Mahjong, a game of skill and luck played by four people using domino-like engraved tiles, is often referred to as China’s “national pastime”. Unlike many other popular leisure games, mahjong requires cooperation and strategy between players, which fosters the ideal forum for interaction between people. And according to a new study conducted at the University of Georgia, this engaging social interaction may boost mental health among Chinese elderly people, who are some of the most vulnerable people to depression in the world.

The history of mahjong is somewhat contested, but the current consensus seems to be that it first appeared around Shanghai in the mid- to late-1800s. It quickly became popular in Shanghai and Beijing, then the entire country, and eventually among American expatriates that brought the game back to the United States, where it spread like wildfire in the 1920s.

It’s common for fans of the game to play mahjong with the same group of people for a long time, routinely meeting for game sessions. Some older Chinese people have had the same mahjong partners for decades. Even during the pandemic, the most dedicated players kept in touch by playing mahjong online.

The benefits of engaging in social activities for mental health have been widely reported, but such research has been mainly done in developed nations, such as the U.S. and Japan. To fill the gap, researchers led by Adam Chen, an associate professor of health policy and management at the University of Georgia, wanted to investigate the mental health impact of playing mahjong among elderly Chinese people.

The researchers analyzed survey data from nearly 11,000 Chinese people aged 40 years and older from the nationally representative China Health and Retirement Longitudinal Study. Depression symptoms were assessed for each participant and compared to the type and frequency of social participation, including visiting with friends, playing mahjong, participating in a sport or social club, and volunteering in the community.

As a whole, engaging in frequent social activities was associated with better mental health outcomes, playing mahjong was particularly associated with a positive effect. That’s not surprising. Studies looking at brain connectivity during social interaction have found that our brains react strongly to social cues, suggesting that our social networks and interactions also help shape the brain. Besides, talking to people can make you feel better, whereas loneliness can increase the level of cortisol and the level of stress, which can hamper brain activity.

Another 2019 study in England found cultural engagement — i.e. going to plays, movies, concerts, and museum exhibits — lowers the risk of developing depression. Studies also suggest that playing brain games can help in sharpening certain cognitive abilities such as planning, processing speed, and decision making.

“What is more surprising is that mahjong playing does not associate with better mental health among rural elderly respondents,” Chen said in a statement. “One hypothesis is that mahjong playing tends to be more competitive and at times become a means of gambling in rural China.”

Poor mental health is a huge burden on China, accounting for 17% of the global disease burden of mental disorders. These findings may offer a guide for policymakers looking to design interventions to improve mental health among older Chinese, which could also translate to Asian American communities.

“Social participation manifests itself in different formats within different cultural contexts,” said Chen.

“Older Asian Americans have a much higher proportion of suicidal thoughts than whites and African Americans,” he said. “Improving social participation among older Asian Americans may help to address this burden to the U.S. population health that has not received due attention.”

The findings appeared in the journal Social Science & Medicine.