Urban governance as a determinant of suicidal tendencies among middle-aged and older adults in China: a longitudinal quasi-experimental study

Evaluating the impact of urban policies on severe mental health outcomes is crucial for aging populations. This study evaluates the causal impact of China’s Healthy City Pilot Policy (HCPP) on suicidal tendencies among urban middle-aged and older adults. It also explores the underlying macro and micro mechanisms. We used a Difference-in-Differences (DID) approach with propensity score matching (PSM). Our analysis used data from 16,691 participants aged 45 and older, covering five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). Suicidal tendency was assessed using a specific item from the Center for Epidemiologic Studies Depression Scale (CES-D). The findings indicate that the HCPP significantly inhibited suicidal tendencies in pilot cities. Mechanism analyses revealed a "dual-pathway" model. The policy reduces suicide risk by increasing urban green coverage at the macro level. It also fosters social participation at the micro level. These protective effects were particularly significant among males, the working population, and individuals with lower incomes. Ultimately, the HCPP serves as an effective socio-ecological intervention. Integrating environmental optimization with social reconstruction can create supportive urban environments that effectively mitigate geriatric suicide risk.