Social Environmental Factors Associated with Depression Among Older Adults in Busan, South Korea: Based on the 2023 Korea Community Health Survey

<b>Background/Objectives</b>: This study examined the prevalence of depression among older adults in Busan-the first metropolitan city in South Korea to become a super-aged society-and identified the social environmental factors associated with depression. <b>Methods</b>: Using data from the 2023 Korea Community Health Survey (KCHS), 5143 individuals aged 65 and older residing in Busan were analyzed. Depressive symptoms were measured using the PHQ-9, and social environmental factors-including unmet medical needs, satisfaction with the community environment, participation in social activities, and frequency of social contact-were derived from KCHS items. Descriptive statistics and logistic regression were performed using SPSS, version 29.0. <b>Results</b>: Participants' mean age was 73.50 ± 0.11 years, and 54.4% were female. The average depression score was 2.85 ± 0.06, with 3.7% having moderate, 1.2% moderately severe, and 0.4% severe depression. Logistic regression revealed that low healthcare accessibility was significantly associated with higher odds of moderate-to-severe depression (OR = 2.54, 95% CI = 1.78-3.62). Conversely, higher satisfaction with community environment (OR = 0.80, 95% CI = 0.73-0.87) and greater participation in social activities (OR = 0.68, 95% CI = 0.53-0.87) were associated with lower odds of depression. <b>Conclusions</b>: Depression in older adults is a multidimensional phenomenon shaped by the complex interplay of individual, health-related, and socio-environmental factors. Region-specific, community-based programs that enhance living environments, expand social participation, improve healthcare access, and promote positive health perceptions are essential. These findings can inform integrated nursing and policy interventions that support healthy aging and enhance older adults' well-being.