The Association Between Health Literacy and Depressive Symptoms With the Mediation Role of Family Health and Perceived Social Support in Older Adults: A Nationwide Cross-Sectional Study in China.

Abstract

Objectives: There was a lack of in-depth understanding of the relationship between health literacy and depressive symptoms, and it was also unclear whether family health and perceived social support mediated this relationship and were negatively associated with the presence of depressive symptoms in older adults. This study aimed to explore the relationship between health literacy and depressive symptoms among older adults, while assessing the mediating roles of family health and perceived social support.

Methods: A cross-sectional study was conducted in China in 2021, involving 1147 participants aged 60 and older recruited using a nationwide multistage random sampling method. Ordered logistic regression and generalized additive models were employed to examine the association between health literacy and depressive symptoms, and the mediating effects of family health and perceived social support were assessed using mediation analysis with non-parametric bootstrapping. The Karlson-Holm-Breen (KHB) method was used to evaluate combined indirect associations, and subgroup mediation analyses were performed for "young-old" (65-74 years) and "old-old" (≥ 75 years) participants.

Results: Higher health literacy was associated with a lower likelihood of depressive symptoms (OR = 0.98, 95% CI: 0.97-0.99). Mediation analysis showed that the total indirect effect was thus estimated at -0.01, and the total effect of health literacy on depressive symptoms was approximately -0.03. The negative association between health literacy and depressive symptoms, as well as the mediating role of family health, remained significant in both the 65-74 and ≥ 75 age groups. However, the mediating effect of perceived social support was significant only in the 65-74 age group.

Conclusions: Health literacy is negatively associated with depressive symptoms in Chinese older adults and could be considered as a focus for intervention strategies. Enhancing health literacy may improve family health and perceived social support, and potentially lower depressive symptoms.