Association Between Social Activities and Depression in Middle-Aged and Older Stroke Patients

Post-stroke depression is a psychological complication among stroke survivors, associated with adverse outcomes. In recent years, social activity engagement has been proposed as a potential intervention to alleviate depression, yet evidence remains limited for middle-aged and older stroke populations in China.

To examine the association of participation and diversity of social activities with depression among middle-aged and older Chinese stroke patients.

Using data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020, we included 731 stroke patients for cross-sectional analysis, with 365 stroke patients without baseline depression used for longitudinal analysis. Weighted logistic regression assessed social activities-depression associations. Unweighted analyses tested robustness, and subgroup analyses explored sex and age differences.

Cross-sectional analysis showed that in the fully adjusted model, interacting with friends (OR = 0.66, 95% CI: 0.45-0.98) and helping others (OR = 0.50, 95% CI: 0.28-0.90) were linked to lower depression likelihood. Longitudinal analysis demonstrated that, in the fully adjusted model, interacting with friends (OR = 0.49, 95% CI: 0.27-0.91), helping others (OR = 0.38, 95% CI: 0.18-0.79), and internet use (OR = 0.36, 95% CI: 0.14-0.91) significantly reduced two-year incident depression likelihood. Compared to non-participants, engagement in multiple social activities was linked to markedly lower odds of depression (OR = 0.48, 95% CI: 0.28-0.81) and two-year incident depression (OR = 0.36, 95% CI: 0.16-0.77). These associations were more prominent in males, those who take care of grandchildren, or those with frequent children visit (once a week or more).

Participation in social activities, particularly diverse engagements, is significantly associated with reduced depression likelihood among middle-aged and older Chinese stroke patients, with a stronger effect in males. Based on the above findings, clinical practice should attach importance to integrating social activities into post-stroke rehabilitation and public mental health programs.