Population aging is a global phenomenon and a fundamental aspect of China’s modernization process. According to the seventh China population census, 18.7% of the total population is over 60 years old, a 5.44% increase from the previous census, with projections indicating that China will become a moderately aging society by the end of 2030 (China Research Center on Aging, 2021). In recent years, active aging has become a key policy strategy to address the challenges posed by an aging population. The World Health Organization defines active aging as the process of optimizing opportunities for health, participation, and security to enhance the quality of life as people age (Walker, 2002). Despite this, the associations between overall and positive perceptions of active aging remain underexplored (Eronen et al., 2021), as do the mechanisms or personal resources that might explain these associations.
Mental health literacy is a key resource for promoting mental health. It encompasses the knowledge, attitudes, and behaviors individuals that develop to enhance their own and others' mental health and to cope with mental illnesses (Jiang et al., 2022). Currently, mental health literacy in China is at a low to moderate level (Jiang et al., 2022) and tends to decline with age (Reavley et al., 2014). Extensive evidence confirms that higher mental health literacy is associated with better active aging outcomes and healthier behaviors, such as early identification of mental illness and reduced internalized stigma (Dogra et al., 2022; Kutcher et al., 2016). Conversely, low mental health literacy increases the risk of depression, anxiety, and stress, and diminishes the effectiveness of help-seeking behaviors (Tambling et al., 2021; Tully et al., 2019), which are significant risk factors for active aging.
1.1. Bidirectional relationship between mental health literacy, active aging, and social participation
Social participation involves the social sharing of individual resources through active engagement in collective activities, such as religious events, hobby clubs, sports groups, and cultural and political events (Lee et al., 2008). According to the activity theory, maintaining middle-aged activities and attitudes for as long as possible ensures vitality and positivity at physical, psychological, and social levels(Havighurst, 1961).
Social participation can enhance mental health literacy and promote active aging. Engaging in social activities is essential for promoting mental health and achieving active aging among older adults (Dogra et al., 2022). An increasing number of researchers have identified a potential bidirectional causal relationship between social participation and mental health in older adults (Ding et al., 2015; Ding et al., 2022). However, whether a bidirectional relationship exists between social participation and mental health literacy remains unclear. Research suggests that social participation predicts mental health literacy (Lee et al., 2020). Older adults who frequently engage in various social activities acquire adequate social support, which in turn increases mental health service utilization and formal help-seeking (Hansen & Aranda, 2012; Martinez et al., 2020). Several studies have also examined the influence of social participation on active aging, indicating that it reduces disability, mortality, and depression rates (Takagi et al., 2013; van Hees et al., 2020), enhances mental well-being (Ding et al., 2015), and promotes positive attitudes toward aging and the likelihood of healthy aging, as observed across different types of community activities (Liu et al., 2020; Y. Lu et al., 2022).
Notably, social participation, as a health behavior, may result from mental health literacy and active aging. Knowledge and attitudes are associated with participation in health behaviors (McAnally & Hagger, 2023). Informed by the theory of social cognition, individuals’ beliefs about a given health behavior shape their intentions and actual participation in that behavior (Mark & Paul, 2015). Similarly, individuals with inadequate mental health literacy may hold beliefs that reduce their propensity to participate in health behaviors, ultimately decreasing opportunities for older adults to engage in these behaviors. For instance, patients who reported higher stigma experienced lower levels of social participation (Q. Lu et al., 2022).
Given the above, a bidirectional relationship likely exists between mental health literacy, active aging, and social participation, warranting further exploration.
1.2. Socioeconomic status as a moderator
Socioeconomic status (SES) is a comprehensive indicator encompassing income level, education, occupational status, and wealth, which collectively enable individuals to achieve specific goals (Gorman & Sivaganesan, 2007). Numerous studies have demonstrated associations between SES and mental health literacy (Holman, 2015; Jiang et al., 2022), SES and active aging (Tian et al., 2023), and SES and social participation (Feng et al., 2020; Zhang et al., 2022). Moreover, SES may modulate the relationships among these variables.
The Andersen model posits that predisposing and enabling factors influence health status through health behaviors (Andersen & Davidson, 1997). As a predisposing factor, SES may moderate the relationship between mental health literacy and active aging. One study found that the relationship between mental health literacy and psychological resilience, key promoters of successful aging (Zabo et al., 2023), was moderated by subjective SES (Zhang et al., 2023). According to the fundamental cause theory, SES-related resources such as knowledge, money, and social connections (i.e., social participation) help prevent health risks and mitigate the consequences of poor health (Link & Phelan, 1995). Therefore, individuals with higher SES are better positioned to maintain good health (Zhang et al., 2022) and have significantly lower odds of physical-psychological-cognitive multimorbidity compared to those with low SES (Ni et al., 2023). Additionally, a longitudinal study found that lower SES was associated with poorer trajectories of active and healthy aging and lower quality of life over 14 years of follow-up (Malkowski et al., 2023). In summary, SES may moderate the bidirectional relationship between mental health literacy, active aging, and social participation. High SES enhances the likelihood that individuals with high mental health literacy or social participation will achieve active aging. Conversely, high SES may increase the susceptibility of those with active ageing to possess high mental health literacy or engage more in social participation.
1.3. Current study
Some limitations in previous literature still warrant attention. Despite evidence suggesting that mental health literacy, social participation, and active aging are closely related, no existing network analysis has considered these factors together. Furthermore, the moderating effect of SES, a key predisposing variable, remains unexplored. This study applies network analysis to enhance the understanding of the complex bidirectional relationships between mental health literacy, social participation, and active aging while identifying potential moderation effects. Network analysis enables the identification of key components (nodes) and their relationships (edges) by examining potential factors and adjusting for their interrelationships (Bjorndal et al., 2023). Each node represents a symptom or variable, and each edge represents the partial correlation between two nodes, with thicker edges indicating stronger relationships. When considering moderators, symptom networks may be inadequate. To address this, moderated network analysis, based on nodewise regression, can be employed. This approach examines how the interaction between two symptoms or variables is moderated by other variables, offering insights into nuanced network relationships (Epskamp et al., 2018; Haslbeck et al., 2021; Swanson, 2020).
The present study posited four hypotheses: (1) The relationship between mental health literacy, active aging, and social participation is bidirectional; (2) SES moderates the relationship between mental health literacy and active aging; (3) SES moderates the relationship between mental health literacy and social participation; and (4) SES moderates the relationship between social participation and active aging.