The Influence of Self-Rated Health on Depression Among Older Adults In South Korea: The Moderating Role of Social Participation

Background: Self-rated health (SRH), defined as individuals’ subjective assessment of their overall health status, is widely used as a robust indicator of general health. A substantial body of research has demonstrated that SRH is a strong predictor of subsequent mortality, morbidity, and a range of adverse health outcomes, including depression. Despite this evidence, relatively little is known about the contextual factors that may mitigate the negative impact of poor SRH on mental health. Social participation, a key component of active aging, has been associated with better psychological well-being and may function as a protective factor against depression. However, empirical research examining the moderating role of social participation in the relationship between SRH and depression remains limited. This study aims to (1) examine whether SRH independently predicts depression among older adults and (2) investigate whether social participation buffers the association between SRH and depression among older adults in South Korea.

Methods: Data were drawn from the 10th wave of the Korean Longitudinal Study of Aging (KLoSA), a nationally representative cohort of community-dwelling adults aged 60 and older (n=6,056). Depression was measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). SRH was assessed with a single question, “In general, how would you rate your health?” with response options ranging from excellent to poor. For analysis, SRH was dichotomized into good (excellent, very good, good) and poor (fair, poor). Social participation was measured based on whether respondents participated in any groups or organizations, defined as engagement at least once a month. Multivariable linear regression were used to examine the association between SRH and depression, adjusting for age, sex, education, marital status, total household income, number of chronic conditions, drinking, and activities of daily living (ADL). To assess the moderating effect of social participation, an interaction term between SRH and social participation was added in the regression model.

Results: Regression analyses indicated that better SRH was significantly associated with lower levels of depressive symptoms (β = −0.68, p < 0.001). In addition, the number of chronic conditions, activities of daily living (ADL), and drinking were significantly associated with depression (β = 0.13, p < 0.001; β = 0.17, p < 0.01; β = −0.18, p < 0.001, respectively). Furthermore, social participation significantly moderated the relationship between SRH and depression (β = 0.34, p < 0.01), indicating that older adults who engaged in social participation were less vulnerable to depressive symptoms.

Implications: This study highlights social participation as a critical buffering mechanism in the relationship between SRH and depression. Our findings suggest that how older adults engage socially is important in shaping their psychological well-being. These results underscore that mental health in later life is not solely determined by internal factors such as perceived health, but is also actively constructed through social interactions. Accordingly, interventions should move beyond medical treatment alone and incorporate “social prescribing,” connecting older adults to meaningful social, recreational, or volunteer activities. Promoting social participation may serve as an effective strategy to reduce vulnerability to depression among older adults.