From Cultural Context to System Resilience: Advancing Global Mental Health for Older Adults

Population aging worldwide has intensified the need to understand how mental health in later life is shaped by both cultural norms and structural systems. The book Mental Health in Older People Across Cultures underscores the central role of culture in shaping expectations about independence, emotional expression, and family roles, particularly in the context of depression. In this commentary, we build on that foundation by emphasizing system-level resilience as a necessary complement to cultural understanding. Drawing on the SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, we argue that mental health outcomes emerge from interactions among cultural beliefs, healthcare access, social infrastructure, and broader system capacity. Structural challenges, including fragmented care coordination, multimorbidity, polypharmacy, digital exclusion, and caregiver strain, often intensify cultural vulnerabilities. Depression also contributes to spending differences among older adults, reinforcing the need for whole-person and whole-system approaches. We discuss the potential of Health information technology (HIT) and artificial intelligence to strengthen system-level resilience by improving early identification, medication management, care coordination, and culturally grounded communication. We conclude by calling for system-level measures that reflect cultural variation, structural capacity, and caregiver context, and for applying SUNSHINE across cultures to guide the development of more adaptive and supportive mental health systems for older adults.