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The Relationships Between Depressive Symptoms, Functional Health Status, Physical Activity, and the Availability of Recreational Facilities: a Rural-Urban Comparison in Middle-Aged and Older Chinese Adults

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Abstract

Purpose

This study drew upon the ecological system theory to demonstrate rural-urban differences in the relationships between the availability of recreational facilities, physical activity (PA), functional health status, and depressive symptoms in middle-aged and older Chinese adults.

Methods

Nationally representative data (n = 5949) from the Chinese Health and Retirement Longitudinal Study (CHARLS, 2011–2013) were examined using the multigroup structural equation modeling approach.

Results

The results suggest that higher availability of recreational facilities in the urban communities was associated with higher levels of leisure time physical activity (LTPA), better functional capacity, and less occurrence of depressive symptoms among urban participants. In contrast, LTPA engagement among rural participants was low and had negligible mitigating effects on functional decline and depressive symptoms. The findings also show that functional health status mediated the association between total PA and depressive symptoms in both rural and urban participants. However, high levels of total PA were directly associated with elevated depressive symptoms, suggesting that the context of PA and related socioeconomic factors might explain this association after the non-LTPA components were included.

Conclusions

The findings highlight how complex patterns of intrapersonal, behavioral, and environmental correlates influence depressive symptoms in middle-aged and older Chinese adults. The context of PA should be considered when creating targeted strategies to prevent depressive symptoms. As an inactive lifestyle evolves with China’s rapid urbanization, joint efforts from public health and urban planning should be made to promote LTPA and develop active living communities for achieving optimal health in later life.

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References

  1. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370(9590):851–8.

    Article  PubMed  Google Scholar 

  2. Xu Y, Yang J, Gao J, Zhou Z, Zhang T, Ren J, et al. Decomposing socioeconomic inequalities in depressive symptoms among the elderly in China. BMC Public Health. 2016;16(1):1214.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Turvey CL, Schultz SK, Beglinger L, Klein DM. A longitudinal community-based study of chronic illness, cognitive and physical function, and depression. Am J Geriatr Psychiatry. 2009;17(8):632–41.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jiang J, Tang Z, Futatsuka M, Zhang K. Exploring the influence of depressive symptoms on physical disability: a cohort study of elderly in Beijing, China. Qual Life Res. 2004;13(7):1337–46.

    Article  PubMed  Google Scholar 

  5. Feng Q, Zhen Z, Gu D, Wu B, Duncan PW, Purser JL. Trends in ADL and IADL disability in community-dwelling older adults in Shanghai, China, 1998–2008. J Gerontol B Psychol Sci Soc Sci. 2013;68(3):476–85.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cooney G, Dwan K, Mead G. Exercise for depression. JAMA. 2014;311(23):2432–3.

    Article  PubMed  CAS  Google Scholar 

  7. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  PubMed  Google Scholar 

  8. Paterson DH, Warburton DE. Physical activity and functional limitations in older adults: a systematic review related to Canada’s Physical Activity Guidelines. Int J Behav Nutr Phys Act. 2010;7(1):38.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sallis JF, Bowles HR, Bauman A, Ainsworth BE, Bull FC, Craig CL, et al. Neighborhood environments and physical activity among adults in 11 countries. Am J Prev Med. 2009;36(6):484–90.

    Article  PubMed  Google Scholar 

  10. Cerin E, Lee KY, Barnett A, Sit CH, Cheung MC, Chan WM. Objectively-measured neighborhood environments and leisure-time physical activity in Chinese urban elders. Prev Med. 2013;56(1):86–9.

    Article  PubMed  Google Scholar 

  11. Day K. Built environmental correlates of physical activity in China: a review. Prev Med Rep. 2016;3:303–16.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bronfenbrenner U, Morris PA. The bioecological model of human development. In: Handbook of child psychology. John Wiley & Sons: New York; 2006.

    Google Scholar 

  13. Greenfield EA. Using ecological frameworks to advance a field of research, practice, and policy on aging-in-place initiatives. Gerontologist. 2012;52(1):1–12.

    Article  PubMed  Google Scholar 

  14. Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China health and retirement longitudinal study (CHARLS). Int J Epidemiol. 2014;43:61–8.

    Article  PubMed  Google Scholar 

  15. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med. 1999;159(15):1701–4.

    Article  PubMed  CAS  Google Scholar 

  16. Schroevers MJ, Sanderman R, Van Sonderen E, Ranchor AV. The evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale: depressed and positive affect in cancer patients and healthy reference subjects. Qual Life Res. 2000;9(9):1015–29.

    Article  PubMed  CAS  Google Scholar 

  17. Chen H, Mui AC. Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China. Int Psychogeriatr. 2014;26(01):49–57.

    PubMed  CAS  Google Scholar 

  18. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31(12):721–7.

    Article  PubMed  CAS  Google Scholar 

  19. IPAQ committee. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ). 2005. http://www.ipaq.ki.se/scoring.htm.

  20. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  21. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.

    Article  PubMed  Google Scholar 

  22. Buuren S, Groothuis-Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3)

  23. Anderson JC, Gerbing DW. Structural equation modeling in practice: a review and recommended two-step approach. Psychol Bull. 1988;103(3):411–23.

    Article  Google Scholar 

  24. Vandenberg RJ, Lance CE. A review and synthesis of the measurement invariance literature: suggestions, practices, and recommendations for organizational research. Organ Res Methods. 2000;3(1):4–70.

    Article  Google Scholar 

  25. Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002;7(4):422–45.

    Article  PubMed  Google Scholar 

  26. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav Res. 2004;39(1):99–128.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Muthén LK, Muthén BO. Mplus Version 8 user’s guide. Los Angeles, CA: Muthén & Muthén.: 1998–2017.

  28. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1–55.

    Article  Google Scholar 

  29. Cheung GW, Rensvold RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Modeling. 2002;9(2):233–55.

    Article  Google Scholar 

  30. Jöreskog KG, Sörbom D. LISREL 8: structural equation modeling with the SIMPLIS command language. Chicago: Scientific Software International; 1993.

    Google Scholar 

  31. Mezuk B, Edwards L, Lohman M, Choi M, Lapane K. Depression and frailty in later life: a synthetic review. Int J Geriatr Psychiatry. 2012;27(9):879–92.

    Article  PubMed  Google Scholar 

  32. Yang Y. How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources. J Health Soc Behav. 2006;47(4):355–72.

    Article  PubMed  Google Scholar 

  33. Feng L, Nyunt MSZ, Feng L, Yap KB, Ng TP. Frailty predicts new and persistent depressive symptoms among community-dwelling older adults: findings from Singapore Longitudinal Aging Study. J Am Med Dir Assoc. 2014;15(1):76. e7-. e12.

  34. Rejeski W, Mihalko S. Physical activity and quality of life in older adults. J Gerontol A Biol Sci Med Sci. 2001;56:23–35.

    Article  PubMed  Google Scholar 

  35. MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol. 2007;58:593–614.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Teychenne M, Ball K, Salmon J. Associations between physical activity and depressive symptoms in women. Int J Behav Nutr Phys Act. 2008;5:27.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Pickett K, Yardley L, Kendrick T. Physical activity and depression: a multiple mediation analysis. Ment Health Phys Act. 2012;5(2):125–34.

    Article  Google Scholar 

  38. Chen L-J, Stevinson C, Ku P-W, Chang Y-K, Chu D-C. Relationships of leisure-time and non-leisure-time physical activity with depressive symptoms: a population-based study of Taiwanese older adults. Int J Behav Nutr Phys Act. 2012;9(1):1–10.

    Article  CAS  Google Scholar 

  39. Bustamante EE, Wilbur J, Marquez DX, Fogg L, Staffileno BA, Manning A. Physical activity characteristics and depressive symptoms in older Latino adults. Ment Health Phys Act. 2013;6(2):69–77.

    Article  Google Scholar 

  40. Ng SW, Howard AG, Wang H, Su C, Zhang B. The physical activity transition among adults in China: 1991–2011. Obes Rev. 2014;15(S1):27–36.

    Article  PubMed  Google Scholar 

  41. Bauman A, Ma G, Cuevas F, Omar Z, Waqanivalu T, Phongsavan P, et al. Cross-national comparisons of socioeconomic differences in the prevalence of leisure-time and occupational physical activity, and active commuting in six Asia-Pacific countries. J Epidemiol Community Health. 2011;65(1):35–43.

    Article  PubMed  Google Scholar 

  42. Shores KA, West ST, Theriault DS, Davison EA. Extra-individual correlates of physical activity attainment in rural older adults. J Rural Health. 2009;25(2):211–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the CHARLS research and field team and all respondents for their contributions.

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Authors and Affiliations

  1. Department of Movement Sciences, University of Idaho, Moscow, ID, USA

    Yazhuo Deng & David R. Paul

Authors
  1. Yazhuo Deng
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  2. David R. Paul
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Correspondence to Yazhuo Deng.

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The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Deng, Y., Paul, D.R. The Relationships Between Depressive Symptoms, Functional Health Status, Physical Activity, and the Availability of Recreational Facilities: a Rural-Urban Comparison in Middle-Aged and Older Chinese Adults. Int.J. Behav. Med. 25, 322–330 (2018). https://doi.org/10.1007/s12529-018-9714-3

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