Mental Health Effects of Social Participation Among Chinese Older Adults: A Three-Wave Longitudinal Analysis of the Moderating Effect of Multimorbidity

OBJECTIVES: This study examined the bidirectional association between social participation and mental health among older adults and whether multimorbidity moderated this association. METHODS: Three wave longitudinal data (2011-2018) from the China Longitudinal Healthy Longevity Survey were analyzed using cross-lagged panel models. Social participation and mental health were assessed by self-reported questionnaires. Multimorbidity was defined as the coexistence of two or more chronic diseases. Analyses were conducted for the overall sample and separately for those with and without multimorbidity. RESULTS: Social participation was positively associated with subsequent mental health across waves. Mental health was positively associated with social participation in the later wave, supporting a bidirectional association. Subgroup analysis revealed a significant bidirectional association among older adults with multimorbidity, whereas no significant longitudinal association was found among those without multimorbidity. CONCLUSIONS: Social participation and mental health are bidirectionally associated among Chinese older adults, with multimorbidity significantly moderating this relationship. Social participation should be prioritized to older adults with multimorbidity. CLINICAL IMPLICATIONS: Clinicians and community health practitioners may consider assessing social participation alongside mental health and chronic disease burden in older adults, particularly those with multimorbidity. Opportunities for meaningful social engagement could be incorporated into community and chronic disease management services.