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To test whether contagious depressive symptoms mediate the association between spousal depressive symptoms (spousal-DS) and the other spouse’s cognitive function, and test the moderated mediation of social activities engagement and sleep quality. A total of 3,230 adults aged ≥60 and one of his/her close relatives were interviewed in 2016 in Xiamen, China. Cognitive function and depressive symptoms were measured by MoCA and GDS-15/CES-D-10, respectively. Social activities engagement and sleep quality were self-reported. Mediation and moderated mediation were tested by PROCESS macro with 5000 bootstrapping re-samples. Among all, 1,193 pairs were husband-wife with complete information and were included. The mean ages of older adults and their spouses were 68.35 ± 6.53 and 66.53 ± 7.91 years, respectively. The mean MoCA and GDS-15 scores for older adults were 22.21 ± 5.45 and 1.73 ± 2.17, respectively. The average score of CES-D-10 for spouses was 14.18 ± 4.77. Spousal-DS were associated with cognitive functions of older adults  via  the contagious depressive symptoms (indirect effect: −0.048, 95% confidence interval (CI): (-0.075, −0.028)). Such mediation can be buffered by attending social activities (interaction: −0.062, 95% CI: (-0.111, −0.013)) and improving sleep quality (interaction: −0.034, 95% CI: (-0.057, −0.012)). Cognitive function of older adults was associated with his/her spouse’s depressive symptoms, and the association was mediated by contagious depressive symptoms and moderated by social activities as well as sleep quality.

The association of spousal depressive symptoms and cognitive function among older adults: mediation and moderated mediation analyses