Mind matters: a comparative study of self-reported severity of depression and cognitive symptoms in China and the USA

Individuals' interpretations of health are inherently subjective, influenced by diverse cultural background and upbringing. This study aimed to examine differences in self- reported severity of depression and cognitive symptoms among middle-aged and older adults from China and the United States.

With data on middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS), Health and Retirement Study (HRS), and the Disability Vignette Survey (DVS), we conducted estimations utilizing generalized ordered probit models. These models captured respondents' ratings of each vignette character's health problem. To account for reporting heterogeneity in depression and cognitive severity, we subsequently applied a hierarchical ordered probit model for adjustment.

Compared to US respondents, Chinese respondents exhibited lower mean scores in self-rated depression and cognitive severity for both themselves and the vignette characters. Upon adjusting the results for reporting heterogeneity, it became evident that Chinese respondents experienced more pronounced depression (β = 0.202, p < 0.001) yet displayed better cognitive status (β = -0.239, p < 0.001) compared to their US counterparts. Notably, the thresholds employed by respondents to assess depression and cognitive status displayed systematic variations between the two countries, often showing non-parallel shifts (p < 0.05). Middle-aged and older adults in China maintained lower health assessment standards or expectations when compared to their US counterparts. Additionally, higher levels of education exerted a positive and protective influence on depression and cognitive status for individuals in both China and the United States. It's important to note that the effects of urban-rural areas and living arrangements varied across these populations.

Significant disparities were observed in self-rated levels of depression and cognitive severity between middle-aged and older adults in China and the United States. Moreover, these disparities extended to the criteria utilized in their assessments. Addressing mental health interventions and management for this demographic in both countries should be prioritized and bolstered.