Urban-rural differences in influencing factors of depressive symptoms among Chinese perimenopausal women

Perimenopause is a high-risk period for depressive symptoms in women. Investigating the urban-rural differences in key factors associated with depressive symptoms among Chinese perimenopausal women can provide a scientific basis for developing targeted intervention strategies. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), we employed a random forest model combined with Shapley value decomposition (a cooperative-game-theoretic approach that quantifies each variable's marginal contribution to model accuracy), supplemented by logistic regression analysis, to systematically explore urban-rural differences in key factors influencing depressive symptoms in perimenopausal women. Among 1,105 perimenopausal women, the overall prevalence of depressive symptoms was 39.3%, with 34.4% in urban areas and 42.4% in rural areas. Life satisfaction, self-rated health, and sleep duration emerged as common factors affecting depressive symptoms in both urban and rural perimenopausal women. Chronic disease, hospitalization history, children's financial support, and child contact were unique key factors influencing depressive symptoms in urban women. In contrast, activities of daily living (ADL), cognitive function, and total annual household income were unique key factors influencing depressive symptoms in rural women. Significant urban-rural differences exist in the key factors associated with depressive symptoms among Chinese perimenopausal women. Policy makers should therefore design context-specific mental-health programmes. for example, urban initiatives could integrate chronic-disease management with family-based psychosocial support, whereas rural programmes might combine economic-security improvements with community-level cognitive-health screening and rehabilitation of activities of daily living-to maximise intervention effectiveness.