Abstract
Background
Mega sporting events are increasingly discussed for their potential public health legacy, yet evidence on their mental health relevance among older adults and the underlying pathways remains limited. This study examined the association between perceived health-related exposure to a mega sporting event and depressive symptoms in community-dwelling older adults, focusing on the roles of physical activity and loneliness.
Methods
This cross-sectional survey was conducted between October and November 2025 in 10 community health service centers in Luohu District, Shenzhen, China. A total of 961 adults aged 60 years and older were included. Depressive symptoms were assessed using the 5-item Geriatric Depression Scale. Perceived event-related health exposure was assessed using a context-specific five-item indicator reflecting event-related health information exposure. Physical activity was measured using the Physical Activity Rating Scale–3 and loneliness using the 3-item UCLA Loneliness Scale. Multivariable regression and serial mediation analysis with 5,000 bootstrap resamples were performed, adjusting for sociodemographic characteristics, self-rated health, and chronic disease status.
Results
Among the 961 participants, 258 individuals (26.85%) met the criteria for depressive symptoms. Higher perceived event-related health exposure was associated with lower depressive symptom scores (B = − 0.045). Indirect effects were observed via physical activity (B = − 0.021) and loneliness (B = − 0.006), as well as via a sequential pathway linking higher perceived exposure to higher physical activity, lower loneliness, and lower depressive symptoms (B = − 0.004). Overall, indirect effects accounted for 68.9% of the total effect. Findings were consistent in sensitivity analyses using binary depressive symptoms.
Conclusions
Higher perceived event-related health exposure was associated with fewer depressive symptoms among older adults, with physical activity and loneliness indicating behavioral and psychosocial pathways. These findings may inform consideration of physical activity promotion and social connectedness in planning the public health implications of large-scale sporting events for aging populations.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-026-08120-y.
Introduction
Population aging is accelerating worldwide, making mental health among older adults an increasingly important public health concern. Depressive symptoms are among the most common mental health problems in later life and have been consistently associated with functional decline, multimorbidity, increased healthcare utilization, and elevated mortality [1]. As societies age, identifying context-sensitive and population-relevant determinants of late-life depression has become a priority across diverse health systems.
In China, rapid demographic transition toward an aging society has further intensified the burden of late-life depression [2]. Epidemiological studies indicate that depressive symptoms are highly prevalent among community-dwelling older adults, with reported rates commonly ranging from 30% to 40% across regions and tending to increase with advancing age [3, 4]. Late-life depression not only compromises quality of life but also contributes to disability, loss of independence, and substantial societal and healthcare costs [5, 6]. Despite this growing burden, prevention and intervention strategies remain largely centered on pharmacological treatment and individual-level psychological interventions, which often have limited reach and sustainability in community settings [7].
Increasingly, research informed by the social ecological model suggests that mental health in later life is shaped not only by individual characteristics but also by broader social and environmental contexts [8]. Compared with younger populations, older adults typically have more constrained activity spaces and rely more heavily on their immediate surroundings for daily activities, social interaction, and health-related behaviors [9]. Consequently, perceived changes in local social and health-related contexts may have disproportionate implications for emotional well-being in later life.
Within this framework, large-scale public events have attracted growing attention as potential contextual influences on population health. Mega sporting events, such as the Olympic Games, continental multi-sport competitions, and national games, are increasingly viewed not only as athletic or economic phenomena but also as social events that may reshape health-related contexts through intensified media exposure, expanded community activities, and heightened public discourse surrounding physical activity and healthy lifestyles [10, 11]. Prior research has shown that the hosting of such events is often accompanied by increased visibility of health-promoting messages and temporary activation of public spaces, which may encourage engagement in health-related behaviors [12, 13]. However, existing studies have largely focused on objective indicators, such as participation rates or infrastructural changes, with relatively limited attention to mental health outcomes and to how individuals subjectively perceive and internalize event-related health signals.
This issue may be particularly salient among older adults. In later life, physical activity, social interaction, and emotional experiences are closely tied to proximal social cues and perceived environmental support [14]. Retirement-related role transitions and shrinking social networks may further increase sensitivity to contextual signals related to health and social participation [15]. Under these circumstances, perceived health-promoting contexts associated with mega sporting events, such as strengthened health atmospheres and increased community engagement, may influence depressive symptoms through behavioral and psychosocial pathways [16]. Nevertheless, empirical evidence examining whether and how perceived sporting event–related health exposure is associated with depressive symptoms among older adults remains limited [17].
From a theoretical perspective, the potential mental health implications of mega sporting events are unlikely to be direct [18]. According to the conservation of resources theory, physical activity constitutes a critical behavioral and health-related resource that contributes to emotional well-being and resilience against depression [19]. A substantial body of evidence has demonstrated that higher levels of physical activity are associated with fewer depressive symptoms in older adults [20], and that perceived environmental support plays an important role in facilitating activity engagement in later life [21]. Social connectedness represents another essential psychosocial resource, with loneliness being a well-established risk factor for late-life depression [22]. Engagement in physical activity may also promote social interaction and a sense of participation, thereby alleviating loneliness [23]. In this context, perceived health-promoting exposure to a mega sporting event may encourage physical activity, reduce loneliness, and ultimately relate to depressive symptoms through interconnected behavioral and psychosocial mechanisms. However, studies that simultaneously examine these pathways within a unified analytic framework remain scarce.
The 15th National Games of the People’s Republic of China, held in November 2025 and jointly hosted across the Guangdong–Hong Kong–Macao Greater Bay Area, provided an empirically relevant context for examining perceived health-related exposure associated with a large-scale sporting event. Against this backdrop, this cross-sectional study focused on community-dwelling older adults in Shenzhen to examine the association between perceived sporting event–related health exposure and depressive symptoms, with particular attention to the mediating roles of physical activity and loneliness. Grounded in the social ecological framework and the conservation of resources theory, this study tested a mediation model in which perceived health exposure to the mega sporting event was hypothesized to be associated with depressive symptoms both directly and indirectly through physical activity and loneliness, independently and sequentially (Fig. 1). By adopting the perspective of older adults, this study contributes to a more nuanced understanding of the mental health–related health legacy of mega sporting events and underscores their potential role in community-based mental health promotion for aging populations.
Fig. 1.
Hypothesized mediation model of perceived sporting event health exposure and depressive symptoms
Methods
Study design and participants
Study design
This study adopted a cross-sectional survey design. Data were collected between October and November 2025, corresponding to the period during which the 15th National Games of the People’s Republic of China were held. The survey was conducted in Luohu District, Shenzhen, China, an urban district characterized by a relatively high level of population aging and a well-established community health service system. A multi-stage convenience sampling approach was employed. Luohu District comprises ten administrative subdistricts, each served by multiple community health service centers. In the first stage, one community health service center was selected from each subdistrict based on service coverage, accessibility, and willingness to participate, yielding a total of ten centers. These centers primarily serve stable residential communities with a high proportion of older adults. In the second stage, during the survey period, community-dwelling older adults attending routine health examinations, chronic disease follow-up visits, or community-based activities at the selected centers were consecutively invited to participate. Recruitment was conducted on-site by trained investigators using face-to-face interviews to ensure eligibility screening and data completeness. No predefined quota was set for each center, and participants were enrolled consecutively until the target sample size was achieved.
Participants and eligibility criteria
Participants were required to meet all of the following criteria: (1) aged 60–85 years; (2) having lived continuously in Luohu District, Shenzhen, for at least 1 year; (3) possessing basic language communication abilities and being able to understand the survey content and complete the questionnaire independently or with assistance from trained investigators; (4) voluntarily agreeing to participate in the study and providing written informed consent. Participants were excluded if they: (1) had a physician-confirmed diagnosis of severe cognitive impairment or dementia that precluded completion of the questionnaire; (2) were experiencing an acute episode of a psychiatric disorder or an acute phase of a severe physical illness at the time of the survey; (3) refused to continue participation during the survey or provided questionnaires with substantial missing or invalid responses.
Sample size estimation
The sample size was estimated based on the expected prevalence of depressive symptoms among older adults. Previous studies have reported a prevalence of depressive symptoms of approximately 37.93% among community-dwelling older adults in China [24]. Using the single-proportion sample size estimation formula: n=Z21−α/2×p (1-p)/d2, where Z1−α/2 was set at 1.96 corresponding to a two-sided significance level of α = 0.05, p represented the expected prevalence (0.3793), and d was set at 0.035 as the acceptable margin of error. Based on these parameters, the minimum required sample size was estimated to be approximately 665 participants. Assuming a 15% non-response or invalid questionnaire rate, the target sample size was set at 768 participants. In total, 1,000 questionnaires were distributed. After excluding questionnaires with incomplete or invalid responses, 961 valid questionnaires were retained for analysis, yielding an effective response rate of 96.1%.
Ethical considerations
This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of Luohu People’s Hospital, Shenzhen (Approval No.2024-LHQRMYY-KYLL-071). All participants were fully informed about the study objectives, procedures, and potential risks prior to participation and provided written informed consent.
Measures
Demographic characteristics and health status
Self-designed questionnaire was used to collect demographic and health-related information. The following variables were assessed: age, sex, marital status, educational level, length of residence in the local area, living arrangement, frequency of contact with children (or close relatives), current primary status (e.g., retired or working), monthly disposable income, type of medical insurance, self-rated health status, number of chronic conditions, history of falls in the past year, physical activity habits prior to the National Games.
Assessment of depressive symptoms (GDS-5)
Depressive symptoms were assessed using the 5-item Geriatric Depression Scale (GDS-5) [25]. The scale consists of five dichotomous (yes/no) items, with a total score ranging from 0 to 5, where higher scores indicate more severe depressive symptoms. Consistent with previous studies, a cutoff score of ≥ 2 was used to indicate the presence of depressive symptoms [26, 27]. GDS-5 scale has been widely used in the elderly population of different cultural backgrounds and has shown good applicability [28, 29]. In the present study, the internal consistency of the GDS-5 was good, with a Cronbach’s α of 0.881.
Perceived health exposure to the mega sporting event
Perceived health exposure to the mega sporting event was developed for the present study as a context-specific questionnaire-based measure, informed by relevant literature on sporting events and health promotion and guided by the social ecological framework. Item generation was based on prior empirical work and refined through consultation with public health researchers, community health professionals, and frontline community practitioners to ensure relevance and clarity for older adults. The index consists of five items covering three conceptually relevant aspects: information and media exposure (one item), perceived health-promoting atmosphere (two items), and perceived personal participation and behavioral change (two items). The five items were as follows: (1) “In the past month, how often did you obtain information about the 15th National Games through television, the internet, or community publicity?” (2) “During the National Games, I felt that the overall atmosphere for physical activity and health promotion in the city became stronger.” (3) “The National Games increased my awareness of the importance of physical activity for health.” (4) “The National Games motivated me to participate more frequently in physical activity.” (5) “The National Games encouraged me to adopt healthier daily behaviors (e.g., exercise, outdoor activities, or reducing sedentary time).” All items were rated on a 5-point Likert scale (1 = strongly disagree/never, 5 = strongly agree/almost daily). The complete English version of this index is provided in Supplementary S1. The overall score was calculated as the mean of the five items, with higher scores indicating stronger perceived health-promoting effects of the National Games. To assess internal consistency and basic structural suitability for analytical purposes, exploratory factor analysis was conducted. The KMO measure of sampling adequacy was 0.827, and Bartlett’s test of sphericity was statistically significant (χ2 = 1051.373, df = 10, P < 0.001), indicating that the data were suitable for factor analysis. The internal consistency of the five-item index was acceptable, with a Cronbach’s α of 0.770. Given that this measure was designed to support mechanism-oriented analysis rather than formal scale development, confirmatory factor analysis was not pursued.
Assessment of physical activity level (PARS-3)
Physical activity level was measured using the Physical Activity Rating Scale–3 (PARS-3), revised by Liang Deqing [30]. The scale assesses physical activity from three dimensions: exercise intensity, duration, and frequency. The total physical activity score was calculated using the following formula: Physical activity score=intensity×duration×frequency. The total score ranges from 0 to 100, with scores ≤ 19 indicating low physical activity, scores of 20–42 indicating moderate physical activity, and scores ≥ 43 indicating high physical activity. The PARS-3 has been widely used in older adult populations and college students [31, 32]. In the present study, the Cronbach’s α coefficient for the PARS-3 was 0.864.
Assessment of loneliness (UCLA-3)
Loneliness was assessed using the 3-item version of the UCLA Loneliness Scale (UCLA-3) [33]. The scale consists of three items, each scored from 1 to 3, yielding a total score ranging from 3 to 9, with higher scores indicating greater loneliness. The UCLA-3 has been widely used in older adult populations and demonstrates acceptable psychometric properties [34, 35]. In the present study, the internal consistency reliability of the UCLA-3 was acceptable, with a Cronbach’s α of 0.903.
Data collection and quality control
Data were collected using face-to-face structured interviews conducted by trained investigators at community health service centers. Prior to data collection, all investigators received standardized training to ensure consistent understanding of questionnaire items and uniform administration procedures. During the survey, completed questionnaires were checked on site to identify missing responses or logical inconsistencies, which were corrected or supplemented promptly when necessary. All data were entered using a double-entry procedure by two independent data clerks. After data entry, consistency checks and logical validation were performed to ensure data accuracy and completeness.
Statistical analysis
Statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA) and the PROCESS macro. Continuous variables were summarized as means ± standard deviations (SD), while categorical variables were presented as frequencies and percentages. Comparisons between participants with and without depressive symptoms were conducted using independent-samples t tests for continuous variables and χ2 tests for categorical variables. Pearson correlation analyses were performed to examine the relationships among perceived health exposure to the National Games, physical activity, loneliness, and depressive symptoms. A chain mediation model was constructed using PROCESS Model 6 to examine whether physical activity and loneliness sequentially mediated the association between perceived health exposure to the National Games and depressive symptoms. The bootstrap method with 5,000 resamples was applied to estimate indirect effects. Mediation effects were considered statistically significant if the 95% confidence interval (CI) did not include zero. A two-sided α level of 0.05 was used, and P < 0.05 was considered statistically significant.
Results
Characteristics of the study population and univariate analysis
961 community-dwelling older adults were included in the final analysis, of whom 258 (26.85%) met the criteria for depressive symptoms according to the GDS-5. Table 1 and Table S1 (seen in Supplementary S2) presents the demographic characteristics of the study population and the results of univariate analyses comparing participants with and without depressive symptoms.
Table 1.
Key baseline characteristics of participants by depressive symptoms status
| Variable | Category | No depression (n = 703) |
Depression (n = 258) | Total n (%) | χ²/t | P |
|---|---|---|---|---|---|---|
| Age (years) | 60–64 | 218 (31.01) | 46 (17.83) | 264 (27.47) | 44.230 | < 0.001 |
| 65–69 | 225 (32.01) | 58 (22.48) | 283 (29.45) | |||
| 70–74 | 111 (15.79) | 53 (20.54) | 164 (17.07) | |||
| 75–79 | 79 (11.24) | 49 (18.99) | 128 (13.32) | |||
| 80–85 | 70 (9.96) | 52 (20.16) | 122 (12.70) | |||
| Sex | Male | 328 (46.66) | 95 (36.82) | 423 (44.02) | 7.409 | 0.006 |
| Female | 375 (53.34) | 163 (63.18) | 538 (55.98) | |||
| Marital status | Unmarried | 41 (5.83) | 14 (5.43) | 55 (5.72) | 41.535 | < 0.001 |
|
Married /cohabiting |
531 (75.53) | 145 (56.20) | 676 (70.34) | |||
| Widowed | 109 (15.50) | 86 (33.33) | 195 (20.29) | |||
|
Divorced /separated |
22 (3.13) | 13 (5.04) | 35 (3.64) | |||
| Education level | No formal education | 100 (14.22) | 48 (18.60) | 148 (15.40) | 13.136 | 0.011 |
| Primary or below | 234 (33.29) | 97 (37.60) | 331 (34.44) | |||
| Junior high | 194 (27.60) | 76 (29.46) | 270 (28.10) | |||
| Senior high | 131 (18.63) | 28 (10.85) | 159 (16.55) | |||
| College or above | 44 (6.26) | 9 (3.49) | 53 (5.52) | |||
| Monthly disposable income (CNY) | < 2000 | 188 (26.74) | 89 (34.50) | 277 (28.82) | 15.001 | 0.005 |
| 2000–3999 | 209 (29.73) | 88 (34.11) | 297 (30.91) | |||
| 4000–5999 | 169 (24.04) | 54 (20.93) | 223 (23.20) | |||
| 6000–7999 | 86 (12.23) | 18 (6.98) | 104 (10.82) | |||
| ≥ 8000 | 51 (7.25) | 9 (3.49) | 60 (6.24) | |||
| Living arrangement | Living alone | 75 (10.67) | 52 (20.16) | 127 (13.22) | 15.962 | 0.003 |
| With spouse | 322 (45.80) | 104 (40.31) | 426 (44.33) | |||
| With children | 211 (30.01) | 75 (29.07) | 286 (29.76) | |||
| With grandchildren/relatives | 64 (9.10) | 20 (7.75) | 84 (8.74) | |||
| With caregiver | 31 (4.41) | 7 (2.71) | 38 (3.95) | |||
| Contact with children/relatives | Almost daily | 445 (63.30) | 130 (50.39) | 575 (59.83) | 28.668 | < 0.001 |
| 1–2 times/week | 171 (24.32) | 60 (23.26) | 231 (24.04) | |||
| 1–3 times/month | 59 (8.39) | 43 (16.67) | 102 (10.61) | |||
| Rarely/none | 28 (3.98) | 25 (9.69) | 53 (5.52) | |||
| Self-rated health status | Very good | 60 (8.53) | 12 (4.65) | 72 (7.49) | 17.918 | 0.001 |
| Good | 215 (30.58) | 58 (22.48) | 273 (28.41) | |||
| Fair | 244 (34.71) | 90 (34.88) | 334 (34.76) | |||
| Poor | 145 (20.63) | 73 (28.29) | 218 (22.68) | |||
| Very poor | 39 (5.55) | 25 (9.69) | 64 (6.66) |
Note: Values are presented as n (%). Depression was defined based on the study-specific cutoff. P values were calculated using chi-square tests
The prevalence of depressive symptoms differed significantly across age groups, with higher proportions observed among participants aged 70 years and older (P < 0.001). Sex differences were also evident, with depressive symptoms being more common among women than men (P = 0.006). Regarding marital status, participants who were widowed or divorced/separated showed a significantly higher prevalence of depressive symptoms compared with those who were married or cohabiting (P < 0.001). Educational attainment was inversely associated with depressive symptoms, with higher prevalence observed among participants with lower educational levels (P = 0.011). In contrast, length of residence in the local area was not significantly associated with depressive symptoms.
Living arrangement was significantly related to depressive symptoms (P = 0.003), with higher prevalence among participants living alone. In addition, less frequent contact with children or close relatives was strongly associated with depressive symptoms (P < 0.001). With respect to socioeconomic factors, monthly disposable income showed a significant association with depressive symptoms (P = 0.005), whereas current occupational status and type of medical insurance were not significantly related to depressive symptoms (P > 0.05).
Health-related characteristics were also associated with depressive symptoms. Participants reporting poorer self-rated health had a significantly higher prevalence of depressive symptoms (P = 0.001). Moreover, depressive symptoms were more common among those with a greater number of chronic conditions (P = 0.031) and among participants who had experienced falls in the past year (P = 0.005). Finally, participants who reported lower levels of physical activity prior to the National Games exhibited a significantly higher prevalence of depressive symptoms compared with those who exercised more regularly (P = 0.002).
Common method bias
To assess the potential impact of common method bias, Harman’s single-factor test was conducted using exploratory factor analysis including all measurement items. The results showed that 5 factors with eigenvalues greater than 1 were extracted, and the first unrotated factor accounted for 24.42% of the total variance, which was below the commonly accepted threshold of 40%. These findings suggest that common method bias was not exist in the present study.
Descriptive statistics and correlation analysis of key variables
Descriptive statistics for the main study variables are presented in Table 2. The mean score for depressive symptoms (GDS-5) was 1.00 ± 1.07. The mean scores for perceived health exposure to mega sporting event, physical activity, and loneliness were 3.11 ± 1.01, 33.71 ± 30.74, and 5.45 ± 1.64, respectively. Pearson correlation analyses based on mean scores were performed to examine the associations among perceived health exposure to the National Games, physical activity, loneliness, and depressive symptoms (Table 2). Perceived health exposure to mega sporting event was positively correlated with physical activity (r = 0.303, P < 0.001) and negatively correlated with loneliness (r=-0.134, P < 0.001) and depressive symptoms (r =-0.234, P < 0.001). Physical activity showed significant negative correlations with loneliness (r=-0.271, P < 0.001) and depressive symptoms (r=-0.546, P < 0.001). Loneliness was moderately and positively correlated with depressive symptoms (r = 0.497, P < 0.001).
Table 2.
Descriptive statistics and correlations for key variables
| Variable | Mean ± SD | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Perceived health exposure to mega sporting event | 3.11 ± 1.01 | — | |||
| Physical activity | 33.71 ± 30.74 | 0.303** | — | ||
| Loneliness | 5.45 ± 1.64 | -0.134** | -0.271** | — | |
| Depressive symptoms | 1.00 ± 1.07 | -0.234** | -0.546** | 0.497** | — |
Note: *P<0.05, **P<0.001
Chain mediation analysis of physical activity and loneliness
After adjustment for age, sex, education, income, marital status, self-rated health, and chronic disease, which were selected a priori based on previous literature and supported by univariate associations with depressive symptoms, a chain mediation model was specified to examine whether physical activity and loneliness statistically accounted for the association between perceived health exposure to the mega sporting event and depressive symptoms. The total effect of perceived health exposure on depressive symptoms was statistically significant (B = − 0.045, 95%CI: −0.058 to − 0.033). After inclusion of the proposed mediators, the direct effect remained statistically significant but was attenuated (B = − 0.014, 95%CI: −0.025 to − 0.004), which is consistent with partial mediation. Regarding indirect pathways, the total indirect effect was statistically significant (B = − 0.031, 95%CI: −0.039 to − 0.023), accounting for approximately 68.9% of the total effect. Specifically, three indirect paths were supported. Physical activity functioned as an independent indirect pathway linking perceived health exposure to the mega sporting event with depressive symptoms (B = − 0.021, 95%CI: −0.026 to − 0.016). Loneliness also constituted an independent indirect pathway between perceived health exposure to the mega sporting event and depressive symptoms (B = − 0.006, 95%CI: −0.012 to − 0.001). Significant sequential indirect association was observed, characterized by higher perceived health exposure being associated with higher physical activity, which was in turn associated with lower loneliness, and lower loneliness being associated with fewer depressive symptoms (B = − 0.004, 95%CI:−0.006 to − 0.003). In the regression models underlying the chain mediation analysis, perceived health exposure to the mega sporting event showed a significant positive association with physical activity (B = 1.624, P < 0.001). Higher physical activity was significantly associated with lower loneliness (B = − 0.011, P < 0.001), while both lower physical activity (B = − 0.013, P < 0.001) and higher loneliness (B = 0.250, P < 0.001) were significantly associated with higher levels of depressive symptoms. All bootstrap confidence intervals were estimated using 5,000 resamples and did not include zero, supporting the robustness of the indirect associations. See Tables 3, 4 and Fig. 2 for details.
Table 3.
Regression analysis of the relationship between perceived health exposure to mega sporting event and depressive symptoms
| Outcome variable | Predictive variable | R | R 2 | F | B | SE | t |
|---|---|---|---|---|---|---|---|
| Depressive symptoms | Perceived health exposure to mega sporting event | 0.342 | 0.117 | 15.807** | −0.045 | 0.006 | −7.033** |
| Physical activity | Perceived health exposure to mega sporting event | 0.328 | 0.107 | 14.328** | 1.624 | 0.187 | 8.665** |
| Loneliness | Perceived health exposure to mega sporting event | 0.288 | 0.083 | 9.543** | −0.025 | 0.011 | −2.399* |
| Physical activity | −0.011 | 0.002 | −6.032** | ||||
| Depressive symptoms | Perceived health exposure to mega sporting event | 0.656 | 0.430 | 71.669** | −0.014 | 0.005 | −2.601* |
| Physical activity | −0.013 | 0.001 | −13.940** | ||||
| Loneliness | 0.250 | 0.017 | 15.069** |
Note: Controlled for age, sex, education, income, marital status, self-rated health, and chronic disease. *P<0.05, **P<0.001
Table 4.
Chain mediation analysis of the association between perceived health exposure to the National Games and depressive symptoms
| Effect type | Path | Effect (B) | Boot SE | 95% Boot CI | Proportion (%) |
|---|---|---|---|---|---|
| Total effect | X → Y | −0.045 | 0.007 | [−0.058,−0.033] | - |
| Direct effect | X → Y | −0.014 | 0.005 | [−0.025,−0.004] | 31.1 |
| Indirect (total) | — | −0.031 | 0.004 | [−0.039,−0.023] | 68.9 |
| Indirect 1 | X → M1 → Y | −0.021 | 0.003 | [−0.026,−0.016] | 46.7 |
| Indirect 2 | X → M2 → Y | −0.006 | 0.003 | [−0.012,−0.001] | 13.3 |
| Indirect 3 | X → M1 → M2 → Y | −0.004 | 0.001 | [−0.006,−0.003] | 8.9 |
Note: X: Perceived health exposure to mega sporting event; M1: Physical activity; M2:Loneliness; Y: Depressive symptoms
Fig. 2.
Mediation model of physical activity and loneliness between perceived health exposure to mega sporting event and depressive symptoms
Sensitivity analysis
To assess the robustness of the serial mediation findings, a sensitivity analysis was conducted by redefining depressive symptoms as a binary outcome based on the established cutoff, and the serial mediation model was re-estimated using logistic regression within the PROCESS framework (Model 6). Table 5 indicated that the direct association between perceived health exposure to the mega sporting event and depressive symptoms remained statistically significant. In addition, the total indirect effect through the mediating variables was significant, with the bootstrap confidence interval excluding zero. All three specific indirect pathways, including those through physical activity, loneliness, and their sequential combination, remained statistically significant and showed consistent directional effects compared with the main analysis based on continuous depressive symptom scores. Taken together, these results support the robustness of the observed indirect association structure across different operationalizations of depressive symptoms, indicating that the findings are not sensitive to the choice of outcome scale.
Table 5.
Sensitivity analysis using dichotomous depressive symptoms as the outcome
| Effect type | Path | Effect (B, log-odds) | Boot SE | 95% Boot CI for B | OR = exp(B) | 95% Boot CI for OR |
|---|---|---|---|---|---|---|
| Direct effect | X → Y | -0.077 | 0.025 | [-0.125, -0.028] | 0.926 | [0.882, 0.973] |
| Indirect effect (total) | — | -0.180 | 0.027 | [-0.243, -0.134] | 0.835 | [0.784, 0.874] |
| Specific indirect 1 | X → M1 → Y | -0.136 | 0.0220 | [-0.186, -0.101] | 0.872 | [0.830, 0.904] |
| Specific indirect 2 | X → M2 → Y | -0.026 | 0.012 | [-0.051, -0.004] | 0.974 | [0.950, 0.996] |
| Specific indirect 3 | X → M1 → M2 → Y | -0.018 | 0.004 | [-0.027, -0.010] | 0.983 | [0.973, 0.990] |
Notes: Bootstrap resampling = 5,000 (percentile). All models adjusted for age, sex, education, income, marital status, self-rated health, and chronic disease. Estimates are on the log-odds scale; ORs were obtained by exponentiating coefficients and confidence limits. PROCESS does not provide a total effect model for dichotomous outcomes; therefore, only direct and indirect effects are reported. X: Perceived health exposure to mega sporting event; M1: Physical activity; M2:Loneliness; Y: Depressive symptoms
Discussion
The present study provides evidence that greater perceived health exposure to a mega sporting event was associated with fewer depressive symptoms among older adults. This association was statistically consistent across models and remained robust when depressive symptoms were analyzed using both continuous and dichotomized outcomes. Physical activity and loneliness were identified as key intervening variables in this association, operating as independent and sequential mediators within the analytical framework, suggesting a multi-level pattern linking event-related health perceptions with late-life mental health. Notably, nearly one-third of participants exhibited clinically relevant depressive symptoms, underscoring the substantial burden of depression in later life [36]. This prevalence is broadly consistent with existing epidemiological evidence and may reflect the accumulation of age-related stressors, including chronic disease burden [37], post-retirement role transitions [38], and progressive contraction of social networks [39]. Within this broader context, mega sporting events may represent underexplored population-level health-promoting environments that are associated with psychological well-being among older adults through behavioral and psychosocial correlates. Collectively, these findings extend prior research on physical activity and mental health by situating individual behaviors and psychosocial experiences within the context of a large-scale sporting event, and by highlighting the relevance of perceived event-related health exposure as a contextual correlate of mental health in aging populations.
Perceived health exposure to a mega sporting event was inversely associated with depressive symptoms among older adults, indicating that the mental health relevance of large-scale sporting events may be reflected primarily through perceived environmental and psychosocial pathways rather than direct participation. International evidence suggests that mega sporting events are often accompanied by short-term changes in public physical activity patterns, potentially related to heightened health promotion and increased visibility of active behaviors. For example, studies of the 2012 London Olympics reported a modest increase in physical activity among previously inactive populations that was limited in duration [40], while research on the Tokyo 2020 Olympics observed localized increases in sports participation without a nationwide effect [41].
Beyond behavioral indicators, mega sporting events have also been associated with enhanced subjective well-being among spectators, likely through shared social experiences and increased opportunities for interaction [42]. Such effects may extend beyond the event period when supported by ongoing community activities and use of public facilities [43]. From a socio-environmental perspective, older adults may be particularly sensitive to these contextual health signals. Compared with younger populations, later life is often characterized by reduced mobility and narrower activity spaces [44], accompanied by greater reliance on proximal community cues for emotional regulation and daily behavior [45]. In this context, an enriched health atmosphere, reflected in increased media exposure, community promotion, and visible collective engagement, may be perceived as a form of ambient social support that is associated with more favorable mental health profiles. This interpretation aligns with international evidence indicating that, among older adults, subjective perceptions of social and environmental cues are often more strongly related to mental health outcomes than objective environmental characteristics, particularly in urban community settings [46, 47].
The observed univariate association between habitual physical activity patterns and depressive symptoms underscores the importance of pre-existing behavioral contexts in late-life mental health. Older adults who engage more regularly in physical activity tend to exhibit lower psychological vulnerability, which may also shape how they perceive and respond to health-related cues in their environment [48]. In this sense, perceived sporting event–related health exposure is unlikely to operate in isolation, but rather within broader, established behavioral patterns. This interpretation suggests that perceived health exposure reflects a meaningful psychosocial context embedded in everyday behavior, rather than a spurious or purely situational correlate.
Beyond the primary association, mediation analyses suggested that physical activity and loneliness jointly accounted for the relationship between perceived sporting event–related health exposure and depressive symptoms through both independent and sequential pathways. Physical activity occupied a central position within this structure, functioning as both a direct mediator and a behavioral correlate linked to subsequent variation in loneliness. Among older adults, higher perceived health exposure to a major sporting event was associated with greater engagement in physical activity, which may reflect their heightened sensitivity to contextual health cues embedded in everyday social settings [49, 50]. Such cues may involve increased visibility of health-related messaging, greater salience of active lifestyles, and stronger perceptions that physical activity is socially valued. Higher levels of physical activity have been consistently associated with more favorable emotional regulation, potentially through neuroendocrine and inflammatory processes [51], as well as with enhanced daily structure and sense of purpose [52]. Loneliness also emerged as a key psychological correlate within this pathway. Stronger perceived health-related atmospheres surrounding a major sporting event were associated with greater feelings of collective engagement and social inclusion, even in the absence of direct participation [53]. Among older adults, such subjective experiences have been linked to lower levels of social withdrawal and reduced vulnerability to depressive symptoms [54, 55].
From a social ecological perspective, mega sporting events can be understood as salient social phenomena that convey health-related norms and cues, which are perceived and interpreted by individuals within their immediate social context. For older adults, whose daily activities and behavioral choices are often more closely shaped by proximal social signals, perceived exposure to a major sporting event may heighten the salience of health-oriented norms and active lifestyles [56]. From the perspective of conservation of resources theory, engagement in physical activity associated with such perceived health signals may be viewed as an initial gain of health-related and psychosocial resources. These initial gains can support the accumulation of additional resources, particularly those related to social connection and emotional support, which are central to emotional well-being in later life [57]. In this context, lower levels of loneliness may reflect a reduced perception of social resource loss, a factor closely linked to depressive symptoms among older adults [58]. Taken together, these findings suggest that the mental health relevance of perceived sporting event–related health exposure lies primarily in how older adults interpret and internalize health-related social signals, rather than in direct or objective environmental modification. This interpretation is consistent with international research applying social ecological and resource-based frameworks to explain the role of perceived social and environmental context in late-life mental health, while extending this literature to the setting of mega sporting events and perceived health exposure [59, 60].
The findings of this study have important public health implications for mental health promotion among older adults in the context of mega sporting events. Although some associations observed at the individual level were modest in magnitude, their potential relevance becomes more pronounced when considered at the population level. Mega sporting events, rather than functioning as clinical interventions, may serve as contextual social phenomena that coincide with strengthened health-oriented community signals, greater salience of active lifestyles, and enhanced opportunities for social engagement. This perspective extends the concept of health legacy beyond physical infrastructure to encompass psychosocial and behavioral dimensions that are particularly relevant in later life. From a policy perspective, the potential mental health relevance of sporting events may be more fully realized when such events are intentionally aligned with community-based health promotion efforts. Enhancing the visibility of age-appropriate physical activity programs, improving access to public spaces, and incorporating social participation elements into event-related initiatives may help sustain health-related behaviors and psychosocial engagement beyond the event period. In rapidly aging urban settings, coordinating large-scale sporting events with community mental health objectives may represent a feasible and scalable approach to supporting healthy aging by leveraging existing social and environmental resources.
Several strengths of this study warrant consideration. The robustness of the findings is supported by consistent results across multiple analytic approaches, including models using both continuous and dichotomized depressive outcomes, as well as parallel and serial mediation structures. The convergence of these results enhances confidence in the stability and internal coherence of the proposed pathways. In addition, the study was guided by an explicit theoretical framework integrating the social ecological systems model and conservation of resources theory, which strengthened the interpretability of the mediation mechanisms and reduced the risk of data-driven inference. Furthermore, by focusing on perceived health exposure to a mega sporting event, the study extends existing research through an emphasis on subjective environmental experience within a real-world community context, particularly among older adults who may be more responsive to social and environmental cues. Several limitations should also be acknowledged. The cross-sectional design precludes causal inference regarding the observed associations, and alternative explanations cannot be fully ruled out. Although baseline physical activity habits were statistically controlled, residual confounding related to long-term behavioral patterns may still exist. Reverse association is also possible, whereby depressive symptoms influence individuals’ perceptions of event-related health exposure rather than the opposite direction. In addition, perceived health exposure to the mega sporting event was assessed using a brief, context-specific questionnaire based on self-reported perceptions rather than a standardized scale, which may introduce reporting bias. Moreover, participants were recruited from a single urban district in Shenzhen, which may limit the generalizability of the findings to other regions, particularly rural areas or settings with different levels of community infrastructure and exposure to large-scale sporting events. Future studies employing multi-site longitudinal or quasi-experimental designs are warranted to strengthen causal inference and assess the broader applicability of these findings. In particular, repeated assessments conducted before, during, and after major sporting events across different cities and regions would help clarify temporal dynamics and support the further development and validation of standardized measures of perceived event-related health exposure.
Conclusion
Perceived health exposure to a mega sporting event was associated with fewer depressive symptoms among older adults through interconnected behavioral and psychosocial pathways. Physical activity and loneliness were identified as key mechanisms linking event-related health perceptions to mental well-being, highlighting the relevance of subjective community context in later life mental health. These findings suggest that older adults’ perceptions of event-related health atmospheres, information exposure, and behavioral salience are meaningfully related to psychological well-being. Aligning mega sporting events with community-based health promotion initiatives may represent a feasible and scalable strategy to support healthy aging.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Acknowledgements
The authors are deeply grateful to all participants and field staff for their essential contributions to the baseline data collection.
Author contributions
BG and DH conceived the study and designed the overall research framework. FY, HY, QT, and XZ were responsible for data collection and field coordination. YS and KL conducted the statistical analyses and processed the study data. BG drafted the manuscript. MZ provided academic guidance on study design and interpretation of findings. PT contributed clinical expertise and supervised the implementation of the study in community and primary care settings. YL provided institutional support and strategic oversight of the research process. DH served as the corresponding author and was responsible for overall supervision, funding acquisition, and project administration. All authors reviewed and approved the final manuscript.
Funding
This work was supported by: the Shenzhen Medical Research Fund (grant number B2503004); the National Natural Science Foundation of China (grant number 82273707 and 82373675); the Natural Science Foundation of Guangdong Province (grant number 2024A1515010972); the Program for Youzuzhikeyan of Shenzhen University (grant number SZU2024YZZKY001); the Science and Technology Development Foundation of Shenzhen (grant number JCY20240813143014019); the Shenzhen Philosophy and Social Sciences Planning Project (No.SZ2024C018); Shenzhen Key Medical Discipline Construction Fund (No.SZXK062); and Hospital management research project of Shenzhen Luohu District People’s Hospital (YYGL2026001).
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy restrictions and confidentiality agreements.
Declarations
Ethical statement
This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of Luohu People’s Hospital, Shenzhen (Approval No.2024-LHQRMYY-KYLL-071). All participants were fully informed about the study objectives, procedures, and potential risks prior to participation and provided written informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Yu Liu, Email: yuliu890130@163.com.
Ping Tang, Email: lhyytp@163.com.
Dongsheng Hu, Email: dongshenghu563@126.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy restrictions and confidentiality agreements.