The Impact of Social Participation on Health Outcomes Among Middle-Aged and Older Adults in China: Evidence from the Chinese General Social Survey

Objective: Against the background of rapid population aging, this study examined the associations between social participation and physical and mental health among middle-aged and older adults in China and explored potential psychosocial pathways involving loneliness and subjective well-being. Methods: Data were drawn from the 2023 Chinese General Social Survey (CGSS). A total of 3823 respondents aged 45 years and older were included in the analysis. Ordinary least squares regression models were used to examine the associations between social participation and physical and mental health. Sensitivity analyses, robustness checks, ordered logit models, and supplementary instrumental variable analyses were conducted to assess the consistency of the findings. Serial mediation analysis was used to explore the potential indirect associations involving loneliness and subjective well-being. Results: Higher levels of social participation were positively associated with better physical health and mental health among middle-aged and older adults (p < 0.001). Sensitivity and robustness analyses generally supported the consistency of these findings. Supplementary instrumental variable analyses showed a significant positive association with mental health, while the positive estimate for physical health was not statistically significant. Exploratory mediation analyses suggested that loneliness and subjective well-being may represent potential psychosocial pathways linking social participation to health outcomes. The total indirect association accounted for 22.40% of the total association with physical health and 33.24% of the total association with mental health. Conclusions: Social participation was positively associated with health among middle-aged and older adults in China, with more consistent evidence for mental health. Loneliness and subjective well-being may represent potential psychosocial pathways linking social participation to health outcomes.