Socioeconomic status and depressive symptoms among older adults in China: the mediating role of cognitive function, lifestyle and social participation

Introduction: Socioeconomic status (SES) is an important risk factor for depression in older adults, while cognitive function, lifestyle and social participation also have an impact on depression. The purpose of this study was to explore the mediating role of cognitive function, lifestyle and social participation in the association between SES and depressive symptoms. Methods: : This Data was obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2017-2018). A total of 7595 participants at age 65 or older were included in this study. The 10-item of the Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to measure depressive symptoms in older adults. SES was assessed using a composite index by considering the participant's education level, occupation, and economic status. Cognitive function was assessed by the Mini Mental State Examination (MMSE). The lifestyle and social participation scores were constructed by collecting information on relevant items in the questionnaire. Mediating effect analysis was used to explore the mediating effect of cognitive function, lifestyle and social participation in the association between SES and depression in older adults. Results: : The incidence of depressive symptoms was 41.1% among 7595 participants. SES negatively predicted depression in older adults (b = -0.887, P < 0.001) after controlling for sociodemographic variables and health status variables. In addition, SES had a significant mediating effect on depression in older adults through “cognitive function” (b = -0.071, 95%CI: -0.095~-0.048), “lifestyle” (b = -0.177, 95%CI: -0.213~-0.140) and “social participation” (b = -0.068, 95%CI: -0.095~-0.042), respectively. Conclusion: It is necessary not only to change the disadvantaged status of SES of some elderly groups, but also to improve their cognitive level, advocate a healthy lifestyle and promote their active social participation.