Persistent socio-demographic inequalities in depression among older adults in China during and after COVID-19: a systematic review and meta-analysis.
To examine socio-demographic inequalities in depressive symptoms among older adults in China during and after the COVID-19 pandemic and assess whether these inequalities remained stable or changed over time.
This systematic review and meta-analysis followed PRISMA guidelines. Nine English and Chinese databases were searched from 1 January 2020 to 15 June 2026. Eligible studies were conducted among community-dwelling adults aged ≥60 years in mainland China, used probability sampling and standardized measures of depressive symptoms, and reported cross-sectional data. Study quality was assessed using the 11-item Agency for Healthcare Research and Quality checklist. Potential publication bias was assessed using Begg's and Egger's tests and trim-and-fill analysis. Year-stratified prevalence and pooled odds ratios (ORs) were estimated for disparities by gender, marital status, urban-rural residence, living arrangement and educational attainment.
Seventy-nine studies involving 199,116 older adults from 21 provincial-level regions were included; 52 studies were rated as high quality and 27 as moderate quality, with none rated as low quality. Pooled prevalence fluctuated across investigation years, from 16.6% (95% CI 12.1-22.4) in 2022 to 22.9% (95% CI 18.3-28.3) in 2024-2025, with substantial between-study heterogeneity (overall I2 = 99.55%). Higher odds of depressive symptoms were observed among women, unmarried older adults, rural residents, those living alone and those with lower educational attainment. The largest disparities were related to education (OR 1.693, 95% CI 1.388-2.060), living arrangement (OR 1.671, 95% CI 1.437-1.945) and marital status (OR 1.652, 95% CI 1.467-1.860). Year-level analyses suggested limited temporal variation overall: marital-status-related inequality showed a small upward trend, whereas living-arrangement-related inequality showed a non-significant tendency toward attenuation. No broad systematic restructuring was observed.
Depressive symptoms among older adults in China fluctuated across the pandemic and post-pandemic periods, while socio-demographic inequalities remained broadly stable. Major public health disruption appeared more likely to expose and prolong pre-existing inequalities than fundamentally reshape them in the short term. These findings provide a useful comparative reference for understanding mental health vulnerability in aging societies facing public health emergencies.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025642200; identifier: CRD42025642200.
This systematic review and meta-analysis followed PRISMA guidelines. Nine English and Chinese databases were searched from 1 January 2020 to 15 June 2026. Eligible studies were conducted among community-dwelling adults aged ≥60 years in mainland China, used probability sampling and standardized measures of depressive symptoms, and reported cross-sectional data. Study quality was assessed using the 11-item Agency for Healthcare Research and Quality checklist. Potential publication bias was assessed using Begg's and Egger's tests and trim-and-fill analysis. Year-stratified prevalence and pooled odds ratios (ORs) were estimated for disparities by gender, marital status, urban-rural residence, living arrangement and educational attainment.
Seventy-nine studies involving 199,116 older adults from 21 provincial-level regions were included; 52 studies were rated as high quality and 27 as moderate quality, with none rated as low quality. Pooled prevalence fluctuated across investigation years, from 16.6% (95% CI 12.1-22.4) in 2022 to 22.9% (95% CI 18.3-28.3) in 2024-2025, with substantial between-study heterogeneity (overall I2 = 99.55%). Higher odds of depressive symptoms were observed among women, unmarried older adults, rural residents, those living alone and those with lower educational attainment. The largest disparities were related to education (OR 1.693, 95% CI 1.388-2.060), living arrangement (OR 1.671, 95% CI 1.437-1.945) and marital status (OR 1.652, 95% CI 1.467-1.860). Year-level analyses suggested limited temporal variation overall: marital-status-related inequality showed a small upward trend, whereas living-arrangement-related inequality showed a non-significant tendency toward attenuation. No broad systematic restructuring was observed.
Depressive symptoms among older adults in China fluctuated across the pandemic and post-pandemic periods, while socio-demographic inequalities remained broadly stable. Major public health disruption appeared more likely to expose and prolong pre-existing inequalities than fundamentally reshape them in the short term. These findings provide a useful comparative reference for understanding mental health vulnerability in aging societies facing public health emergencies.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025642200; identifier: CRD42025642200.