Big five personality traits, family health, and health literacy among older adults with and without depressive symptoms: a path analysis based on a nationwide survey

Abstract

Depressive symptoms are common in later life, but research on personality, family health, and health literacy has rarely examined whether their associations differ by depressive-symptom status. This large-scale nationwide cross-sectional study examined the associations among Big Five personality traits, family health, and health literacy in older adults with and without depressive symptoms. We analysed the 2022 Psychology and Behavior Investigation of Chinese Residents (PBICR) data from 4,334 adults aged 60 years or older. Measures included the BFI-10, FHS-SF, HLS-SF9, and PHQ-9. Structural equation models used the same 11 focal structural paths and the same covariate paths in both PHQ-9 screening groups. Between-group differences in corresponding focal-path coefficients were evaluated using critical ratios. In the specified total-sample model, family health was positively associated with health literacy ( β = 0.498, p < 0.001). Four of the five personality traits were associated with family health (extraversion, agreeableness, conscientiousness, and neuroticism, all p < 0.001), with the exception of openness. Although overall structural invariance was supported across the PHQ-9 screening groups, exploratory unadjusted comparisons identified four paths meeting the nominal critical-ratio criterion: extraversion → family health, family health → health literacy, conscientiousness → health literacy, and neuroticism → health literacy. After Benjamini-Hochberg FDR correction, only two paths remained statistically significant: extraversion → family health and neuroticism → health literacy. These findings describe differences in statistical associations and do not establish causal moderation or mediation. Personality traits, family health, and health literacy were associated in this cross-sectional sample. Overall structural invariance was supported between PHQ-9 screening groups, and although four exploratory path comparisons met the nominal criterion, only two survived FDR correction. These findings are exploratory and hypothesis-generating, and do not establish depressive symptoms as a formal moderator. They warrant confirmation in future longitudinal or intervention studies. STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology).

The authors' abstract, as published at the source. BMC Public Health, 2026 · DOI ↗