Bidirectional Association Between Internet Use and Depressive Symptoms Among Middle-Aged and Older Adults in China: A Cross-Lagged Model of Proactive Health Behavior as the Mediating Role.

Objectives: The present study aimed to examine the bidirectional relationship between internet use and depressive symptoms among middle-aged and older adults. Moreover, it explored whether proactive health behavior mediates the association between internet use and depressive symptoms. Methods: We used the latest three-wave data (2015, 2018, and 2020) from the China Health and Retirement Longitudinal Study (CHARLS), which included 11,332 participants aged 45 years and older. The bidirectional relationship between internet use and depressive symptoms was examined using a cross-lagged model. The mediating role of proactive health behavior was also investigated using a cross-lagged mediation model. Results: Cross-lagged models indicated reciprocal effects between depressive symptoms and internet use. Internet use had a greater impact on subsequent depressive symptoms than vice versa. Mediation analyses further revealed that proactive health behavior significantly mediated the path from internet use to depressive symptoms. Furthermore, subgroup analyses showed these effects were not significantly heterogeneous in subgroups by age and chronic disease status. Conclusions: This study sheds light on the direction of the association between internet use and depressive symptoms. Internet use could reduce depressive symptoms among middle-aged and older adults by enhancing proactive health behavior.