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RESEARCH ARTICLE

The association between changes in health behaviors and depressive symptoms among Chinese older adults: A national cross-sectional study

Shilong Zhang1,2,3,4 ,  Xi Lu5,6,7,8 ,  Wenyv Fan1,3,4 ,  Xingli Ma1,3,4 ,  Xindan Zhang1,3,4 ,  Beibei Zhang9 ,  Haipeng Wang1,3,4*
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1 Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong , China
2 Department of Human Resources, Jinan Third People’s Hospital, Jinan, Shandong , China
3 NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong , China
4 Center for Health Management and Policy Research (Shandong Provincial Key New Think Tank), Shandong University, Jinan, Shandong , China
5 Eye Institute, Shandong First Medical University, Jinan, Shandong , China
6 State Key Laboratory Cultivation Base, School of Ophthalmology, Shandong First Medical University, Jinan, Shandong , China
7 Shandong Key Laboratory of Eye Diseases, School of Ophthalmology, Shandong First Medical University, Jinan, Shandong , China
8 School of Ophthalmology, Shandong First Medical University, Jinan, Shandong , China
9 Department of Clinical Laboratory, Shandong Mental Health Center, Jinan, Shandong , China
HPR, 026290159 https://doi.org/10.36922/HPR026290159
Received: 13 July 2026 | Revised: 20 October 2026 | Accepted: 22 October 2026 | Published online: 30 October 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Depressive symptoms are common in older adults. However, few studies have assessed changes in health behaviors during the pandemic and gender differences among Chinese older adults.

Objective: To examine the association of changes in health behaviors with depressive symptoms among Chinese older adults during the pandemic, and gender differences.

Methods: The data were obtained from the 2020 China Health and Retirement Longitudinal Study, which included 7,947 older adults. Binary logistic regression examined associations between changes in health behaviors and depressive symptoms, and subgroup analyses assessed gender differences in effects of physical activity, smoking, and alcohol consumption changes on depressive symptoms.

Results: The prevalence of depressive symptoms among older adults in China was 39.37% during the COVID-19 pandemic in 2020. Female (odds ratio [OR] = 1.790, 95% CI: 1.578–2.031), unmarried (OR = 1.438, 95% CI: 1.266–1.634), rural residency (OR = 1.479, 95% CI: 1.321–1.657), and two or more chronic diseases (OR = 1.472, 95% CI: 1.253–1.729) were associated with higher odds of depressive symptoms. Decreased intense activities (OR=1.301, 95% CI: 1.133–1.493) and decreased smoking (OR = 1.500, 95% CI: 1.183–1.903) were associated with higher odds of depressive symptoms. Subgroup analyses revealed a significant interaction between gender and changes in alcohol consumption on depressive symptoms.

Conclusion: The study found that decreased intense activities and decreased smoking were associated with higher odds of depressive symptoms. Health administrators should develop policies based on the relationship between changes in health behaviors and depressive symptoms among older adults of different genders.

Keywords
Depressive symptoms
Older adults
Health behaviors
Smoking
Physical activities
Drinking
Funding
This study was funded by the National Key Research and Development Program of China (Grant Number: 2020YFC2006500, 2020YFC2006505).
Conflict of interest
The authors declare that they do not have any conflicts of interest.
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