Abstract
The global aging problem is very serious. With the increase of age, the risk of depression in the elderly is also increasing. It is necessary to find effective strategies to reduce the depressive symptoms of the elderly. This study investigated the relationship between depressive symptoms, walking ability, and self-evaluation health of middle-aged and elderly Chinese after controlling demographic variables, health status, and lifestyle. The data is from the China health and retirement longitudinal study database in 2018. Six thousand eight hundred thirty-five people over the age of 50 have complete information on walking ability, self-assessed health status, and depressive symptoms. SPSS 27.0 software was used to conduct Z-test, logistic regression and linear hierarchical regression analysis on the collected data. The results showed that poor walking ability and poor self-evaluation health status of middle-aged and elderly people were significantly related to depression. The study concluded that middle-aged and elderly people with good walking ability and self-rated health status had a lower risk of depression. This study can provide reference for formulating specific and effective intervention measures for senile depression.
Keywords: depression, middle-aged and elderly people, relationship, self-rated health, walking ability
1. Introduction
The global aging problem is very serious. China now has 280 million people aged 60 and over,[1] Japan has 36 million people aged 65 and over, and South Korea has 9 million people aged 60 and over.[2] With the increase of age, the risk of depression in the elderly is also increasing.[3] Depression is one of the most common and harmful psychological diseases in the elderly, mainly manifested by sadness, loss of interest, low self-worth, decreased appetite, poor sleep quality, and easy fatigue.[4,5] Depressive symptoms refer to the negative emotions and behaviors that occur in a certain period of time.[6] Not all depressive symptoms indicate depression, but the occurrence of depressive symptoms will increase the risk of depression.[7] Depression can seriously damage the ability of daily life of the elderly, and even lead to suicide.[8] It is important to find effective prevention strategies to reduce the prevalence of depression in the elderly. Some studies report that depression symptoms are affected by some factors, such as high body mass index (BMI), little exercise, no breakfast, poor health, poor walking ability, etc.[9,10] It is worth noting that more and more evidence shows that good walking ability is negatively correlated with the risk of depression in the elderly, while the risk of depression in the elderly with poor walking ability is higher than that in the elderly with strong walking ability.[11,12] Another study shows that walking ability is one of the factors for the elderly to maintain physical and mental health.[13]
Self-assessment of health status is one of the important factors that reflect the quality of life of the elderly and predict mortality.[6,14] At present, many studies have proved that there is a significant relationship between the elderly’s self-assessed health status and depressive symptoms.[7,15] Poor health and various diseases will increase the risk of depression in the elderly. The higher the score of depression symptoms of the elderly, the more serious the decline of their self-health status score.[14,16] With the improvement of depression symptoms of the elderly in the community, their self-evaluation health scores will be higher and higher.[17] A study found a positive correlation between the number of self-care disorders and the risk of depressive symptoms.[18] Another study found that regular and appropriate outdoor activities among elderly people can reduce the risk of depression.[19] However, the amount of research evidence on the impact of walking ability and self-assessment of health on depression is limited, and the scientific quality of various studies varies. In previous studies, the mixed effects of demographic variables, health status, lifestyle and walking ability, self-rated health status, and depression have not been fully studied and need further study. The purpose of this study is to explore the relationship between walking ability, self-assessed health status, and depressive symptoms of middle-aged and elderly people after adjusting demographic variables, health status, and lifestyle.
2. Methods
2.1. Participants and data
China health and retirement longitudinal study (CHARLS) is a large-scale interdisciplinary research project implemented by Peking University in China.[20] The purpose is to collect data on the population information, physical and mental health, personal and family economic status, medical services, and insurance of the elderly in China, so as to analyze China’s population aging and promote interdisciplinary research on aging. In our study, CHARLS 2018 data was used. All data collected in CHARLS are stored in the CHARLS database of Peking University, China. All data can be found in http://charls.pku.edu.cn. This study was approved by the Ethics Review Committee of Anshan Normal University, China.
2.2. Variables
2.2.1. Demographic, health status, and lifestyle variables.
Demographic variables include gender (male or female), age (50–59 or 60–69 or 70–79 or 80–89 or 90 and above),[21] type of household registration (urban or rural), education level (below high school or above high school), and widowhood (yes or no). Health status and lifestyle variables include hypertension (yes or no), hyperlipidemia (yes or no), diabetes (DM) (yes or no), stroke (yes or no), asthma (yes or no), arthritis (yes or no), bad mood (yes or no), physical activity (PA) level (high or low), and smoking (yes or no).
2.2.2. Walking ability and self-rated health.
Participants’ ability to walk 1 km and self-assessed health information were obtained through participants’ self-reports. The questionnaire question is whether you can easily walk 1 km. Yes or no. Your health condition: good or bad.
2.2.3. Depression.
The degree of depression in middle-aged and older individuals was evaluated using the short form of the CES-D scale. The CES-D scale has strong reliability and validity in investigations of the Chinese population, according to Radloff (1977).[22,23] The CHARLS questionnaire’s short CES-D scale consists of the following 10 questions: ① I am worried by seemingly insignificant things, ② I have difficulties focusing while I’m doing things, ③ I feel melancholy, ④ I think doing everything is very tough, ⑤ I’m optimistic about the future, ⑥ I’m terrified, ⑦ I don’t sleep well, ⑧ I’m joyful, ⑨ I’m lonely, and ⑩ I think I can’t carry on with my life. Each question’s reflection of sadness is given a score between 0 and 3, ranging from low to high; the scores of ⑤ and ⑧ are computed backwards. The individual is considered “depressed” and receives a total score of 10 points if their total score is 10 points or above. participants were classified as “not depressed” and below.
2.3. Statistical analysis
Statistical description of all included variables. Multiple logistic regression analysis was used to analyze the influencing factors of walking ability, self-rated health status, and depressive symptoms. The relationship between walking ability and self-rated health status and the risk of depressive symptoms was estimated by taking depressive symptoms as dependent variables and walking ability and self-rated health status as independent variables. Multilayer linear regression analysis was used to estimate the relationship between walking ability and the risk of depressive symptoms after adjusting the variables. In model 1, the relationship between walking ability and depressive symptoms was evaluated. On the basis of model 1, model 2 adjusted gender, age, type of household registration, education level, and widowhood status. On the basis of model 2, model 3 adjusted the self-assessment of health status, hypertension, hyperlipidemia, DM, stroke, arthritis, asthma, poor mood, PA level, and smoking. Multilayer linear regression analysis was used to estimate the relationship between the self-rated health status and the risk of depressive symptoms after adjusting the variables. In model 1, the relationship between self-rated health status and depressive symptoms was evaluated. On the basis of model 1, model 2 adjusted gender, age, type of household registration, education level, and widowhood status. Model 3 adjusted hypertension, hyperlipidemia, DM, stroke, arthritis, asthma, bad mood, PA level, walking ability, and smoking on the basis of model 2. For all statistical analyses, P < .05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics 27.0 software (IBM SPSS Inc., Chicago, IL).
3. Results
3.1. Demographic characteristic
A total of 6835 participants were included in this study. Among them, 3375 men (49.4%) were <3460 women (50.6%), and there was no significant difference in the gender of participants through the Z-test (P = .304). In terms of walking ability, 83.8% of participants were able to walk 1 km. In terms of self-evaluation of health status, 24.4% of participants rated themselves as good. In terms of depressive symptoms, the proportion of participants with depressive symptoms was 34.8%. The proportion of participants aged 50 to 59, 60 to 69, 70 to 79, 80 to 89, 90 and above is 6.3%, 17.3%, 38.2%, 31.4%, and 6.5%, respectively. From the type of registered residence of participants, urban registered residence accounts for 22.4%. From the perspective of educational level, 81.4% of participants are below high school. Among the participants, the proportion of widows was 11.8%. In terms of health status, 12.1% of participants had hypertension, 13.5% had hyperlipidemia, 7.5% had DM, 6.3% had stroke, 1.8% had asthma, and 7.0% had arthritis. In terms of lifestyle habits, 26.5% of participants have smoking habits, and 48.2% of participants with high levels of PA. The Z-test showed that there were statistical differences (P < .05) between variables other than gender (Fig. 1 and Table 1).
Figure 1.
. A total of 19,752 participants participated in the 2018 China Health and Retirement Longitudinal Study (CHARLS). Eight thousand five hundred seventy people were excluded because of incomplete information on walking ability, self-rated health, and depression variables, leaving 10,522 people. Three thousand six hundred eighty-seven people were excluded from 10,522 because they were under 50 years old. Finally, the remaining 6835 participants were included in the study.
Table 1.
Characteristics of middle-aged and elderly participants of the CHARLS in 2018 (n = 6835).
| Number of participants | % | Z | P | |
|---|---|---|---|---|
| Gender | ||||
| Male | 3375 | 49.4 | ||
| Female | 3460 | 50.6 | 1.028 | .304 |
| Age (yr) | ||||
| 50–59 | 454 | 6.3 | ||
| 60–69 | 1183 | 17.3 | ||
| 70–79 | 2608 | 38.2 | ||
| 80–89 | 2148 | 31.4 | ||
| ≥90 | 442 | 6.5 | −71.981 | .00 |
| Location of residence | ||||
| City | 1531 | 22.4 | ||
| Rural | 5304 | 77.6 | 45.637 | .00 |
| Degree of education | ||||
| Junior high school and below | 5564 | 81.4 | ||
| High school and above | 1271 | 18.6 | -51.927 | .00 |
| Widowed | ||||
| Yes | 806 | 11.8 | ||
| No | 6029 | 88.2 | 63.176 | .00 |
| Self-rated health status | ||||
| Good | 1671 | 24.4 | ||
| Bad | 5164 | 75.6 | 42.250 | .00 |
| Hypertension | ||||
| Yes | 829 | 12.1 | ||
| No | 6006 | 87.9 | 62.619 | .00 |
| Hyperlipemia | ||||
| Yes | 926 | 13.5 | ||
| No | 5909 | 86.5 | 60.273 | .00 |
| Diabetes | ||||
| Yes | 513 | 7.5 | ||
| No | 6322 | 92.5 | 70.264 | .00 |
| Stroke | ||||
| Yes | 430 | 6.3 | ||
| No | 6405 | 93.7 | 72.272 | .00 |
| Arthritis | ||||
| Yes | 481 | 7.0 | ||
| No | 6346 | 93.0 | 70.983 | .00 |
| Asthma | ||||
| Yes | 121 | 1.8 | ||
| No | 6705 | 98.2 | 80.950 | .00 |
| Physical activity level | ||||
| High | 3295 | 48.2 | ||
| Low | 3540 | 51.8 | 2.963 | .003 |
| Smoke | ||||
| Yes | 1812 | 26.5 | ||
| No | 5023 | 73.5 | 38.839 | .00 |
| Walking ability | ||||
| Good | 5727 | 83.8 | ||
| Bad | 1106 | 16.2 | −55.902 | .00 |
| Depression | ||||
| Yes | 2381 | 34.8 | ||
| No | 4454 | 65.2 | 25.074 | .00 |
3.2. Analysis of influencing factors of walking ability
Age, household registration type, education level, self-evaluation health status, hypertension, DM, stroke, poor mood, PA, and depression were significantly related to the walking ability of participants (P < .05). With the increase of age (odds ratio [OR] = 0.477), the walking ability of participants decreased significantly. The walking ability of participants with urban household registration type (OR = 0.655) was significantly worse. Participants with lower education level (OR = 0.699) had poorer walking ability. Participants with hypertension (OR = 0.716), DM (OR = 0.743), and stroke (OR = 0.465) had significantly worse walking ability. The worse the self-rated health status (OR = 1.753), the worse the mood (OR = 0.318), the lower the level of PA (OR = 2.219), and the depression (OR = 0.697), the worse the walking ability of the participants (Table 2).
Table 2.
Analysis of influencing factors of walking ability.
| Walking ability | B | SE | Wald | P | OR | 95%CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | |||||||
| Yes | Gender | .014 | .090 | .025 | .874 | 1.014 | .850 | 1.210 |
| Age (yr) | −.741 | .214 | 12.008 | .001 | .477 | .313 | .725 | |
| Location of residence | −.424 | .116 | 13.377 | .000 | .655 | .522 | .822 | |
| Degree of education | −.358 | .124 | 8.321 | .004 | .699 | .548 | .891 | |
| Widowed | −.002 | .135 | .000 | .991 | .998 | .766 | 1.301 | |
| Hypertension | −.435 | .227 | 7.613 | .000 | .716 | .577 | .918 | |
| Hyperlipemia | .059 | .127 | .217 | .641 | 1.061 | .828 | 1.360 | |
| Diabetes | −.297 | .150 | 3.934 | .047 | .743 | .554 | .996 | |
| Stroke | −.767 | .150 | 26.227 | .000 | .465 | .346 | .623 | |
| Bad mood | −1.144 | .301 | 14.428 | .000 | .318 | .176 | .575 | |
| Arthritis | .368 | .173 | 4.526 | .083 | 1.445 | 1.029 | 2.030 | |
| Asthma | .533 | .321 | 2.764 | .096 | 1.704 | .909 | 3.195 | |
| Physical activity | .756 | .098 | 59.322 | .000 | 2.129 | 1.757 | 2.581 | |
| Smoke | .150 | .102 | 2.171 | .141 | 1.162 | .952 | 1.419 | |
| Depression | −.361 | .096 | 13.980 | .000 | .697 | .577 | .842 | |
| Self-rated health status | .561 | .115 | 23.837 | .000 | 1.753 | 1.399 | 2.197 | |
Bold numbers represent significant correlations.
3.3. Analysis of influencing factors of self-rated health
Age, education level, widowhood, hypertension, hyperlipidemia, DM, stroke, bad mood, arthritis, asthma, PA, walking ability, and depression were significantly related to the participants’ self-assessment health status (P < .05). With the increase of age (OR = 0.787), the participants’ self-rated health status became significantly worse. The participants with lower education level (OR = 0.855) had significantly worse self-rated health status. The participants who were widowed (OR = 1.333) rated themselves as better health. Participants with hypertension (OR = 0.642), hyperlipidemia (OR = 0.722), DM (OR = 0.673), stroke (OR = 0.265), arthritis (OR = 0.558), and asthma (OR = 0.430) had significantly worse self-assessment health status. Participants with poor mood (OR = 0.325), low level of PA (OR = 1.946), poor walking ability (OR = 1.786), and depression (OR = 0.623) had significantly worse self-rated health status (Table 3).
Table 3.
Analysis of influencing factors of self-rated health.
| Self-rated health | B | SE | Wald | P | OR | 95%CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | |||||||
| Good | Gender | −.021 | .059 | .129 | .720 | .979 | .872 | 1.099 |
| Age (yr) | −.239 | .115 | 4.314 | .038 | .787 | .629 | .987 | |
| Location of residence | .101 | .074 | 1.873 | .171 | 1.107 | .957 | 1.280 | |
| Degree of education | −.157 | .072 | 4.699 | .030 | .855 | .742 | .985 | |
| Widowed | .287 | .090 | 10.213 | .001 | 1.333 | 1.117 | 1.589 | |
| Hypertension | −.494 | .123 | 5.713 | .017 | .642 | .454 | .867 | |
| Hyperlipemia | −.325 | .097 | 11.243 | .001 | .722 | .597 | .874 | |
| Diabetes | −.396 | .127 | 9.694 | .002 | .673 | .524 | .863 | |
| Stroke | − 1.327 | .191 | 48.091 | .000 | .265 | .182 | .386 | |
| Bad mood | − 1.124 | .434 | 6.709 | .010 | .325 | .139 | .761 | |
| Arthritis | −.584 | .127 | 21.060 | .000 | .558 | .435 | .716 | |
| Asthma | −.844 | .302 | 7.810 | .005 | .430 | .238 | .777 | |
| Physical activity | .666 | .063 | 112.728 | .000 | 1.946 | 1.721 | 2.201 | |
| Smoke | .017 | .066 | .068 | .795 | 1.017 | .894 | 1.158 | |
| Walking ability | .580 | .113 | 26.286 | .000 | 1.786 | 1.431 | 2.229 | |
| Depression | -.421 | .268 | 9.826 | .002 | .623 | .483 | .841 | |
Bold numbers represent significant correlations.
CI = confidence intervals, OR = odds ratio.
3.4. Analysis of influencing factors of depression
Gender, age, hypertension, DM, arthritis, PA level, smoking, self-assessment health status, and walking ability were correlated with depression (P < .05). Compared with male participants, women (OR = 0.579) were more likely to suffer from depressive symptoms. With the increase of age (OR = 0.406), the risk of depression symptoms of participants is higher and higher. Participants with hypertension (OR = 1.170), DM (OR = 1.279) and arthritis (OR = 1.450) had significantly higher risk of depression. Participants with high level of PA (OR = 0.175), no smoking habit (OR = 1.182), good self-rated health status (OR = 0.518) and good walking ability (OR = 0.700) had significantly lower risk of depressive symptoms (Table 4).
Table 4.
Analysis of influencing factors of depression.
| Depression | B | SE | Wald | P | OR | 95%CI | ||
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | |||||||
| Yes | Gender | −.546 | .060 | 83.182 | .000 | .579 | .515 | .651 |
| Age (yr) | −.901 | .123 | 53.368 | .000 | .406 | .319 | .517 | |
| Location of residence | .035 | .077 | .210 | .647 | 1.036 | .891 | 1.204 | |
| Degree of education | −.093 | .077 | 1.462 | .227 | .911 | .784 | 1.059 | |
| Widowed | −.038 | .092 | .167 | .682 | .963 | .804 | 1.154 | |
| Hypertension | .349 | .113 | 9.523 | .002 | 1.170 | 0.956 | 1.388 | |
| Hyperlipemia | .163 | .089 | 3.388 | .066 | 1.177 | .989 | 1.400 | |
| Diabetes | .246 | .112 | 4.822 | .028 | 1.279 | 1.027 | 1.592 | |
| Stroke | .099 | .116 | .724 | .395 | 1.104 | .879 | 1.387 | |
| Bad mood | −.408 | .276 | 2.188 | .139 | .665 | .387 | 1.142 | |
| Arthritis | .371 | .113 | 10.771 | .001 | 1.450 | 1.161 | 1.810 | |
| Asthma | .175 | .212 | .676 | .411 | 1.191 | .785 | 1.806 | |
| Physical activity | − 1.741 | .063 | 773.058 | .000 | .175 | .155 | .198 | |
| Smoke | .167 | .066 | 6.303 | .012 | 1.182 | 1.037 | 1.346 | |
| Self-rated health | −.165 | .068 | 5.879 | .002 | .518 | .403 | .734 | |
| Walking ability | −.356 | .097 | 13.403 | .000 | .700 | .579 | .847 | |
Bold numbers represent significant correlations.
3.5. Analysis of linear hierarchical regression models between participants’ depressive symptoms and walking ability
Model 1 showed that there was a significant relationship between walking ability and depressive symptoms (P < .05). Model 2 adjusted demographic characteristic variables (gender, household registration type, education level, age, and widowhood) on the basis of model 1, and the results were also statistically significant (P < .05). Model 3 adjusted the health status and lifestyle characteristics (poor mood, arthritis, asthma, self-rated health, DM, stroke, PA, smoking, hyperlipidemia, and hypertension) on the basis of model 2, and the results were still significant (P < .05) (Table 5).
Table 5.
Analysis of linear hierarchical regression models between participants’ depressive symptoms and walking ability.
| Model | R | R2 | Adjusted R2 | Variation statistics | ||
|---|---|---|---|---|---|---|
| R2 variation | F variation | P | ||||
| 1 | .120* | .014 | .014 | .014 | 99.292 | .000 |
| 2 | .263† | .069 | .068 | .055 | 80.108 | .000 |
| 3 | .431‡ | .186 | .184 | .116 | 97.091 | .000 |
Predicted variables: walking ability.
Predicted variables: walking ability, gender, household registration type, education level, age, and widowhood.
Predicted variables: walking ability, gender, household registration type, education level, age, widowhood, poor mood, arthritis, asthma, self-rated health, diabetes, stroke, physical activity, smoking, hyperlipidemia, and hypertension.
3.6. Analysis of linear hierarchical regression models between participants’ depressive symptoms and self-rated health
Model 1 showed that there was a significant correlation between self-rated health status and depressive symptoms (P < .05). Model 2 adjusted demographic characteristic variables (gender, household registration type, education level, age, and widowhood) on the basis of model 1, and the results were also statistically significant (P < .05). Model 3 adjusted the health status and lifestyle characteristics (poor mood, arthritis, DM, asthma, stroke, PA, smoking, hypertension, hyperlipidemia, and walking 1 km) on the basis of model 2, and the results were still significant (P < .05) (Table 6). Good self-evaluation of health status and good walking ability are significantly negatively correlated with depressive symptoms in middle-aged and elderly people. After adjusting for demographic variables, health status variables, and lifestyle variables, this significant negative correlation still exists.
Table 6.
Analysis of linear hierarchical regression models between participants’ depressive symptoms and self-rated health
| Model | R | R2 | Adjusted R2 | Variation statistics | ||
|---|---|---|---|---|---|---|
| R2 variation | F variation | P | ||||
| 1 | .026* | .001 | .001 | .001 | 4.751 | .029 |
| 2 | .246† | .061 | .060 | .060 | 86.916 | .000 |
| 3 | .431‡ | .186 | .184 | .125 | 104.572 | .000 |
Predicted variables: self-rated health.
Predicted variables: self-rated health, gender, household registration type, education level, age, and widowhood.
Predicted variables: self-rated health,gender, household registration type, education level, age, widowhood poor mood, arthritis, asthma, self-rated health, diabetes, stroke, physical activity, smoking, hyperlipidemia, and hypertension walking ability.
4. Discussion
The purpose of this study was to evaluate the relationship between walking ability, self-rated health status, and depressive symptoms in middle-aged and elderly people, and to evaluate the influencing factors of walking ability, self-rated health status, and depressive symptoms. This study found that good walking ability and good self-evaluation health status had a significant negative correlation with depression symptoms of middle-aged and elderly people, and this significant negative correlation still existed after adjusting demographic variables, health status variables, and lifestyle variables.
In general, our research results show that the proportion of middle-aged and elderly people with good walking ability (83.8%) is higher than that of middle-aged and elderly people with poor walking ability (16.2%), and the number of depressive symptoms of middle-aged and elderly people with good walking ability is significantly lower than that of middle-aged and elderly people with poor walking ability, which indicates that good walking ability can reduce the risk of depression symptoms of middle-aged and elderly people. This result is supported by a previous study conducted by Omar HR et al[24] Through their research, they found that the walking ability of heart failure patients with depression was worse than that of non-depression heart failure patients. The study of Gao W et al[25] also supports the conclusion of this study. They recruited 1489 elderly Americans aged 60 and above to evaluate the relationship between walking disorders and visual impairment, depression and cognitive function in the elderly. A multivariate logistic regression model was used to examine the correlation between walking disorder and visual impairment, depression and cognitive function. The study concluded that among the elderly in the United States, walking disorder is associated with depression and is positively correlated with the number of walking disorder indicators. Depression should be assessed in elderly people with walking disorders. A person’s walking ability is a comprehensive reflection of their muscle strength, heart function, digestive system condition, bone and joint health, and mental and emotional state.[9] Good walking ability means an increase in PA, which has been proven to reduce physiological responses to stress.[11] Physical activity can increase the level of serotonin and endorphin and change the activity of central norepinephrine, promote the enhancement of self-efficacy and sense of control, and thus reduce the risk of depression.[26] These factors may be the reason for the negative correlation between good walking ability and depression. Therefore, our research provides a reference for the middle-aged and elderly people to customize specific and effective interventions for depression. The study of Yu, DJ et al[27] also supports the conclusion of this study. They conducted a randomized controlled trial to preliminarily compare the effects of moderate walking exercise of 150 minutes per week and vigorous walking exercise of 75 minutes per week on relieving depression in middle-aged and elderly people. A total of 35 participants were randomly divided into control group, moderate walking exercise group or severe walking exercise group. The frequency of walking exercise was 3 times a week, and the intervention time was 12 weeks. The main outcome was the severity of depression assessed by the Becker Depression Scale. Compared with the control group, the severity of depression of participants in the moderate walking exercise group and the severe walking exercise group decreased significantly after intervention. The study concluded that the minimum amount of walking exercise of moderate or intense intensity can alleviate depression among the middle-aged and elderly. Elderly people should improve their physical fitness to improve their walking ability, thereby reducing the risk of depression in the elderly. Our research results show that the proportion of middle-aged and elderly people with good self-evaluation health status (24.4%) is lower than that with poor self-evaluation health status (75.6%), and the number of depressive symptoms of middle-aged and elderly people with good self-evaluation health status is significantly lower than that with poor self-evaluation health status, which indicates that good self-evaluation health status can reduce the risk of depression symptoms of middle-aged and elderly people. This result is supported by a previous study conducted by Kim GS.[28] Kim GS assessed the effect of self-rated health on anxiety and depression in patients with advanced cancer. A total of 260 patients with advanced cancer participated in the study, and the collected data were analyzed by structural equation model. The result is that the self-assessed health status is positively correlated with anxiety and depression. Meng Dijuan et al [29] 210 elderly people in the community were investigated with the universal scale, the Luben social network scale, the geriatric depression scale and the health self-assessment scale. The study concluded that the self-health status of the elderly in the community was negatively correlated with the depressive symptoms, and measures should be taken to improve the health status of the elderly in the community and thus promote the physical and mental health of the elderly.
Lim SK et al[30] evaluated the relationship between depression and self-evaluation of health in the elderly with disabilities. In this study, they used the data from the nationwide survey of the Korean Welfare Commission in 2017, and the analysis method used multiple regression analysis to analyze the causal relationship and interaction between variables. Multiple regression was conducted to determine the correlation between self-rated health status and depression. This study shows that there is a significant negative correlation between the self-evaluation health of the disabled elderly and depressive symptoms. Sohn K et al[31] evaluated the reciprocal causal relationship between the elderly’s self-assessed health status and depression. The study used the 5th, 6th and 7th wave data of the Korean Longitudinal Study on Aging to analyze 3363 elderly people aged 65 or above. The regression cross-lag model is used to analyze the obtained data. The result of this study is that the self-rated health status of the elderly is negatively correlated with the depressive symptoms. Based on the above findings and the results of this study, we believe that there is a significant negative correlation between the elderly’s self-rated health status and depressive symptoms. It is necessary to formulate systematic policies and health promotion strategies to improve the basic health status of the elderly, thereby improving the physical and mental health status of the elderly and improving the quality of life of the elderly.
The results of our model also quantify the impact of demographic characteristics and physical and mental health characteristics variables on the relationship between walking ability, self-rated health status, and depressive symptoms. Considering the influence of gender, this study found that the risk of depression in middle-aged and elderly women is higher than that in middle-aged and elderly men, which is consistent with the previous study of Zheng H et al[32] They used the data of the European Health, Aging and Retirement Survey to explore the gender difference of depression. A total of 3990 participants aged 50 or above participated in the European Health, Aging, and Retirement Survey. A generalized estimation equation model was used to study the locus of depression after sex stratification. The results showed that there were gender differences in depressive symptoms, and the frequency of depression in elderly women was higher than that in elderly men. Health care practitioners and policy makers should focus on the middle-aged and elderly women, and should develop appropriate strategies to prevent and treat the depression symptoms of the middle-aged and elderly women, and improve their mental health.
Age is one of the important factors affecting depressive symptoms in the elderly. This study found that older people have a higher risk of depressive symptoms. This result is consistent with the results of Zhang Y et al[21] They found that PA level of middle-aged and elderly decreases with age, but the risk of depression also increases. They suggested that more attention should be paid to the effect of aging on mental health of older people. As the aging middle-aged and elderly people become weak, the weakness will cause a series of negative effects, such as a significant decline in the quality of life of middle-aged and elderly people. The decline in the quality of life will lead to the mood and mood of middle-aged and elderly people becoming worse and worse, which may be the reason why depression in middle-aged and elderly people increases with the growth of age. China is one of the countries with the most serious problem of aging. Healthcare practitioners and policy makers should pay more attention to the mental health of the elderly. It is necessary to publicize the aging culture of the middle-aged and elderly in the community, so that the elderly can maintain a good attitude in the process of aging, and appropriate strategies should be formulated to improve the mental health of the middle-aged and elderly.
This study assessed the impact of health status (hypertension, DM, and arthritis) of middle-aged and elderly people on walking ability, self-assessment health status and depressive symptoms. We found that middle-aged and elderly people with hypertension, DM, and arthritis are more likely to suffer from depression, and their walking ability and self-rated health status are poor. This result is partially consistent with the previous study by Araújo CG et al,[33] who assessed the relationship between depression and high blood pressure among elderly people in the community. A total of 231 elderly people in the community provided information on the following variables: gender, age, nationality, smoking habits, PA level, BMI, and DM. The logistic regression technique was applied, with hypertension as the dependent variable and depression as the predictive variable. The results showed that there was no significant correlation between unadjusted depression and hypertension. However, after adjusting for PA levels, BMI, and DM, the strength of the association between depression and hypertension increased significantly. The study concluded that PA, BMI, and DM directly affect the relationship between depression and hypertension in the elderly. Kim S et al[34] investigated the risk of depression among DM patients in the general population. Their data are from the National Health and Nutrition Examination Survey of Korea in 2016. The study sample includes 5374 adults. The results showed that there was a significant correlation between impaired fasting blood glucose in the elderly and DM and depression in middle-aged people. After adjusting for gender, education level and family income, BMI, HbA1c, and hypertension, this significant correlation still exists. Scuteri, A. et al[35] studied the relationship between depression and left ventricular hypertrophy (LVH) and left ventricular structure in a group of elderly subjects. After adjusting for age, sex, and traditional cardiovascular risk factors, depression was significantly associated with LVH, and the incidence of depression accompanied by concentric LVH in the elderly was higher. Jo, EJ and other[36] people evaluated the risk of depression and anxiety in elderly asthma patients. A total of 281 patients diagnosed with asthma and treated for more than 1 year were included in the study. The results showed that the elderly patients with asthma had a higher degree of depression and a lower quality of life. In order to fully control asthma, it is necessary to evaluate the depression of elderly patients with asthma. The psychology and mood of the elderly with chronic diseases will change greatly. Many elderly people suffering from chronic diseases will have a significant reduction in their psychological endurance. When they encounter unstable conditions or new complications, they feel confused or helpless, which leads to more intense emotional reactions and a significant decline in their mental health. The elderly with chronic diseases should learn the basic treatment and rehabilitation knowledge of the disease, correctly understand the disease, strengthen the ability of self-care, and establish a strong belief and a correct view of life and death. The elderly with chronic diseases should strengthen their own quality, encourage diligent learning, and adapt themselves to the development of society through continuous learning, which is conducive to maintaining a good attitude.
In addition, this study shows that the risk of depressive symptoms of middle-aged and elderly people with high level of PA is significantly lower than that of middle-aged and elderly people with low level of PA. The walking ability and self-rated health status of middle-aged and elderly people with high level of PA are also better than those with low level of PA. Knapik A et al[37] studied the effect of COVID-19 isolation on the self-evaluation of physical fitness, PA, anxiety, and depression in patients with Parkinson disease. The results showed that the isolation of COVID-19 pandemic significantly reduced the PA of patients with Parkinson disease. Physical activity deficiency was significantly associated with self-rated health status and depressive symptoms. Insufficient PA is an important predictor of anxiety and depression in patients with Parkinson disease. Ekelof K et al[38] evaluated the correlation between PA level and postpartum depression in Swedish women. The results showed that the higher level of PA during pregnancy was related to the lower symptoms of postpartum depression. Sports activities are a factor in promoting a healthier lifestyle and help to improve the mental health of pregnant women, new mothers and their children. Kutsuna T et al[39] evaluated the relationship between PA level and walking ability of hemodialysis patients. The results showed that the PA time of hemodialysis patients should be more than 50 minutes/day to prevent the deterioration of normal and maximum walking speed. Therefore, hemodialysis patients should have at least 50 minutes of PA every day to prevent their walking ability from decreasing. The increase in health benefits brought by PA has reduced the risk of cardiorespiratory diseases, DM, obesity, osteoporosis, and cerebrovascular diseases, which have been proved to be related to the increased risk of depression.[26] Physical activity can enhance the mood and social relationships of elderly people, and a good mood can reduce the risk of depression. These studies are consistent with the conclusions of this study.
5. Conclusion and limitations
The walking ability, self-rated health status, and depressive symptoms of middle-aged and elderly people are closely related, but at present, the research on walking ability, self-rated health status, and depressive symptoms of middle-aged and elderly people in China is at the initial exploration stage. In this study, the risk of depression in elderly women is higher than that in men, while the risk of depression in middle-aged and elderly people with good walking ability and self-rated health is lower. At the same time, middle-aged and elderly people who are older, suffer from hypertension, DM, arthritis, low level of PA, and smoke are more likely to suffer from depressive symptoms. This study helps to better understand the relationship between walking ability, self-rated health status, and depressive symptoms of middle-aged and elderly people, which has important reference significance for formulating accurate exercise prescriptions to improve the health status and depressive symptoms of the elderly.
This study has various limitations. First, walking ability and self-rated health status are based on self-reported surveys, which may be affected by bias and inaccuracy. Second, we did not include the economic status of the elderly in this study, which may be an influential factor leading to depression in the elderly. Third, the participants were recruited from China, so the research results could not be extended to all the elderly people in the world. Future research may consider recruiting a wider range of participants from different countries and regions to obtain more general results on the relationship between elderly people’s walking ability, self-rated health status, and depression.
Acknowledgments
The authors thank all the participants in CHARLS team for their time and effort devoted to the project.
Author contributions
Conceptualization: Yaqun Zhang, Xin Jiang.
Data curation: Yaqun Zhang, Xin Jiang.
Investigation: Yaqun Zhang, Xin Jiang.
Methodology: Yaqun Zhang.
Resources: Xin Jiang.
Software: Yaqun Zhang.
Writing – original draft: Yaqun Zhang, Xin Jiang.
Writing—review & editing: Xin Jiang.
Abbreviations:
- BMI
- body mass index
- CHARLS
- China health and retirement longitudinal study
- OR
- odds ratio
- PA
- physical activity
The datasets generated during and/or analyzed during the current study are publicly available.
The authors have no conflicts of interest to disclose.
This study was supported by the Elderly Fall Prevention and Injury Prevention Fitness Guidance Project (20DZ2311900).
How to cite this article: Zhang Y, Jiang X. The relationship between walking ability, self-rated health, and depressive symptoms in middle-aged and elderly people after controlling demographic, health status, and lifestyle variables. Medicine 2023;102:29(e34403).
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