{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:24:04Z","timestamp":1789608244915,"version":"build-2803163510"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>China is presently facing the challenge of meeting enormous health demands because of its rapidly aging society. Enrolling older persons in eldercare institutions is a helpful alternative for relieving family caregivers and promoting healthy aging. However, changes in the living environment may negatively affect the mental health of the elderly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore the association between different living arrangements and depressive symptoms among over-65-year-old people in China and the moderating role of outdoor activities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) used a mixed sampling method to collect the health and demographic information of 15,874 older adults over 65 years from 23 provinces in China. After considering this study's inclusion and exclusion criteria, the final sample comprised 12,200 participants. The participants' risk of depressive symptoms was assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). The potential association between the two elements was tested using a regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>This study's findings suggested a significant relationship between depressive symptoms and living arrangements (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). Participants living alone and those living in eldercare institutions had 1.26-times (95%CI: 1.10\u20131.44) and 1.39-times (95%CI: 1.09\u20131.77) higher risks of depressive symptoms, respectively, than those living with household members. Outdoor activities play a moderating role between different living arrangements and depressive symptoms. Among participants who engaged in outdoor activities, no significant difference was observed in the risk of depressive symptoms between those living in eldercare institutions and those living with household members (adjusted odds ratio = 1.15, 95%CI = 0.81\u20131.64, <jats:italic>P<\/jats:italic> = 0.426).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The high risk of depressive symptoms among older Chinese people living alone or in eldercare institutions requires considerable attention. The evidence from this study suggests that older people living alone and those living in eldercare institutions should regularly engage in appropriate outdoor activities.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.954416","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T06:02:06Z","timestamp":1659592926000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":33,"title":["Determining the association between different living arrangements and depressive symptoms among over-65-year-old people: The moderating role of outdoor activities"],"prefix":"10.3389","volume":"10","author":[{"given":"Rixiang","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingyu","family":"Mu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaping","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caiming","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3390\/geriatrics4030047","article-title":"Population ageing: the need for a care revolution in a world 2 0","volume":"4","author":"Boccardi","year":"2019","journal-title":"Geriatrics (Basel)."},{"key":"B2","unstructured":"2022"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e243559","DOI":"10.1371\/journal.pone.0243559","article-title":"The spatiality and driving forces of population ageing in China","volume":"16","author":"Wu","year":"2021","journal-title":"PLoS ONE."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e159","DOI":"10.1016\/S2468-2667(19)30019-2","article-title":"Measuring population ageing: an analysis of the global burden of disease study 2017","volume":"4","author":"Chang","year":"2019","journal-title":"Lancet Public Health."},{"key":"B5","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1186\/s12877-021-02322-7","article-title":"Disability-adjusted life years associated with population ageing in China, 1990-2017","volume":"21","author":"Li","year":"2021","journal-title":"BMC Geriatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1016\/S0140-6736(18)31948-2","article-title":"Depression","volume":"392","author":"Malhi","year":"2018","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S0140-6736(07)61415-9","article-title":"Depression, chronic diseases, and decrements in health: results from the world health surveys","volume":"370","author":"Moussavi","year":"2007","journal-title":"Lancet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1007\/s11596-020-2270-5","article-title":"Relationships between chronic diseases and depression among middle-aged and elderly people in China: a prospective study from CHARLS","volume":"40","author":"Jiang","year":"2020","journal-title":"Current Med Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1186\/s12888-021-03428-3","article-title":"Relationship between chronic diseases and depression: the mediating effect of pain","volume":"21","author":"Ma","year":"2021","journal-title":"BMC Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1080\/13607863.2015.1065791","article-title":"Issues in research on aging and suicide","volume":"20","author":"Van Orden","year":"2015","journal-title":"Aging Ment Health."},{"key":"B11","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.jad.2020.12.059","article-title":"Relationship between cognitive performance and depressive symptoms in Chinese older adults: the China Health and Retirement Longitudinal Study (CHARLS)","volume":"281","author":"Zhou","year":"2021","journal-title":"J Affect Disorders."},{"key":"B12","unstructured":"2022"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e21741","DOI":"10.1136\/bmjopen-2018-021741","article-title":"What factors influence older people's intention to enrol in nursing homes? a cross-sectional observational study in Shanghai, China","volume":"8","author":"Lou","year":"2018","journal-title":"BMJ Open."},{"key":"B14","first-page":"2013","article-title":"Mental health of the elderly under different elderly care models","volume":"38","author":"Xiaohua","year":"2018","journal-title":"Ch J Gerontol"},{"key":"B15","volume-title":"Environmental Psychology and Psychological Environment","author":"Ma","year":"1996"},{"key":"B16","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1007\/s00038-017-0958-5","article-title":"Parks and green areas and the risk for depression and suicidal indicators","volume":"62","author":"Min","year":"2017","journal-title":"Int J Public Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"113247","DOI":"10.1016\/j.psychres.2020.113247","article-title":"Light therapy in non-seasonal depression: an update meta-analysis","volume":"291","author":"Tao","year":"2020","journal-title":"Psychiat Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/camh.12520","article-title":"Adolescents' thoughts and feelings about the local and global environment: a qualitative interview study","volume":"27","author":"Thompson","year":"2022","journal-title":"Child Adol Ment H-Uk."},{"key":"B19","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1192\/bjp.111.470.105","article-title":"Changes in 5-hydroxytryptophan metabolism in depression","volume":"111","author":"Coppen","year":"1965","journal-title":"Brit J Psychiat"},{"key":"B20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1097\/00008877-199601000-00011","article-title":"In vivo measurement of extracellular serotonin in the ventral hippocampus during treadmill running","volume":"7","author":"Wilson","year":"1996","journal-title":"Behav Pharmacol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e916898","DOI":"10.3389\/fpubh.2022.916898","article-title":"Social support and depressive symptoms among adolescents during the COVID-19 pandemic: the mediating roles of loneliness and meaning in life","volume":"10","author":"Liu","year":"2022","journal-title":"Front Public Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1016\/S0140-6736(17)30548-2","article-title":"Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study","volume":"389","author":"Zeng","year":"2017","journal-title":"Lancet."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1016\/S0140-6736(13)60777-1","article-title":"Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart","volume":"382","author":"Christensen","year":"2013","journal-title":"Lancet."},{"key":"B24","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/S0749-3797(18)30622-6","article-title":"Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale)","volume":"10","author":"Andresen","year":"1994","journal-title":"Am J Prev Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.13342\/j.cnki.cjhp.2015.07.023","article-title":"Reliability and validity of 10 - item CES - D among middle aged and older adults in China","volume":"23","author":"Huang","year":"2015","journal-title":"Chin J Health Psychol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"104183","DOI":"10.1016\/j.archger.2020.104183","article-title":"Prevalence and related influencing factors of depression symptoms among empty-nest older adults in China","volume":"91","author":"Huang","year":"2020","journal-title":"Arch Gerontol Geriat."},{"key":"B27","doi-asserted-by":"publisher","first-page":"6557","DOI":"10.3390\/ijerph18126557","article-title":"Rural\u2013Urban inequalities in poor self-rated health, self-reported functional disabilities, and depression among Chinese older adults: evidence from the china health and retirement longitudinal study 2011 and 2015","volume":"18","author":"Jiang","year":"2021","journal-title":"Int J Env Res Pub He."},{"key":"B28","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/S2215-0366(21)00251-0","article-title":"Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study","volume":"8","author":"Lu","year":"2021","journal-title":"Lancet Psychiat."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e266950","DOI":"10.1371\/journal.pone.0266950","article-title":"Association between self-care disability and depressive symptoms among middle-aged and elderly Chinese people","volume":"17","author":"Mu","year":"2022","journal-title":"PLoS ONE."},{"key":"B30","doi-asserted-by":"publisher","first-page":"465","DOI":"10.18502\/ijph.v48i3.890","article-title":"Gender Differences in the relationship between Living alone and depressive symptoms in elderly Korean adults","volume":"48","author":"Kim","year":"2019","journal-title":"Iran J Public Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"315","DOI":"10.2188\/jea.JE20170065","article-title":"Living alone or with others and depressive symptoms, and effect modification by residential social cohesion among older adults in Japan: the JAGES longitudinal study","volume":"28","author":"Honjo","year":"2018","journal-title":"J Epidemiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e182145","DOI":"10.1371\/journal.pone.0182145","article-title":"Social isolation, loneliness and their relationships with depressive symptoms: a population-based study","volume":"12","author":"Ge","year":"2017","journal-title":"PLoS ONE."},{"key":"B33","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1038\/s41398-022-01880-7","article-title":"The association between midlife living arrangement and psychiatrist-diagnosed depression in later life: who among your family members reduces the risk of depression?","volume":"12","author":"Ogawa","year":"2022","journal-title":"Transl Psychiatry."},{"key":"B34","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1080\/13607863.2013.837142","article-title":"The influence of domestic living arrangement and neighborhood identity on mental health among urban Chinese elders","volume":"18","author":"Yea","year":"2014","journal-title":"Aging Ment Health."},{"key":"B35","doi-asserted-by":"publisher","first-page":"3275","DOI":"10.1590\/1413-81232018249.30942017","article-title":"Souto CS, Souza SJN, et al. Depressive symptoms and associated factors in elderly long-term care residents Sintomas depressivos e fatores associados em idosos residentes em institui\u00e7\u00e3o de longa perman\u00eancia","volume":"24","author":"Pithon","year":"2019","journal-title":"Cien Saude Colet."},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.14283\/jnhrs.2019.8","article-title":"Depression, anxiety, and pain among newly admitted nursing home residents","author":"Ulbricht","year":"2019","journal-title":"J Nurs Home Res Sci."},{"key":"B37","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.jpainsymman.2006.02.008","article-title":"Self-Care management and risk factors for depressive symptoms among elderly nursing home residents in Taiwan","volume":"32","author":"Tsai","year":"2006","journal-title":"J Pain Symptom Manag."},{"key":"B38","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.jamda.2008.01.008","article-title":"Nursing homes in China","volume":"9","author":"Chu","year":"2008","journal-title":"J Am Med Dir Assoc."},{"key":"B39","first-page":"72","article-title":"Analysis for cause of the disability old people aid to Xinjiang choose long-term home care","volume":"19","author":"Yuhuan","year":"2013","journal-title":"Population Develop"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2975","DOI":"10.2147\/RMHP.S283145","article-title":"Current status and challenges of community-based elderly care centers in chongqing, china: a cross-sectional study","volume":"13","author":"Yang","year":"2020","journal-title":"Risk Manag Healthc Policy."},{"key":"B41","first-page":"169","article-title":"Analysis on the mental health problems of the elderly in welfare homes and the advantages of social work intervention","volume":"11","author":"Jing","year":"2020","journal-title":"Soc Public Welfare"},{"key":"B42","doi-asserted-by":"publisher","first-page":"473","DOI":"10.31887\/DCNS.2008.10.4\/plfranzen","article-title":"Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications","volume":"10","author":"Franzen","year":"2008","journal-title":"Dialogues Clin Neuro."},{"key":"B43","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1177\/0020764017744582","article-title":"Living environment and its relationship to depressive mood: a systematic review","volume":"64","author":"Rautio","year":"2018","journal-title":"Int J Soc Psychiatr."},{"key":"B44","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1002\/nop2.601","article-title":"Death depression in Egyptian clinical and non-clinical groups","volume":"8","author":"Abdel Khalek","year":"2021","journal-title":"Nurs Open."},{"key":"B45","first-page":"4113","article-title":"Investigation and problem an analysis of nursing staff in elderly care institutions in Zhejiang province","volume":"17","author":"Rui","year":"2019","journal-title":"Chin General Pract Nurs"},{"key":"B46","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.psychres.2016.03.009","article-title":"The contribution of lifestyle factors to depressive symptoms: a cross-sectional study in Chinese college students","volume":"245","author":"Xu","year":"2016","journal-title":"Psychiat Res."},{"key":"B47","doi-asserted-by":"publisher","first-page":"299","DOI":"10.24095\/hpcdp.40.10.01","article-title":"Evidence-based recommendations to assist adults with depression to become lifelong movers","volume":"40","author":"Fortier","year":"2020","journal-title":"Health Promot Chronic Dis Prev Can."},{"key":"B48","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1007\/s12529-013-9351-9","article-title":"The effects of Tai Chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis","volume":"21","author":"Wang","year":"2014","journal-title":"Int J Behav Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1176\/appi.focus.20170042","article-title":"Qigong and Tai-Chi for mood regulation","volume":"16","author":"Yeung","year":"2018","journal-title":"Focus (Am Psychiatr Publ)."},{"key":"B50","doi-asserted-by":"publisher","first-page":"699778","DOI":"10.3389\/fpsyt.2021.699778","article-title":"Effect of square dance exercise on older women with mild mental disorders","volume":"12","author":"Chang","year":"2021","journal-title":"Front Psychiatry"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.954416\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T06:02:14Z","timestamp":1659592934000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.954416\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,4]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2022.954416"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.954416","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,4]]},"article-number":"954416"}}