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Depressive symptoms is more prevalent in middle-aged and older populations, and the development of Internet technology has brought new challenges and opportunities for the mental health of this group. This study aims to explore the bidirectional relationship between Internet device diversity and levels of depressive symptoms through longitudinal data analysis, as well as investigate the mediating role of social participation. Data for the analysis was retrieved from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, 2018, and 2020, which included 9259 middle-aged and older adults. The sum of the number of devices mentioned by each participant was calculated to assess the diversity of internet device use, a weighted total score of how frequently and to what extent individuals had participated in various social activities in the past month was calculated to measure the social engagement, and the Center for Epidemiological Studies Depression Scale was used to calculate depressive symptoms. A cross-lagged mediation model and bivariate correlation analysis were employed to examine the longitudinal relationships among depressive symptoms, internet device diversity, and social participation. Age, gender, highest education level, marital status, drinking status, smoking history, self-rated health, sleep duration, and chronic health conditions were adjusted as covariates. The results from the three waves of longitudinal data revealed mutual predictive relationships among internet device diversity, social participation, and depressive symptoms. The mediating effect was significant (β = −0.612, 95 % CI −0.796 to −0.429), with significant gender differences observed. Furthermore, our findings indicated that social participation functioned as a protective factor against depressive symptoms, and the association between social participation and depressive symptoms was not a straightforward linear relationship. This suggests that participation in social activities (either high or low) is associated with a lower risk of depressive symptoms compared to no social participation, with no gender differences. This study suggests that there is a relationship between internet device diversity and lower levels of depressive symptoms among middle-aged and older adults in China. Social participation mediates the relationship between internet device diversity and depressive symptoms, and different levels of social engagement have different effects on depressive symptoms. It is recommended to increase support for social participation among middle-aged and older adults, strengthen structural social capital, and better leverage the use of the internet to reduce depressive symptoms levels and promote the physical and mental well-being of this population. • The diversity of internet use devices is associated with lower levels of depression symptoms. • Social participation plays a mediating role in the bidirectional relationship between internet device diversity and depression. • Different levels of social participation result in varying risks of depression symptoms. • Compared to middle-aged and older men, women's depression symptoms is more sensitive to the influence of internet usage. [ABSTRACT FROM AUTHOR]

Amid the COVID-19 pandemic, the mental health of middle-aged and older adults has become an increasing concern, and the role of the internet in addressing this public health crisis has drawn the attention of researchers. This study evaluated the impact of internet access during COVID-19 on depressive symptoms among middle-aged and older adults. Data were derived from China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020. Difference-in-differences analysis was performed to compare changes in depressive symptoms between the internet users during COVID-19 and those who didn't have access to the internet before and during the pandemic. We found that internet access during COVID-19 pandemic significantly reduced middle-aged and older adults' depressive symptoms. Further investigation identified the underlying mechanisms through which internet access helps in alleviating depressive symptoms by reducing the likelihood of experiencing negative emotions about COVID-19. Heterogeneity analyses showed that rural residents and middle-aged individuals benefited more from internet access during the pandemic. Since internet access can alleviate middle-aged and older adults' depressive symptoms amidst public health crisis, policy makers should focus on enhancing their access to the internet. • This paper investigated the impact of internet access on middle-aged older adults' depressive symptoms during the COVID-19. • We found that internet access during COVID-19 was beneficial to alleviate middle-aged and older adults' depressive symptoms. • Mechanism analysis showed that internet access can improve depressive symptoms by reducing negative emotions about COVID-19. • The effects were more salient among middle-aged adults and rural residents. [ABSTRACT FROM AUTHOR]

The relationship between depression and cognition in middle-aged adults is a topic of interest. Whether poor cognitive function exacerbates depression remains controversial. We clarified the association between cognitive decline and depression based on six nationwide cohorts. 89,056 participants were retrieved from six cohorts in Europe, North America, Asia and Africa. Each two consecutive interviews were collected as a sample set with a total of twenty-eight sample sets to assess changes in depression and cognitive function. Multiple linear regression was conducted within each sample set to evaluate the association between cognitive decline and depression. A two-stage meta-analysis was performed to obtain the average effect within each cohort and the overall effect excluding population and regional heterogeneity. Meta-regression and subgroup analysis were used to explore heterogeneity and potential effect modifiers. Almost all sample sets indicated negative association between changes in cognitive function and depression scores. The average effects varied across regions: Korea (−0.150 [−0.175, −0.126]), Europe (−0.130 [−0.149, −0.112]), South Africa (−0.090 [−0.129, −0.060]), China (−0.083 [−0.137, −0.030]), Mexico (−0.063 [−0.084, −0.042]), and North America (−0.048 [−0.056, −0.040]). The overall effect excluding population and regional heterogeneity was −0.094 [−0.129, −0.060], and was robust across populations of different age, sex, alcohol consumption, daily living activities and marital status. The cross-sectional design limited our ability to determine causal relationships. Cognitive decline was associated with the exacerbation of depression status in middle-aged and older adults worldwide. Country-level factors, rather than individual-level factors, are more likely to modify this effect. • It is the first global study to examine the association between cognition and depression in middle-aged and older adults worldwide. • Declines in cognitive function are associated with the exacerbation of depression status. • This relationship is more likely to be modified by macro-level factors than by individual-level factors. • Cognitive training or cognitive therapy may be helpful to control or prevent depression. [ABSTRACT FROM AUTHOR]

Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population. 8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015–2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms. The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19–2.02; 20 % rule: OR 1.71, 95 % CI 1.16–2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: β 0.96, 95 % CI 0.38–1.54; 20 % rule: β 0.94, 95 % CI 0.08–1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance. Depressive assessment was based on self-reported screening instrument. The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions. • The presence of both HGS asymmetry and weakness was strongly associated with incident depression. • HGS asymmetry combined with weakness was related to a significant increase in depression score. • Early recognition and intervention of HGS asymmetry and weakness may help reduce depression risk. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are one of the causes of depression in middle-aged and older adults, but the combined effects of ACEs, cognitive function and ability to perform activities of daily living (ADL) on depression have not been fully explored. This study was based on data from 4 waves (2013, 2014, 2015 and 2018) of data from the China Health and Retirement Longitudinal Study, including 10,995 middle-aged and older adults. ACEs were derived from the 2014 self-report life history module. A latent variable growth curve model was used to assess the mediating effect of cognitive function and ability to perform ADL in the relationship between ACEs and depression. ACEs were significantly associated with lower initial cognitive status (β = −0.156, P <.001), worse ability to perform ADL (β = 0.051, P <.001) and higher severity of depression (β = 0.228, P <.001). The results of mediation analysis indicated that the association between ACEs and the intercept of depression was partly mediated by the initial level of cognitive function and ADL, and the association between ACEs and the slope of depression was total mediated by cognitive (intercept and slope) and ADL (intercept and slope). ACEs were associated with higher severity of depression in part due to lower cognitive function and worse ability to perform ADL. Interventions that focus on reducing ACEs and improving cognitive level and ability to perform ADL may effectively reduce the incidence of depression among middle-aged and older individuals. • ACEs can longitudinally affect the development of depression. • Cognitive function and ADL play a mediating role in the relationship between ACEs and depression. • Efforts to reduce ACEs, increase the level of cognitive function and ADL will help to reduce the occurrence of depression [ABSTRACT FROM AUTHOR]

The optimal multimorbidity measures for predicting disability trajectories are not universally agreed upon. We developed a multimorbidity index among middle-aged and older community-dwelling Chinese adults and compare its predictive ability of disability trajectories with other multimorbidity measures. This study included 17,649 participants aged ≥50 years from the China Health and Retirement Longitudinal Survey 2011–2018. Two disability trajectory groups were estimated using the total disability score differences calculated between each follow-up visit and baseline. A weighted index was constructed using logistic regression models for disability trajectories based on the training set (70 %). The index and the condition count were used, along with the pattern identified by the latent class analysis to measure multimorbidity at baseline. Logistic regression models were used in the training set to examine associations between each multimorbidity measure and disability trajectories. C-statistics, integrated discrimination improvements, and net reclassification indices were applied to compare the performance of different multimorbidity measures in predicting disability trajectories in the testing set (30 %). In the newly developed multimorbidity index, the weights of the chronic conditions varied from 1.04 to 2.55. The multimorbidity index had a higher predictive performance than the condition count. The condition count performed better than the multimorbidity pattern in predicting disability trajectories. Self-reported chronic conditions. The multimorbidity index may be considered an ideal measurement in predicting disability trajectories among middle-aged and older community-dwelling Chinese adults. The condition count is also suggested due to its simplicity and superior predictive performance. • The present study is the first to construct a new multimorbidity index using disability trajectories as the outcome. • The multimorbidity index performed better than count- and pattern-based measures in predicting disability trajectories. • The multimorbidity index may ideally be considered when measuring multimorbidity to predict disability trajectories. • The condition count is also suggested due to its simplicity and superior predictive performance. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the associations between the multidimensional health status of one spouse and the onset of depressive symptoms in partner, and whether the associations differed by gender and residence. We analyzed data from 2401 females and their husbands (scenario 1), and 2830 males and their wives (scenario 2) who participated in the 2011/2012 and 2015 waves of China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Multidimensional health indicators included mobility disability, activities of daily living disability, frailty, global cognition, depressive symptoms, comorbidity, and self-reported health. Principal component analysis was used to construct a composite health indicator reflecting overall health status that was then categorized into three groups (poor, moderate, and excellent). Logistic regression models were performed. We observed strong associations of spouse's health status with the onset of depressive symptoms in partner. For instance, females whose husbands had poor overall health status reported more depressive symptoms than those having husbands with excellent overall health after four years (OR: 1.75; 95 % CI: 1.35, 2.26). These associations were statistically significant in rural females and urban males, but surprisingly disappeared in rural males and urban females. No exact timing of depressive symptoms onset. In Chinese middle-aged and older adults, spouse's health status is associated with depressive symptoms in partner and the associations vary by gender and residence. The findings underscore the importance of considering partner's health status to manage one spouse's mental health. • Spouse's health status is associated with the onset of depressive symptoms in partner • Associations between spouse's health status and depressive symptoms in partner vary by gender and residence in China • Considering partner's health status in a couple may improve one spouse's mental health [ABSTRACT FROM AUTHOR]

Background: The World Alzheimer Report showed that 46.8 million people suffered from dementia in 2015. This study examined how the duration and quality of sleep are associated with cognition among older adults in China.Method: Data were drawn from waves 2011, 2013, and 2015 of the China Health and Retirement Longitudinal Study (CHARLS), including noninstitutionalized adults aged 45 and older (n=10,768). Cognition was measured by interview-based assessments of mental status (TICS-10), episodic memory, and visuospatial abilities. Sleep duration was categorized as long, medium, or short and sleep quality was categorized as good, fair, or poor.Results: Sleep duration had an inverted U-shape relationship with cognitive scores (P <.001); and sleep quality had a positive linear relationship with cognitive scores (P <.001). Short and long sleep durations were associated with consistently lower cognition scores with increasing age (both P <.001); and fair and poor quality of sleep were associated with consistently lower levels of cognition (both P <.001). Tests of interactions between sleep duration and sleep quality showed that participants reporting long durations of sleep with poor quality of sleep had the lowest overall cognitive scores.Limitations: Self-reported methods were used to measure sleep quality and duration and thus our findings underscore the need for more evidence-based research to improve prevention efforts and tailor interventions to reduce cognitive decline among Chinese older adults.Conclusions: Suboptimal sleep duration and quality were associated with poor cognition. Cognitive scores were lowest among those who reported long durations of sleep that were of poor quality. [ABSTRACT FROM AUTHOR]

• People with sensory loss have increased risk of developing depression. • Depression is significantly associated with higher risk of incident sensory loss. • Findings of this study are helpful to improve management strategies for both mental and physical health. Most studies on the relationship between sensory loss and depression focus on the unidirectional association between sensory loss and the risk of depression based on cross-sectional designs. The present study aimed to explore the bidirectional longitudinal associations of vison loss (VL), 1 1 VL: vision loss; hearing loss (HL), 2 2 HL: hearing loss; and dual sensory loss (DSL) 3 3 DSL: dual sensory loss. with depressive symptoms among Chinese population. A longitudinal study was conducted among 13,690 participants aged 45 years and older over four years. VL, HL, and DSL were identified through self-reporting, and depressive symptoms were assessed using a 10-item Center for Epidemiologic Studies Depression Scale. Multivariable Cox proportional hazards regression models were constructed to estimate the bidirectional associations of VL, HL, and DSL with depressive symptoms. Participants with self-reported VL (HR: 1.14, 95%CI: 1.04–1.24), HL (HR: 1.22, 95%CI: 1.07–1.37), and DSL (HR: 1.27, 95%CI: 1.08–1.49) were associated with higher risk of developing depressive symptoms, compared with those without VL, HL, and DSL, respectively. In comparison with those without depressive symptoms, participants with depressive symptoms in the baseline had higher risk of developing VL (HR: 1.43, 95%CI: 1.33–1.54), HL (HR: 1.49, 95%CI: 1.36–1.63), and DSL (HR: 1.76, 95%CI: 1.59–1.95). Sensory loss was defined only based on participants' self-report. Significant bidirectional associations exist between self-reported VL, HL, or DSL and depressive symptoms. The mental health of people with VL and HL should be focused on, and regular assessments of vision and hearing in people with depressive symptoms are recommended. [ABSTRACT FROM AUTHOR]

Backgrounds: Adverse childhood experiences are co-occurring factors of multimorbidity and depression in mid-late life, but the combined effect of ACEs and multimorbidity on depression over life has not been fully studied.Methods: We used data from the China Health and Retirement Longitudinal Study which includes 4,440 middle-aged and older adults. Different types of ACEs experienced up to the age of 17 were assessed based on self-reports. We used parallel process Latent Growth Curve modelling to evaluate the longitudinal mediation role of ACEs, multimorbidity and depression.Results: People who had more ACEs were found to have a higher level of multimorbidity (intercept: 0.057, 95% CI: 0.031 to 0.079) and depression (intercept: 0.047, 95% CI: 0.013 to 0.076) at the baseline and a faster increase in multimorbidity (slope: 0.107, 95%CI: 0.078 to 0.136) and depression (slope: 0.074, 95%CI: 0.035 to 0.153). The mediation analysis indicated that there was a positive indirect association of ACEs via the multimorbidity intercept with the intercept of depression (0.028, 95%CI: 0.012 to 0.043), and a small negative association with the slope of depression (-0.002, 95%CI: -0.003 to -0.001). We also found a positive indirect association of ACEs via the multimorbidity slope with the intercept (0.035, 95%CI: 0.021 to 0.049) and slope (0.008, 95%CI: 0.004 to 0.011) of depression.Conclusions: ACEs were related to higher depression partly via elevated multimorbidity. Public health services and behavioural interventions to prevent and reduce the occurrence of ACEs might help to lower the risk of multimorbidity and depression in later life. [ABSTRACT FROM AUTHOR]

Objectives: Male lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is common and may increase the risk of depressive symptoms. This study aimed to investigate the associated factors of LUTS/BPH and its association with depressive symptoms in middle-aged and older Chinese men.Methods: This study used data from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A total number of 8,586 men aged ≥45 years were included in this study. Participants answered positively to whether they have ever been diagnosed with a prostate illness (excluding prostatic cancer) were defined as LUTS/BPH individuals. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Multivariate logistic analyses were applied to explore the associated factors of LUTS/BPH, association between LUTS/BPH and depressive symptoms, and risk factors of depressive symptoms according to LUTS/BPH status.Results: The weighted overall prevalence of LUTS/BPH was 13.1% in Chinese men aged ≥45 years. The prevalence of depressive symptoms was 29.1% in LUTS/BPH individuals and 22.9% in non-LUTS/BPH individuals. Depressive symptoms and LUTS/BPH shared some same risk factors, which were education, living regions, annual household consumption, sleep duration and multimorbidity. The results from logistic models showed that education, sleep duration and multimorbidity were significantly and independently associated with depression of LUTS/BPH individuals (P<0.001).Conclusions: Prevalence of depressive symptoms in LUTS/BPH population was higher than in non-LUTS/BPH population. Education, sleep duration and multimorbidity were associated with the onset of depressive symptoms in LUTS/BPH individuals (P<0.001). [ABSTRACT FROM AUTHOR]

Objective: Previous studies have not investigated the contribution of medical insurance to income-related inequality in depressive symptoms. To fulfill this research gap, this study aimed to assess the contribution of Urban and Rural Resident Basic Medical Insurance (URRBMI) to income-related inequality in depressive symptoms among middle-aged and older adults in China.Methods: The data of this study was obtained from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). The data of Particulate Matter 2.5 (PM2.5) concentrations were sourced from Atmospheric Composition Analysis Group. Furthermore, concentration curve and concentration index were employed to measure the extent of income-related inequality in depressive symptoms. Moreover, decomposition method of concentration index was used to quantify the contribution of URRBMI to the income-related inequality in depressive symptoms.Results: The concentration index values of depression occurrence and score were -0.1067 and -0.0712, respectively, indicating pro-rich inequality. The decomposition results reveal that the contribution rate of URRBMI to concentration index of depression occurrence was 18.88%, which indicates that it reduced the pro-rich inequality in depression occurrence. In addition, the contribution rate of URRBMI to concentration index of depression score was 3.55%, indicating that it relieved the pro-rich inequality in depression score.Conclusion: This study found pro-rich inequalities in depression occurrence and score which were reduced with the coverage of URRBMI. It is quite necessary to further expand the coverage of URRBMI. [ABSTRACT FROM AUTHOR]

Background: Evidence of the association between common chronic diseases and depression is sparse.Methods: Totally 7819 participants aged 45+ without depression at baseline were followed-up (2011-2015) to detect incident depression. Chronic diseases and depression were defined by self-reported diagnosis and the Center for Epidemiological Studies Depression Scale (CES-D10), respectively. Cox proportional hazards model was used to explore the association between chronic diseases and depression adjusting for age, gender, education, marital/living conditions, area, smoking, drinking, economic status, BMI and health insurance.Results: During an average of 3.42 years follow-up, 2271 participants developed depression (85 per 1000 person-year). Chronic diseases were related to significantly higher risk of depression (HR = 1.38). A higher risk of depression was also associated with specific diseases: stomach/other digestive diseases (HR = 1.19), diabetes (HR = 1.22), arthritis/rheumatism (HR = 1.30), and kidney diseases (HR = 1.34) (P < 0.05). The risk of depression increased with increasing in the number of chronic diseases (1: HR = 1.27, 2: HR = 1.49, and 3+: HR = 1.51, P-trend < 0.001). No significant difference was observed across age, gender, education, and area.Limitations: Chronic diseases and depression were based on self-reported diagnosis and measurement scale, respectively, which could lead to information bias. Some unmeasured confounders might have biased the results.Conclusions: The occurrence of depression in people aged 45+ is associated with number of chronic diseases in a dose-response fashion. These results may provide guidance on preventing depression and improving the quality of life in middle and late adulthood. [ABSTRACT FROM AUTHOR]

Objective: While diabetes links with comorbidity of depression, there is no evidence in China regarding whether health behaviors modified the effect of depressive symptoms on diabetes. This study examined the influence of depressive symptoms on the incident diabetes, and investigated whether health behavior was a moderator in the depression-diabetes relationship in Chinese mid-aged and older adults.Methods: Using data from the China Health and Retirement Longitudinal 2011-2015 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms in 47,671 Chinese mid-aged and older adults. Diabetes was diagnosed through self-reported measures. We used random effect logistic regression models to examine the effect of depressive symptoms on the incidence of depressive symptoms.Results: Participants with depressive symptoms were more likely to suffer from diabetes than their non-depressive symptoms counterparts, with an odds ratio (OR) of 1.33 (95% CI: 1.13, 1.58). We found that unhealthy behaviors moderated the influence of depressive symptoms on risk of diabetes (OR = 1.01, 95% CI = 1.01, 1.02), indicating that depressive symptoms patients with two or more unhealthy behaviors had a higher risk of diabetes compared with their peers without unhealthy behaviors.Conclusion: Our findings suggested that depressive symptoms were a risk factor in developing diabetes, and that response to this factor varied by individuals' health behaviors. Clinicians should be aware of increased risk of elevated diabetes in population with depressive symptoms and consider routine screening for depressive symptoms among them. [ABSTRACT FROM AUTHOR]

Background: Co-morbid diabetes and depression is common; however, little evidence was regarding the effect of education on this association. This study aimed to investigate the role of education in the effect of diabetes on depressive symptoms in China.Methods: We used data from the China Health and Retirement Longitudinal Study, including 6,921 participants free from depressive symptoms in three waves of cohort study from 2011. We assessed the depressive symptoms based on Center for Epidemiological Studies-Depression scale. We fitted Cox proportional hazards regression models to examine the effect of baseline diabetes on the subsequent depressive symptoms.Results: Participants with diagnosed diabetes were more likely than their nondiabetic peers to develop depressive symptoms only in 45-64 years group, with a hazard ratio of 1.30 (95% CI: 1.05, 1.61). In addition, the effect of diagnosed diabetes on depressive symptoms only occurred in participants with a diploma of primary school or below.Limitations: Information was unavailable may offer additional explanatory power.Conclusion: Our findings suggested that diagnosed diabetes was a chronic stressor in developing depressive symptoms, and that response to this stressor varied by individuals' educational attainment. Action to prevent and treat diabetes may contribute to the fight against depressive symptoms, especially in the lower-education population. [ABSTRACT FROM AUTHOR]