Regularly playing the popular Chinese strategy game Mahjong may be associated with a reduced risk of depression among urban adults, according to a study conducted in China.
Mahjong is a tile-based game that was developed in China during the Qing dynasty and has spread throughout the world since the early 20th century. It is commonly played by four players.
"Global economic and epidemiologic trends have led to significant increases in the burden of mental health among older adults, especially in the low- and middle-income countries," said Adam Chen, an associate professor at the University of Georgia in the US.
Poor mental health is a major issue in China, which accounts for 17 per cent of the global disease burden of mental disorders, according to the study published in the journal Social Science & Medicine.
Mental health issues related to social isolation and loneliness are on the rise as China's number of older adults -- as in other countries -- continues to increase, the researchers said.
The benefits of participating in social activities to mental health have been widely acknowledged, and some work has been done in developed nations, including the US and Japan, to better understand this relationship.
However, little is known about the role of social interaction and mental health outside of these settings.
"Social participation manifests itself in different formats within different cultural contexts," said Chen.
"Our paper provides evidence on the association between social participation and mental health in the context of a developing country. We also examined the rural-urban difference, which has not been examined extensively in this line of literature," he said.
Chen and collaborators from China's Huazhong University of Science and Technology analysed survey data from nearly 11,000 residents aged 45 years and older from the nationally representative China Health and Retirement Longitudinal Study.
They looked at symptoms of depression and compared it to the type and frequency of social participation, including visiting with friends, playing Mahjong game, participating in a sport or social club, and volunteering in the community.
They found that, on the whole, participating in a wide variety of activities more frequently was associated with better mental health. Specifically, urban residents who played Mahjong, a popular strategy game, were less likely to feel depressed.
The finding was in line with other studies, but Chen was surprised to find that rural Chinese overall tended to report poor mental health compared to their urban counterparts.
"Traditionally, rural China featured tight-knit communities of close kinship, often with a limited number of extended large families in a village," he said.
"We were expecting strong ties and communal bonds in rural China, but it appears that we were wrong," said Chen.
He suspects that the social structures in rural China were disrupted as many able-bodied adults moved into cities to find work. While family ties remained strong, community ties weakened in rural areas.
"What is more surprising is that mahjong playing does not associate with better mental health among rural elderly respondents," added Chen.
"One hypothesis is that mahjong playing tends to be more competitive and at times become a means of gambling in rural China," he said.
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