women (mean age 74.7 ± 6.8). The measurement model showed good fit to the data. SEP was inversely associated with depressive symptoms in crude models (β = −0.25, 95% CI: −0.30–−0.20), and this association was reduced after adjustment (β = −0.16, −0.20–−0.11). After including mediators, the direct effect disappeared, while the total indirect association remained (β = −0.23, −0.34–−0.14), primarily driven by lifestyle (β = −0.21, −0.31–−0.12) and sequential pathway (β = −0.02, −0.04–−0.002). Subgroup analyses showed that the sequential mediation pathway and the direct path from digital participation to healthy lifestyle were significant only among the women (β = 0.17, 0.05–0.29), older-old (β = 0.18, 0.04–0.31) and those in more deprived areas (β = 0.15, 0.02–0.29).

Conclusions

SEP-based mental health disparities are largely driven by lifestyle behaviours, with digital participation playing an additional role. Interventions focusing on promoting digital participation and healthy lifestyle may help reduce SEP-related health inequalities among older adults.

Key messages

• Socioeconomic inequalities in depressive symptoms are primarily mediated by lifestyle, highlighting the critical role of health-related behaviors in mental health disparities among older adults.

• Digital participation enhances healthy lifestyles and reduces depression, with stronger benefits for women, the older-old, and those in deprived areas, helping narrow health inequalities.