Effect of home and community-based services on older adults’ depressive symptoms in China: a multilevel analysis

Background: As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have become of increasing importance in China. However, few studies have assessed the impact of HCBSs utilization on depressive symptoms among older adults. This study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults. Methods This study included 7,787 older adults (≥ 60years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, “What kind of HCBSs were being utilized in their community?”. Data were analyzed using generalized hierarchical linear models. Results Of the 7,787 participants, 20.1% (n = 1,567) reported they utilized HCBSs, and 36.7% (n = 2,859) were currently with depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.189, 95% CI:1.043–1.356, p  < 0.01) among older adults. Additionally, the depressive symptoms were associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health, smoking, and provincial GDP per captia. Conclusions This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is important that the government provides targeted HCBSs at the community level to address the unmet care needs of older adults to reduce the occurrence of negative emotions and consequently the depressive symptoms.