The association between education level, widowhood, and depression among elderly Chinese after controlling for demographic, health, and behavioral variables.

With the rapid advancement of China's aging population, the mental health problems of the elderly, especially depression, have become an important concern in the field of public health. However, research on the combined effect of education level and widowhood on depression is still relatively limited. The aim of this study is to explore the association between education level, widowhood status, and depression symptoms among elderly people in China, and further analyze the moderating effects of health status, demographic characteristics, and behavioral variables in this association. Data from the 2018 China Health and Retirement Longitudinal Study were used. A total of 3243 participants aged 50 and above were analyzed. A simplified 10 item CES-D scale was used to assess depression. Logistic regression models were used to examine the independent and interactive effects of education level and widowhood on depression, while adjusting for demographic variables (age, gender, type of residence), health status (chronic disease, self-rated health), and behavioral factors (physical activity, smoking). Even after controlling for confounding factors, lower levels of education were significantly associated with a higher risk of depressive symptoms (odds ratio [OR] = 1.52, P < .01). Widowhood is also a strong predictor of depression (OR = 1.79, P < .01), especially in women. Interaction analysis indicates that poor self-rated health and a sedentary lifestyle exacerbate the negative impact of low education and widowhood on depression. In addition, rural residents and individuals with lower socioeconomic status face a higher risk of depression symptoms. Low education level and widowhood are independent factors contributing to the high incidence of depression among elderly people in China. Health status and lifestyle factors play a crucial mediating role in this association. These findings emphasize the necessity of targeted intervention measures, such as community-based education programs, sports promotion, and strengthening social support networks, to reduce the risk of depression among vulnerable elderly people in China.