Associations Between a History of Depression and Cognitive Performance Among Older Adults in Shandong, China

  • Bo Yuan
  • Vasoontara YiengprugsawanEmail author
Original Paper


This study investigates the relationships between depression and cognitive performance among older adults living in Shandong province. Data were derived from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE) China Wave 1 aged 50 and over residing in Shandong province (n = 1926). Cognitive performance was assessed by overall cognitive score. Data were analysed by multivariate linear regression. In rural Shandong, having a history of depression (− 4.0; p < 0.001), female (− 9.3; p < 0.001), and poor household wealth (− 8.9; p < 0.001) and primary level of education (− 6.4; p < 0.001) were main factors associated with their poor cognitive performance. Notably, in urban Shandong, lowest household wealth (− 12.5; p < 0.001) and not having health insurance (− 9.7; p < 0.001) were significant predictors of adverse cognitive performance. Findings could help inform policy in monitoring depressive symptoms and cognitive performance among older adults in China.


Ageing China Cognitive function Cross-sectional study Risk factors 



This paper uses data from Study on Global Ageing and Adult Health (SAGE) is supported by the World Health Organization and the US National Institute on Aging. The authors wish to thank Peter Sbirakos for editorial guidance on various stages of the manuscript.


This study was supported by the Australian Research Council Discovery Project Understanding ageing in China and Australia (DP160103023) and ARC Centre of Excellence in Population Ageing Research (CEPAR CE1101029 and CE170100005).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval

Human Ethics approval was received from the Chair of the Science & Medical Delegated Ethics Review Committee, the Australian National University on 29/08/2017 (Protocol: 2017/636 Depressive Symptoms and Cognitive Ability among Aging Chinese in Shandong Province).


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 ® ). Arlington: American Psychiatric Pub.CrossRefGoogle Scholar
  2. Barba, C., Cavalli-Sforza, T., Cutter, J., & Darnton-Hill, I. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363(9403), 157.CrossRefGoogle Scholar
  3. Ding, D., Zhao, Q., Guo, Q., Meng, H., Wang, B., Luo, J.,… Hong, Z. (2015). Prevalence of mild cognitive impairment in an urban community in China: A cross-sectional analysis of the Shanghai Aging Study. Alzheimer’s & Dementia, 11(3), 300–309. e302.Google Scholar
  4. Evandrou, M., Falkingham, J., Feng, Z., & Vlachantoni, A. (2014). Individual and province inequalities in health among older people in China: Evidence and policy implications. Health Place, 30, 134–144. Scholar
  5. Georgakis, M. K., Papadopoulos, F. C., Protogerou, A. D., Pagonari, I., Sarigianni, F., Biniaris-Georgallis, S. I., et al. (2016). Comorbidity of cognitive impairment and late-life depression increase mortality: Results from a cohort of community-dwelling elderly individuals in rural Greece. Journal of Geriatric Psychiatry and Neurology, 29(4), 195–204. Scholar
  6. Giri, M., Chen, T., Yu, W., & Lu, Y. (2016a). Prevalence and correlates of cognitive impairment and depression among elderly people in the world’s fastest growing city, Chongqing, People’s Republic of China. Clinical Interventions in Aging, 11, 1091–1098. Scholar
  7. Giri, M., Chen, T., Yu, W., & Lü, Y. (2016b). Prevalence and correlates of cognitive impairment and depression among elderly people in the world’s fastest growing city, Chongqing, People’s republic of China. Clinical Interventions in Aging, 11, 1091.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Halahakoon, D. C., Lewis, G., & Roiser, J. P. (2019). Cognitive impairment and depression-cause, consequence, or coincidence? JAMA Psychiatry, 76(3), 239–240. Scholar
  9. Hao, X. 郝., Chen, C. 陈., Li, J. 李., & Li, S. 李. (2009). Analysis of cognitive function and influencing factors in 22 provinces (cities). 22 省 (市) 老年人认知功能及影响因素的调查分析. 中国老年学杂志.. Chinese Journal of Gerontology 中国老年学杂志, 29(23), 3095–3097.Google Scholar
  10. Hidaka, S., Ikejima, C., Kodama, C., Nose, M., Yamashita, F., Sasaki, M., et al. (2012). Prevalence of depression and depressive symptoms among older Japanese people: Comorbidity of mild cognitive impairment and depression. International Journal of Geriatric Psychiatry, 27(3), 271–279. Scholar
  11. Hu, H. 胡., Zhang, X. 张., & Zhao, Y. 赵. (2012). The impact of social health insurance on the use of health services for the elderly—A counterfactual estimation based on the propensity score matching. 社会医疗保险对老年人卫生服务利用的影响——基于倾向得分匹配的反事实估计. Chinese Journal of Population Science 中国人口科学(2), 57–66.Google Scholar
  12. Huang, Y. (2011). Status quo and challenge of mental health in China. Chinese Journal of Health Policy, 4(9), 5–9.Google Scholar
  13. Ismail, Z., Elbayoumi, H., Fischer, C. E., Hogan, D. B., Millikin, C. P., Schweizer, T., et al. (2017). Prevalence of depression in patients with mild cognitive impairment: A systematic review and meta-analysis. JAMA Psychiatry, 74(1), 58–67. Scholar
  14. Lara, E., Koyanagi, A., Domenech-Abella, J., Miret, M., Ayuso-Mateos, J. L., & Haro, J. M. (2017). The impact of depression on the development of mild cognitive impairment over 3 years of follow-up: A population-based study. Dementia and Geriatric Cognitive Disorders, 43(3–4), 155–169. Scholar
  15. Li, N., Chen, G., Zeng, P., Pang, J., Gong, H., Han, Y., et al. (2018). Prevalence and factors associated with mild cognitive impairment among Chinese older adults with depression. Geriatrics & Gerontology International, 18(2), 263–268. Scholar
  16. Li, M., & Wang, C. (2017). The association between the New Rural Cooperative Medical System and health care seeking behavior among middle-aged and older Chinese. Journal of Aging & Social Policy, 29(2), 168–181. Scholar
  17. Li, C., Yu, X., Butler, J. R., Yiengprugsawan, V., & Yu, M. (2011). Moving towards universal health insurance in China: Performance, issues and lessons from Thailand. Social Science and Medicine, 73(3), 359–366. Scholar
  18. Mayor, S. (2016). One in three with mild cognitive impairment has depression, review finds. BMJ, 355, i6387. Scholar
  19. Mirza, S. S., Ikram, M. A., Bos, D., Mihaescu, R., Hofman, A., & Tiemeier, H. (2017). Mild cognitive impairment and risk of depression and anxiety: A population-based study. Alzheimers Dement, 13(2), 130–139. Scholar
  20. National Bureau of Statistics. (2016). China statistical yearbook 2016 (Chinese-English Edition). Beijing: China Statistics Press.Google Scholar
  21. Shao, Y., Wang, J., & Xie, B. (2015). The first mental health law of China. Asian Journal of Psychiatry, 13, 72–74. Scholar
  22. Shen, Y. (2014). Community building and mental health in mid-life and older life: Evidence from China. Social Science and Medicine, 107, 209–216. Scholar
  23. US CDC. (2011). Cognitive impairment: A call for action, now!. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  24. Üstün, T. B. (2010). Measuring health and disability: Manual for WHO disability assessment schedule WHODAS 2.0. Geneva: World Health Organization.Google Scholar
  25. Wang, L., Li, Y., Li, H., Holdaway, J., Hao, Z., Wang, W., et al. (2016). Regional aging and longevity characteristics in China. Archives of Gerontology and Geriatrics, 67, 153–159. Scholar
  26. Wang, Z., Shu, D., Dong, B., Luo, L., & Hao, Q. (2013). Anxiety disorders and its risk factors among the Sichuan empty-nest older adults: A cross-sectional study. Archives of Gerontology and Geriatrics, 56(2), 298–302.CrossRefPubMedGoogle Scholar
  27. WHO. (2018). Fact sheets: Depression. Geneva: WHO.Google Scholar
  28. Wu, Y. T., Ali, G. C., Guerchet, M., Prina, M., Chan, K. Y., Prince, M. J., et al. (2017). A systermatic review and meta-analysis of the prevalence of dementia in mainland China, Hongkong and Taiwan: 2017 update. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 13(7), P1564.CrossRefGoogle Scholar
  29. Wu, F., Jiang, Y., Rao, K. Q., Qian, J. C., Li, X. J., Ying, S. X.,… Kowal, P. (2012). China: Study on global AGEing and adult health (SAGE) Wave 1 National Report. Shanghai Municipal Center For Disease Control & Prevention (SCDC), Geneva.Google Scholar
  30. Xiang, Y. T., Yu, X., Sartorius, N., Ungvari, G. S., & Chiu, H. F. (2012). Mental health in China: Challenges and progress. Lancet, 380(9855), 1715–1716. Scholar
  31. Xie, C., Chen, D., Jin, C., Du, L., Wang, C., Xin, H., et al. (2016). Higher incidence of deteriorated mental health in older people being mistakenly labeled as dementia: A two-year consecutive community-dwelling study in Shanghai, China. The Tohoku Journal of Experimental Medicine, 238(4), 317–324.CrossRefPubMedGoogle Scholar
  32. Xu, Z., Huang, F., Kosters, M., & Rusch, N. (2017a). Challenging mental health related stigma in China: Systematic review and meta-analysis. II. Interventions among people with mental illness. Psychiatry Research, 255, 457–464. Scholar
  33. Xu, X., Li, X. M., Zhang, J., & Wang, W. (2017b). Mental health-related stigma in China. Issues in Mental Health Nursing. Scholar
  34. Yang, J. (2016). The politics and regulation of anger in Urban China. Culture, Medicine and Psychiatry, 40(1), 100–123.CrossRefPubMedGoogle Scholar
  35. Yang, L., Jin, X., Yan, J., Jin, Y., Yu, W., Wu, H., et al. (2016). Prevalence of dementia, cognitive status and associated risk factors among elderly of Zhejiang province, China in 2014. Age and Ageing, 45(5), 708–712.PubMedGoogle Scholar
  36. Yiengprugsawan, V., D’Este, C., Byles, J., & Kendig, H. (2019). Geographical variations in self-rated health and functional limitations among older Chinese in eight WHO-SAGE provinces. BMC Geriatrics, 19(1), 10. Scholar
  37. Yu, S., Kowitt, S. D., Fisher, E. B., & Li, G. (2017). Mental health in China: Stigma, family obligations, and the potential of peer support. Community Mental Health Journal. Scholar
  38. Zhou, C., Ji, C., Chu, J., Medina, A., Li, C., Jiang, S., et al. (2015). Non-use of health care service among empty-nest elderly in Shandong, China: A cross-sectional study. BMC Health Services Research, 15(1), 294.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Zou, C., Chen, S., Shen, J., Zheng, X., Wang, L., Guan, L., et al. (2018). Prevalence and associated factors of depressive symptoms among elderly inpatients of a Chinese tertiary hospital. Clinical Interventions in Aging, 13, 1755–1762. Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Research School of Population HealthAustralian National UniversityCanberraAustralia
  2. 2.Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, College of Health and MedicineThe Australian National UniversityCanberraAustralia
  3. 3.Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), University of New South WalesSydneyAustralia

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