Objective  To explore the relationship between elder abuse and mental health and the gender differences in the relationship among rural elderly in China.

  Methods  Using multistage cluster random sampling, we recruited 1 418 rural permanent residents aged ≥ 60 years in 6 counties/districts of 3 municipalities of Hunan province and conducted a face-to-face interview between May 2017 and March 2018. Modified Vulnerability to Abuse Screening Scale (VASS), 90-item Hopkin′s Symptom Checklist (SCL-90), Social Support Rating Scale (SSRS), and a self-designed questionnaire were adopted in the survey. Logistic regression model was used in data analysis.

  Results  Among all the respondents, the prevalence rate of elder abuse was 32.9% and the prevalence rates of overall abuse, psychological abuse, and caring neglect were 59.3%, 64.5%, and 59.4% among the female respondents and 40.7%, 35.5%, and 40.6% among the male respondents, respectively. There were 12.7% of the respondents reporting experience of severe abuse and 92.1% reporting two or more types of abuse. The prevalence rate of repeated and multiple abuse were 55.0% and 54.5% among the female respondents and 45.0% and 45.5% among the male respondents. The mean score of overall mental health was 2.74 ± 0.86 and 2.45 ± 0.18 in a scale with the maximum score of 5 for the poorest condition among the female and male respondents. There were significant gender differences in the prevalence rate of repeated and multiple abuse and in the mean score of overall mental health among the respondents (P < 0.05 for all). After adjusting socio - economic and social support variables, the overall abuse, mental abuse, and repeated/multiple abuse were significantly correlated inversely with mental health level among the respondents, with the adjusted odds ratios of 1.96, 1.56, 1.76 and 1.56, respectively (P < 0.01 for all); the correlation was still significant for the female respondents after including social support variables in the regression model, but not significant for the male respondents.

  Conclusion  Elder abuse is prevalent, with repeated manner and multiple types, among rural elder residents in Hunan province and results in adverse effect on mental health of the elderly, especially in female elderly; targeted interventions are needed to deal with the situation.