How Aging anxiety Relates to Self-Rated Health in Middle-Aged and Older Adults: The Role of Psychological Pathways

YuXin Zhou¹Dong Bo²Menghan Jiang²Hao Sun^3*

• ¹School of Marxism, Xi'an Jiaotong University‌, Xi'an, China
• ²School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
• ³Shandong Cancer Hospital and Institute, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China

Objective: Aging anxiety is not only a critical practical issue for understanding the psychology of middle-aged and older adults, but also a key pathway for improving their health levels, optimizing aging policies, and achieving active and healthy aging. Existing research has insufficiently addressed the pathways and heterogeneity through which aging anxiety impacts health. This study aims to reveal the effects of aging anxiety on the health of middle-aged and older adults, its underlying mechanisms, and the differences in its impact across various groups. Methods: Drawing on large-scale data from the 2021 China General Social Survey (CGSS), this study first employs a logistic regression model to analyze the impact of aging anxiety on the health of middle-aged and older adults. Then, we employ structural equation modeling to examine the mediating roles of psychological pessimism, sleep disturbance, and loss of self-efficacy in this relationship. Subsequently, a moderation analysis examines the buffering effects of six factors— including social participation and social support—on the relationship between aging anxiety and health outcomes. Finally, heterogeneity analysis explores variations in aging anxiety impacts across different groups defined by income, household registration status, education level, and age. Results: Higher aging anxiety is significantly associated with poorer self-rated health among middle-aged and older adults. Mediation analyses suggest that this association may be partially mediated by psychological pessimism, sleep disturbance, and loss of self-efficacy. Psychological pessimism accounts for 26.53% of the total indirect effect, sleep disturbance for 8.21%, and loss of self-efficacy for 27.22%. Moderation analyses indicate that social participation, social support, social capital, healthcare utilization, insurance coverage, and digital technology use attenuate the negative association between aging anxiety and health. Heterogeneity analyses further show that the negative association is stronger among low-income, rural, less-educated, and older respondents. Conclusion: These findings highlight the potential value of a multidimensional coping framework to address aging-related concerns and support healthy aging. Such efforts may include fostering more positive perceptions of aging, strengthening psychologically informed and behaviorally oriented supports (e.g., pessimism reduction, sleep management, and self-efficacy enhancement), improving social and institutional resource support systems, and prioritizing targeted strategies for vulnerable and older populations.