Relative importance of social connectedness indicators for depression and suicidal ideation among urban and rural older adults in South Korea

Abstract

Objectives: This study aimed to examine the associations and relative importance of multiple social connectedness indicators for mental health outcomes among urban- and rural-dwelling older adults in South Korea. Methods: This study used data from the 2023 Korea Community Health Survey, a nationally representative crosssectional survey. Of 231,752 individuals who completed the survey, 77,930 adults aged 65 and older were included (mean age 74.7 +/- 7.0, 57.5% female). Social connectedness indicators included social contact frequency, social activity participation, neighborhood cohesion, and neighborhood satisfaction. Mental health outcomes included major depressive disorder (MDD), suicidal ideation (SI), and comorbid MDD and SI. Multiple logistic regression and dominance analyses were performed to identify and quantify the relative importance of social connectedness indicators associated with mental health outcomes across urban and rural groups. Results: Overall, 4.7% of participants screened positive for probable MDD, 9.2% for SI, and 3.2% for comorbid MDD and SI. Most social connectedness indicators were independently associated with lower odds of mental health outcomes in both urban and rural groups. Neighborhood cohesion was relatively important in urban context, while contact with neighbors was important in rural context. Participation in social gatherings, frequent contact with friends, and participation in leisure activities consistently emerged as the strongest factors. Discussion: While multiple social connectedness indicators are known to protect mental health of older adults, certain indicators have stronger associations depending on the regional context. These findings underscore the need for both universal strategies to expand meaningful social participation and context-specific approaches tailored to urban and rural environments.