Longitudinal muscle strength trajectories, incident depressive symptoms, and life satisfaction in Chinese middle-aged and older adults.

The role of internet use between ADL disability and depressive symptoms in Chinese middle-aged and older adults: Evidence from a longitudinal study.

Sleep duration and depressive symptoms in Chinese middle-aged and older adults: The moderating effects of grip strength

More middle-aged and older adults are often encouraged to volunteer (Gray et al., 2012). However, the effects of various volunteering activities on physical, psychological and cognitive health remain unknown. This study thereby aims to investigate such effects and the moderating effect of age in such associations. Data of 501 middle-aged and older Hong Kong Chinese adults (Mage = 53.06, SD = 4.55; and Mage = 70.46, SD = 7.34, respectively; range = 45 – 96) from a survey on Adult Development and Aging were analysed. Engagements in instrumental (e.g., food preparation, fundraising) and cognitively demanding volunteering (e.g., counselling, mentoring), hand-grip strength, life satisfaction, depressive symptoms, and cognitive functioning were measured. Factorial ANOVA revealed significant main effects of age group and volunteering type (F = 29.71, and F = 3.96, respectively, ps < .001), and an interaction effect of age and volunteering type (F =1.80, p = .03) on health outcomes. Comparisons among the four volunteering types (no volunteering, instrumental volunteering, cognitively demanding volunteering, and both types) revealed that individuals engaging in cognitively demanding volunteering had better hand-grip strength, life satisfaction, and cognitive functioning, and lower depressive symptoms than those who engaged in instrumental volunteering (all ps < .05). The health outcomes of instrumental volunteering were even worse than those who did not volunteer at all. These patterns were more prevalent in the middle-aged adults than in the older adults. Findings of this study indicated the beneficial effects of cognitively demanding volunteering, providing valuable directions for future programs on volunteering.

Volunteering is a popular activity among middle-aged and older adults as means to contribute to the society and to maintain personal health and wellbeing. While the benefits of volunteering have been well-documented in the current literature, it does not tend to distinguish between various types of volunteering activities. This cross-sectional study aims to compare the effects of instrumental (e.g. food preparation, fundraising) and cognitively demanding volunteering activities (e.g. befriending, mentoring) in a sample of 487 middle-aged and older Hong Kong Chinese adults. Participation in instrumental and cognitively demanding volunteering, life satisfaction, depressive symptoms, cognitive functioning and hand-grip strength were measured. The results of two-way between-subject robust analyses of variance demonstrated significant main effects of volunteering type and their interaction effect with age on life satisfaction and depressive symptoms. Comparisons among four volunteering groups (no volunteering, instrumental volunteering, cognitively demanding volunteering and both types) revealed that individuals engaging in instrumental volunteering exhibited lower life satisfaction and more depressive symptoms compared to those who engaged in cognitively demanding volunteering and those who did not volunteer at all. This detrimental pattern of instrumental volunteering was only seen in middle-aged adults, but not in older adults. Findings of this study revealed distinctive effects of two volunteering types, and provide valuable directions for designing future volunteering programmes.

There are no longitudinal studies investigating determinants of incident and persistent depressive symptoms in Southeast Asia. To estimate the proportion and correlates of incident and persistent depressive symptoms in a prospective cohort study among middle-aged and older adults (≥45 years) in Thailand. We analysed longitudinal data from the Health, Aging, and Retirement in Thailand (HART) surveys in 2015 and 2017. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to calculate predictors of incident and persistent depressive symptoms. In total, 290 of 4528 participants without depressive symptoms in 2015 had incident depressive symptoms in 2017 (9.8%) and 76 of 640 adults had persistent depressive symptoms (in both 2015 and 2017) (18.3%). In adjusted logistic regression analysis, having diabetes (adjusted odds ratio AOR = 1.48, 95% CI 1.07-2.05), musculoskeletal conditions (AOR = 1.56, 95% CI 1.01-2.41) and having three or more chronic conditions (AOR = 2.55, 95% CI 1.67-3.90) were positively associated and higher subjective economic status (AOR = 0.47, 95% CI 0.31-0.72) and social participation (AOR = 0.66, 95% CI 0.49-0.90) were inversely associated with incident depressive symptoms. Having a cardiovascular disease (AOR = 1.55, 95% CI 1.01-2.39) and having three or more chronic conditions (AOR = 2.47, 95% CI 1.07-5.67) were positively associated and social participation (AOR = 0.48, 95% CI 0.26-0.87) was inversely associated with persistent depressive symptoms. One in ten middle-aged and older adults had incident depressive symptoms at 2-year follow-up. The prevalence of incident and/or persistent depression was higher in people with a lower subjective economic status, low social participation, diabetes, musculoskeletal disorders, cardiovascular conditions and a higher number of chronic diseases.

Under China’s dual economic structure of urban and rural areas, rural regions face issues such as low socioeconomic status, inadequate healthcare resources, and neglect of mental health, leading to a higher prevalence of depression among middle-aged and older adults (above 45 years) in this area. This prospective cohort study used data from 6,183 rural Chinese middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS, 2018–2020). A random forest model was developed to predict 3-year incidents of depressive symptoms. Independent risk factors were identified via chi-square tests followed by binary logistic regression (Odds Ratios [ORs] and 95% Confidence Intervals [CIs] reported for significant variables, p < 0.05). The model’s performance and clinical utility were assessed using standard metrics and Decision Curve Analysis (DCA). SHapley Additive exPlanations (SHAP) values determine the individual feature impact on predictions. A subgroup analysis also compared depression-related characteristics in middle-aged (45–59 years) versus older adults (≥ 60 years) with incident depressive symptoms. Over a 3-year follow-up, 1,629 (26.35%) participants developed incident depressive symptoms. A Random Forest model, optimized using Recursive Feature Elimination (RF-RFE), which selected 28 key predictors from an initial 33. After threshold adjustment (optimal threshold = 0.43) to maximize the F1-score, the model achieved an accuracy of 0.736, precision of 0.499, recall of 0.607, F1-score of 0.548, and an AUC of 0.776 (95% CI: 0.763–0.788). The mean Brier score was 0.163 ± 0.006. DCA confirmed its clinical utility. Key protective factors identified via logistic regression included being male, higher education, and internet access. Conversely, increased age, poor self-rated health, lower life satisfaction, and functional limitations were significant risk factors for incident depressive symptoms. The random forest model demonstrates moderate predictive ability to estimate the risk of depressive symptoms in individuals aged 45 and above in rural China over the next 3 years. It offers a potentially valuable screening tool for rural regions with low mental health awareness and high depression prevalence, enabling more targeted interventions and prevention strategies.

BackgroundFew studies have explored the longitudinal association between eating alone and depressive symptoms, and have focused on the effect of eating alone transition. This study aims to explore the longitudinal association between eating alone, its transition and depressive symptoms among two national surveys using a cohort study design.MethodsThe participants aged ≥ 45 years were recruited for the 2016 to 2018 waves China Family Panel Data (CFPS) and 2015 to 2018 waves China Health and Retirement Longitudinal Study (CHARLS). Eating alone was assessed by self-reported. Depressive symptoms were evaluated by Center for Epidemiologic Studies Depression Scale. Cox hazard regression was used to explore the associations between eating alone, its transition and depressive symptoms after adjusting for covariates.ResultsA total of 21,476 participants were included in this study. The Cox model showed that compared with commensality, eating alone was associated with a higher risk of depressive symptoms, both in the CFPS, CHARLS and pooled analysis. In addition, compared with commensality consistently, the transition from commensality to alone and eating alone consistently were associated with a higher risk of depressive symptoms. The sensitivity analyses showed that the association remained robust.ConclusionsEating alone and a change from commensality to eating alone were associated with higher risks of depressive symptoms among Chinese middle-aged and older adults in two cohorts. This study suggested that providing eating partners may be an effective intervention method to prevent depressive symptoms in middle-aged and older adults.

This study investigates the relationship between life satisfaction and chronic disease development in older adults, with depressive symptoms and frailty serving as mediating factors. This study utilized data from the 2011 and 2018 China Health and Retirement Longitudinal Study (CHARLS), comprising 7809 middle-aged and older Chinese adults. Life satisfaction (including health, marriage, children relationship satisfaction, and air quality satisfaction) and chronic disease diagnosis were assessed, using self-reported questionnaires. Depressive symptoms were measured using the CES-D-10 scale, while frailty was evaluated by the FFP criterion. Negative binomial regression and logistic regression models were used to investigate associations among life satisfaction and chronic diseases, calculating incidence rate ratios (IRR) and odds ratios (OR). Additionally, mediation analysis was performed to examine whether depression and frailty mediated the relationship between life satisfaction and chronic diseases. Sensitivity and subgroup analyses confirmed the robustness of our findings. Our results showed that life satisfaction was significantly associated with a reduced prevalence of chronic diseases in middle-aged and older adults (IRR=0.87; 95% CI: 0.85-0.88; p<0.001). Significant associations were observed from four types of satisfaction, including satisfactions of health (IRR=0.77; 95% CI: 0.75-0.78; p<0.001), marriage (IRR=0.95; 95% CI: 0.94-0.97; p<0.001), children relationship (IRR=0.93; 95% CI: 0.91-0.95; p<0.001) and air quality (IRR=0.94; 95% CI: 0.92-0.96; p<0.001). Mediation analysis further revealed that depression and frailty partially mediated the relationship between life satisfaction and chronic diseases, accounting for 19.4% and 7.3%. These findings indicate that higher life satisfaction is associated with a lower burden of chronic diseases among middle-aged and older adults. Depressive symptoms and frailty statistically accounted for part of this association, emphasizing the need to address both psychological and physical factors to reduce burden of chronic disease burden in aging populations.

BackgroundThis study aimed to evaluate whether social, familial and personal factors can predict incident and prevalent depressive symptoms in Chinese adults aged ≥ 45 years using data from the China Health and Retirement Longitudinal Study (CHARLS).MethodsStudy subjects without depressive symptoms from CHARLS at baseline were enrolled. Depressive symptoms were defined by the 10-item Center for Epidemiologic Studies Depression Scale. Statistical adjustment, subgroup exploration and unmeasured confounding assessment were undertaken to derive reliable estimates.Results1681 (27.04%) of 6215 subjects who had no depressive symptoms in 2011, suffered one or more depressive symptoms in 2018. Multivariate analyses showed that number of grandchildren (odds ratio [95% confidence interval]: 1.06 [1.02, 1.10]), social activity score (0.95 [0.91, 0.98]), instrumental activities of daily living (IADL) (1.35 [1.11, 1.65]) and number of comorbidities (1.16 [1.10, 1.22]) were independently and significantly associated with the presence of incident depressive symptoms. Further categorization revealed significance for social activity score (odds ratio [95% confidence interval]: 0.78 [0.69, 0.89] and 0.71 [0.53, 0.95] for 1–5 and > 5 vs. 0), IADL (1.35 [1.11, 1.65] for yes vs. no) and number of comorbidities (1.38 [1.20, 1.58], 1.44 [1.16, 1.81] and 2.42 [1.54, 3.80] for 1–2, 3–4 and > 4 vs. 0) associated with incident depressive symptoms. Restricting analysis to wave IV data in 2018 observed significant association of number of grandchildren, social activity score, IADL and number of comorbidities with prevalent depressive symptoms.ConclusionsThe present study findings support the marked contribution of social activity score, IADL and number of comorbidities to incident and prevalent depressive symptoms in Chinese middle-aged and older adults.

Background: Physical performance is an important indicator that reflects current and predicts future health. In this study, we examined the association of alcohol use and depression with grip strength a national sample of middle aged and older Chinese adults. Methods: We used the baseline data from the China Health and Retirement Longitudinal Study (CHARLS) and constructed a multivariate linear regression using SAS 9.4 to examine the independent association of alcohol use (never, former, moderate, and at-risk drinkers) and depression with grip strength controlling for socio-economic factors and domestic partner status. Results: The study population consisted of 12,488 Chinese adults（mean age 59）. The prevalence of ever drinking during lifetime and current at-risk drinking (>14 standard drinks [one standard drink contains 14 grams of pure alcohol] per week) in this population was 25.7% and 15.2% respectively. 28.4% of the study population had depression. Compared with never drinkers, moderate and at-risk alcohol use were independently associated with better grip strength (P<0.0001). Depression was independently negatively associated with grip strength (P<0.0001). Conclusions: We found that current alcohol use might be protective of grip strength while depression might be detrimental to grip strength among middle-aged adults. However, the underlying mechanism is unclear. Given the negative impact of alcohol and depression on adults’ overall health, clinicians should assess alcohol use and depression in middle-aged and older patients using validated tools and provide resources. Clinicians should counsel patients that if depression is not managed, patients may suffer from depression associated health consequences such as declined grip strength.

BackgroundRecent meta-analyses indicate that the relationship between grip strength (GS) and cognition is more complex than that was previously assumed. Multiple studies have established a significant correlation between body composition and GS.ObjectiveTo assess longitudinal relationships between absolute and relative GS trajectories and cognitive function.MethodsThe China Health and Retirement Longitudinal Study (CHARLS) data with 2549 participants were analyzed using the Group-Based Trajectory Model (GBTM) to ascertain GS trajectories over time. Absolute GS was defined as the raw force, while relative GS was defined as grip strength adjusted by body weight. Directed Acyclic Graphs (DAGs) were used to identify confounding variables, which were subsequently adjusted for in generalized estimating equation (GEE) models that assessed associations between these trajectories and changes in cognitive function over time.ResultsWe observed that relative GS exhibited three distinct trajectories: The three relative GS trajectories were labeled as Low-decline (n = 823, 32.29%), Medium-decline (n = 1292, 50.69%), and High-decline (n = 434, 17.03%). Absolute GS showed similar downward trends. GEE revealed a uniform five-year decline in cognitive function across all GS trajectory groups (all ptime < 0.001). The overall interaction between the timing and patterns of changes in both absolute and relative GS and cognitive function was statistically significant (p < 0.001).ConclusionsIn middle-aged and older adults, lower grip strength trajectories align with accelerated cognitive decline, while higher grip strength is associated with slower cognitive deterioration. Monitoring grip strength may serve as a practical marker for cognitive health in aging populations.

ObjectiveLong-term untreated vision and hearing impairments can negatively impact physical and mental wellbeing. We investigated the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.Methods:This was a prospective cohort study of 9,492 participants from the China Health and Retirement Longitudinal Study (CHARLS) carried out in 2011, 2013, 2015, and 2018. This study used self-reported vision and hearing status to determine the degree of impairment. Depressive symptoms were examined using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with a total score of ≥ 12 indicating depressive symptoms. A Cox proportional hazards model adjusted for age, sex, residence, marital status, educational level, smoking history, alcohol consumption, hypertension, diabetes, heart disease, digestive disease, arthritis, wearing glasses, and hearing aids was used to estimate the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.Results:Of the 9,492 participants [mean (SD) age at CHARLS baseline, 58.12 (9.00) years], 3,238 (34.11%) participants reported incident depressive symptoms during the 7-year follow-up period. Participants who self-reported only vision impairment [hazard ratios (HR): 1.14, 95% confidence intervals (CI): 1.05–1.24], only hearing impairment (HR: 1.24, 95% CI: 1.06–1.46), and both vision and hearing impairments (HR: 1.25, 95% CI: 1.08–1.45) were independently associated with a greater increase in the hazard risk of incident depressive symptoms compared to those without vision and hearing impairments. An increase in participants' vision and hearing scores was associated with a significant increase in the hazard risk of incident depressive symptoms (HR: 1.04, 95% CI: 1.03–1.06).Conclusion:Vision and hearing status was associated with increased depressive symptoms among middle-aged and older Chinese adults during the 7-year follow-up period. Participants' use of glasses and hearing aids did not improve their depressive symptoms. Our findings may facilitate the development of effective treatments to prevent and treat vision and hearing impairments, thereby enhancing the physical and mental wellbeing of middle-aged and older adults.

BACKGROUNDS: The associations of adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) with incident depressive symptoms remain incompletely understood. The study sought to explore the complex associations of ACEs and AAEs with incident depressive symptoms among middle-aged and older adults. METHODS: Data of 4516 participants aged ≥ 45 years were sourced from the China Health and Retirement Longitudinal Study. Information on ACEs, AAEs, depressive symptoms, sociodemographic profiles, health behaviors, self-reported chronic diseases, retirement status, and adulthood social support was collected. Modified Poisson regression analysis, Karlson-Holm-Breen mediation analysis and interaction analysis were conducted. RESULTS: The overall numbers of ACEs (RR: 1.12; 95% CI: 1.08, 1.16) and AAEs (RR: 1.10; 95% CI: 1.06, 1.14) were independently associated with an increased risk of incident depressive symptoms. Significant dose-response relationships were detected between the numbers of ACEs (P-trend < 0.001) and AAEs (P-trend < 0.001) and the risk of incident depressive symptoms. The overall AAEs mediated 5.78% of the total effect of ACEs on incident depressive symptoms. No significant multiplicative (RR: 0.99; 95% CI: 0.77, 1.25) or additive [RERI (95% CI): 0.02 (-0.27, 0.30); AP (95% CI): 0.01 (-0.19, 0.21); SI (95% CI): 1.04 (0.49, 2.20)] interactions were detected between ACEs and AAEs on incident depressive symptoms. CONCLUSIONS: Both ACEs and AAEs were independently associated with an increased risk of incident depressive symptoms in a dose-response manner, with AAEs partially mediating the total effect of ACEs on incident depressive symptoms. These findings support preventive strategies targeting ACEs and AAEs to mitigate the risk of incident depressive symptoms in later adulthood.

Long-term associations between the stability of physical activity trajectories and depressive symptom trajectories among middle-aged and older adults: A multi-trajectory modeling analysis using China Health and Retirement Longitudinal Study data.

Unhealthy alcohol consumption such as binge drinking and depression are common problems among adults. The combined effect of binge drinking and depression might contribute to negative health outcomes, such as accidents, addiction, or sleep problems. Previous evidence has indicated that alcohol consumption differs by age. However, little is known about the association between binge drinking, depression, and sleep health, and how age might play a role in this association. This study aimed to examine the association between binge drinking, depressive symptoms, and sleep health in middle-aged and older adults and characterize any age differences. A total of 5191 middle-aged and older adults from the 2014 Core Survey of the Health and Retirement Survey (HRS) data aged 50 to 80 were included for this study. Binge drinking was defined as the consumption of 5 or more drinks (men) and 4 or more drinks (women) per drinking day. Depressive symptoms were measured using a validated 8-item Center for Epidemiologic Studies Depression Scale. Sleep health was assessed using a composite measure. Age was grouped into middle-aged (50-64.9 years) and older (65-79.9 years) adults. Multiple linear regression analysis was used to examine the associations between variables of interest. Our findings indicated that binge drinking and depressive symptoms negatively influenced sleep health among middle-aged adults, however this relationship was not found in older adults. Clinicians should simultaneously assess problematic alcohol consumption, depressive symptoms, and sleep health. Future research can develop and test age-specific interventions to reduce unhealthy drinking behaviors in middle-aged adults.