The association between digital communication tool use and perceived mental health among older adults in Canada

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Abstract
This study examines the association between digital communication tool use and perceived mental health among older adults aged 55 years and older in Canada, using data from the 2022 Canadian Internet Use Survey. The sample included 13,536 adults, weighted to represent 12,735,479 individuals. Perceived mental health was self-rated and assessed using a 5-point Likert scale. Digital communication tool usage was measured by reported engagement in activities such as sending emails, using instant messaging apps, accessing social networking sites, making online calls, and uploading content. Multiple linear regression models were used to examine the associations between digital communication tool usage and perceived mental health, adjusting for sociodemographic factors. Results indicated that over half of older adults engaged in digital communication. Use of social networking sites was associated with poorer perceived mental health (Adjβ = -0.080; p = 0.002), whereas email use was positively associated with perceived mental health (Adjβ = 0.113; p < 0.001). These findings may inform policies and interventions to support the mental health of older adults in the digital era.
Citation: Zangiabadi S, Kesibi D, Ali-Hassan H (2026) The association between digital communication tool use and perceived mental health among older adults in Canada. PLOS Glob Public Health 6(6): e0006540. https://doi.org/10.1371/journal.pgph.0006540
Editor: Massimiliano Orri, McGill University, CANADA
Received: September 19, 2025; Accepted: May 8, 2026; Published: June 24, 2026
Copyright: © 2026 Zangiabadi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The Canadian Internet Use Survey (CIUS) data used in this study is publicly available and can be found at Statistics Canada website: https://www.statcan.gc.ca/en/survey/household/4432 https://www150.statcan.gc.ca/n1/en/catalogue/56M0003X.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
The rapid advancement of the digital technologies has extensively transformed the way individuals communicated and interacted across all age groups. While younger generations have seamlessly integrated digital tools into their daily lives, older adults have also increasingly adopted the use of digital technologies such as the internet, digital communication tools, and social networking sites in the recent years [1]. The use of online social networking sites (e.g., Facebook, Twitter) and technology-based communication tools (e.g., e-mail, instant messaging) enables older adults to stay connected with family and friends, maintain social ties, and access information and care services [1,2]. In 2022, 83% of Canadian seniors used the Internet, engaged in various online activities and were considered as the fastest growing group on the Internet [3]. The accessibility and availability of digital tools offer older adults an alternative means of social engagement and communication, particularly when traditional forms of socialization may be restricted due to mobility constraints, retirement, or geographical distance [4]. Furthermore, Internet-based interventions have shown promising potential in supporting the management of chronic diseases, facilitating lifestyle modifications, and promoting overall health. For instance, during the pandemic there was a widespread adoption of telehealth technologies among older adults to maintain access to essential healthcare services which was found to be beneficial for individuals with limited mobility and helped reduce the risk of virus transmission [5,6]. Subsequently, the use of Internet and digital communication tools has been linked to reduced social isolation and feelings of loneliness, increased social support, and a greater life satisfaction among older adults [7,8].
Despite the potential benefits of the digital communication activities, the literature presents mixed findings on the impact of the digital communication tool us on mental health among older adults. These inconsistencies may be explained by differences in the mechanisms through which digital tools shape social interactions. Specifically, variations in communication timing (real-time versus asynchronous), levels of reciprocity, and patterns of engagement (active versus passive) may differentially influence social support, social comparison, and emotional processing, thereby contributing to differences in mental health outcomes [9,10]. Some studies linked internet use to improved mental health by decreasing social isolation and loneliness. For instance, studies of older adults in China found that internet use reduced depression and feelings of loneliness, while improving cognitive abilities, thereby promoting better mental health in older adults [11–13]. Additionally, a study of older adults in the United States with a mean age of 68 found an association between increased use of online social networking and reduced depressive symptoms, mediated by reduced feelings of loneliness [14]. A review study further suggested that older adults who used the internet for social networking and communication purposes exhibited better mental health during the COVID-19 pandemic [15]. Conversely, some studies suggest that digital behaviors may be associated with poorer mental health outcomes. For example, excessive internet use has been associated with adverse psychological outcomes, including increased symptoms of depression and anxiety, greater social comparison, and reduced face-to-face-interactions, all contributing to poorer overall mental health [11,16]. Additionally, a study of older adults aged 60 and above in the United States found that digital social interactions, such as participating in online communities and discussing health and aging were associated with increased symptoms of anxiety, ultimately impacting their mental health [17]. Given the multifaceted relationship between digital engagement and mental health, further research is essential to explore how various digital communication tools influence the mental health of older adults.
Meanwhile, Canada is experiencing a demographic shift with a rapidly growing aging population. According to Statistics Canada, seniors currently comprise about 19% of the population, or approximately 7.6 million people, and this number is projected to increase to nearly one-quarter of the population by 2030 [18]. Such substantial growth in the number of older adults necessitates adequate measures and resources to meet the care needs of the aging population and to mitigate the financial burden associated with an aging population [19]. Hence, ensuring the mental health and overall well-being of this portion of the population becomes a public health priority. Particularly, mid-to-later adulthood (typically defined as age > 55 years) is characterized by shifts in social roles, networks, and patterns of interaction, influenced by factors such as employment transitions, retirement planning, changes in family structure, and evolving health status. These changes can affect both the form and quality of social engagement. As individuals navigate this life stage, alterations in daily routines and social connections may lead to subtle changes in participation and engagement [20]. Examining this period provides an important opportunity to identify early shifts in social involvement that may have important implications for mental health, before the onset of more pronounced age-related functional limitations. However, existing research on the impact of digital communication tool use on older adults’ mental health remains limited, leaving a gap in knowledge regarding their unique experiences, particularly in the context of Canada’s rapidly aging population.
Understanding how digital communication tools are associated with mental health outcomes can inform policy and practice aimed at supporting mental well-being in this age group. Therefore, this study examines the association between the use of digital communication tools and the self-rated perceived mental health among adults aged 55 years and older in Canada. The findings may inform the development of targeted interventions and strategies to support mental well-being among older adults.
Methods
This study utilized the data from the 2022 Canadian Internet Use Survey (CIUS) conducted by Statistics Canada between December 2022 and April 2023 [21]. This was a cross-sectional survey aimed at measuring internet access, usage, and the adoption of digital communication tools for online activities among Canadians aged 15 years and older across ten provinces, excluding individuals residing in institutions for more than six months. Participation in the survey was voluntary, with data collected using an electronic questionnaire or computed assisted telephone interviewing (CATI). No identifying information of the participants is included. The overall response rate was 45.3%. For the purposes of this study, the analysis was restricted to individuals 55 and older.
The main outcome of the study was perceived mental health measured by the question “In general, how is your mental health?”. The response options provided ranged from 1 to 5 on a 5-point Likert Scale, with 1 representing “Poor” to 5 representing “Excellent”. The independent variable explored in this study was the use of digital communication tools, measured by the question “In the past three months, which of the following communication-related activities have you conducted online”. Respondents reported on their personal internet use, excluding business and school-related activities in accordance with the survey instructions. Response options included sending and receiving emails, sending messages using instant messaging apps, using social networking websites, making online voice or video calls, using dating websites, and uploading self-created content online. Each response was categorized as either “Yes” or “No”. Additionally, sociodemographic factors such as gender (male/female), age (55–64 years/65 years and over), employment status (yes/no), education (high school or less/some post-secondary/university degree), province (Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia), immigration status (landed immigrant, non-landed immigrant), number of persons in the household (one person household, two person household, more than two people), and household income (<= $42,256/ $42,257 - $72,366/ $72,367 - $107,480/ $107,481 - $163,750/ > $163,750) were assessed. The information presented on income and immigration status was based on linkage to administrative data sources. Definitions and detailed response categories for all variables are available in the survey questionnaire [21] and a summary can be found in S1 Appendix.
Simple linear regression was performed to examine the bivariate association between use of various digital communication tools and sociodemographic factors with self-rated perceived mental health. Also, multiple linear regression analysis was performed for the outcome of perceived mental health and the main independent variable of digital communication tool use and other sociodemographic variables. The beta coefficient and 95% confidence intervals (95% CI) were reported. Also, statistical significance was set at alpha = 0.05 for all analyses.
To ensure the sample accurately reflects the broader population, all analyses were conducted using population weights applied to each estimate. Bootstrapping techniques were also employed to account for the complex survey design, based on the bootstrap replicate weights supplied with the dataset, further ensuring that the findings are representative at the population level. All statistical analyses were performed using Stata Statistical Software: Release 18 [22]. Ethical review was not required for this study, as the 2022 CIUS public use microdata files are publicly available through Statistics Canada and are protected by legal frameworks such as the Data Liberation Initiative.
Results
Table 1 summarizes the characteristics of the study participants and the bivariate association between socio-demographic factors and various communication activities with perceived mental health. The analytic sample was restricted to individuals 55 years and older, comprising 13,536 participants, weighted to represent a total population of 12,735,479. Over half (52.15%) were female, and 59% were 65 years or older. The majority, 63.9% were not employed and nearly 60% had had a post-secondary or a university degree. Among participants, (38.22%) resided in Ontario and were non-landed immigrants (83.16%). Additionally, 45.89% of households consisted of two members, and 27.6% reported an annual income of $42,256 or less. More than half reported engaging in communication activities, such as sending and receiving emails (80.21%), using instant messaging applications (59.57%), and accessing social networking websites (52.31%). Regarding perceived mental health, 1.7% of participants rated their mental health as poor, 8.1% as fair, 29.7% as good, 34.7% as very good, and 25.9% as excellent. The overall mean perceived mental health score was 3.75 (SE = 0.01; 95% CI: 3.73, 3.77). The bivariate regression analysis indicated a positive relationship between communication activities including, email communication, instant messaging, and online voice and video calls and perceived mental health (Table 1). Additionally, several sociodemographic factors were positively associated with perceived mental health, including being aged 65 or older, employed, having a post-secondary or university degree, residing in Quebec, being a non-landed immigrant, living in a two-person household, and having an income above $42,257. However, being a female was negatively associated with perceived mental health.
Table 2 presents the findings of the multiple linear regression analysis. All assumptions of multiple linear regression were met, and there was no evidence of multicollinearity among the independent variables. After adjusting for all covariates, social media engagement was inversely associated with perceived mental health, with online engagement linked to poorer perceived mental health (Adjβ = -0.080; p = 0.002). In contrast, email communication was positively associated with perceived mental health, with individuals who sent and received emails reporting better self-rated mental health (Adjβ = 0.113; p < 0.001). Furthermore, no significant relationship was found between perceived mental health and the use of instant messaging apps, online voice or video calls, dating websites, or uploading self-created content. Among sociodemographic factors, individuals aged 65 and older reported better perceived mental health compared to those aged 55–64 (Adjβ = 0.230; p < 0.001). Those who were employed, held a university degree, and had an income exceeding $42,256 reported higher perceived mental health. Moreover, residents of Quebec reported significantly better perceived mental health than those living in Ontario (Adjβ = 0.326; p < 0.001). Households with two residents also reported better perceived mental health compared to single-person households.
Discussion
This study aimed to examine the association between digital communication tools usage and self-rated perceived mental health among older adults aged 55 and above, a topic of increasing importance given the rapid growth of digital technology and Canada’s aging population. The results revealed that more than half of the older adults engaged in digital communication activities, such as sending and receiving emails, using instant messaging applications, and accessing social networking websites. The associations between specific digital communication tool use and perceived mental health varied, with some tools linked to more positive and others to more negative perceptions of mental health. The findings indicated that using email as a digital communication tool was associated with better perceived mental health (Adjβ = 0.113; p < 0.001), while engaging in social network use was linked to poorer perceived mental health (Adjβ = -0.080; p = 0.002). These results highlight the association between digital communication tool usage and the mental health of older adults in Canada, providing valuable insights for developing interventions and policies that support the well-being and healthy aging of older adults in an increasingly digital world.
Findings of our study indicated that sending and receiving emails were linked to better perceived mental health. This result was consistent with a previous longitudinal study of older adults aged 50 and above in England, which found that email use for communication was linked to improved mental health [8]. This association may be attributed to the central role of communication in promoting positive mental health, as it enables individuals to maintain strong social connections with family and friends, which in turn alleviates the negative effects of social isolation and loneliness on mental health [2,8]. Additionally, another plausible explanation is that email, as a more structured and asynchronous form of communication, may reduce stress and anxiety compared to more instantaneous methods like instant messaging apps. This may be particularly relevant for older adults, as the ability to read and respond to emails at their own pace can provide them with a greater sense of control over interactions [23].
Furthermore, results revealed that social media engagement among older adults is associated with poorer perceived mental health outcomes, consistent with previous literature that highlights the potential negative effects of social media use on mental well-being [17,24]. While existing studies on this topic presents mixed findings, these variations may stem from differences in study designs, definitions of social media engagement, measurement of outcome variables, and the inclusion of various covariates. One possible explanation for the negative association is that social media may expose older adults to distressing content and promote social comparison, both of which could adversely affect their mental health [17]. For instance, studies of adults aged 60 and older in the United States found that certain online social activities were linked to poorer mental health outcomes, but this association varied based on the type of online engagement. For instance, individuals who reached out to check on someone missing from an online community reported increased feelings of depression, while those participating in online discussions about health and aging reported greater anxiety [17,24]. Additionally, social media use during the COVID-19 pandemic, driven by isolation and loneliness, may have further exacerbated mental health issues among older adults. A study of adults aged 65 and older in California suggested that social media engagement during the pandemic, influenced by feelings of isolation and loneliness, was associated with exposure to distressing content, may be linked to poorer mental health outcomes [25].
The findings showed no significant associations between instant messaging and mental health in older adults. While instant messaging facilitates rapid communication, it may lack the depth and richness needed for meaningful social engagement, making face-to-face interactions more impactful for emotional well-being and reducing loneliness [26]. Similarly, no significant association was found between video calls use and mental health outcomes. This contrasts with a previous study conducted in the United States, which reported that older adults who used video chat technologies such as Facetime and Skype had a significantly lower risk of developing depressive symptoms, likely because these platforms mimic in-person social interaction and enhances connectedness [27]. However, these differing findings could be due to variations in study populations, research design and methods, or the frequency and context of video call usage among older adults. Additionally, the use of dating websites and content-sharing platforms was not linked to mental health outcomes in this study. This may be due to the lower usage rates among older adults, which could have limited the statistical power to detect potential associations rather than indicating a lack of relevance to mental health.
Regarding sociodemographic factors, individuals aged 65 and above reported better perceived mental health than those aged 55–64. This may be due to older adults experiencing less work-related anxiety and stress after retirement, thereby enhanced mental well-being [28]. Additionally, retired older adults often have greater autonomy and more time to build social networks and increase their social capital, which can positively influence their mental health [29]. Moreover, employment was associated with better perceived mental health in older adults. This aligns with global studies showing that employment enhances mental health by providing a sense of purpose, promoting social interaction, and reducing feelings of isolation and loneliness [30–32]. For example, a longitudinal study of seniors in Singapore found that working older adults had better cognitive function, fewer depressive symptoms, and improved mental health [31]. This association might also be attributed to a smoother transition from employment to retirement, where material resources and socio-economic status play a critical role [33].
Older adults with higher income also reported improved mental health. A higher income level provides the opportunity for older adults to attend more social functions, enhances social engagements, and thereby improves mental well-being. The availability of financial resources can also support self-esteem, promoting more social connections and reducing feelings of loneliness, and ultimately contributing to better mental well-being [34]. Similarly, higher educational attainment was positively linked to better perceived mental health outcomes. This aligns with previous study that found a positive relationship between higher education levels and psychological well-being [35]. Education is recognized as a key factor in enabling social engagements and promoting the overall well-being of older adults, potentially contributing to a more positive outlook on life and improved mental health [36].
The results also showed that living arrangement of older adults is linked to mental health outcomes. Individuals living in two-person household reported significantly better perceived mental health than those living alone. This association may stem from the increased social interaction and emotional support that cohabitation provides, which helps reduce loneliness and isolation [37,38]. Additionally, shared responsibilities and financial burdens may alleviate stress, contributing to overall well-being. Lastly, the residents of Quebec reported better perceived mental health compared to those in Ontario. This finding aligns with the 2024 State of Mental Health in Canada report, which noted that the prevalence of negative mental health outcomes, such as mood disorders, anxiety, and depression, was lower among individuals in Quebec than in Ontario [39]. This difference may be partially attributed to Quebec’s lower cost of living and greater housing affordability, factors that can positively impact the mental well-being of older adults, particularly in contrast to Ontario [39,40]. Additionally, Quebec’s stronger emphasis on community-based social services, broader social protection policies, and more integrated primary and mental healthcare delivery may contribute to greater social support and lower psychosocial stress, influencing perceived mental health [41,42].
Limitations
This study is one of the first to examine the association between various digital communication tools and self-rated mental health in the general older adult population in Canada. Nonetheless, several limitations should be considered. First, due to the cross-sectional design of the study, causal relationships cannot be established, and reverse causation is possible whereby individuals with better mental health may be more likely to engage in certain digital communication activities. Second, there is a potential for information bias, as all responses were self-reported, and the primary dependent variable measured perceived overall mental health rather than using a validated and objective assessment. Third, the generalizability of the results may be limited due to the exclusion of individuals residing in long-term institutions. In addition, the findings are restricted to older adults who reported Internet use in the past three months and may not generalize to those with no recent Internet use. Fourth, digital communication tool use in the CIUS 2022 survey is measured as a binary indicator and does not capture frequency, duration, or context of use, nor distinguish between active and passive engagement. This dichotomization may result in limited depth of information, potential misclassification, and limits the ability to assess dose–response relationships. Fifth, the results may be affected by residual confounding, as data were not available on several important factors that may influence both digital communication use and mental health outcomes, including pre-existing mental health conditions, chronic illness, functional limitations, and rural or urban residence.
Conclusion
The findings of this study offer valuable insights into the complex relationship between digital communication tool usage and mental health of older adults in Canada. Results indicated that email communication was associated with better mental health, while social media use was linked to poorer outcomes. These findings underscore the need for targeted public health interventions to support the mental well-being of older adults in today’s digital landscape. Initiatives such as educational campaigns on responsible social media use, assessing the credibility of online information, and recognizing potential risks may help empower older adults to engage more effectively and safeguard their mental health. However, further research is needed to evaluate the effectiveness of these approaches in improving mental health outcomes among older adults.
References
- 1. Grady A, Stinchcombe A. Social networking site use, sexual orientation, and associations with mental health: Findings from the Canadian Longitudinal Study on Aging. Comput Hum Behav Rep. 2025;17:100541.
- 2. Chen E, Wood D, Ysseldyk R. Online Social Networking and Mental Health among Older Adults: A Scoping Review. Can J Aging. 2022;41(1):26–39. pmid:33736725
- 3. Government of Canada. Canadian seniors more connected than ever. https://www.statcan.gc.ca/o1/en/plus/4288-canadian-seniors-more-connected-ever#:~:text=More%20seniors%20staying%20in%20touch&text=About%20three%20in%20four%20(74.7,social%20networking%20websites%20or%20apps. 2023.
- 4. Freeman S, Marston HR, Olynick J, Musselwhite C, Kulczycki C, Genoe R, et al. Intergenerational Effects on the Impacts of Technology Use in Later Life: Insights from an International, Multi-Site Study. Int J Environ Res Public Health. 2020;17(16):5711. pmid:32784651
- 5. Khanassov V, Ilali M, Ruiz AS, Rojas-Rozo L, Sourial R. Telemedicine in primary care of older adults: a qualitative study. BMC Prim Care. 2024;25(1):259. pmid:39020277
- 6. Chu C, Brual J, Fang J, Fleury C, Stamenova V, Bhattacharyya O. The use of telemedicine in older-adults during the COVID-19 pandemic: a weekly cross-sectional analysis in Ontario, Canada. Can Geriatr J. 2022;25(4):380–9.
- 7. Ali-Hassan H, Sekharan V, Kim T. Internet non-use among the Canadian older adult population: General Social Survey (GSS). J Community Inform. 2019;15.
- 8. Lam SSM, Jivraj S, Scholes S. Exploring the Relationship Between Internet Use and Mental Health Among Older Adults in England: Longitudinal Observational Study. J Med Internet Res. 2020;22(7):e15683. pmid:32718913
- 9. Valkenburg PM, Peter J. Online communication among adolescents: an integrated model of its attraction, opportunities, and risks. J Adolesc Health. 2011;48(2):121–7. pmid:21257109
- 10. Verduyn P, Ybarra O, Résibois M, Jonides J, Kross E. Do Social Network Sites Enhance or Undermine Subjective Well‐Being? A Critical Review. Social Issues Policy Review. 2017;11(1):274–302.
- 11. Zhang C, Wang Y, Wang J, Liu X. Does internet use promote mental health among middle-aged and older adults in China?. Frontiers in Psychology. 2022;13:999498.
- 12. Chai Y, Xian G, Wang M, Guo L, Luo S. Aging wisely: The impact of Internet use on older adults’ mental health. J Affect Disord. 2024;364:139–45. pmid:39147146
- 13. Zhang L, Li S, Ren Y. Does internet use benefit the mental health of older adults? Empirical evidence from the China health and retirement longitudinal study. Heliyon. 2024;10(3):e25397. pmid:38352772
- 14. Chopik WJ. The Benefits of Social Technology Use Among Older Adults Are Mediated by Reduced Loneliness. Cyberpsychol Behav Soc Netw. 2016;19(9):551–6. pmid:27541746
- 15. Foong HF, Lim SY, Rokhani FZ, Bagat MF, Abdullah SFZ, Hamid TA, et al. For Better or for Worse? A Scoping Review of the Relationship between Internet Use and Mental Health in Older Adults during the COVID-19 Pandemic. Int J Environ Res Public Health. 2022;19(6):3658. pmid:35329343
- 16. Xie L, Yang H lei, Lin X yu, Ti S ming, Wu Y yang, Zhang S. Does the Internet Use Improve the Mental Health of Chinese Older Adults?. Front Public Health. 2021;9:673368.
- 17. Hunsaker A, Hargittai E, Piper AM. Online social connectedness and anxiety among older adults. International Journal of Communication. 2020;14:29.
- 18. Statistics Canada. The older people are all right. https://www.statcan.gc.ca/o1/en/plus/7059-older-people-are-all-right#:~:text=Approximately%207.6%20million%20Canadians%20were,social%20fabric%20of%20our%20country. 2024.
- 19.
Gibbard R. Meeting the care needs of Canada’s aging population. The Conference Board of Canada. 2018. https://www.cma.ca/sites/default/files/2018-11/Conference%20Board%20of%20Canada%20-%20Meeting%20the%20Care%20Needs%20of%20Canada%27s%20Aging%20Population%20%281%29.PDF
- 20. Santini S, Fabbietti P, Galassi F, Merizzi A, Kropf J, Hungerländer N, et al. The Impact of Digital Coaching Intervention for Improving Healthy Ageing Dimensions among Older Adults during Their Transition from Work to Retirement. Int J Environ Res Public Health. 2023;20(5):4034. pmid:36901045
- 21. Government of Canada. Canadian Internet Use Survey 2022. 2024. https://www.statcan.gc.ca/en/survey/household/4432
- 22.
StataCorp. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC. 2023.
- 23. Chen C, Lou S, Kaewkitipong L. Online social anxiety and mobile instant messaging adoption and continuance usage intention: How does it relate to social, technical, and mobility factors?. Cogent Business & Management. 2022;9(1):2133632.
- 24. Hofer M, Hargittai E. Online social engagement, depression, and anxiety among older adults. New Media & Society. 2021;26(1):113–30.
- 25. Siddiq H, Teklehaimanot S, Guzman A. Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019–2020. Soc Psychiatry Psychiatr Epidemiol. 2024;59(6):969–77.
- 26. Vauclair C-M, Rudnev M, Hofhuis J, Liu JH. Instant messaging and relationship satisfaction across different ages and cultures. Cyberpsychology. 2023;17(3).
- 27. Teo AR, Markwardt S, Hinton L. Using Skype to Beat the Blues: Longitudinal Data from a National Representative Sample. Am J Geriatr Psychiatry. 2019;27(3):254–62. pmid:30442532
- 28. Drentea P. Retirement and mental health. J Gerontol B Psychol Sci Soc Sci. 2002;14(2):167–94.
- 29. Vo TT, Phu-Duyen TT. Mental health around retirement: evidence of Ashenfelter’s dip. Glob Health Res Policy. 2023;8(1):35. pmid:37620953
- 30. Bjelajac AK, Bobić J, Kovačić J, Varnai VM, Macan J, Smolić Š. Employment status and other predictors of mental health and cognitive functions in older Croatian workers. Arch Ind Hyg Toxicol. 2019;70(2):109–17.
- 31. Schwingel A, Niti MM, Tang C, Ng TP. Continued work employment and volunteerism and mental well-being of older adults: Singapore longitudinal ageing studies. Age Ageing. 2009;38(5):531–7. pmid:19474036
- 32. Forbes MK, Spence KM, Wuthrich VM, Rapee RM. Mental Health and Wellbeing of Older Workers in Australia. Work, Aging and Retirement. 2015;1(2):202–13.
- 33. Sperandei S, Page A, Spittal MJ, Pirkis J. Low education and mental health among older adults: the mediating role of employment and income. Soc Psychiatry Psychiatr Epidemiol. 2023;58(5):823–31. pmid:34357405
- 34. Cohen-Mansfield J, Hazan H, Lerman Y, Shalom V. Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights. Int Psychogeriatr. 2016;28(4):557–76. pmid:26424033
- 35. Belo P, Navarro-Pardo E, Pocinho R, Carrana P, Margarido C. Relationship Between Mental Health and the Education Level in Elderly People: Mediation of Leisure Attitude. Front Psychol. 2020;11:573. pmid:32296375
- 36. Townsend BG, Chen JT-H, Wuthrich VM. Barriers and Facilitators to Social Participation in Older Adults: A Systematic Literature Review. Clin Gerontol. 2021;44(4):359–80. pmid:33393443
- 37. Lee G, Kim C. Social isolation and mental well-being among Korean older adults: a focus on living arrangements. Front Public Health. 2024;12:1390459. pmid:38721531
- 38. Hwang EJ, Sim IO. Association of living arrangements with happiness attributes among older adults. BMC Geriatr. 2021;21(1):100. pmid:33541268
- 39.
Canadian Mental Health Association. The state of mental health in Canada 2024. Canadian Mental Health Association. 2024. https://cmha.ca/wp-content/uploads/2024/11/CMHA-State-of-Mental-Health-2024-report.pdf
- 40. Centre for Addiction and Mental Health. Aging and Mental Health Policy Framework. 2023. https://www.camh.ca/-/media/files/pdfs---public-policy-submissions/camh-aging-and-mental-health-policy-framework-pdf.pdf
- 41.
Dinan S, Noël A. Quebec’s resilient redistribution model: Activation policies in the 2010s. Paperbpresented at: Canadian Political Science Association Annual Cnference; Vancouver, BC, Canada, 2019.
- 42. Fleury M-J, Grenier G, Vallée C, Aubé D, Farand L. Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles. Int J Integr Care. 2017;17(1):3. pmid:29042845