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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences logoLink to The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
. 2021 Aug 13;77(11):2137–2147. doi: 10.1093/geronb/gbab153

Depressive Symptoms, Leisure Activity Engagement, and Global Cognition in Non-Hispanic Black and White Older Adults

Neika Sharifian 1, Ketlyne Sol 2, Afsara B Zaheed 3, Emily P Morris 4, Jordan D Palms 5, Alexa G Martino 6, Laura B Zahodne 7,✉
Editor: Alyssa Gamaldo
PMCID: PMC9683487  PMID: 34387343

Abstract

Objectives

Prior research indicates that depressive symptoms disproportionately affect cognition in non-Hispanic Blacks relative to non-Hispanic Whites. Depressive symptoms have been linked to worse global cognition in older adulthood through lower leisure activity engagement, but less is known regarding the distinct types of activities that drive these associations and whether associations involving depressive symptoms, leisure activities, and cognition differ across racial groups.

Methods

This cross-sectional study used data from the Michigan Cognitive Aging Project (n = 453, 52.80% Black, Mage = 63.60 years). Principal components analysis identified 6 subtypes of leisure activities (cognitive, creative, community, physical, children, and games). Mediation models examined whether distinct leisure activity subtypes mediated the association between depressive symptoms and performance on a comprehensive neuropsychological battery and whether race moderated these associations.

Results

There were no racial differences in the level of depressive symptoms after adjusting for sociodemographic, socioeconomic, and health covariates. Only lower cognitive activity engagement mediated the negative association between depressive symptoms and global cognition. Multigroup models revealed that this indirect effect was only evident in Blacks, who showed a stronger negative association between depressive symptoms and cognitive activity engagement than Whites. After accounting for indirect effects, a direct effect of higher depressive symptoms on worse cognition remained and did not differ across racial groups.

Discussion

Depressive symptoms may disproportionately affect cognition among Blacks through a greater negative impact on engagement in cognitively stimulating activities that have been shown to promote cognitive reserve. Additional research is necessary to identify other mechanisms linking depressive symptoms and cognition.

Keywords: Activity engagement, Cognitive aging, Depressive symptoms, Race disparities

Later-life depressive symptoms are a salient risk factor for worse cognitive functioning (Brewster et al., 2017; Zahodne et al., 2014), mild cognitive impairment, and dementia (Richard et al., 2013). For instance, an examination of population-attributable risk of Alzheimer’s disease (AD) in 2010 found that 8% of the cases of AD worldwide may be attributable to depression (Norton et al., 2014). Further, the impact of depressive symptoms on cognitive functioning appears to be stronger for Black older adults (Zahodne, Nowinski, et al., 2014), who also show disproportionate dementia risk (Tang et al., 2001), compared with White older adults. As depressive symptoms represent a modifiable psychosocial factor that contributes to cognitive health, a better understanding of the pathways through which depressive symptoms influence cognitive health in different racial groups may help to guide more targeted interventions to optimize cognitive aging and reduce racial disparities. Therefore, the current study aimed to investigate potential behavioral pathways that may link depressive symptoms and cognition in non-Hispanic Black (hereafter “Black”) and non-Hispanic White (hereafter “White”) older adults.

The Mediating Role of Leisure Activities

Reduced engagement in leisure activities may be one pathway through which depressive symptoms affect later-life cognition. Indeed, prior research has linked more depressive symptoms to less leisure activity engagement (Holtfreter et al., 2017; Sharifian et al., 2020; Watts et al., 2018). For example, in a longitudinal study, depressive symptoms were prospectively linked to reduced physical activity, but not vice versa, suggesting that depressive symptoms may act as a barrier to physical activity in older adulthood (Watts et al., 2018). Informed by motivational intensity theory (Brehm & Self, 1989), depressive symptoms may reduce engagement in leisure activities through reduced perceptions of the intrinsic value of activities and/or increased perceptions of task difficulty. Prior research has shown that greater depressive symptoms increased controlled motivation (i.e., external, introjected) but reduced intrinsic motivation for physical activity (Scarapicchia et al., 2014), which may also extend to cognitive and social activities.

Less engagement in leisure activities may, in turn, negatively affect cognitive functioning. Indeed, prior research has linked higher overall leisure activity engagement to better cognitive functioning and lower risk of AD (Crowe et al., 2003; Niti et al., 2008; Scarmeas et al., 2001; Sharifian et al., 2020). When broken down by activity type, leisure activities that would typically be categorized as cognitively stimulating tend to have the strongest effect on later-life cognition relative to physical or social activities (Crowe et al., 2003; Niti et al., 2008; Scarmeas et al., 2001).

Distinct types of leisure activities may influence cognitive functioning through unique pathways (see review, Fratiglioni et al., 2004). In line with the cognitive reserve hypothesis (Stern, 2002), cognitively stimulating leisure activities may improve the efficiency, capacity, or redundancy of neural networks, thereby helping to preserve cognitive functioning in the face of neuropathology (Hassing, 2020; Niti et al., 2008) and reduce risk of AD (Crowe et al., 2003; Scarmeas et al., 2001). For example, in a cross-sectional study, associations between brain integrity and cognition were moderated by cognitive activity, such that individuals with greater cognitive activity engagement showed similar levels of global cognition, regardless of their level of brain integrity (Casaletto et al., 2020). Physically stimulating leisure activities have also been linked to better cognitive functioning in late life (Calamia et al., 2018; Casaletto et al., 2020; Sumic et al., 2007) and may benefit cognition through reduced development of age-related brain changes and pathology (i.e., brain maintenance), as well as increased brain volume (i.e., brain reserve; Mortimer & Stern, 2019). For example, in a randomized controlled trial examining the benefits of exercise for older adults, aerobic training was associated with increased hippocampal volume as well as greater serum levels of brain-derived neurotrophic factor, which is a mediator of neurogenesis in the dentate gyrus (Erickson et al., 2011). Cognitively protective effects of social activities may operate through both cognitive reserve and/or brain reserve pathways. For instance, prior research has shown that those with larger social networks show weaker associations between brain and cognitive health compared to those with smaller social networks (i.e., cognitive reserve; Bennett et al., 2006). Additionally, social support has been shown to buffer the detrimental neural and physiological effects of stress (Eisenberger et al., 2007), and may in turn promote brain reserve and brain maintenance. Because distinct types of leisure activities may influence cognition through unique pathways, greater specificity in the types of leisure activities in studies of cognitive aging may help to refine future intervention research aimed at promoting cognition through increased activity engagement.

The Moderating Role of Race

Although prior research has linked depressive symptoms and cognitive functioning (Brewster et al., 2017; Zahodne et al., 2014), the strength of this association can vary depending on the characteristics and contexts of the individual. Self-identified race, in particular, is a proxy for a variety of sociocultural experiences that may influence the impact of depressive symptoms on cognitive health. Prior research has shown that the chronicity and functional impact of clinical depression (Williams et al., 2007) differ across White and Black adults. For example, clinical depression tends to be more disruptive (Stein et al., 2010) and follows a more persistent course (Williams et al., 2007) among African American and Caribbean Black adults compared with White adults, despite the observation that White adults have a greater prevalence of lifetime major depressive disorder than African American and Caribbean Black adults (Williams et al., 2007).

Few studies have investigated whether race may moderate the association between depressive symptoms and cognition. One cross-sectional study investigating racial differences in depressive symptoms–cognition associations in a national sample found that elevated depressive symptoms were more disruptive to cognitive functioning in African American older adults compared with White older adults (Zahodne, Nowinski, et al., 2014). Additional studies have found that more depressive symptoms are more consistently associated with poorer physical health indicators among Black adults relative to White adults, including cardiovascular disease (Lewis et al., 2011), dysregulated glucose metabolism (Boyle et al., 2007), and C-reactive protein (Deverts et al., 2010). Overall, these studies provide support for the notion that depressive symptoms may be more strongly associated with health outcomes, including cognition, in Black compared with White adults.

The Present Study

The current cross-sectional study had two primary goals. First, we aimed to examine whether specific subtypes of leisure activity engagement mediated the association between depressive symptoms and cognitive functioning. Based on prior research (Sharifian et al., 2020; Watts et al., 2018), we hypothesized that more depressive symptoms would be associated with lower leisure activity engagement and, in turn, lower cognitive functioning. We specifically hypothesized that cognitively stimulating leisure activities would show the strongest association with cognitive functioning relative to social and physical activities because prior research has supported this claim (Crowe et al., 2003; Niti et al., 2008; Scarmeas et al., 2001). Second, the current study aimed to examine whether race moderated the associations between (a) depressive symptoms and leisure activity engagement and/or (b) depressive symptoms and cognitive functioning (see Figure 1). Based on prior research (Williams et al., 2007; Zahodne, Nowinski, et al., 2014), we hypothesized that depressive symptoms would have stronger negative associations with activity engagement and cognitive functioning in Black participants compared with White participants.

Figure 1.

Figure 1.

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Conceptual figure of leisure activity engagement mediation and race moderation.

Method

Participants and Procedure

Data were obtained from participants from the Michigan Cognitive Aging Project (MCAP). MCAP is an ongoing longitudinal study that started in 2017 and follows adults from Southeast Michigan aged 55 and older. Although MCAP is an ongoing longitudinal study, only baseline data were available at the time of this study and, therefore, the current project is cross-sectional. To date, 500 participants have been recruited using address-based sampling, targeting census tracts with high sociodemographic diversity, supplemented by respondent-driven sampling. As the current study aimed to examine racial differences, 36 participants who self-identified as Hispanic or any other race besides non-Hispanic White or non-Hispanic Black were excluded. Additionally, 11 participants were excluded due to missing sociodemographic or health variables. Therefore, the final sample included 453 White or Black participants (52.80% Black, and 59.60% female) who were, on average, 63.60 years old (SD = 3.16) (see Table 2).

Table 2.

Descriptive Statistics of Variables of Interest

Whole sample (n = 453) Non-Hispanic White (n = 214) Non-Hispanic Black (n = 239)
M or % SD M or % SD M or % SD Unadjusted differences
Age 63.60 3.16 63.71 3.21 63.51 3.12 NHW = NHB
% Female 59.60 — 56.50 — 62.30 — NHW = NHB
Education (years) 14.20 2.61 15.21 2.46 13.30 2.40 NHW > NHB
Total yearly income (dollars) 51,372.03 72,226.49 73,161.46 89,788.91 31,861.84 43,392.83 NHW > NHB
Health problems (0–9) 2.96 1.73 2.58 1.65 3.31 1.74 NHW < NHB
Depressive symptoms (0–30) 8.15 6.07 6.91 5.76 9.27 6.15 NHW < NHB
Cognitive (1–7) 4.47 1.43 5.10 1.15 3.91 1.43 NHW > NHB
Creative (1–7) 3.06 1.29 3.53 1.28 2.64 1.39 NHW > NHB
Community (1–7) 2.20 0.89 2.33 0.89 2.09 0.88 NHW > NHB
Physical (1–7) 4.43 1.72 4.79 1.63 4.11 1.73 NHW > NHB
Children (1–7) 2.66 1.30 2.36 1.20 2.91 1.34 NHW < NHB
Games (1–7) 3.21 1.59 3.12 1.50 3.30 1.66 NHW = NHB
Global cognition 0.01 0.96 0.58 0.74 −0.52 0.82 NHW > NHB
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Notes: NHB = non-Hispanic Black; NHW = non-Hispanic White. ANOVAs were conducted to examine racial differences in baseline sample characteristics. Less than and greater than symbols indicate significant differences, whereas equal signs indicate nonsignificant differences.

Measures

Depressive Symptoms

Depressive symptoms were measured using a 10-item version of the Center for Epidemiological Studies-Depression (CES-D) scale (Radloff, 1977). Items, such as “I felt depressed” and “I had trouble keeping my mind on what I was doing,” were rated on a 4-point Likert-type scale ranging from Rarely or none of the time (less than 1 day) (0) to Most or all of the time (5–7 days) (3). Positively worded items were reverse-scored. Items were summed and higher scores represented more depressive symptoms.

Leisure Activity Engagement

Leisure activities were self-reported by participants and consisted of 21 items from a lifestyle activities questionnaire (Smith et al., 2013). Participants indicated the frequency with which they participated in each activity over the past month, ranging from Daily (1) to Never/Not Relevant (7). Items were reverse-scored so that higher scores represented more frequent activity engagement.

In order to reduce analytic complexity and to create a more parsimonious model of leisure activity engagement, a principal components analysis (PCA) was conducted. Consistent with prior research (Crowe et al., 2003; Hassing, 2020), an oblique rotation (i.e., direct oblimin) was used to allow intercorrelation among the components. Results from the PCA are summarized in Table 1, showing the highest loading for each item. Six components were identified to have an eigenvalue greater than one: (a) cognitive, (b) community, (c) physical, (d) children, (e) games, and (f) creative. Consistent with prior research using the same measure (Kim et al., 2021), three items that did not adequately load on any of the six components were excluded: watch TV, private prayer, and care for a sick or disabled adult. Items that loaded onto each of the six components were averaged, and higher scores represented greater activity engagement.

Table 1.

Standardized Loadings for Principal Components Analysis of Leisure Activities

Components
Items Cognitive Community Physical Children Games Creative
Use a computer for e-mail, internet, or other tasks? 0.80
Do home or care maintenance or gardening? 0.55
Do writing (such as letters, stories, or journal entries)? 0.52
Read books, magazines, or newspapers? 0.48
Attend meetings or nonreligious organizations, such as political, community, or other interest groups? 0.71
Attend an educational or training course? 0.70
Do any other volunteer or charity work? 0.64
Participate in a local community arts group such as choir, dance, photography, theater, or music group? 0.57
Go to a sport, social, or other club? 0.48
Walk for 20 min or more? −0.82
Play sports or exercise? −0.69
Do activities with grandchildren, nieces/nephews, or neighborhood children? 0.83
Do volunteer work with children or young people? 0.69
Play cards or games such as chess? 0.81
Do word games such as crossword puzzles or scrabble? 0.71
Make clothes, knit, embroider, etc.? 0.73
Bake or cook something special? 0.67
Work on a hobby or project? 0.48
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Cognition

Cognition was measured with a comprehensive neuropsychological battery. A prior factor analysis identified five cognitive domains (Zahodne, in press): episodic memory, executive functioning, processing speed, language, and visuospatial functioning (see Supplementary Table 1 for specific measures). As cognitive domains were highly correlated (0.80 < r < 0.98) and we did not have a priori hypotheses regarding domain-specific effects, factor scores were z-scored and then averaged across the five domains to represent global cognition, which demonstrated good internal consistency (α = 0.98).

Race

Race was self-identified and represented by two mutually exclusive groups: non-Hispanic Black and non-Hispanic White participants (White as the reference group).

Covariates

This study controlled for age, sex/gender, race, education, income, and physical health problems. Age was calculated from the participant’s birthdate and date of study visit and was continuous. Sex/gender was self-reported. Because no participants reported sex/gender other than male or female, it was represented by a binary variable with men as the reference group. Education was represented by self-reported years of education completed. Income was represented as total yearly household income and was represented as a continuous variable. Physical health problems were represented by the sum of nine health problems: high blood pressure, chronic lung disease, diabetes, cancer, heart attack, high cholesterol, eye problems, hip fracture, and arthritis.

Analytic Strategy

Descriptive statistics, correlations, and group comparisons were conducted using IBM SPSS (Version 27), and mediation models were conducted in Mplus (Version 8.5). Initially, a mediation model examined whether activity engagement (cognitive, creative, community, physical, children, and games) mediated the relationship between depressive symptoms and global cognition. Exposure, mediator, and outcome variables were regressed onto all covariates, and therefore, model fit was perfect. Activity domains were allowed to covary.

Subsequently, multiple-group mediation models were conducted to assess whether race moderated associations between depressive symptoms and activity engagement or between depressive symptoms and global cognition (see Figure 1). All pathways were first constrained to be the same across White and Black participants (i.e., fixed model). Next, paths were individually freed one at a time allowing variation across White and Black participants. The chi-square difference between each pair of fixed and freed models was calculated to determine whether a particular parameter differed across the two groups based on alpha = 0.05.

Results

Descriptive statistics across White and Black participants are reported in Table 2. Results from ANOVAs examining unadjusted racial differences across variables of interest are also summarized in Table 2. Compared with White participants, Black participants evidenced more depressive symptoms (F(1, 450) = 17.61, p < .001, η 2 = 0.04), lower cognitive activity engagement (F(1, 450) = 93.47, p < .001, η 2 = 0.17), lower creative activity engagement (F(1, 447) = 61.78, p < .001, η 2 = 0.12), lower community activity engagement (F(1, 429) = 7.52, p = .006, η 2 = 0.02), lower physical activity engagement (F(1, 422) = 17.21, p < .001, η 2 = 0.04), higher engagement in activities involving children (F(1, 426) = 19.73, p < .001, η 2 = 0.04), and lower global cognitive functioning (F(1, 441) = 220.37, p < .001, η 2 = 0.33).

There were no longer racial differences in the levels of depressive symptoms (F(1, 445) = 2.82, p = .094, η 2 = 0.01), community activity engagement (F(1, 424) = 0.04, p = .849, η 2 = 0.00), or physical activity engagement (F(1, 417) = 2.77, p = .097, η 2 = 0.01) after adjusting for covariates (age, sex/gender, education, income, and health), but racial differences in cognitive activity engagement (F(1, 445) = 31.43, p < .001, η 2 = 0.07), creative activity engagement (F(1, 442) = 46.84, p < .001, η 2 = 0.10), activities involving children (F(1, 428) = 19.31, p < .001, η 2 = 0.04), and global cognition (F(1, 436) = 129.01, p < .001, η 2 = 0.23) remained in adjusted analyses. No significant racial differences were found for games in unadjusted (F(1, 450) = 1.50, p = .222, η 2 = 0.003) or adjusted models (F(1, 445) = 2.77, p = .097, η 2 = 0.01). Unadjusted and adjusted racial differences for individual items of the CES-D are shown in Supplementary Table 2.

Aim 1: Mediation Model

More depressive symptoms were associated with lower cognitive (β = −0.16, SE = 0.04, p < .001) and creative (β = −0.15, SE = 0.05, p = .001) activity engagement. Depressive symptoms were not associated with engagement in community activities (β = −0.07, SE = 0.05, p = .136), physical activities (β = −0.05, SE = 0.05, p = .310), activities involving children (β = 0.00, SE = 0.05, p = .955), or games (β = −0.07, SE = 0.05, p = .169).

Higher engagement in cognitive activities (β = 0.22, SE = 0.04, p < .001) and games (β = 0.11, SE = 0.03, p = .001) were both independently associated with better global cognition. Engagement in creative activities (β = 0.02, SE = 0.04, p = .560), community activities (β = −0.01, SE = 0.04, p = .732), physical activities (β = −0.04, SE = 0.04, p = .273), and activities involving children (β = −0.004, SE = 0.04, p = .917) were not associated with global cognition.

A negative total effect of depressive symptoms was found on global cognition (standardized total effect = −0.15, SE = 0.04, p < .001). When examining indirect effects, only lower cognitive activity engagement mediated the negative association between depressive symptoms and global cognition (standardized indirect effect = −0.04, SE = 0.01, p = .002), accounting for approximately 27% of the overall association. No other leisure activity subtypes mediated this association (ps > .20). After accounting for covariates and the indirect effect of depressive symptoms through cognitive activity engagement, a direct effect of depressive symptoms remained (β = −0.10, SE = 0.04, p = .003). All covariate associations and intercorrelations between activities are reported in Supplementary Tables 3 and 4, respectively.

Aim 2: Moderated Mediation Model

In multigroup models, chi-square difference tests shown in Table 3 revealed that model fit improved when the association between depressive symptoms and cognitive activity engagement was unconstrained across groups. More depressive symptoms were associated with lower cognitive activity engagement in Black participants (β = −0.26, SE = 0.05, p < .001), but not in White participants (β = −0.06, SE = 0.06, p = .308). As a result, lower cognitive activity engagement partially mediated the negative association between depressive symptoms and global cognition for Black participants (standardized indirect effect = −0.06, SE = 0.02, p = .001) but not White participants (standardized indirect effect = −0.01, SE = 0.01, p = .319).

Table 3.

Fit Statistics for Multiple-Group Model by Race for Global Cognition

Model χ 2 ∆χ 2 p
Fully constrained model 99.67 — —
Depressive symptoms → Cognitive 90.30 9.37 .002
Depressive symptoms → Creative 98.36 1.31 .253
Depressive symptoms → Community 98.52 1.15 .283
Depressive symptoms → Physical 91.41 8.26 .004
Depressive symptoms → Child 99.26 0.41 .520
Depressive symptoms → Games 99.32 0.35 .552
Depressive symptoms → Global cognition 99.60 0.07 .796
Final adjusted model 83.93 15.74 .000
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Additionally, model fit improved when the association between depressive symptoms and physical activity engagement was unconstrained across groups. More depressive symptoms were associated with lower physical activity engagement for White participants (β = −0.18, SE = 0.07, p = .006), but not Black participants (β = 0.06, SE = 0.07, p = .403). Physical activity engagement, however, did not mediate the association between depressive symptoms and global cognition for either group due to the absence of an association between physical activity and global cognition (standardized indirect effect = 0.01, SE = 0.01, p = .352).

Model fit did not significantly improve when associations between depressive symptoms and all other leisure activities were systematically unconstrained. Similarly, model fit did not improve when the association between depressive symptoms and global cognition (i.e., direct effect) was unconstrained. Model fit of the final multigroup model was adequate, χ 2(66) = 83.83, Comparative Fit Index = 0.97, Root Mean Square Error of Approximation = 0.04 [0.00, 0.06], Standardized Root Mean square Residual = 0.05.

Sensitivity Analyses

Antidepressants may influence reported depressive symptoms and/or the behavioral and cognitive consequences of depressive symptoms. There may also be racial differences in access to antidepressant treatment. Therefore, the following sensitivity analyses were conducted: (a) exclusion of those who reported use of antidepressant medication, and (b) including antidepressant use as a binary covariate. Medication use was self-reported, and antidepressants were coded based on Food and Drug Administration-Approved Antidepressants (see Center for Medicare & Medicaid Services, 2015). Approximately 20% of the sample reported use of at least one antidepressant medication (n = 91), and a greater proportion of White older adults (25.70%) reported antidepressant use compared with Black older adults (15.10%). Across both sensitivity analyses, the pattern of findings was consistent with primary models.

Private prayer was not included in primary analyses because it did not adequately load onto any of the six leisure activity components, which is consistent with previous studies of leisure activities (e.g., Kim et al., 2021). However, private prayer may vary across race such that Black adults may be more likely to use prayer and spirituality (Taylor & Chatters, 2010). Therefore, we conducted sensitivity analyses including private prayer as an additional mediator in our models. In the initial mediation model (i.e., controlling for race), we found that depressive symptoms were not associated with private prayer (β = −0.02, SE = 0.05, p = .708), nor was private prayer associated with global cognition (β = −0.01, SE = 0.04, p = .846). Therefore, private prayer did not mediate the association between depressive symptoms and global cognition (standardized indirect effect = 0.00, SE = 0.00, p = .864). Subsequently, we conducted a sensitivity analysis in which we included private prayer as an additional mediator in the moderated mediation model and found an identical pattern of findings as in the primary moderated mediation model. Specifically, race moderated depressive symptoms–cognitive activity and depressive symptoms–physical activity associations, but not the association between depressive symptoms and private prayer (∆χ 2 = 1.801, p = .180).

Finally, in our primary models, global cognition was calculated as an average of five cognitive domain scores and and was modeled as an observed variable. As sensitivity analyses, we modeled global cognition (a) as a latent variable based on the original confirmatory factor analysis or (b) a latent variable based on a bifactor model. In both sensitivity analyses, the patterns of findings were identical to our primary model. Similarly, we examined whether representing depressive symptoms as a latent variable rather than the traditional CES-D sum variable influenced our pattern of findings and found an identical pattern of findings to our primary models.

Discussion

Expanding on prior research showing that Black older adults show stronger negative associations between depressive symptoms and cognition than White older adults (Zahodne et al., 2014) and that leisure activities mediate depressive symptom–cognition associations (Sharifian et al., 2020), the current study examined racial differences in links between depressive symptoms, distinct types of leisure activities, and global cognition. In a racially balanced sample, lower engagement in cognitive activities, but not other types of activities, was found to partially mediate the association between more depressive symptoms and worse global cognition. When examined across racial groups, this mediation effect was only found for Black older adults, who showed a stronger negative association between depressive symptoms and cognitive activity engagement than Whites. These results may help to explain the disproportionate cognitive impact of depressive symptoms among Black older adults and point to cognitively stimulating activities as a potential intervention target to reduce this disparity.

The Mediating Role of Distinct Leisure Activities

Although depressive symptoms were associated with lower engagement in both cognitive (e.g., reading, writing) and creative (e.g., hobbies, knitting) activities, only cognitive activities were associated with global cognition and therefore mediated the association between depressive symptoms and cognition in the initial model. While cross-sectional, these findings may suggest that depressive symptoms negatively affect cognition by decreasing engagement in cognitive activities that help to promote cognitive reserve (Casaletto et al., 2020). Games (e.g., crossword puzzles, chess) were also associated with better global cognition, consistent with prior research suggesting that activities categorized as cognitively stimulating tend to have stronger association with later-life cognition than social or physical activities (Crowe et al., 2003; Niti et al., 2008; Scarmeas et al., 2001). However, because depressive symptoms were not associated with games, this leisure activity subtype did not mediate associations between depressive symptoms and global cognition.

Our finding that depressive symptoms were only associated with more solitary activities (i.e., cognitive, creative) may relate to the level of intrinsic versus extrinsic motivation underlying participation in the different leisure activity subtypes. Intrinsic motivation is often affected by depression (Leibold et al., 2014; Winch et al., 2015) and may be more strongly associated with activities typically engaged in isolation (e.g., reading, writing, hobbies). For example, in a younger adult sample, more depressive symptoms were associated with less intrinsic motivation (i.e., perceived as less fun/enjoyable) for approach goals (Winch et al., 2015). In contrast, social and physical activities may rely more on extrinsic motivation. For instance, some evidence has suggested that while depressive symptoms are associated with reduced intrinsic motivation, they are also associated with increased controlled motivation (Scarapicchia et al., 2014). In other words, those with higher depressive symptoms experienced greater motivation due to external demands and rewards (external motivation) as well as internal pressures or to avoid guilt and shame (introjected motivation; Scarapicchia et al., 2014).

Prior qualitative research has found that depressed older adults report reducing their engagement in leisure activities due to the perception that these activities have lower intrinsic value (i.e., are not as meaningful), as well as lower physical and cognitive energy availability (Leibold et al., 2014). It is important to note, however, that the initial mediation model did not reveal associations between depressive symptoms and physical or social (i.e., community, children) activities. The lack of association between depressive symptoms and physical activity contrasts with prior prospective longitudinal studies (see review, Roshanaei-Moghaddam et al., 2009). Similarly, the lack of association between depressive symptoms and engagement in community activities (e.g., clubs, community organizations, etc.) or activities involving children (e.g., volunteering with children) contrasts with some evidence suggesting that depressed individuals restrict their social circles (Leibold et al., 2014) and report fewer social interactions (Holtfreter et al., 2017). These divergent findings may reflect methodological differences (cross-sectional vs longitudinal; less detailed measures of physical and social activity; racial diversity of samples). Further longitudinal research examining associations between depressive symptoms and domain-specific leisure activities may help clarify these findings.

Overall, results suggest that depressive symptoms are negatively associated with global cognition, in part, through lower cognitive activity engagement. After accounting for mediators and covariates, a direct effect of higher depressive symptoms on worse global cognitive functioning remained, indicating that activity engagement only partially explained the link between depressive symptoms and cognition. Future research is necessary to examine other potential mechanisms, such as other health-related behaviors (e.g., smoking, diet; Barros et al., 2017). Additionally, future research investigating the association between depressive symptoms and activity engagement would benefit from an explicit assessment of the types of motivation that drive engagement in distinct types of activity (i.e., intrinsic, extrinsic).

Racial Differences

The current study found that race moderated the indirect effect of depressive symptoms on global cognition through cognitive activities. Specifically, lower cognitive activity engagement only mediated the negative association between depressive symptoms and cognition among Black participants because higher depressive symptoms were only associated with lower cognitive activity engagement in Black older adults. This finding is consistent with prior research suggesting that depressive symptoms are more disruptive (Stein et al., 2010) and more strongly associated with worse cognitive (Zahodne et al., 2014) and physical (Boyle et al., 2007; Deverts et al., 2010; Lewis et al., 2011) health in Black adults compared with White adults.

One mechanism that may explain the more disruptive effect of depressive symptoms in Black older adults may be structural racism, which results in racial differences in access to and utilization of mental health care services. Even though Black adults show greater chronicity and severity of depression compared with White adults (González et al., 2010; Williams et al., 2007), prior research has consistently shown that Black adults are less likely than White adults to have access to any mental health care treatment (Alegría et al., 2008), receive psychotherapy or pharmacotherapy (González et al., 2010), and use complementary and alternative medicines (e.g., chiropractic, biofeedback, herbal therapy) for psychiatric disorders (Woodward et al., 2009). In line with these documented disparities, the current study showed that White older adults were more likely to report antidepressant use compared with Black older adults. It is important to note, however, that sensitivity analyses indicated that antidepressant use did not drive our pattern of findings.

Additionally, depressive symptoms may be more disruptive in Black older adults due to racially patterned stressors such as discrimination. Racial discrimination may reduce psychological resources available to buffer the detrimental effects of depressive symptoms on behavior and cognition. Indeed, prior research has shown racial discrimination is associated with lower perceived control, or the feeling that you have control over your life outcomes (Williams et al., 2012). Among older adults, lower perceived control has been associated with lower leisure activity engagement (Menec & Chipperfield, 1997). Thus, it is possible that the racial discrimination disproportionately experienced by Black adults depletes psychological resources such as perceived control that is needed to maintain cognitive activity engagement in the presence of depressive symptoms.

Finally, the associations between depressive symptoms, lower cognitive activity engagement, and worse cognition in Black adults may reflect other structural inequalities experienced throughout the life course that have implications for later-life cognitive activity engagement. For example, persistent racial disparities in educational quality could result in a later age at introduction to reading and/or lower access to a variety of high-quality cognitive activities among Black children. Racial differences in the built environment due to residential segregation may also contribute to racial inequalities in leisure activity participation (Galster & Sharkey, 2017). In the United States, Black individuals are less likely to have access to beneficial neighborhood resources (e.g., libraries, parks) compared with White individuals (Acevedo-Garcia et al., 2020), which may restrict engagement in cognitively stimulating activities. Indeed, Black individuals report more perceived constraints to participating in leisure activities than White individuals (Shores et al., 2007). Finally, Black adults in the United States are also less likely to have been exposed to and/or socialized to engage in certain cognitive activities (e.g., reading for pleasure) than White adults (Hofferth & Sandberg, 2001). These structural inequalities may have contributed not only to the Black–White disparity in the frequency of cognitive activity engagement documented in this study, but also the finding that Black older adults appeared to be more vulnerable to the negative effect of depressive symptoms on cognitive activity engagement than Whites.

Finally, although physical activity did not mediate the association between depressive symptoms and global cognition, higher depressive symptoms were only associated with lower physical activity in White older adults. Distinct effects of depressive symptoms on engagement in different activities may point to distinct profiles of depressive symptoms displayed by White versus Black older adults (Myers et al., 2002). Additional research is necessary to understand whether different symptom profiles or other factors may contribute to the impact of depressive symptoms on patterns of activity engagement across racial groups.

Limitations and Future Directions

The current study has some notable limitations. First, these analyses were cross-sectional. Therefore, caution is warranted regarding the interpretation of the directionality of our findings. While our cross-sectional findings are consistent with a review of prospective longitudinal studies showing that depressive symptoms influence subsequent activity engagement (Roshanaei-Moghaddam et al., 2009), some studies have also found activity engagement to influence subsequent depressive symptoms (Poelke et al., 2016). Future longitudinal research is necessary to investigate the potential bidirectional relationship between depressive symptoms and activity engagement. Similarly, future longitudinal research is necessary to fully disentangle the directional association between depressive symptoms and cognitive functioning. Some prior longitudinal research indicates that depressive symptoms precede and predict cognitive functioning rather than vice versa (Zahodne et al., 2014), supporting the hypothesized pathways tested in the current cross-sectional study. However, additional research is necessary to determine whether depressive symptoms represent a prodrome and/or causal risk factor for cognitive decline in older adulthood. Second, leisure activities were self-reported, and future research should replicate these findings with objective assessments, as self-reported activity engagement may be subject to recall bias or influenced by socially desirable responding.

Strengths of the current study include the use of a comprehensive neuropsychological battery to capture global cognitive functioning, the use of a racially balanced sample to investigate racial differences in these associations, and the examination of distinct types of leisure activities to help pinpoint the specific behavioral pathways by which depression may influence cognition in Black and White older adults.

Conclusion

In conclusion, racial differences in depressive symptoms–cognition associations may reflect a greater impact of depressive symptoms on cognitive activity engagement among Black compared with White older adults. Future research is necessary to clarify the direction of associations between depressive symptoms, activity engagement, and cognition, to identify additional behavioral mechanisms underlying the link between depressive symptoms and cognition, and to test interventions to combat racial disparities in cognitive aging and the impact of depressive symptoms.

Supplementary Material

gbab153_suppl_Supplementary_Materials
Click here for additional data file. (167.4KB, pdf)

Acknowledgments

The sponsors had no role in the current analyses or the preparation of this paper. In addition, the authors acknowledge the many University of Michigan research assistants in the Zahodne laboratory who assisted with data collection and data entry, particularly Gabrielle Hooper who also coded the antidepressant data. Aggregate data, analytic code, and other study materials will be made available by e-mail request to the corresponding author. Access to individual-level data will require a data-sharing agreement with the University of Michigan. This study was not preregistered.

Contributor Information

Neika Sharifian, Department of Psychology, University of Michigan, Ann Arbor, USA.

Ketlyne Sol, Department of Psychology, University of Michigan, Ann Arbor, USA.

Afsara B Zaheed, Department of Psychology, University of Michigan, Ann Arbor, USA.

Emily P Morris, Department of Psychology, University of Michigan, Ann Arbor, USA.

Jordan D Palms, Department of Psychology, University of Michigan, Ann Arbor, USA.

Alexa G Martino, Department of Psychology, University of Michigan, Ann Arbor, USA.

Laura B Zahodne, Department of Psychology, University of Michigan, Ann Arbor, USA.

Funding

This work was supported by the National Institute on Aging (grant numbers AG012846, AG024824, AG053760, AG054520).

Conflict of Interest

None declared.

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