Adult Education and Depressive Symptoms Among Middle-Aged and Older Adults: A Nationwide Longitudinal Cohort Study in China.

Objectives: Depression is a significant public health concern among middle-aged and older adults in China. While formal education's protective role against depression is well-established, the association of adult education with depression remains understudied. Adult education refers to organized learning activities for adults who have completed or left formal schooling. This nationwide longitudinal cohort study examined the association between adult education and depressive symptoms among Chinese adults aged 45 and older.

Methods: Using data from the China Health and Retirement Longitudinal Study (2011-2018), we analyzed 37,325 observations from 11,453 participants. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale, while adult education was measured by participation, duration, and attainment.

Results: Generalized estimating equation models showed that adult education participation was associated with 27.2% lower odds of depressive symptoms (odds ratios = 0.728, 95% CI: 0.620-0.854). Each additional year of adult education was associated with 13.1% lower odds, and those who attained a diploma or degree through adult education showed 61.3% lower odds. Notably, even participation without earning a degree showed 22.1% lower odds. These associations remained consistent across formal education levels, age, gender, and other subgroups. Current smoking, social participation, digital exclusion, and instrumental activities of daily living disability collectively explained 34.0% of the total association.

Discussion: These findings suggest that potential benefits of adult education in addressing depression among China's aging population, with implications for mental health policy and healthy aging initiatives in developing countries.