From socioeconomic disadvantage to depression: How social welfare fitness perception shapes mental health in later life

Abstract

The rising prevalence of later life depression threatens individual well-being and exacerbates health inequalities globally. While low socioeconomic status (SES) is consistently linked to higher depression risk, the mechanisms through which structural disadvantage translates into mental health outcomes remain incompletely understood. This study introduces the concept of social welfare fitness perception (SFP), defined as people’s tendency to perceive and internalize the rational logic underlying social welfare policy system, including the balance of rights and obligations, reasonable expectations of benefits, and the principle of mutual support. The study investigates whether SFP mediates the association between SES and later life depression, proposing SFP as an individualized cognitive perceptual linkage between structural position and human mental health. Using a cross-sectional design, this study surveys 628 older adults from communities in eastern China, measuring their later life depression, SES, SFP, and trust in medical institutions. A moderated mediation analysis was constructed using bootstrapping procedures. Lower SES was significantly associated with higher later life depression. SFP partially mediated such a relationship. Older adults with lower SES demonstrated weaker SFP, which in turn predicted greater depressive symptoms. Trust in medical institutions moderates the linkage between SFP and later life depression. SFP only protected against depression only among those with low medical institutional trust. The conditional indirect effect of SES on later life depression via SFP was only significant for the medical institutional low-trust older adults. SFP constitutes a novel mechanism linking socioeconomic disadvantage to later life depression. This capacity to cognitively appraise the social welfare policy system rationally suggests that health equity not only depends on social welfare policy provision, but also on residents’ ability to internalize the logic of social welfare as a source of psychological security. Enhancing SFP may represent an innovative strategy for mental health intervention, particularly in cases where older adults’ institutional trust is fragile.

The authors' abstract, as published at the source. International Journal for Equity in Health, 2026 · DOI ↗