{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T14:14:06Z","timestamp":1783692846267,"version":"3.55.0"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Institutional-Level Scientific Research Project of Xiangyang Central Hospital","award":["2025YA01A"],"award-info":[{"award-number":["2025YA01A"]}]},{"name":"Xiangyang Central Hospital Personnel-Training Project","award":["2025RCGD-016"],"award-info":[{"award-number":["2025RCGD-016"]}]},{"name":"Health Science and Technology Project of Hubei Province","award":["WJ2025Q067"],"award-info":[{"award-number":["WJ2025Q067"]}]},{"name":"Hubei Provincial Natural Science Foundation of China","award":["2025AFD099"],"award-info":[{"award-number":["2025AFD099"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Digital inclusion has become increasingly important for healthy aging, yet evidence on its association with depression among older adults remains limited, particularly with respect to potential cognitive heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study examined the association between digital inclusion and depressive symptoms among Chinese older adults and explored whether cognitive function moderates this association, as well as potential mediating pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were drawn from the 2020 wave of the China Health and Retirement Longitudinal Study, including 9,111 individuals aged 60 years and older. A multidimensional digital inclusion index was constructed based on access, use, and skills related to digital technologies, standardized to a 0\u201310 scale. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10; each item scored 0\u20133, total range 0\u201330, treated as a continuous score). Multi-variable regression models were used to examine associations, with interaction terms and Johnson\u2013Neyman analysis applied to assess moderation by cognitive function, with effect size estimated using Cohen\u2019s f\n                      <jats:sup>2<\/jats:sup>\n                      . Structural equation modeling was conducted to explore potential mediating mechanisms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cognitive function significantly moderated the association between digital inclusion and depressive symptoms (\u03b2 = \u22120.002,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Among participants in the highest quartile of cognitive function, each unit increase in digital inclusion was associated with a 0.517-point decrease in depression scores, whereas no statistically significant association was observed among those in the lowest quartile (\u03b2 = \u22120.137,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.327). Pathway analyses suggested that the association operated through multiple pathways, with the direct pathway accounting for 66.7% of the total association\u2014likely reflecting immediate psychological mechanisms including enhanced self-efficacy, expanded access to health information, and a sense of digital mastery\u2014while cognitive-related and social participation pathways explained 8.3% and 8.0%, respectively; a sequential cognitive\u2013social pathway accounted for a further 2.8%, and the remaining 14.2% was attributable to other model-estimated pathways, with all pathways together accounting for 100% of the total association. Executive function and immediate memory emerged as the cognitive domains most strongly associated with moderation patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that greater digital inclusion is associated with lower depressive symptoms among older adults and that cognitive function shapes heterogeneity in this association. Enhancing digital inclusion while accounting for cognitive differences may help inform digital health strategies aimed at promoting mental well-being in aging populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076261467827","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:46:31Z","timestamp":1783507591000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital inclusion and depressive symptoms among Chinese older adults: The moderating role of cognitive function"],"prefix":"10.1177","volume":"12","author":[{"given":"Gang","family":"Xiao","sequence":"first","affiliation":[{"name":"Hanshan Normal University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Yang","sequence":"additional","affiliation":[{"name":"Hubei Cancer Hospital"},{"name":"Tongji Medical College"},{"name":"Huazhong University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuyun","family":"Bai","sequence":"additional","affiliation":[{"name":"Xiangyang No.1 People\u2019s Hospital"},{"name":"Hubei University of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlong","family":"Jia","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital"},{"name":"Affiliated Hospital of Hubei University of Arts and Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-1333","authenticated-orcid":false,"given":"Tingting","family":"Nie","sequence":"additional","affiliation":[{"name":"Hubei Cancer Hospital"},{"name":"Tongji Medical College"},{"name":"Huazhong University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_3_7_2_2","volume-title":"Draft global strategy on digital health 2020-2025","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. 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