Association between Depression Severity and Physical Function among Chinese Nursing Home Residents: The Mediating Role of Different Types of Leisure Activities

Abstract

Despite strong evidence associating depression with poor physical function, the underlying mechanisms of this association remain unknown. This study aimed to ascertain whether different types of leisure activities mediate the effect of depression severity on physical function. This cross-sectional descriptive study included 353 Chinese nursing home residents (aged ≥ 60 years; 197 female) from nursing homes of five districts (Lixia, Tianqiao, Huaiyin, Shizhong, and Licheng) in Jinan, Shandong Province, China, from March to June 2018. Multiple-mediation analyses, including regression and bootstrap analyses, were conducted to evaluate the association of depressive symptoms' severity and active or passive leisure activities with physical function. Active, but not passive, leisure activities significantly mediated the effect of moderate/severe depressive symptoms on physical function compared to those without depressive symptoms. In contrast, there was no significant association between mild depressive symptoms and physical function. This study demonstrates that leisure activities affect the association between depressive symptoms' severity and physical function, and its protective role depends on the type of leisure activities. Interventions for physical function should be designed by focusing on active leisure activities among older adults, especially those with moderate/severe depressive symptoms, to delay physical function and improve overall well-being.

Keywords: depression; leisure activities; nursing homes; older adults; physical function.

Figure 1

Flowchart depicting the participant selection process.

Figure 2

The mediating role of active and passive leisure activities in the association between depressive symptoms and physical function (n = 353). Standardized coefficients are shown along the path arrows; solid lines represent the statistical significance at p < 0.05, and dashed lines represent non-significant effects; they are adjusted for age, sex, years of schooling, having a spouse, self-reported economic conditions, comorbidity conditions, and body mass index; Path a₁ represents the effect of mild depression on active leisure activities; Path a₂ represents the effect of mild depression on passive leisure activities; Path a₃ represents the effect of moderate/severe depression on active leisure activities; Path a₄ represents the effect of moderate/severe depression on passive leisure activities; Path b₁ represents the effect of active leisure activities on physical function; Path b₂ represents the effect of passive leisure activities on physical function; Path c₁ indicates the total effect of mild depression on physical function; Path c’₁ represents the direct effect of mild depression on physical function; Path c₂ indicates the total effect of moderate/severe depression on physical function; Path c’₁ represents the direct effect of moderate/severe depression on physical function; * p < 0.05, ** p < 0.01, *** p < 0.001.