Does Social Participation Modify the Association Between Depression and Cognitive Functioning among Older Adults in China? A Secondary Analysis Based on CHARLS

Abstract

Background Cognitive impairment and depression have a tremendous impact on the mental health and well-being of older adults in China. As previous studies showed the beneficial effect of social participation on cognitive functioning and depression, social participation has great implications for older Chinese adults’ mental health. However, few studies investigated the influence of specific types of social participation on the relationship between depression and cognitive functioning. The current study explored which specific types of social activities alleviate cognitive impairment in older adults in China and whether social participation moderates the influence of depression on their cognitive functioning. Methods The study conducted hierarchical regression analysis on the China Health and Retirement Longitudinal Study (CHARLS) dataset of 5,056 older adults. The Mini-Mental State Examination (MMSE) was employed to measure the cognitive performance of the subjects, and the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was utilized to evaluate depressive symptoms. Descriptive statistical analysis was first conducted to describe the demographic information and the distribution of MMSE and CESD-10 scores of the studied subjects. Then, hierarchical regression analysis was performed to test the best fit of constructed step-wise models that reflect the main effect of depression on cognitive functioning (Model 1), the main effects of formal and informal social participation, and the interaction between social participation and depression on cognitive functioning (Model 2 & 3), and the main effects of social participation broken down into specific categories as well as their interactions with depression on cognitive functioning, respectively (Model 4 & 5). We controlled for demographic factors such as age and gender in each model and the influence of depression in Model 2, 3, 4, and 5. Results Older Chinese adults in the CHARLS database demonstrated varying degrees of cognitive impairment (M = 20.96, SD = 5.62), given that an MMSE score of 23 or lower indicates dementia. The subjects also manifested “minimal” to “moderate-severe” depression (M = 8.78, SD = 6.67) with a CESD-10 cut-off score of 10 implying cases of depression. Regression results showed that depression had a significant negative main effect on older Chinese adults’ cognitive functioning across all Models. Participating in both formal and informal social activities mitigated cognitive decline among older adults in China. When social participation was broken down in types, “playing mahjong, chess, or cards or going to a community club”, “going to a sport, social or other kinds of the club”, “taking part in a community-related organization”, and “investing in stock” positively associated with the MMSE scoring of older Chinese adults. No interaction between the overall or specific types of social participation and depression was found. Conclusion Overall, the study revealed the benefit of social participation on the mental health and well-being of older adults in China, particularly favoring informal social activities. The implications of this study are relevant to the areas of public policy and public health, such as creating social venues for older adults and organizing social activities for the older population. These could improve the life satisfaction of older adults and reduce the burden on the Chinese health system.