Digital inclusion and depressive symptoms among Chinese older adults: The moderating role of cognitive function.
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.
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.
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 0-10 scale. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10; each item scored 0-3, total range 0-30, treated as a continuous score). Multi-variable regression models were used to examine associations, with interaction terms and Johnson-Neyman analysis applied to assess moderation by cognitive function, with effect size estimated using Cohen's f2. Structural equation modeling was conducted to explore potential mediating mechanisms.
Cognitive function significantly moderated the association between digital inclusion and depressive symptoms (β = -0.002, P < 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 (β = -0.137, P = 0.327). Pathway analyses suggested that the association operated through multiple pathways, with the direct pathway accounting for 66.7% of the total association-likely reflecting immediate psychological mechanisms including enhanced self-efficacy, expanded access to health information, and a sense of digital mastery-while cognitive-related and social participation pathways explained 8.3% and 8.0%, respectively; a sequential cognitive-social 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.
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.
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.
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 0-10 scale. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10; each item scored 0-3, total range 0-30, treated as a continuous score). Multi-variable regression models were used to examine associations, with interaction terms and Johnson-Neyman analysis applied to assess moderation by cognitive function, with effect size estimated using Cohen's f2. Structural equation modeling was conducted to explore potential mediating mechanisms.
Cognitive function significantly moderated the association between digital inclusion and depressive symptoms (β = -0.002, P < 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 (β = -0.137, P = 0.327). Pathway analyses suggested that the association operated through multiple pathways, with the direct pathway accounting for 66.7% of the total association-likely reflecting immediate psychological mechanisms including enhanced self-efficacy, expanded access to health information, and a sense of digital mastery-while cognitive-related and social participation pathways explained 8.3% and 8.0%, respectively; a sequential cognitive-social 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.
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.