Association of healthy lifestyle and social determinants with depression and anxiety in elderly patients with chronic diseases.
TL;DR
A dual-level approach represents a practical public health response to the growing need for accessible mental health care in contexts where specialized services remain limited and promotes healthy lifestyles and strengthening community-based social support.
Abstract
INTRODUCTION The growing burden of chronic diseases in aging populations has made mental health a pressing public health concern, but the combined contributions of lifestyle and social factors to depression and anxiety in this group are still poorly defined. Mental health is essential for promoting healthy aging and sustaining a good quality of life in later years. However, the influence of healthy lifestyles and social determinants on the mental health of older adults with chronic diseases-whether considered individually or in combination-remains poorly understood. This study investigates the associations of these factors with depression, anxiety, and their comorbidity.
Methods
This cross-sectional study included older adults (aged ≥60 years) with chronic conditions. A total of 8986 patients with chronic diseases were surveyed from July to September 2024. Healthy lifestyle factors (diet, physical activity, sleep, and social engagement) and social determinants of health (economic status, educational attainment, healthcare accessibility, built environment, and social environment) were assessed. Depressive symptoms and anxiety symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) and the 7-item Generalized Anxiety Disorder scale (GAD-7), respectively. Logistic regression analysis was conducted to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for relevant covariates.
Results
Compared with the reference group (0-1 healthy lifestyle behaviors and 0-1 SDH), both the subgroup with a higher number of healthy lifestyle behaviors and the subgroup with a higher number of favorable SDH factors were significantly associated with lower odds of depressive symptoms, anxiety symptoms, and their comorbidity. Adjusted logistic regression analysis indicated that both healthy lifestyle behaviors and social determinants were significantly associated with lower odds of depressive symptoms, anxiety symptoms, and co-occurring depressive symptoms and anxiety symptoms. The observed associations with healthy lifestyle behaviors were primarily related to balanced nutrition, moderate physical activity, and adequate sleep, whereas the associations with social determinants were mainly related to access to quality education, positive neighborhood relationships, and supportive community environments.
Conclusions
Depressive symptoms and anxiety symptoms are highly prevalent worldwide and contribute substantially to the global burden of disease. In resource-limited settings, promoting healthy lifestyles and strengthening community-based social support have been associated with a lower burden of depressive symptoms and anxiety symptoms. This dual-level approach represents a practical public health response to the growing need for accessible mental health care in contexts where specialized services remain limited.