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Background <p>Although the association between depressive symptoms and instrumental activities of daily living (IADL) in older Chinese adults has been documented, whether this association varies by demographic characteristics and outdoor activity engagement remains unclear. This study aimed to explore the association of depressive symptoms with IADL and investigate whether age, sex, and outdoor activity modify the association.</p> Methods <p>This population-based cross-sectional study derived data from the 2017–2018 Chinese Longitudinal Healthy Longevity Survey (2017–2018 CLHLS). Depressive symptoms was measured using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). The presence of depressive symptoms was defined using the CESD-10 cut-off score (≥ 10). Secondary analyses additionally categorized CESD-10 scores into quintiles to examine dose-response associations with IADL disability. IADL was assessed using eight items, including (1) visiting neighbors, (2) shopping, (3) cooking, (4) washing clothes, (5) walking one kilometer, (6) carrying five-kilogram weight, (7) crouching and standing three times, and (8) taking public transportation. Multivariate linear regression models were used to calculate β-coefficients and 95% CI to examine the association of depressive symptoms with IADL. Modification of the associations by age (65–79 years and ≥ 80 years), sex (male and female), and outdoor activity engagement (including socializing with friends, Tai Chi, and square dancing; yes and no) were performed using stratified analyses and interaction tests.</p> Results <p>Of the 12,261 participants (59.91% aged ≥ 80 years and 53.45% women), 26.65% had depressive symptoms. Participants with depressive symptoms (CESD-10 ≥ 10) had greater IADL disability than those without depressive symptoms (adjusted β = 0.81, 95% CI = 0.71, 0.92). In secondary analyses, compared with participants in quintile 1 of depressive symptoms, those in quintile 5 had greater IADL disability (adjusted β = 1.19, 95% CI = 1.06, 1.33). The association between depressive symptoms and IADL disability was significantly modified by age, sex, and outdoor activity engagement (all <i>P</i> for interaction &lt; 0.05), stronger associations observed among participants aged ≥ 80 years, men, and those without outdoor activity engagement.</p> Conclusions <p>In this cross-sectional study in China, exposure to depressive symptoms was associated with IADL disability. This association was modified by age, sex, and outdoor activity engagement. These findings indicate a need to prevent depressive symptoms and a need for an intervention strategy for mental health to reduce the potential risk of IADL disability. Moreover, emphasizing personalized interventions that target individuals with depressive symptoms exposure may minimize the burden of IADL disability in later life.</p>

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The relationship between depressive symptoms and instrumental activities of daily living among older adults in China and its associations with age, sex, and outdoor activity engagement

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Yu Dong,
  • Jinghong Huang,
  • Yilin Wang,
  • Taiyue Zhang,
  • Xinyu Cai,
  • Runguo Gao,
  • Hongqing Liu

摘要

Background

Although the association between depressive symptoms and instrumental activities of daily living (IADL) in older Chinese adults has been documented, whether this association varies by demographic characteristics and outdoor activity engagement remains unclear. This study aimed to explore the association of depressive symptoms with IADL and investigate whether age, sex, and outdoor activity modify the association.

Methods

This population-based cross-sectional study derived data from the 2017–2018 Chinese Longitudinal Healthy Longevity Survey (2017–2018 CLHLS). Depressive symptoms was measured using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). The presence of depressive symptoms was defined using the CESD-10 cut-off score (≥ 10). Secondary analyses additionally categorized CESD-10 scores into quintiles to examine dose-response associations with IADL disability. IADL was assessed using eight items, including (1) visiting neighbors, (2) shopping, (3) cooking, (4) washing clothes, (5) walking one kilometer, (6) carrying five-kilogram weight, (7) crouching and standing three times, and (8) taking public transportation. Multivariate linear regression models were used to calculate β-coefficients and 95% CI to examine the association of depressive symptoms with IADL. Modification of the associations by age (65–79 years and ≥ 80 years), sex (male and female), and outdoor activity engagement (including socializing with friends, Tai Chi, and square dancing; yes and no) were performed using stratified analyses and interaction tests.

Results

Of the 12,261 participants (59.91% aged ≥ 80 years and 53.45% women), 26.65% had depressive symptoms. Participants with depressive symptoms (CESD-10 ≥ 10) had greater IADL disability than those without depressive symptoms (adjusted β = 0.81, 95% CI = 0.71, 0.92). In secondary analyses, compared with participants in quintile 1 of depressive symptoms, those in quintile 5 had greater IADL disability (adjusted β = 1.19, 95% CI = 1.06, 1.33). The association between depressive symptoms and IADL disability was significantly modified by age, sex, and outdoor activity engagement (all P for interaction < 0.05), stronger associations observed among participants aged ≥ 80 years, men, and those without outdoor activity engagement.

Conclusions

In this cross-sectional study in China, exposure to depressive symptoms was associated with IADL disability. This association was modified by age, sex, and outdoor activity engagement. These findings indicate a need to prevent depressive symptoms and a need for an intervention strategy for mental health to reduce the potential risk of IADL disability. Moreover, emphasizing personalized interventions that target individuals with depressive symptoms exposure may minimize the burden of IADL disability in later life.