Background: So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. Objective: This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. Methods: An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. Results: Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; P<.001). Conclusions: We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs.

Objectives: A number of studies have established the link between childhood adversity (CA) and depression across the life span. This association can be culturally specific, and it remains unclear whether and how different aspects of CA affect depressive symptoms in later life in non-Western societies. Method: Data were from the China Health and Retirement Longitudinal Study in 2011, 2013, 2014 (Life Event History survey) and 2015 (N = 13,710). Depressive symptoms were measured repeatedly in 2011, 2013, and 2015 using the ten-item Centre for Epidemiologic Studies Depression Scale (CES-D-10). CA was assessed in 2014 by parental physical abuse, maternal emotional neglect, early parental death, parental mental health problems, poor quality of parental relationship, and childhood socioeconomic disadvantage. Multilevel linear models were used to analyse the data. Results: Parental physical abuse was associated with 0.51 (95% confidence interval [CI]: 0.28, 0.74) and 0.59 (95% CI: 0.31, 0.88) higher CES-D-10 scores compared to those without such abuse experience for men and women, respectively. Emotional neglect predicted 0.30 (95% CI: 0.07, 0.51) and 0.33 (95% CI: 0.08, 0.58) higher CES-D-10 scores for men and women. Elevated CES-D-10 scores were also found among men and women whose parents had poor mental health and poor relationship, and those who experienced food inadequacy (men: 0.78, 95% CI: 0.54, 1.01; women: 1.15, 95% CI: 0.90, 1.41). Early parental death nevertheless was not associated with CES-D-10 scores. Conclusion: CA exerts long-term detrimental effects on mental health in mid- and late-life among Chinese adults. The findings are consistent with those from Western societies, except for early parental death.

The global aging phenomenon has raised concerns about the cognitive abilities of older individuals. This study aimed to explore the relationship between social participation, depressive symptoms, and cognitive function among middle-aged and older adults. This study utilized data from the China Longitudinal Study of Health and Retirement (CHARLS) from wave 1 to wave 4. We used linear regression and generalized estimation equations to investigate the correlation between social participation, depressive symptoms, and cognitive function. Moreover, three models were constructed by adjusting covariates, and we used the sobel test and bootstrap method to analyze the mediating effects of depressive symptoms on social activities and cognitive function. The results of both linear regression and generalized estimation equation showed that social participation had a positive correlation with cognitive function (P < 0.05), and the impact of social participation on cognition increased with the number of social activity types. Meanwhile, depressive symptoms had a negative association with cognitive function (P < 0.05). Furthermore, there was no interaction between social participation and depressive symptoms on cognitive function. Finally, after adjusting the model, social participation could affect cognitive function by affecting depressive symptoms (P < 0.05). The study emphasizes the mediating role of depressive symptoms in the relationship between social participation and cognitive function. Notably, no interaction was observed between social participation and depressive symptoms. These findings highlight the potential of active social participation in reducing depressive symptoms and enhancing cognitive function in middle-aged and older adults.

No consensus has been reached on whether depression decreases or increases with age in later life. Majority of the evidence comes from Western societies, while little is known about this relationship and its rural-urban disparities in the Chinese context. Three waves of data from 15,501 Chinese adults aged 45–85 years from the China Health and Retirement Longitudinal Study, Chinese sister study of Health and Retirement Study, were used. Depression caseness was identified using the 10-item Center for Epidemiologic Studies Depression Scale (score ≥12). Urbanisation levels were determined by combining rural-urban residence and rural-urban Hukou (a household registration system). Odds ratios and predicted probabilities of depression caseness were estimated using generalised linear mixed models. For both men and women and across all ages, the crude predicted probability of depression caseness was the highest in the rural group, followed by the semi-urban group, and the lowest in the urban group. The probability was stable over age among urban men (around 0.05), but it increased at an accelerated rate with age among semi-urban men (0.25 at age 85, 95% confidence interval [CI]: 0.13–0.44) and rural men (0.29 at age 85, 95% CI: 0.22–0.39). Among women the age pattern was similar between the urbanisation groups: the probability increased with age, reached a peak at ages 75–80 (urban women: 0.16, 95% CI: 0.13–0.20; semi-urban women: 0.28, 95% CI: 0.20–0.39; rural women: 0.41, 95% CI: 0.36–0.46), and decreased slightly afterwards. These differences were significantly attenuated when socio-demographic characteristics and physical disability, but not when behaviour-related factors, were controlled for. The age trajectories of later-life depression caseness varied by gender and urbanisation levels, and were not U-shaped as in many Western societies. The increasing depression caseness with age and the large rural disadvantage were substantially driven by socio-demographic characteristics and physical disability.

Background Despite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is akin to that observed in Western societies. We compared incident risk of mid–late life depression by childhood and adulthood SEP in China and England, a country where mental health inequality is firmly established. Methods Depression-free participants from the China Health and Retirement Longitudinal Study (N=8508) and the English Longitudinal Study of Ageing (N=6184) were studied over 4 years. Depressive symptoms were classified as incident cases using the Center for Epidemiologic Studies Depression Scale criteria. Associations between SEP (education, wealth, residence ownership and childhood/adolescent deprivation) and depression symptom onset were assessed using Cox proportional hazards models. In China, we also investigated children’s government employment status as a SEP marker. Results Higher education and wealth predicted lower incidence of depression in both countries. The association with non-ownership of residence appeared stronger in England (HR 1.61, 95% CI 1.41 to 1.86) than in China (HR 1.11, 95% CI 0.95 to 1.29), while that with childhood/adolescent deprivation was stronger in China (HR 1.43, 95% CI 1.29 – 1.60) than in England (HR 1.33, 95% CI 0.92 to 1.92). Chinese adults whose children were employed in high-status government jobs, had lower rates of depression onset. Conclusions Consistent findings from China and England demonstrate that SEP is a pervasive determinant of mid–late life depression in very diverse social contexts. Together with conventional measures of SEP, the SEP of children also affects the mental health of older Chinese.