Is how older adults understand the welfare system linked to depression, especially when they distrust medical institutions?

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The rising prevalence of depression in later life threatens individual well-being and worsens health inequalities globally. Low socioeconomic status (SES) is consistently linked to higher depression risk, but how structural disadvantage translates into mental health outcomes remains incompletely understood.

This study introduces social welfare fitness perception (SFP): people’s tendency to understand and internalize the rational logic underlying the social welfare policy system. This includes the balance of rights and obligations, reasonable expectations of benefits, and mutual support. The researchers investigated whether SFP mediates the association between SES and later-life depression, proposing it as an individual cognitive and perceptual link between structural position and mental health.

Using a cross-sectional design, the researchers surveyed 628 older adults from communities in eastern China. They measured later-life depression, SES, SFP, and trust in medical institutions. They used bootstrapping procedures to conduct a moderated mediation analysis, examining both the indirect association through SFP and whether that association differed with medical institutional trust.

Lower SES was significantly associated with higher later-life depression. SFP partially mediated this relationship. Older adults with lower SES had weaker SFP, which in turn predicted greater depressive symptoms in the analysis.

Trust in medical institutions moderated the association between SFP and later-life depression. Stronger SFP was associated with less depression only among older adults with low trust in medical institutions. The conditional indirect effect of SES on later-life depression through SFP was also significant only among those with low medical institutional trust.

The authors interpret SFP as a novel mechanism linking socioeconomic disadvantage to later-life depression. They suggest that health equity depends not only on providing social welfare policies, but also on residents’ capacity to rationally appraise the system and internalize its logic as a source of psychological security. Enhancing SFP may offer an innovative mental health intervention strategy, particularly where older adults’ institutional trust is fragile.