Depressive symptoms and healthy lifestyle behaviours in soon-to-be old and older adults in China: an analysis of data from a nationwide cross-sectional survey

Abstract

BackgroundDepression is the leading cause of disability worldwide. Adults aged 45–64 years have a higher prevalence of depression than do other age groups. In China, over 54 million people have depression, leading to severe disability and economic burden. The association between depressive symptoms and lifestyle behaviours among Chinese population have been little studied. We aimed to examine the association of various lifestyle behaviours on the presence of depressive symptoms among Chinese residents aged 45 years and older. MethodsData were drawn from the 2011–12 baseline survey of Chinese Health and Retirement Longitudinal Study (using multi-stage stratified probability-proportional-to-size sampling), involving 14 481 participants aged 45 years and older from 28 provinces of mainland China who completed the measurement of depressive symptoms presence. Lifestyle behaviours included smoking, alcohol drinking, sleep duration, social activities, and meal patterns. Presence of depressive symptoms (yes or no) was measured with a 10-item Center for Epidemiological Studies Depression (CES-D) scale. We did multivariate logistic regression analyses were conducted to test the association between various lifestyle behaviours and presence of depressive symptoms, adjusted for age, sex, urban or rural, socio-economic factors, and underlying conditions. All data analyses were done with R 3.3.3 and a p value lower than 0·05 was considered significant. Ethical approval for the study was granted by the Ethical Review Committee of Peking University, and all the participants provided written consent at the time of participation. FindingsThe prevalence of having depressive symptoms was 37·1% among all the participants, higher in rural (40·7%) than urban (25·4%) area (p<0·0001), and higher among females (43·3%) than male individuals (30·3%; p<0·0001). Participants who were current smokers (adjusted OR 1·14, 95% CI 1·02–1·28) and ate less than three meals per day (1·63, 1·46–1·82) were more likely to have depressive symptoms. Participants who had longer sleep duration (adjusted OR 0·45, 0·41–0·48 for 7–10 h sleep; 0·51, 0·41–0·62 for ≥10 h sleep), had more social activities (0·86, 0·82–0·90), and ate more than three meals per day (0·74, 0·55–0·99) were less likely to have depressive symptoms. No significant association was found between presence of depressive symptoms and alcohol drinking. InterpretationThe nationwide survey revealed high prevalence of depressive symptoms among Chinese adults aged 45 years and older. The association between depressive symptoms and lifestyle behaviours highlight the urgent need for depression prevention programmes addressing healthy lifestyle behaviours for the psychological wellbeing of Chinese adults. Further studies are essential to examine the casual inference and impact between lifestyle behaviours and depressive symptoms. FundingNone.