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BMC Public Health volume 25, Article number: 733 (2025)
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Psychological well-being is becoming an increasingly important part of the public health mission, and is multifaceted and has various interrelated dimensions. A thorough understanding of its presentation patterns (i.e., subtypes) and change process is essential for effective interventions. However, longitudinal research examining the subtypes of psychological well-being among Chinese older adults remains scarce, and little is known about the factors influencing the belonging and transition of these subtypes.
We used two waves of national longitudinal data (2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey, with 5778 respondents aged 65 and above. Psychological well-being was assessed by eight indicators from three dimensions: quality of life, positive feelings, and negative feelings. Latent profile transition analysis was used to identify subtypes of psychological well-being and explore the transition of older adults among different subtypes over time.
Four distinct subtypes of psychological well-being were identified, with the Mainly Unhappy Subtype being prevalent among Chinese older adults. Unhappiness and uselessness were indicative; eliminating unhappiness was vital to complete psychological recovery; feeling of uselessness was found as a crossroads in the process of psychological health. The psychological well-being of older adults was unstable; emotion blunting was found in the transition from the Mainly Unhappy Subtype to the Satisfied and Positive Subtype, and emotion augmentation was found in the transition from the Resilient yet Useless Subtype to the Discontented and Negative Subtype. A paradox in aging was observed in the membership of the Mainly Unhappy Subtype and the Discontented and Negative Subtype. Marital status, residence, education, household income, exercise, and leisure activity were significantly positively related to both initial membership and transition of the psychological well-being subtypes. Smoking status, drinking status, and social support were significantly associated with the transition between subtypes. Physical health was significantly correlated with the initial subtype membership.
Our findings suggest some indicators and critical steps in improving psychological well-being among older adults. These provide insight for healthcare professionals and policymakers to develop tailored interventions considering subtypes and individual characteristics.
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Population aging, a significant social trend of the 21st century, has brought the issue of psychological well-being to the forefront [1]. Psychological well-being is not only a target for promoting healthy aging but also a key factor associated with a reduced incidence of several age-related conditions and a slower decline in physical function [2,3,4]. The implications of poor psychological well-being are far-reaching: This includes increased risks of mental health problems, lower quality of life, increased unscheduled care, high economic and social costs, and even mortality [5].
Psychological well-being has been defined in various ways, and its exact content and contours are contested, evolving with new empirical research and theoretical models [6]. Two main perspectives characterize its essential features: the hedonic approach proposes three components of psychological well-being (life satisfaction, pleasant affect, unpleasant affect), defining it as the frequent experience of positive emotions, infrequent experience of negative emotions, and a satisfying evaluation of life [7]. The eudaimonic approach defines psychological well-being as a person’s ability to identify meaningful pursuits, and the act of striving toward them through virtuous activities in the quest of achieving one’s ultimate potential, which posed theoretical foundations of psychological well-being including six core dimensions (purpose in life, autonomy, personal growth, environmental mastery, positive relations, and self-acceptance) [8].
Moreover, the correlation between distinct psychological well-being components and their co-occurrence was discussed [9]. For example, positive emotions are more strongly related to life satisfaction than the absence of negative emotions [10]; low level of negative emotions moderates the relationship between self-efficacy, hope, and optimism with subjective well-being [11]; in terms of mixed emotions, participants experienced the co-occurrence of happy and relaxed states more; the co-occurrence of angry and sad states less than any other emotion combination [12]. These provide an interactive perspective of examining psychological well-being and its changes, suggesting future explorations of presentation patterns and underlying processes through the dynamic interplay of domains of psychological well-being [13, 14]. Understanding the patterns and processes of psychological well-being is also valuable for informing interventions and policies [1].
With respect to the measurement of psychological well-being, standardized scores are assessed commonly using measurement scales [15, 16]. These variable-centered strategies help us understand levels of psychological well-being; however, they can not adequately capture the qualitative traits of psychological well-being status and its changes, as the complexity of psychological well-being may not be fully represented by quantitative scores or grades alone. Person-centered approaches (e.g., Latent class modeling, LCM) provide an opportunity to reveal the heterogeneous groups of psychological well-being (i.e., subtypes) based on response patterns of individuals on domains of well-being [17], which may inform population-level interventions and allow for more targeted individual-level interventions.
Existing studies have explored latent classes of psychological well-being among older adults. For example, Shima and Muto reported three patterns of psychological flexibility: high, moderate, and low [18]. Saadeh et al. identified three well-being profiles: worst, intermediate, and best, focusing on behavioral, social, and psychological factors [19]. Yuhan et al. used latent transition analysis to study changes in depression subtypes over time [20]. While these studies provided valuable insights, there remains a gap in understanding the patterns and process of overall psychological well-being among older Chinese adults, who comprise the largest population worldwide, with a fast growth rate of population aging [21]. This gap will hinder the development of targeted subpopulation interventions and policies aimed at improving older adults’ psychological health in China.
In addition, research has extensively documented associations between sociodemographic characteristics [22], physical health [22], social support [23], lifestyle [24], and psychological well-being levels. However, few researchers have addressed the predictors of the patterns and processes of psychological well-being. Correspondingly, there is a wide variation of effects of influencing factors across distinct components of psychological well-being. For example, physical activity and minimizing sedentary behavior can reduce the risk of depression and anxiety [25]; while environmental factors have been shown to significantly impact feelings of worthlessness and loneliness, a latent growth modeling analysis using national survey data of older adults in the United States has revealed that higher neighborhood social cohesion was also associated with lower levels of loneliness at the beginning and across the 8-year study period, and demonstrated the significant role of environmental factors beyond individual predictors [26]. Another study on Chinese older adults indicated that environmental factors mostly referred to social environments including family/social supports(i.e. currently married, having helpful/trusted/frequently contacted persons, community care/social services available) and cultural context (i.e. receiving/giving money or food from children), and suggested that cultural factors such as intergenerational transfer were linked to reduced perceived uselessness [27].
Thus, the aims of this study were as follows: (a) to explore the patterns of presentation and change process of psychological well-being among older adults in China, using LCM to identify the subtypes of psychological well-being and explore the transitions between subtypes, and (b) to investigate the predictors of subtype membership and transitions by introducing covariates to LCM. The results of this study will offer a nuanced understanding of risk indicators and factors of psychological distress by unveiling the process. These will aid in more tailored healthcare policies and prevention strategies for older adults considering their psychological well-being subtypes as well as individual characteristics.
We used data from the Chinese Longitudinal Health Longevity Survey (CLHLS), a nationwide follow-up survey of older adults jointly conducted by Peking University and Duke University. Since the baseline survey in 1998, the CLHLS collected eight subsequent waves of data in 2000, 2002, 2005, 2008, 2011, 2014, 2018, and 2021. The survey randomly selected a sample of rural and urban older adults from 22 provinces, which account for approximately 85% of China’s total population [28]. The rural and urban areas are defined by the administrative divisions of China, which are characterized by the residence place participants in the data [29]. The age range of respondents has expanded from 80 to 99 years old to those aged 65 and over since 2002. At each wave, survivors were re-interviewed, and deceased interviewees were replaced by new participants [30]. The CLHLS targeted on both community-dwelling and institutionalized older adults. Employing a multistage stratified cluster sampling method, octogenarians and nonagenarians were randomly selected based on gender and residence place (i.e., living in the same city, county, village, or street) for a given centenarian [31]. Information regarding socio-demographic characteristics, physical and mental health status, family and social support, and health behaviors was obtained [32]. All information was collected during face-to-face interviews in participants’ homes using internationally compatible questionnaires by trained investigators [30]. A detailed description of the CLHLS has been reported elsewhere [29, 33].
Considering the consistency of information, this study used two data waves: 2011 (Time 1) and 2014 (Time 2). 5778 older people aged 65 or older who participated in both time surveys were included in this longitudinal cohort study, the reasons for not participating at Time 2 were ‘death’ (N = 2879) and ‘lost to follow-up’(N = 820). See Table 1 for sample characteristics.
Considering data applicability and the common measurement practices in literatures [16, 34], this study incorporated the hedonic perspective to evaluate psychological well-being. Under this perspective, in this study, psychological well-being is defined as an individual’s overall judgement of life satisfaction and their affective state characterized by the presence or absence of positive and negative emotions [7]. This definition encompasses the experienced aspect, capturing transient emotions, and the evaluative aspect, reflecting a person’s beliefs about whether their life was good and rewarding [15]. These components (i.e. positive affect, negative affect, and life satisfaction) are also the most commonly used measure of well-being [15].
According to the survey content, we selected eight items from the three dimensions to identify the psychological well-being status of older adults: quality of life (QOL) ranging from “very bad(1)” to “very good(5)”; positive feelings (4 items, “I look on the bright side of things,” “I am happy as when I was younger,” “I keep my belongings neat and clean,” and “I make my own decision”); and negative feelings (3 items, “I feel fearful or anxious,” “I feel lonely and isolated,” and “I feel useless with age”). All items used a 5-point scale, ranging from “never (1)” to “always (5)”. Although these items included in CLHLS are not established indices such as the 20-item Life Satisfaction Index or the 20-item Center for Epidemiologic Studies Depression Scale, prior work has shown that these items tap critical dimensions of psychological well-being such as optimism, conscientiousness, personal control, happiness, neuroticism, loneliness, and self-esteem [35]. Previous CLHLS studies have also applied these items to measure psychological well-being [16, 36].
Building upon previous literature, we included several covariates important to individual psychological well-being. We classified these covariates into four categories: demographic characteristics, social support, lifestyle, and physical health.
The following demographic characteristics were self-reported: (1) age (in years); (2) gender (1 = male, 0 = female); (3) marital status (1 = married and living with spouse, 0 = others); (4) residence (1 = urban/city, 0 = rural); (5) educational attainment (in years of schooling); and (6) household income (1 = lowest quartile, 0 = upper three quartiles ).
The concept of social support is quite broad and encompasses many dimensions. Using a comprehensive measurement is a common method to study psychological well-being of older adults [37, 38]. Following the existing study using the CLHLS data [39], we generated a continuous variable based on questions regarding the availability of help from others in the following situations: when you had problems/difficulties, when you needed to share thoughts, when you wanted to talk frequently in daily life; when you were sick; when you needed financial support, i.e., the monetary support received from your son or daughter received in the past year. The total score ranged from 0 to 6, with higher scores reflecting greater availability of help from others across various situations.
Lifestyle-related factors included (1) being a current or past smoker (1 = yes, 0 = no); (2) being a current or past drinker (1 = yes, 0 = no); (3) exercising presently or in the past (1 = yes, 0 = no); (4) engaging in physical activities, scored by the frequency of activities such as housework, outdoor activities, garden work, raising domestic animals, and organized activities, categorized as “almost every day” or “sometimes” (versus “never”); (5) engaging in leisure activities, summed based on reporting “almost every day” or “sometimes” (versus “never”) to activities such as reading newspapers/books, playing cards and/or mah-jong, watching TV and/or listening to radio, and religious activities.
We used chronic conditions and disability in activities of daily living (ADLs) to evaluate the physical health of older adults. Chronic diseases were counted as present (1) or otherwise (0), including hypertension, diabetes, heart disease, stroke, bronchitis, etc., while less impactful conditions such as cataracts and glaucoma were excluded [16]. ADL disability was quantified by counting the number of activities the respondent had difficulties with, including bathing, dressing, mobility, and self-care tasks.
We used latent profile analysis (LPA) and latent profile transition analysis (LPTA) to identify subtypes of psychological well-being among older adults in China and estimate the distribution and changes across subtypes. All latent analyses were carried out with Mplus 8.0. Multinomial logistic regression was conducted by Stata 17.0 to investigate the influence of various factors on an individual’s membership in and transition between psychological well-being subtypes. Data analysis occurred in phases described in detail below.
To account for the missing values in the outcome measures, the LPTA analysis within Mplus treats incomplete data as missing at random (MAR) [40], and models were estimated robust maximum likelihood estimator (MLR) in conjunction with Full Information Maximum Likelihood (FIML) [41]. Listwise deletion was employed in missing data for covariates when running multinomial logistic regression models in Stata.
LPA is a form of LCM which categorizes individuals into distinct latent profiles (i.e., subtypes) based on their response patterns to a set of continuous observed indicators [42]. LPA was estimated separately at Time 1 and 2 without covariates to ensure consistency in the number of profiles extracted at each time point. The eight items of psychological well-being served as manifest indicators.
To select the best fitting model (i.e. the most appropriate number of latent profiles), for each time point, fit statistics were examined for 2 to 6 solutions with five commonly-used measures: the Bayesian Information Criterion (BIC) [43], the Akaike Information Criterion (AIC) [44], Entropy [45], a Lo-Mendell-Rubin Test (LMR), and a Bootstrap Likelihood Ratio Test (BLRT) [46]. The BIC and AIC are comparative fit measures; although models with lower values are preferred, the magnitude of change in the indices is considered more important than comparing to a standard value. Entropy, ranging from 0 to 1, has a higher value indicating a more certain fit. The BLRT and LMR assess adding more profiles significantly improves model fit.
Besides these indices, consideration of parsimony, the theoretical significance of latent profiles, and the size of each profile were also used as evidence to determine the optimal number of profiles [17, 47]. Time 1 LPA and Time 2 LPA were considered when exploring the appropriate number of psychological well-being subtypes.
LPTA is a longitudinal extension of LPA. It integrates auto-regressive modelling to estimate group membership simultaneously over time and the incidence of transitions from one group to another, allowing for exploring the change process of subtypes [47]. We used LPTA based on both Time 1 and Time 2 data without covariates, estimating the proportion of each latent profile at the two time points and calculating the transition probabilities between these profiles within the time intervals using transformation matrices established by a hidden Markov process. Similar fit statistics and methods were examined to select the best LPTA model and confirm the appropriateness of the latent profiles found from LPA.
We used Most Likely Class Regression to incorporate covariates into the LPTA model [48], applying multinomial logistic regression analysis. Following Yuhan et al.(2017), we considered the Time 1 latent profile as the outcome variable to determine the predictive factors for profile membership. We created dependent variables for each row of transition probability matrix to assess factors affecting subtype changes. Odds Radio (OR) with the corresponding 95% confidence interval (CI) served as measure of effect.
Table 2 shows the fit indices for LPA models with 2–6 latent profiles at Time 1 and Time 2. As the BIC and AIC never reached their lowest point at both time points, the magnitude of change was used as a guide. Five profiles were preferred, as the magnitude of decrease gradually slowed down after reaching this number. LMR and BLRT consistently favored the four- and five-profile models, as indicated by significant p-values. Entropy values reached 0.8 at four profiles and then remained at a relatively high level with only marginal improvement (0.848 to 0.877 at Time 1, 0.839 to 0.871 at Time 2), suggesting at least 90% correct assignment for four to six profiles [49]. Considering simplicity, careful choice should be made for a higher number of profiles.
To further clarify the optimal number of latent profiles, we compared the meaning of the profiles and their relative size (see Figure S1 in Appendix 1). The mean distribution of scores for each psychological well-being indicator showed consistent trends across time for the four- and five-profile models. The five-profile model identified an additional subtype at Time 1, accounting for a 4.4% share, which separated from Subtype 1 of the four-profile model, with only minor score differences in the item “I look on the bright side of things.” A similar scenario was observed for the Time 2 data. Given the marginal size of the additional subtype and the lack of significant distinction, the four-profile solution was retained for its simplicity.
Given that the model was largely stable and a four-profile solution was supported at both Time 1 and Time 2, we proceeded with latent transition analyses of the longitudinal data. The change in magnitude for the AIC (205449.38, 203189.69, 202383.32 for models with 3–5 profiles) and BIC (205764.14, 203602.82, 202907.93 for models with 3–5 profiles) decreased between the four- and five-profile models, and the entropy peaked at four profiles (0.698, 0.791, 0.773 for models with 3–5 profiles) (see Table S1 in Appendix 2), confirming the suitability of the four profiles.
The scores of indicators in Fig. 1 show that four distinct subtypes of psychological well-being could be interpreted meaningfully. The Discontented and Negative Subtype characterized older adults with high scores in negative feelings and low scores in life satisfaction and positive feelings. Within this subtype, the sense of uselessness was high, and feelings of loneliness at a moderate level or higher emerged. Those in the Satisfied and Positive Subtype had high scores in life satisfaction and positive feelings, and low scores in negative feelings. The remaining two subtypes exhibited a divergence in specific factor scores. The Resilient yet Useless Subtype featured the second-highest scores in negative feelings following the Discontented and Negative Subtype, particularly in perceived uselessness. Nonetheless, these individuals reported a moderately high level of life satisfaction and positive feelings, with happiness being still high. The Mainly Unhappy Subtype displayed a profile with a pronounced unhappiness, ranking just below the Discontented and Negative Subtype, but also exhibited relatively high scores in other positive feelings and relatively low scores in negative feelings among four profiles.
Table 3 shows the latent profile membership probabilities representing the proportion of subtypes. At Time 1, the Satisfied and Positive Subtype had the highest latent profile probability (39.14%), followed by the Mainly Unhappy Subtype (33.60%). At Time 2, the probability of the Mainly Unhappy Subtype increased to 34.47%, while the probability of the Satisfied and Positive Subtype decreased to 34.80%. The Resilient yet Useless Subtype’s probability decreased slightly from 13.09 to 12.27%, remaining the least common. The Discontented and Negative Subtype’s probability increased from 14.18 to 18.49%.
An alluvial plot describes the transitions of subtypes during the period from 2011 to 2014 (see Fig 2). Table 3 lists the transition probabilities. For the Satisfied and Positive Subtype, the probability of remaining was 52.4%, and the probability of transitioning to the Mainly Unhappy Subtype was 32.2%. The Mainly Unhappy Subtype was most likely to transition to the Satisfied and Positive Subtype (30.6%), with a 42.2% probability of remaining. The Resilient yet Useless Subtype had higher probabilities of transitioning to the Mainly Unhappy Subtype (31.6%) and the Discontented and Negative Subtype (27.6%). The Discontented and Negative Subtype had a 44.1% probability of remaining and a 24.9% probability of transitioning to the Mainly Unhappy Subtype.
LPTA four-profile solution according to mean scores of eight psychological well-being items
Alluvial plot of transition of four psychological well-being subtypes in 2011–2014. Note: 1: the Mainly Unhappy Subtype; 2: the Resilient yet Useless Subtype; 3: the Satisfied and Positive Subtype; 4: the Discontented and Negative Subtype
Figure 3 contains a heat map describing the effect of each influencing factor on the Time 1 subtype (see detailed logistic regression odds ratios in Table S2 in Appendix 2). The individuals in the Satisfied and Positive Subtype were taken as the reference group. Educational attainment, exercise, and ADL performance are positively associated with classification into the Satisfied and Positive Subtype. The likelihood of older adults in the Mainly Unhappy Subtype or the Discontented and Negative Subtype decreased with age. Marriage, urban residence, and greater engagement in leisure activities were associated with a reduced likelihood of being in the Resilient yet Useless Subtype or the Discontented and Negative Subtype; lower family income and a higher number of chronic diseases were linked to higher probabilities of membership in these two subtypes.
Heat map of the relationship between factors with belonging and transition of psychological well-being subtypes. Note: S1: the Mainly Unhappy Subtype; S2: the Resilient yet Useless Subtype; S3: the Satisfied and Positive Subtype; S4: the Discontented and Negative Subtype
Figure 3 also shows the predicted transition between subtypes from 2011 to 2014, using the participants remaining in the original subtype as the reference category. The detailed logistic regression odds ratios can be seen in Table S2 in Appendix 2. For the Mainly Unhappy Subtype, individuals aged 75 to 84 or with more ADL limitations had lower odds of transitioning to the Satisfied and Positive Subtype; smokers and those participating more in leisure activities had decreased odds of transitioning to the Discontented and Negative Subtype. The Resilient yet Useless Subtype was less likely to transition to the Mainly Unhappy Subtype with higher education or family income but more likely with greater leisure activity engagement and urban residence. For the Resilient yet Useless Subtype, fewer chronic conditions were associated with a higher chance of transitioning to the Satisfied and Positive Subtype, and participating more in leisure activities reduced the probability of moving to the Discontented and Negative Subtype. The Satisfied and Positive Subtype was less likely to transition to the Mainly Unhappy Subtype with marriage and leisure activity engagement, and less likely to transition to the Resilient yet Useless Subtype or the Discontented and Negative Subtype with male gender, exercise, and higher family income. For the Discontented and Negative Subtype, marriage, social support, and exercise were linked to higher probabilities of transitioning to the Satisfied and Positive Subtype. Individuals aged 75 to 84, those who were married or had social support, were less likely to transition to the Resilient yet Useless Subtype, those with lower family income or who engaged in drinking were more likely to make this transition.
In this study, we identified the latent subtypes of psychological well-being and transition within these subtypes among Chinese older adults using LPTA. We examined the factors affecting membership and transition of each subtype by introducing covariates. From the same perspective of comprehensive measurement, Yang et al.’s research utilized the latent class model and latent growth mixture model to define three mental health states and four dynamic trends among Chinese older adults, based on four items [50]. Our results revealed four types according to eight indicators reflecting psychological well-being across various aspects, expecting to provide more precise classification and overall characterization. To our knowledge, this is the first study to explore latent transition patterns and related influencing factors targeting a Chinese population using the LPTA model.
The typical subtypes revealed provide empirical evidence for the theoretical model of the hedonic approach which focuses on happiness and defines well-being in terms of achieving pleasure and avoiding pain, including components such as happiness, life satisfaction, and positive/negative affects [51]. Under this perspective, well-being is described as a person’s emotional state and evaluation of current life circumstances, with personality and individual differences being most concerned [52]. In contrast, the eudaimonic approach emphasizes meaning and self-realization, defining well-being as the extent of an individual’s full functioning, which links to resilience, personal growth, and self-actualization from a long-term view [52]. Focusing on psychological well-being status and changes among older adults, this study employed the hedonic view for measurement. Despite differences in definitions and philosophies, these two theoretical perspectives, while to some degree overlapping, often pose distinct questions and thus enrich each other’s understanding, offering a comprehensive view of the various personal, contextual, and cultural elements involved in the essence and enhancement of well-being [53]. Future research could conduct empirical analyses from an integrated perspective.
In this study, the Mainly Unhappy Subtype had a high self-evaluation of QOL, few negative feelings, and many positive feelings like optimism but low happiness, which shares a number of similarities with the contradictory type in the previous study [50]. This also implied that QOL and happiness are correlated, yet a variety of factors influence both; for example, QOL is intimately connected to physical and material conditions, whereas professional pride and altruism play a more significant role in facilitating happiness [54,55,56]. Such explanations also correlate favorably with the case of the “happy poor” [57].
We also found the Mainly Unhappy Subtype, into which other unhealthy subtypes mainly transition and which easily interchanged with the Satisfied and Positive Subtype, accounted for the highest proportion, second only to the Satisfied and Positive Subtype. This may highlight the uniqueness of happiness among psychological elements, that is, poor psychological well-being might start with unhappiness, and eliminating unhappiness is a crucial step in recovering psychological health. Happiness is a personal feeling shaped by a person’s values, propensities, character, genes, and other factors; it transcends cheerfulness and contentment, representing a desirable yet elusive sense of inner equilibrium and balance [58]. Those who are not detected in psychopathology but report diminished subjective happiness or who are “pure languishing” in life need to be noticed [50].
Previous research has shown that the significant increase in feelings of uselessness among older adults in China is primarily driven by cultural shifts, family structure changes, and health decline, which together diminish their sense of societal and familial contribution [59,60,61]. Consistently, this study revealed the Resilient yet Useless Subtype, characterized by a typically high level of perceived uselessness. Notably, compared to the other subtypes, the Resilient yet Useless Subtype was most likely to transition to the Discontented and Negative Subtype with lower scores in life satisfaction and happiness and higher scores in uselessness and other negative feelings (i.e. loneliness and anxiety). This supports a prior finding that recurrent self-perceived uselessness can be a chronic stressor that influences people’s thoughts, feelings, and behaviors, which, in turn, may adversely impact their psychological and physiological well-being [62]. Concomitantly, we observed that the probabilities of the Resilient yet Useless Subtype transitioning to the other three subtypes were relatively close. Such great instability further suggests the Resilient yet Useless Subtype may serve as a crossroads for the deterioration or improvement of psychological health, emphasizing early intervention in self-perceived uselessness of Chinese older adults [63], and avoidance of turning into more negative states.
Self-perceived uselessness, a key aspect of self-perceived aging, represents a negative view of one’s declining contribution and importance to others [27]. This negative assessment of usefulness at older ages is a social process that reflects the internalization of culturally valued attributes [64]. Studies have indicated that Chinese older adults consider family dynamics heavily when assessing the quality of their aging [60], and interrelated changes in living arrangements [65] and health [66] are increasingly common as they age. Consequently, an individual’s feeling of usefulness within family and social contexts might fluctuate as these events occur over the latter life course [60]. For example, health-related reductions in social network size could limit the social and family roles where older adults feel valuable [67]. Environmental factors, particularly family/social support, correlate with perceived usefulness and cognitive health by offering emotional support, enhancing social connections, and a sense of participation of older adults [27, 68]. Data from a Chinese national sample also indicated that cultural environmental factors such as coresidence with children and intergenerational transfer decreased perceived uselessness of older adults [27]. Studies generally found that socioeconomic resources, particularly financial ones, correlated with reduced perceived uselessness, enabling access to better housing, healthcare, and social services, and promoting positive aging beliefs [63]. Thus, supporting policies for older adults with lower economic status are crucial for enhancing their sense of usefulness. Since previous longitudinal studies have shown that self-perceived uselessness among older adults can generalize to perceptions held by the wider public and can change over time, interventions should involve all stakeholders to better shape the discourse and perception of aging in society [62], including government efforts to cultivate a culture of care, encourage regular family contact, and refine elder care policies, such as labor leave improvements and integrated support services [69].
In general, psychological well-being among older adults tends to be unstable, as we found the proportion of older adults in any subtype who maintain their original category was less than or close to 50%. With some caution regarding the generalizability of such explorative results, these transitions could potentially mirror the interplay between emotions [12]. On the one hand, positive emotions have a buffering and suppressing effect on negatives, termed “emotion blunting” [14, 70]. As this study indicated, the Mainly Unhappy Subtype with higher optimism and conscientiousness mostly changed into the Satisfied and Positive Subtype; the Resilient yet Useless Subtype with moderate-high scores in positive feelings like optimism was more likely to turn into the Mainly Unhappy Subtype with lower scores in uselessness and loneliness. Multilevel analyses have shown that across nations, the experience of positive emotions was correlated more strongly with life satisfaction than the absence of negatives [10], suggesting cultivating positive emotions to optimize health and well-being in later life [14]. On the other hand, augmentation between negative emotions could be considered to play a role in the comorbidity of negative emotional symptoms in mood disorders [71]. In line with this, we revealed the Discontented and Negative Subtype, predominantly originating from the Mainly Unhappy Subtype, characterized by high levels of perceived uselessness, loneliness, and accompanying unhappiness.
Several studies have shown that demographic and socioeconomic characteristics, social support, lifestyle, and physical health are closely related to the psychological well-being of older adults [61, 72]. This study takes a step forward to explore the predictive factors of the change process of psychological well-being by estimating the influence of individual characteristics on membership and transition of latent subtypes. Previous studies have demonstrated the paradox of aging in life satisfaction and negative affect from a longitudinal and multidimensional perspective, yet across dimensions SWB change were more negative in old-old than in young-old age [73, 74]. Under a person-centered and comprehensive reconsideration, we found the paradox of aging existed in the memberships of the Mainly Unhappy Subtype and the Discontented and Negative Subtype. This is in accordance with the adaptation processes to age-associated losses that older individuals benefit from giving up blocked goals in terms of well-being [75]. Additionally, there may be some social factors, such as social support, which play a particularly strong role in the old-old as moderators of the relationships between age and loneliness, especially in countries that emphasize filial piety [76]. Compared to the young-old, it was more challenging for those aged 75 to 84 to recover from unhappiness and loneliness. Furthermore, there was a higher risk of transitioning from the Satisfied and Positive Subtype to the Mainly Unhappy Subtype in individuals aged 85 and older compared to the 65–74 age group, emphasizing the importance of prevention for specific psychological conditions in different age groups, particularly in relation to psychological well-being subtypes and the change process. Our findings also showed that male older adults in the Satisfied and Positive Subtype were less likely to transition to the Resilient yet Useless Subtype than females. This might be because in traditional Chinese culture, males often assume the leadership role in important decisions and act as the authority figures with regard to family and social issues [77], making male older adults more inclined to maintain a positive attitude towards life and a sense of self-worth.
We also found that older adults with higher educational levels had lower risks of membership in the three unhealthy subtypes. In particular, the relationship between education and loneliness is widely discussed, yet no consensus has been reached [78]. We found an eliminating effect of education on loneliness as the greater likelihood of transitioning to the Satisfied and Positive Subtype from the Discontented and Negative Subtype, which supports the view that a higher level of education acts as a protective factor against loneliness [79]. Possible explanations include that higher education can lead to a better perception of aging changes — such as physical, social, and professional—and enhance psychological adaptability concerning well-being [80].
In terms of family characteristics, we found that older adults with higher household incomes or who married and lived with a spouse were less likely to belong to the Resilient yet Useless Subtype or the Discontented and Negative Subtype. Initially classified as the Satisfied and Positive Subtype, they were also less likely to turn into the Discontented and Negative Subtype, and if they did, they tended to change more quickly. These findings underscore the critical role of culturally normative family traits in fostering well-being in old age [63], especially in the Chinese context where family obligations closely align with personal expectations and are vital for overcoming daily challenges [81, 82]. These findings also reinforce the notion that sharing life with a partner is a fundamental precondition of social integration [82], and the role of a spouse serves as a critical supportive factor to relieve life pressure and promote positive mental health development [83].
From a broader societal perspective, in Chinese society, Confucian values prioritize large families and co-residence, which are vital for maintaining communication, contact, understanding, and enhancing family solidarity [84]. This arrangement also allows older adults to contribute to families, which improves their sense of usefulness, health, and positive views on aging [85]. However, some studies have claimed that as societal modernization and individualization of younger generations progress, filial piety is fading away, and intergenerational support patterns are altered [86]. The feeling of uselessness may be exacerbated by children’s migration for employment and urbanization’s impact on family relocation and structure [60]. These changes also exacerbate feelings of loneliness, especially in the Chinese context that emphasizes collectivist culture [87]. In addition, a systematic review and meta-analysis on the influencing factors of loneliness among older adults in China has found that marital status, living arrangements, having children(or not), receiving family and social support, relationships with family members, and social activities are the main influencing factors of loneliness [88]. From these perspectives, it is necessary to coordinate the efforts of all sectors of society and form a system of coordinated advancement involving families, government, and society [69].
In this study, the effect of social support was found in the transitions of the Discontented and Negative Subtype, showing a greater likelihood of moving to either the Satisfied and Positive Subtype or the Mainly Unhappy Subtype. Possible underlying mechanisms involved in this transition during the period include: Social support partially mediates the relationship between loneliness and a broad range of mental health consequences, which could be explained by the Evolutionary Theory of Loneliness (ETL) [37]. Social support has a beneficial effect on health independent of stressors, providing individuals with socially rewarding roles that support positive affect and, consequently, promote mental health [89]. Furthermore, social support might promote physical health through emotionally-induced improvements in immune system functioning, thereby improving the mental health [90].
It is worth noting that different types of social support have varying impacts on the psychological well-being of older adults. For example, friend support is more important in reducing loneliness than other supports (i.e., family and significant other support) among older adults, since the importance of social support from specific sources varies across different developmental stages [91]. In comparison to those with non-integrated social network types, older adults with diverse social networks showed the highest score of self-rated quality of life [92]. Coresidence with adult children is linked to a lower risk for frequent self-perceived uselessness whereas receiving financial and instrumental support from children is associated with a high risk [27]. Nevertheless, social support is broad conception and was categorized by different dimensions in previous literatures. Some studies divided it into emotional and financial support, as well as living arrangements [31]. Others included formal/informal support [68], or instrumental (including financial support)/emotional support [93]. Some focused on family, relatives, and community, considering marriage, family structure, and community services [94]. In general, social support includes not only the structural characteristics of the social networks (the social context of the interactions) but also the functional aspects of the interactions between its members [38]. Future research should delve into social support with in-depth, systematic exploration and comparative analysis, especially regarding the change of older adults’ psychological well-being.
As this study showed, the impact of lifestyle on psychological well-being was all-encompassing, beyond the buffering effect against negative emotions, as discussed for other factors above, a healthy lifestyle demonstrated a significant correlation with happiness. For example, we found that exercise was associated positively with belonging to the Satisfied and Positive Subtype and with the transition from the Mainly Unhappy Subtype to the Satisfied and Positive Subtype. This is in good agreement with the previous view that regular exercise enhances life’s meaning and self-esteem, which are vital for older adults’ motivation to seek continued personal growth and happiness [95]. We also found that older adults who participated in more leisure activities were less likely to belong to the Discontented and Negative Subtype or the Resilient yet Useless Subtype. This value is barely distinguishable from Liddle et al. who indicated that leisure activities serve as a protective factor against depression by enhancing motivation and providing social support and meaning in life [96]. Additionally, our findings imply that leisure activities may help to avoid augmentation between negative emotions; specifically, those of the Mainly Unhappy Subtype or the Resilient yet Useless Subtype had a lower probability of transitioning into the Discontented and Negative Subtype with an overall decline in life satisfaction, positive emotions, and an increase in negative emotions. These findings highlight the importance of resources that promote physical exercise and leisure activities [16].
Physical health is generally considered crucial for mental health [3], and our findings underscore the significant impact of physical health on the initial state of psychological well-being. Both ADL disabilities and chronic illnesses were negatively related to feelings of loneliness and uselessness; ADL disabilities were also linked to unhappiness. Meanwhile, older adults in the Resilient yet Useless Subtype are more susceptible to the impact of chronic illnesses on their recovery to the Satisfied and Positive Subtype. Previous findings have suggested that chronic diseases and disabilities might be the most pronounced predictors of perceived uselessness among older adults in China [27], as these health issues directly affect daily living functions and independence, influencing behavior and self-perception [97], and are not conducive to eliminating the feeling of uselessness. The reciprocal relationships between physical health conditions and psychological well-being could be discussed more thoroughly. A multiple mediation analysis indicated that loneliness and social isolation have an indirect effect on cardiovascular disease and type 2 diabetes through both baseline psychological and health behavioral factors [67], as lonely and socially isolated individuals may cope less adaptively with stress, making them more prone to the pathogenic influence of stress [98].
Considering the generalizability of our findings, a systematic review has shown that marital status, social support, and activities of daily living are key factors affecting life satisfaction among older adults in Asia [99]. A survey in Great Britain identified the pattern of loneliness in older age groups, often resulting from the loss of social networks due to retirement or bereavement, living alone, or reduced mobility related to health conditions [100] which also supports our findings. A study across 24 countries also found that despite cultural and socioeconomic differences, certain core factors such as social support and the feeling of loneliness have a universal impact on the mental health of older adults worldwide [101]. Recognizing unique cultural factors in China, such as filial piety and family structure, as we discussed above, which may distinctly influence the psychological well-being of older adults, further empirical and comparative analyses should be conducted to explore the transition of psychological well-being states across different cultural and socioeconomic contexts.
The findings provide practical implications. For healthcare professionals, it is essential to value the interplay between emotions and to cultivate and enhance positive emotions, leveraging their buffering and protective effects against negative emotions. Prevention and management strategies targeting certain emotions, such as unhappiness and uselessness are critical, forming a significant component of full recovery and acting as the tipping point between recovery and decline. Resources for promoting physical exercise, which are crucial for the prevention and recovery of the Mainly Unhappy Subtype, should be considered an integral component of community-based interventions. As for the Resilient yet Useless Subtype, it is important to build a social atmosphere that encourages regular family contact and focuses on an older adult care culture in families and the maintenance of a holistic care environment. Policy design and support services should integrate labor leave improvements and family care assistance. In addition, policies to support older adults with limited financial resources (i.e., pension and medical insurance systems) are also important to improve their self-perceived usefulness. As modernization progresses, educating both older adults and young adults to be aware, understand, and accept such changes may improve positive attitudes toward aging and the perception of usefulness of older cohorts. As for the Discontented and Negative Subtype, which not only has a sense of uselessness, but also feelings of loneliness evident, it is necessary to coordinate the efforts of all sectors and form a system of coordinated advancement by families, government, and society. The integration of all social support resources, including financial, emotional, and instrumental support from family, friends, and community, is essential. As our findings underscore the significant impact of physical health on feelings of loneliness and uselessness, public health programs or medical interventions may target the Resilient yet Useless Subtype and the Discontented and Negative Subtype to reduce feelings of uselessness and social isolation among old adults in China. Health policies and treatments require a comprehensive approach that considers the psychological states of older adults, their physical function, chronic conditions, educational level, and the need for financial and environmental support.
This study has several vital strengths. To the best of our knowledge, this is the first to explore latent subtypes of psychological well-being among Chinese older adults in a large and representative sample size. Our study also contributes new knowledge about risk indicators and factors of psychological well-being by unveiling the patterns and the development from a constructivist and systematic perspective. For instance, we observed that the Resilient yet Useless was the least stable, with a relatively average rate of transitioning to any other subtype. In other words, older people with pronounced perceived uselessness require early attention to avoid further deterioration and even reverse the trend.
This study has some limitations. LTA, an exploratory data-based analysis, may require further validation for generalizability across different populations and settings. Measurement bias may exist as we only used self-reported data to assess psychological health; future studies should include objective measures. Data spanned only two time points, overlooking the annual change and complex situations. This lack of more frequent data made it difficult to determine whether the observed transitions are part of a larger, ongoing trend or if they are more episodic and variable over time. Given that the psychological well-being status of individuals may change more than once within a period, the conclusions drawn may be rough. This study relied on logistic regression to examine influencing factors. Caution should be exercised in comparing and explaining the psychological status and its change. Future research should employ longitudinal data to comprehensively understand the causal mechanism, accounting for individual and external factors. A more targeted and detailed examination of how certain factors, such as various forms of support, impact these psychological subtypes and their transitions would offer a clearer understanding of the underlying mechanisms.
Psychological well-being is becoming an increasingly important part of the public health mission. This study presents a comprehensive examination of the psychological well-being of older adults in China, employing latent transition analyses to identify distinct subtypes and their transitions over time. Our findings contribute to the literature by providing empirical evidence of the dynamic nature of psychological well-being and the influence of various demographic, social, and health-related factors. These results could provide insights for researchers and policymakers, enabling them to develop tailored interventions and treatments that consider subgroups and individual characteristics for older adults with poor psychological well-being.
The datasets used and analyzed during the current study are publicly available from Peking University Open Research Data Platform (https://opendata.pku.edu.cn/dataset.xhtml? persistentId=doi:10.18170/DVN/XRV2WN).Researchers can obtain these data after submitting a data use agreement to the CLHLS team.
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We acknowledge the Chinese Longitudinal Healthy Longevity Survey (CLHLS) team for the public data.
This research was supported by the youth project of Shanghai philosophy and Social Science Planning Foundation (Grant No.2020EGL020).
Institute of Sociology, Shanghai Academy of Social Sciences, 622 Huaihai Middle Rd., Huangpu District, Shanghai, 200020, China
Shuai Fang
School of Nursing, Fudan University, 305 Fenglin Rd., Xuhui District, Shanghai, 200032, China
Zi’an Yi & Yan Liang
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SF designed and drafted the text. SF also prepared the data and performed the analyses. ZAY contributed to data visualization. YL supervised the data analysis, revised the paper, and interpreted the results. All authors read and approved the final version of the manuscript.
Correspondence to Yan Liang.
Written informed consent was obtained from all participants and/or their proxy respondents, and the study was approved by the Research Ethics Committee of Peking University (IRB00001052–13074). The study was performed in accordance with the Declaration of Helsinki.
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Fang, S., Yi, Z. & Liang, Y. Changes in psychological well-being among older adults: a latent transition analysis from China. BMC Public Health 25, 733 (2025). https://doi.org/10.1186/s12889-025-21495-z
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DOI: https://doi.org/10.1186/s12889-025-21495-z
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