Association Between Cognitive Leisure Activities and Symptoms of Depression in Chinese Middle-Aged and Older Adults: A CHARLS Cohort Study from 2011 to 2018

Background: Cognitive leisure activities (CLA) and pain may affect depressive symptoms in middle-aged and older people in China.This study aimed to clarify the association between CLA and depressive symptoms in middle-aged and older groups, and further analyze the mediating function of pain in this relationship.Methods: Data were obtained from the CHARLS from 2011 to 2018.The association between the CLA Score (CLAS) and depressive symptoms was assessed by the multilevel logistic regression model to analyze regional differences.Subgroup analysis was performed by age and sex.The mediating effect of pain was tested.Results: High CLAS (Group 4) was significantly related to a reduced risk of depressive symptoms (OR = 0.58, 95% CI: 0.44-0.76,P < 0.0001).Results were consistent across eastern and western regions.Subgroup analysis revealed no significant interaction associations.Pain accounted for 10.0% of the mediating effect. Conclusion:Higher CLAS is notably related to a reduced risk of depressive symptoms.This finding provides new directions for interventions targeting depression symptoms in middle-aged and older adults.