Quality of Life Research

https://doi.org/10.1007/s11136-020-02674-4

The relationship between health‑promoting lifestyles and depression

in the elderly: roles of aging perceptions and social support
Wei Zhou1,2 · Defeng Chen1 · Zijing Hong1,2 · Hang Fan1 · Shen Liu3 · Lin Zhang1

Accepted: 6 October 2020

© Springer Nature Switzerland AG 2020

Abstract
Purpose At present, it is not clear about the influence of health-promoting lifestyle, aging perceptions, social support, and
other psychosocial factors on elderly depression. This study aims to explore the mediating role of aging perceptions between
health-promoting lifestyle and elderly depression, and the moderating role of social support in the mediating process.
Methods A cross-sectional survey was conducted among 359 elderly people in six districts of a city. The Chinese version
of the Health-Promoting Lifestyle Profile-II (HPLP-IIR), the Brief Aging Perceptions Questionnaire (B-PQ), the Center
for Epidemiological Studies Depression Scale (CES-DR), and the Social Support Rate Scale (SSRS) were conducted and
recollected on the spot. Stepwise analysis was used to test the mediating effect and moderating effect, and age and gender
variables were controlled.
Results The results showed the following: (1) health-promoting lifestyle is an important influencing factor of elderly depres-
sion; (2) aging perceptions plays a mediating role in the relationship between health-promoting lifestyle and elderly depres-
sion, accounting for 31.8% of the total utility; and (3) social support plays a moderating role between aging perceptions and
elderly depression, with a high level of social support. The effect of aging perceptions on depression is less than that of the
elderly with low social support level.
Conclusion Health-promoting lifestyle influence the depression of elderly people through aging perceptions and social sup-
port moderates the influence of aging perceptions on the elderly depression.

Keywords Health-promoting lifestyle · Depression · Aging perceptions · Social support · Elderly

Introduction of the most common psychological symptoms of the elderly,

is a negative emotion caused by the inability to cope with
The advent of the aging society has, to a certain extent, external stress [2, 3]. Studies have shown that age and gen-
caused some psychological problems in the elderly, such as der are important factors affecting depression in elderly peo-
anxiety, loneliness, and depression [1]. Depression, as one ple. The incidence rate of depression in older adults is higher
than that in other adult groups, with a significant increase
with age, and women are more likely to have depression
Wei Zhou and Defeng Chen contributed equally to this work. than men [4, 5]. Depression can lead to cognitive impair-
ment, Alzheimer’s disease, and even suicide in the elderly
* Shen Liu
[email protected] [6]. In order to better understand the causes of depression in
the elderly, this study based on previous studies found that,
* Lin Zhang
[email protected] after controlling age and gender variables, we explored the
influence of psychological and environmental factors on the
1
Department and Institute of Psychology, Ningbo University, elderly depression.
No. 818 Fenghua Road, Jiangbei District, Ningbo 315211, Depression of the elderly is often accompanied by an
China
unhealthy lifestyle and depression can affect the health
2
School of Management, Jinan University, Jinan 510632, promotion behavior of the elderly [7]. Health-promoting
China
lifestyle is a way for individuals to maintain physical and
3
School of Humanities and Social Sciences, University mental health by maximizing their subjective initiative and
of Science and Technology of China, Hefei 230022, China

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 Quality of Life Research

adopting health-promoting behaviors. This lifestyle could function and the generation of negative emotions [22]. In
prevent the health diseases, reducing physical and mental other words, health-promoting lifestyles may have an impact
problems [8]. It is found that health-promoting lifestyle on depression in the elderly through aging perceptions.
can improve individual physical function and health level, Based on this, the current study proposes the Hypothesis 2:
and it is also an important influencing factor of individual Aging perceptions could play a mediating role in the rela-
depression [7, 9, 10]. According to the health promotion tionship between health-promoting lifestyle and depression
model (HPM), individuals can maximize their subjective in the elderly.
initiative, improve health-care awareness and ability, self- Constructing a good social support system can enhance
esteem and self-efficacy with a health-promoting lifestyle social support for the elderly, so as to effectively reduce
[11, 12]. Instead, individuals adopting an unhealthy life- the incidence of depression and help improve their mental
style show more tendency to experience negative emotions, health [23, 24]. Social support is the care, comfort, and help
like depression and anxiety [13, 14]. This difference may that individuals can receive from family members, relatives,
be due to the fact that health-promoting lifestyle increases friends, colleagues, organizations, and communities. It helps
individuals’ health-promoting behaviors and enhances emo- reduce mental stress reactions and tensions of the elderly,
tion management abilities. Therefore, it is speculated that as well as to help them improve social adaptability [25].
a health-promoting lifestyle may reduce depression in the The stronger the social support system of the elderly, the
elderly. Previous studies pay more attention to the relation- more likely they are to cope with aging in a positive way
ship between the lifestyle and the emotions of the elderly. and maintain optimism [26]. The buffering model of social
This study explores whether the elderly actively develop a support believes that social support, as a buffer, plays its
healthy lifestyle will have an impact on the elderly’s depres- role through the human internal cognitive system. Social
sion, and whether this conscious increase in health behavior support may function as an intermediate link between stress-
can alleviate the elderly’s depression. Based on this, the cur- ful events and subjective evaluations [27]. In the current
rent study proposes the Hypothesis 1: There was a signifi- study, social support may moderate the relationship between
cant negative correlation between health-promoting lifestyle health-promoting lifestyle and aging perceptions, namely,
and depression in the elderly. the good social support could moderate the impact of health-
Successful aging, indicated by the degree to which indi- promoting lifestyle on aging perceptions. The manifesta-
viduals adapt to aging, means that the elderly could keep tion may be that high social support reduces the negative
physical and mental health, as well as maintain good family effect of unhealthy lifestyle on aging perceptions. Based on
and social relationships after entering the old age. In the this, the current study proposes the Hypothesis 3: Social
trend of intensified aging, confronted with physical and men- support would play a moderating role in the first half of
tal aging as well as social aging, the elderly experience sub- the mediation path of “health-promoting lifestyle → aging
jective perceptions and emotional responses, namely aging perceptions → depression.”
perceptions. Aging perceptions, both positive and negative, According to the ABC theory of emotion, an individual’s
affect the behavioral tendencies of the elderly during the emotions are not caused by an event itself, but by the indi-
aging process [15]. Positive aging perceptions refer to the vidual’s interpretation and evaluation of the event. It is the
positive effects and experience brought by the increasing old unreasonable beliefs that cause individuals to be emotion-
age, while negative aging perceptions refer to the negative ally disturbed, such as thinking that something must happen
experience of mental, physical, and social aspects due to or not happen, or irrational generalizations [28]. In other
aging [16]. For the elderly, aging perceptions is an important words, the individual’s emotional experience comes from
factor affecting their physical and mental health. Positive his perceptions of things [29], and the irrational percep-
Aging perceptions has a positive effect on their physical tions may be the conducive reason for the depression of the
and mental health, while negative aging perceptions has a elderly. As a protective factor, social support can reduce the
negative impact on their physical and mental health [17–20]. adverse impact of negative cognition on depression, while
According to the schema theory [21], the information pro- the elderly without social support are more likely to have
cessing schema formed by individuals during negative life depression [17, 30]. High levels of social support alleviate
experiences has higher susceptibility, thus is more likely the negative effects of high aging perceptions on depres-
to cause depression and anxiety among the elderly. The sion, while lower levels of social support may enhance the
elderly who do not adopt a health-promoting lifestyle might negative effects. Based on this, the current study proposes
experience negative life events, and the formed information the Hypothesis 4: Social support would play a moderating
processing schemes may make the elderly feel more nega- role in the second half of the mediation path of “health-
tive perceptions toward aging [14]. Moreover, an unhealthy promoting lifestyle → aging perceptions → depression.”
lifestyle impairs the use of self-regulation strategies in the Hypotheses 3 and 4 aimed to explore how social support
elderly and is closely related to the decline of their body play its moderating role in the mediation path, i.e., whether

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Quality of Life Research

by moderating the effect of health-promoting lifestyle on

aging perceptions or by moderating the effect of aging per-
ceptions on depression. In previous studies, social support
has been a major influencing factor of the health-promoting
lifestyles and depression in the elderly [23, 26]. The cur-
rent study intended to verify the possible moderating role
of social support in the relationship between health-promot-
ing lifestyles and older people’s depression, in an effort to
remind families and society to strengthen the social support
for the elderly and help them better cope with the threat of
aging. The current study infers that the elderly with differ-
ent levels of social support would respond to risks in varied Fig. 1  A Mediated moderation model
ways when they do not adopt a health-promoting lifestyle. If
the elderly can quickly escape from stressful situations, they
can maintain their mental health. Based on this, the current with each other when answering questionnaires. They were
study proposes the Hypothesis 5: Social support would play informed beforehand that the questionnaires were collected
a moderating role in the direct path of health-promoting and used only for research purposes. The total test time was
lifestyles → depression. about 30 min. All the questionnaires were conducted and
In summary, the current study intended to explore the recollected on the spot. A total of 380 questionnaires were
effects of health-promoting lifestyles, aging perceptions, and distributed and 359 valid questionnaires were collected,
social support on depression in the elderly. Firstly, it investi- with an effective recovery rate of 94.5%. There were 155
gated whether aging perceptions play a mediating role in the males and 204 females, aged 60 to 84, with an average age
relationship between health-promoting lifestyles and depres- of 69 years (SD 8.95). The Ethics Committee of authors’
sion in the elderly. Secondly, it examined whether social sup- University approved this study, in accordance with the ethi-
port could moderate the mediating process in which health- cal principles of the Declaration of Helsinki. All subjects
promoting lifestyles affect the depression in the elderly. The gave written informed consent in accordance with the ethical
hypothetical model of the relationship between variables is principles of the Declaration of Helsinki. After the survey,
shown in Fig. 1. the participating elderly were thanked with remuneration
and equivalent small gifts for their support and cooperation.

Methods
Measures and procedures
Participants
The Chinese version of the Health-promoting lifestyle pro-
Taking the elderly community in each district of a city as file-II (HPLP-IIR) compiled by Walker [31] and revised by
the measurement unit, there are six districts under the city. Cao et al. [32] was adopted. It was a 40-item questionnaire
In each district, the largest elderly community is selected for of six dimensions, including interpersonal relationships,
recruitment. According to the actual situation, 60–70 ques- nutrition, health and responsibility, sports, stress manage-
tionnaires are distributed to each district. Finally, 380 elderly ment, and spiritual growth. Each item was scored on a
people are recruited for on-site random questionnaire survey. 4-point Likert scale, where 1 means “never” and 4 means
The admission criteria included the following: aged 60 and “definitely.” The higher the score, the higher the level of
above, with clear consciousness, with no communication health promotion. In the current study, the Cronbach’s α of
barriers or psychopath, and able to complete questionnaires this scale was 0.82, and the Cronbach’s α of each subscale
independently or with the help of researchers. The exclu- was 0.85, 0.83, 0.91, 0.88, 0.89, and 0.92, respectively.
sion criteria included the following: with severe dementia The Brief aging perceptions questionnaire (B-PQ) com-
or disability, with unstable emotion, and unable to complete piled by Sexton et al. [33] and revised by Hu et al. [34]
questionnaires. Psychology graduate students served as the was adopted. It was a 17-item questionnaire of five dimen-
main test and provide explanation and guidance before and sions, including negative outcomes and control, positive
during the questionnaire. Questionnaires were collectively outcomes, chronic time, active control, and emotional
conducted in units of communities. Professionally trained representation. Each item was scored on a 5-point Likert
graduate students in psychology served as the main testers, scale, where 1 means “strongly disagree” and 5 means
who explained the instructions and assisted the participants “strongly agree.” The higher the score, the lower the level
with the questionnaires. The participants did not interfere of aging perceptions. In the current study, the Cronbach’s

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α of this scale was 0.84, and the Cronbach’s α of each (Process v3.5, download address: https ​ : //www.Afhay​
subscale was 0.87, 0.89, 0.91, 0.88, and 0.85, respectively. es.com/) Hayes [39] was used to test the moderation media-
The Social Support Rate Scale (SSRS) compiled by tion model. According to Wen et al., the structural equation
Xiao [35] was adopted. It was a 10-item questionnaire of model (SEM) was established by amos23.0 to evaluate the
three dimensions, including objective support, subjective fitting index of the comprehensive model. If CFI, NFI, and
support, and utilization of social support. Among them, GFI are greater than 0.90 and RMSEA is less than 0.06, it
questions 1–4 and 8–10 are scored on a 4-point Likert can be considered as an acceptable fitting model [40].
scale, where 1 means “cannot get support” and 4 means
“get sufficient support.” Question 5 counts the total score
of five items: A, B, C, D, and E. Each item was scored on Results
a 4-point Likert scale, where 1 is for “no support” and
4 for “full support.” If questions 6 and 7 were answered Since all data were collected from the subjects’ self-reports,
with “no source,” participants scored 0; if questions 6 and results were susceptible to common method bias. Accord-
7 were answered with “those from the following sources,” ing to Zhou and Long [40], Harman’s single-factor test
participants scored the number of the listed sources. The was adopted for the common method bias test. The results
higher the score, the higher the higher level of social sup- showed that 18 components emerged with eigenvalues of
port. In the current study, the Cronbach’s α of this scale over 1.0, and the largest single component accounted for
was 0.80, and the Cronbach’s α of each subscale was 0.87, 19.33% of the variance, far less than 40%, which indicated
0.82, and 0.85, respectively. that there was no obvious common method bias in this study
The Center for epidemiological studies depression scale [41].
(CES-DR) compiled by Radloff [36] and revised by Feng The mean, standard deviation, and correlation matrix of
et al. [37] was adopted. It was a 10-item questionnaire variables in the current study are shown in Table 1. The
of four dimensions, including negative emotions, positive depression of women was significantly higher than that of
emotions, physical symptoms, and interpersonal relation- men. Education level was significantly positively corre-
ships. Each item was scored on a 4-point Likert scale, lated with monthly income and health promotion lifestyle.
where 1 means “very little or never” and 4 means “many Health-promoting lifestyle and social support were both
or all times.” The higher the score, the higher the level of significantly negatively correlated with depression, while
depression. In the current study, the Cronbach’s α of this aging perceptions were significantly positively correlated
scale was 0.79, and the Cronbach’s α of each subscale was with depression. Health-promoting lifestyle was significantly
0.82, 0.85, 0.86, and 0.81, respectively. negatively correlated with aging perceptions and signifi-
cantly positively correlated with social support. Aging per-
Statistical analysis plan ceptions were significantly negatively correlated with social
support. Moreover, since gender was significantly positively
Due to common method biases, we conducted a common related to depression, it was included as a control variable
method biases test based on the Harman single factor test in subsequent analysis in order to exclude its effect on the
before data analysis. Less than 40% of the tests showed no study results.
significant common method biases [38]. Spss22.0 statistical According to Wen and Ye [42], the current study exam-
software was used to analyze the demographic variables and ined the relationship between health-promoting lifestyles
descriptive statistics of the four research variables, and the and depression and the mediating effects of aging percep-
correlation matrix was used to further control the variables tions in the above relationship. All variables were normal-
and conduct model test. Model 59 of process macro program ized, using standardized variables in SPSS 22.0 and then

Table 1  Means, standard M SD 1 2 3 4 5 6

deviations, and correlation
matrices of variables (N = 359) 1. ­Gendera – – 1
2. Age 68.86 8.95 0.11* 1
3. Health-promoting lifestyles 75.22 23.09 − 0.04 0.05 1
4. Aging perceptions 48.70 16.23 0.00 0.02 − 0.38*** 1
5. Social support 27.33 7.39 − 0.03 − 0.07 0.14* − 0.20*** 1
6. depression 26.63 6.53 0.20*** − 0.02 − 0.43*** 0.48*** − 0.54*** 1

Gender is a dummy variable, male = 0, female = 1; N = 359; *p-value < 0.05, **p-value < 0.01, and
***p-value < 0.001, the same as below

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Quality of Life Research

three regression equations were tested by stepwise analysis

[43, 44]. Equation 1 estimates the moderating effect of social
support on the relationship between health-promoting life-
style and depression; Equation 2 estimates the moderating
effect of social support on health-promoting lifestyles and
aging perceptions; and Equation 3 estimates the moderating
effect of social support on aging perceptions and depression.
The results are shown in Table 2. In equation 1, both health-
promoting lifestyle and social support were important influ-
encing factors of elderly depression (p < 0.001, p < 0.01),
while in equation 2, health-promoting lifestyle was an
important influencing factor of aging perceptions (p < 0.01).
The results of equation 3 showed that aging perceptions was
the influencing factor of elderly depression (p < 0.001). The
interaction between aging perceptions and social support had Fig. 2  Moderation effects of social support on the effect of aging
a significant impact on the elderly depression (p < 0.001). perceptions on depression. Slope is the regression coefficients in the
regression equation, where aging perceptions as the independent vari-
In summary, the analysis of the moderated mediation able, elderly depression as the dependent variable, and social support
effects of the current study found that aging perceptions as the moderating variable
played a partial mediating role in the relationship between
health-promoting lifestyles and depression in the elderly. It
was also found that social support moderated the second fitted well (χ2/df = 2.43, CFI = 0.93, NFI = 0.95, GFI = 0.91,
half of the path mediated by aging perceptions. In order RMSEA = 0.07), as shown in Fig. 3. Among them, health-
to explain the moderated mediation model more clearly, promoting lifestyle had a significant negative impact on
Johnson-Neyman analysis technique was used to perform a depression (γ =  − 0.27, p < 0.001), and it had a significant
simple slope test [39, 45]. These results are shown in Fig. 2 negative impact on aging perceptions (γ =  − 0.37, p < 0.001).
(social support was continuous variable in this study); the Aging perceptions had a significant positive impact on
value range of social support (after standardization) was depression (γ = 0.98, p < 0.001), indicating its partial mediat-
[− 2.21, 1.45], and the simple slope was significantly not ing role between health-promoting lifestyles and depression;
0. At the same time, the more social support the elderly social support had a significant negative impact on depres-
received, the relationship between aging perceptions and sion (γ =  − 0.53, p < 0.001). The interaction between social
depression in the elderly was comparatively weakened. In support and aging perceptions negatively affected depression
other words, high social support can reduce the negative (γ =  − 0.84, p < 0.001), indicating that social support played
effects of aging perceptions on depression in the elderly. a moderating role in the second half of the path mediated by
According to Wen et al. [40], the integration model aging perceptions.
was further tested. The results have shown that the model

Table 2  Analysis of mediated moderation effects

Equation 1 (validity criterion: Equation 2 (validity criterion: Equation 3 (validity criterion:
depression) aging perceptions) depression)
β SE 95%CI β SE 95%CI β SE 95%CI

Health-promoting lifestyles − 0.35*** 0.19 [− 0.72, − 0.16] − 0.59** 0.23 [− 1.04, − 0.15] 0.13* 0.18 [− 0.48, − 0.23]
Social support − 0.47** 0.15 [− 0.77, − 0.18] − 0.34 0.18 [− 0.70, 0.02] − 0.55* 0.22 [− 0.98, − 0.13]
Health-promoting lifestyle × Social − 0.02 0.26 [− 0.52, 0.48] 0.33 0.31 [− 0.27, 0.93] − 0.54* 0.24 [− 1.02, -0.07]
support
Social support × Aging perceptions − 0.96*** 1.71 [− 1.29, − 0.62]
Aging perceptions 1.09*** 0.15 [0.80, 1.38]
Age 0.01 0.01 [− 0.01, 0.01] 0.03 0.01 [− 0.01, 0.01] − 0.02 0.01 [− 0.10, 0.01]
R2 0.42 0.16 0.53
F 83.88*** 17.88*** 66.07***

Variables in the model are normalized, the same as below

*p < 0.05, **p < 0.01, ***p < 0.001

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 Quality of Life Research

lifestyle can indirectly influence the depression of the elderly

through aging perceptions; thus, Hypothesis 2 is supported.
Elderly people can enhance their ability to regulate emo-
tions by sticking to health-promoting lifestyles. They have a
stronger ability to deal with the psychological and physical
threats caused by aging and maintain positive aging per-
ceptions. The results supported the schema theory of Jaffe
that a health-promoting lifestyle can reduce the negative life
experience of the elderly [21]. If the elderly adopt a posi-
tive attitude toward aging and maintain a good mood, the
Fig. 3  Mediated moderation model. R2 means variance interpretation; occurrence of depression can be reduced. This is consistent
*p-value < 0.05, **p-value < 0.01, and ***p-value < 0.001
with previous studies [22]. A healthy lifestyle guarantees
the physical and mental health of the elderly, promotes their
Discussion higher expectations for the future, and makes them more
positive toward aging.
The current study explores the relationship between health- The current research results suggest that health-promot-
promoting lifestyles and depression in the elderly, and ing lifestyles can affect older people’s mood through aging
examines the mediating role of aging perceptions and the perceptions. Living in families, communities, and the soci-
moderating role of social support. These factors are of sig- ety, the elderly tend to be affected by many risks. Due to
nificance for understanding the mechanism of depression in the coming aging wave, a large number of “empty-nest”
the context of aging. The current study found that a health- elderly people have emerged, and so it has a social reality
promoting lifestyle was significantly negatively related to that their children cannot take care of them. In most cases,
the depression of elderly people, suggesting that a health- the elderly need to take care of themselves, and adopting
promoting lifestyle was a protective factor in the depres- a negative lifestyle will adversely affect their physical and
sion. Therefore, hypothesis 1 is supported. Also, this result mental health and also their beliefs, which is manifested in
is consistent with previous studies [9, 46], indicating that self-evaluation, lowered self-esteem, and frustration [48].
the elderly adopt the health-promoting lifestyle to increase These negative psychological feelings improve the level of
health-promoting behaviors, so as to reduce depression. The aging perceptions, affect their psychological adaptability,
findings support the health promotion model, in which the and increase the risk of depression. Therefore, the elderly
elderly adopt positive behaviors to cope with life, making should be encouraged and guided to adopt a health-pro-
better use of physical and psychological resources to control moting lifestyle, increase health-promoting behaviors, and
and reduce mental stress, thus reducing depression [46]. The develop healthy habits, which can greatly reduce the adverse
results showed that gender is significantly positively related effect of unhealthy lifestyles on their aging perceptions and
to depression in the elderly, and women are more likely to thus reduce the risk of depression.
develop depression than men. The gender difference may be The current study found that social support played a mod-
due to the fact that women tend to be more delicate and sen- erating role in the relationship between aging perceptions
sitive, paying more attention to the changes brought by age. and depression in the elderly. Although aging perceptions is
Moreover, society’s poor evaluation of the elderly makes an important factor affecting depression in the elderly, the
women more likely to have depression [5]. effect on the elderly with different degree of social support
The current study also found that aging perceptions play is not exactly the same, because social support alleviates
a partial mediating role in the relationship between health- the effect of negative aging perceptions on elderly depres-
promoting lifestyles and depression, and that the mediat- sion. The current study indicates that, for the elderly with
ing role accounts for 31.8% of the total utility. The lack of a high level of social support, although the effect of aging
health-promoting behaviors can directly affect the depres- perceptions on depression is still significant, the effect is
sion of the elderly. The results show that the health-promot- far less than the elderly with low social support. The results
ing lifestyle is significantly negatively correlated with aging show that social support not only has a negative effect on
perceptions, which is consistent with the research results that depression in the elderly but also weakens the effect of posi-
unhealthy lifestyle impairs the self-regulation mechanism tive aging perceptions caused by unhealthy lifestyles [27];
of the elderly, and feels more about the negative effects of therefore, Hypothesis 4 is proved true. The probable cause
aging [14, 22]. Elderly people with low HPLP-IIR scores are is that the older people, though with less positive aging per-
more likely to have physical weakness, cognitive decline, ceptions, can better respond to stressful events by obtaining
and other issues, which makes them more negative of aging social support, thereby relieving their depression [48]. In
and exacerbates their depression [47]. Health-promoting addition, Wang et al. [49] found that social support can affect

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Quality of Life Research

the quality of life of the elderly through depression [50], Author contributions LZ and SL conceived this work. WZ, DC, ZH,
while this study points out that health-promoting lifestyle and HF performed this work, analyzed the data, and wrote the draft.
WZ, DC, ZH, HF, SL, and LZ revised the draft and approved the final
affects elderly depression. This may be because the quality version of this work.
of life and depression of the elderly are mutually causal.
The change of depression will lead to the change of qual- Funding This work was supported by the National Natural Science
ity of life, and the change of quality of life in turn affects Foundation of China [No. 71874170], the Fundamental Research Funds
the depression of the elderly. As a protective factor, social for the Central Universities [No. YD2110002004], and the K. C. Wong
Magna Fund at Ningbo University.
support provides physiological and psychological support
for the elderly. It is not difficult to understand that due to
Data availability It will be available upon request.
the lack of support from the external environment, elderly
people with low social support are more inclined to gener-
Code availability It will be available upon request.
ate irrational beliefs and lower their cognitive evaluation,
which makes them more susceptible to depression. The
results show that social support is significantly negatively
related to aging perceptions. This indicates that social sup-
Compliance with ethical standards
port can alleviate the negative effects of high aging percep-
tions on depression. Children are the most important source Conflict of interest The authors declares that they have no conflict of
of social support for the elderly. Therefore, children should interest.
provide adequate support to the elderly both materially and
emotionally, and maintain good communication to ensure
the mental health of the elderly. Therefore, social support References
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opment and psychometric tests of a Chinese version of the jurisdictional claims in published maps and institutional affiliations.

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