title: Association between eating alone and depressive symptom in elders: a cross-sectional study.
abstract: BACKGROUND
  Depression is one of the main health concerns in elders which could lead to many negative outcomes. Eating alone is an emerging issue in elders in China and would become more serious along with the fast course of industrialization and urbanization, as well as population aging. However, their relationship was seldom researched.
  
  
  METHODS
  Using a two-stage cluster sampling strategy, an investigation was conducted in 2014 among 9,361 permanent residents aged 60 years and above in Zhejiang Province, China. Totally, 7,968 cognitively normal elders were included in our analysis. Multilevel logistic regression was used to explore the association between eating arrangement (number of companions in mealtime) and depressive symptom as well as the association between eating alone and depressive symptom in relation to living alone.
  
  
  RESULTS
  In our sample, 17.1% of the elders ate alone and 8.7% had depressive symptom. We observed a distinct inverse association between eating arrangement (number of companions in mealtime) and geriatric depressive symptom (female: OR = 1.12, P = 0.027; aged 60-74 years: OR = 1.16, P = 0.002), after adjustment for demography, socioeconomic status, social relation, health behaviors, underlying conditions and living alone. We then introduced a combined variable of eating alone and living alone and examined its relationship with depressive symptom. We found that compared with elders who ate and lived with others, those who ate alone but lived with others had a significant increased odds of depressive symptom (female: OR = 1.62, P = 0.027; aged 60-74 years: OR = 1.59, P = 0.025).
  
  
  CONCLUSIONS
  Our results suggested that a lack of companionship in mealtime might be independently associated with geriatric depressive symptom for females and those aged 60-74 years. What's more, eating alone might be a stronger factor associated with depressive symptom than living alone. We recommend interventions to be performed in encouraging elders especially females and those aged 60-74 years to eat with others. Longitudinal studies in different populations which focus on this topic are required to better understand this issue.
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. xyiwang@cdc.zj.cn.
authors.forename: Xinyi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. wshen@cdc.zj.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Shen
authors.affiliation: Tongxiang Centre for Disease Control and Prevention, 64 East Maodun Road, Wutong Subdistrict, Tongxiang, Zhejiang Province, China. chunmei328@sina.com.
authors.forename: Chunmei
authors.initials: C
authors.lastname: Wang
authors.affiliation: Tongxiang Centre for Disease Control and Prevention, 64 East Maodun Road, Wutong Subdistrict, Tongxiang, Zhejiang Province, China. zhangxiaoyi811121@163.com.
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: School of Public Health, Kunming Medical University, 1168 Yuhua Road, Chenggong District, Kunming, Yunnan, China. 33225647@qq.com.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. fhe@cdc.zj.cn.
authors.forename: Fan
authors.initials: F
authors.lastname: He
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. yjzhai@cdc.zj.cn.
authors.forename: Yujia
authors.initials: Y
authors.lastname: Zhai
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. fdli@cdc.zj.cn.
authors.forename: Fudong
authors.initials: F
authors.lastname: Li
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. xpshang@cdc.zj.cn.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Shang
authors.affiliation: Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province, China. zjlinjunfen@163.com.
authors.forename: Junfen
authors.initials: J
authors.lastname: Lin
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D007398:Interpersonal Relations; D008132:Loneliness; D008297:Male; D008875:Middle Aged; D012923:Social Class