Triple digital divide and depressive symptoms among middle-aged and older Chinese adults: a disparity analysis.

Background: The triple digital divide refers to the lack of internet access, use and knowledge among specific populations. In China, middle-aged and older adults and those living in rural areas or various regions of the country are more likely to have limited internet access and skills and, thus, have less accessibility to internet services. Few longitudinal studies have explored the association between the digital divide and the progression of depressive symptoms among middle-aged and older Chinese adults. Significantly, none of the existing studies have estimated this long-term relationship from a disparity perspective. Aims: This study investigates the association between the triple digital divide and depressive symptom trajectories among middle-aged and older adults in China during a 10-year follow-up period from 2011 to 2020. Methods: The sample for this secondary analysis comprises 3019 urban and 10 427 rural respondents selected from the China Health and Retirement Longitudinal Study baseline survey in 2011. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Employing longitudinal mixed-effects models, this study explored the association between the triple digital divide and depressive symptom trajectories among middle-aged and older Chinese adults by examining gender, rural-urban and regional disparities in this relationship. Results: Our findings revealed a significant association between the triple digital divide and increasing trajectories of depressive symptoms, showing significant disparities based on gender, rural-urban dwelling and regional location. Notably, for both male and female participants who resided in urban areas or the central region of the country, their ability to use the internet, coupled with enhanced internet skills and greater access to internet services, was found to have a mitigating effect on the increasing trajectories of depressive symptoms. Conclusions: To alleviate some of the confounding influences on the trajectory of depression in middle-aged and older adults, policymakers in China should continue to prioritise the development of internet technology, foster easy access to the internet to ensure it is 'elder-friendly', provide internet skill training platforms for this population and broaden access to various internet services appropriate for them. Additionally, the implementation of tailored interventions to address depression, especially targeting the more vulnerable cohorts, such as middle-aged and older women, those residing in rural areas and the western regions, is crucial. Such tailored approaches are essential for addressing the disparities and challenges associated with the triple digital divide.