Gender-modulated relationships among depression, light household tasks and physical activity: population-based moderation analysis

Gender-modulated relationships among depression, light household tasks and physical activity: population-based moderation analysis Domingo de-Pedro-Jim enez, Esther Foncubierta-Sierra, Esther Domínguez-Romero, Juan Vega-Escaño, Marta Hern andez Martín and Cristina Gavira Fern andez Abstract Purpose –This paper aims to study the influence of leisure-time physical activity on depression crises and the difficulty in performing light household tasks. Design/methodology/approach –A population-based cross-sectional study was conducted using data from the 2020 European Health Survey in Spain. A total of 1,076 individuals diagnosed with depression were selected. ANOVA, chi-square, Fisher’s exact test and Mann–Whitney U test were applied, and a simple moderation analysis was conducted using the SPSS PROCESS 4.0 macro. Findings –Women had higher percentages of some or much difficulty in performing domestic activities (p¼0.007). Differences were found between experiencing a crisis in the past 12 months versus not having one (p<0.001): less physical activity was performed, perceived health was worse and difficulty in performing domestic activities increased. The moderation analysis confirmed the moderating effect of physical activity on the relationship between experiencing a crisis and having difficulty with domestic activities (p¼0.017). Research limitations/implications –The usual limitation of descriptive cross-sectional studies, which cannot establish causal relationships, must be added to low sample sizes in some categories. Practical implications –The analysis with gender differentiation, promoting gender-specific adapted practices, considering age and personal circumstances of the patient, appropriate exercise prescription, as well as its evaluation and follow-up, are areas where specialist nurses need to delve deeper to enhance the quality of care. Originality/value –Leisure-time physical activity moderates the relationship between experiencing a crisis and having difficulty with light household tasks: those who engage in occasional physical activity have less difficulty compared to those who do not engage in it. Keywords Depression, Activities of daily living, Activity physical, Mental health Paper type Research paper Introduction Estimates on the prevalence of mental disorders worldwide, summarizing the results from 28 countries across the globe through the World Health Organization’s (WHO) World Mental Health Survey, indicated that 18.1% to 36.1% of individuals will develop some disorder over the course of their lifetime (Kessler et al.,2009). Subsequent studies, such as Steel et al.’s research on the global prevalence of common mental disorders or Vigo et al.’s estimation of the true global burden of mental illnesses, have confirmed that approximately one in three individuals will experience some form of mental health issue throughout their lifetime (Steel et al.,2014;Vigo et al.,2016). (Information about the authors can be found at the end of this article.) Received 1 November 2023 Revised 17 December 2023 8 January 2024 Accepted 13 January 2024 ©Domingo de-Pedro-Jim enez, Esther Foncubierta-Sierra, Esther Domı ´nguez-Romero, Juan Vega-Escan ˜o, Marta Hern andez Martı ´n and Cristina Gavira Fern andez. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons. org/licences/by/4.0/legalcode PAGE 76 jJOURNAL OF PUBLIC MENTAL HEALTH jVOL. 23 NO. 1 2024, pp. 76-91, Emerald Publishing Limited, ISSN 1746-5729 DOI 10.1108/JPMH-11-2023-0098 In Europe, the European Study of the Epidemiology of Mental Disorders (Alonso et al., 2002), which examines the associated factors and prevalence of mental disorders, estimates that 25.9% of the population, at some point in their lives, has been diagnosed with a mental health issue (de Pedro Cuesta et al.,2016). The WHO has equated mental health with subjective well-being, the perception of selfefficacy, autonomy, competence, intergenerational dependence and the realization of intellectual and emotional capacities (J. Alonso et al.,2002). Several of these factors can be influenced by gender differences, as indicated in the 1970s by the epidemiologist Myrna M. Weissman, who highlighted that the prevalence of depressive disorders was higher in women (Meil Landwerlin, 2005;Salk et al.,2017). Additionally, other authors have noted that the prevalence of poor mental health was higher among women in all age groups (23.4% compared to 15.6% in men), exceeding 30% among those aged 75 and older, as well as the frequency of diagnoses of depression or anxiety (19.4% compared to 8.5%) and surpassing 25% among those aged 60 and older (Bacigalupe et al.,2020). There are other factors that affect mental health, such as educational level, social support and economic status. In various countries, including Spain, an increase in the prevalence of depression and anxiety diagnoses is observed as socioeconomic status declines (Meil Landwerlin, 2005;Salk et al., 2017). Regarding educational level, the inequalities are greater among lower education groups, with an 86% higher likelihood of being diagnosed with depression or anxiety (Bacigalupe et al., 2020). Regarding marital status and having or not having children, depressive symptoms increase in widowed women (in men, it is higher in those who are separated) who have two or more children, while in men, symptoms increase when they do not have children (Matud et al., 2006). Although there have been advancements in gender equality, inequality and differentiation still exist in many aspects of everyday life, ranging from the clear example of gender-based violence to more subtle aspects such as the division of household chores, which often leads to an excessive burden (Salk et al., 2017). Men tend to engage in sporadic tasks that involve less daily load, avoiding repetitive, rigorous and routine activities. Therefore, women tend to take on a higher frequency of light domestic tasks (Larran ˜aga et al., 2004). Defined as unpaid tasks performed for the comfort and maintenance of household members and the home, these tasks include light chores such as washing, ironing, dishwashing, cooking, dusting and other activities such as maintenance, repair and management, among others. From the 1980s to the year 2000, men’s commitment to household chores in Spain increased by 35%, while women’s commitment decreased by 5%. Nevertheless, women’s workload was still twice as much as men’s (7.22 h and 3.1 h, respectively). As families grow, demands increase and the gender difference becomes more pronounced, although it is smaller when women have full or part-time employment, income or higher education (Larran ˜aga et al., 2004). The most common mental disorder is depression, affecting 4.4% of the global population and carrying a significant economic burden (Coto-Lesmes et al., 2020;Organizaci on Mundial de la Salud, 2017). Depression, characterized by a low mood and disrupted behavior, thought processes and activity levels, can adversely impact daily and work activities, health perception and lifestyle habits such as nutrition, exercise and rest (Mendes Rodrigues et al., 2020). The multifactorial nature of depression requires further exploration and understanding. One of the factors that has contributed to the global increase in depression is the COVID-19 pandemic (Becerra-Garcı ´aet al., 2023;Jalloh et al., 2018). During the lockdown, there was a rise in internet searches related to mental health issues such as anxiety, sadness and insomnia, among others (Becerra-Garcı ´aet al., 2023). Moreover, the organizations responsible for providing mental health care were temporarily suspended as they were not considered essential services, exacerbating the situation. The most common diagnosis was anxiety, often accompanied by sleep disturbances, and it primarily affected individuals who already had depression (Nicolini, 2020). VOL. 23 NO. 1 2024 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 77 Furthermore, not only the pandemic but also the improper management of health problems, in general, make depression the most common mental health issue among older adults. The way depression presents in this population is variable, whether it be due to a preexisting mental disorder, iatrogenic causes, physical health issues and so on (Mol es Julio et al., 2019). Therefore, identifying symptoms in older adults is even more challenging as they often overlap with physical decline due to aging, cognitive impairment, as well as other psychosocial factors (such as the aging culture and social isolation). Within this group, individuals who are most susceptible to developing a depressive disorder are widowed women, individuals with mobility difficulties and social isolation due to illness, and those who have experienced stressful events (Toro et al.,2014). The experience of significant illness, chronic diseases, institutionalization or requiring mobility aids is directly related to the emergence of crises and depressive disorders. In this stage of life, depression often goes unnoticed due to the stigmatization of older adults, not only by family members or caregivers but also by health-care professionals, resulting in up to 40% of cases going unreported. There is a belief that feeling depressed in old age is normal (Toro et al., 2014). To provide effective and comprehensive nursing care, it is essential to be familiar with the key nursing diagnoses related to depression: hopelessness (00124), situational low selfesteem (00120), impaired mood regulation (00241) and risk for self-directed violence (0140). Common interventions include emotional support (5270), cognitive restructuring (4700), group therapy (5450), teaching disease process (5602) and enhancing selfconfidence (5395) (NNNconsult, 2015). Additionally, therapeutic activities (4310) and exercise promotion (0200) are repeated in each diagnosis. Interventions related to physical activity are easy to implement, monitor and evaluate, with short-term results, making their assessment simpler. Currently, from a therapeutic perspective, physical activity is primarily directed toward combating physical rather than mental illnesses (Almagro Valverde et al., 2014). However, its utility in mental health conditions is increasingly supported (Dauwan et al., 2021;Heissel et al., 2023). Therefore, the role of psychiatric nurses is crucial in promoting exercise that is tailored to the patient’s preferences, environment and lifestyle (Cornejo-Callejo and Bejarano-Ramı ´rez, 2017). They play a vital role in encouraging individuals with mental health conditions to engage in suitable physical activity, which can have positive effects on their overall well-being and contribute to their recovery process. In summary, a significant difference in the prevalence of depressive disorders has been observed between men and women, with women being significantly more affected. It has also been highlighted that depressive crises can impact various aspects of daily life, including the performance of domestic activities, which are also influenced by gender disparities. Among the tools to combat depression, physical activity has been identified as a quick and effective intervention. However, it is necessary to delve deeper into how physical activity affects these patients and their ability to engage in activities that may be limited by their condition, taking into consideration a gender perspective as well. Therefore, the objective of this study was to analyze the influence of physical activity as a moderating variable between experiencing a depressive crisis in the past 12 months and having difficulty performing light household tasks. Methods Study design. Population and simple This is a population-based cross-sectional study conducted using data from the European Health Survey in Spain in 2020 (Instituto Nacional de Estadistica, 2021), carried out by the National Institute of Statistics (INE) in collaboration with the Ministry of Health. PAGE 78 jJOURNAL OF PUBLIC MENTAL HEALTH jVOL. 23 NO. 1 2024 A three-stage stratified sampling was conducted, with the first stage being the stratification by municipality size (first-stage units) within each autonomous community. The second-stage units consisted of main single-family dwellings, and the third-stage units corresponded to eligible individuals who were surveyed. In the first stage, a proportional probability sampling was used within each stratum, based on the size measured by the number of main dwellings. In the second stage, the dwellings were selected using systematic sampling with random start (which provides self-weighted samples by stratum). In the third stage, the Kish method was used, ensuring an equal probability of selection for individuals. The data collection method, initially established as computer-assisted personal interviews supplemented by telephone interviews, when necessary, was modified to exclusively conduct interviews by phone due to the COVID-19 pandemic. The method included periodic and occasional inspections to ensure accurate data collection. The interviewers received training from the INE. Eligibility, inclusion and exclusion criteria The records that responded “yes” to having a diagnosed depression were selected. Those that responded, “don’t know,” “no answer,” “did not attempt” or “I need to do it” were eliminated, as well as those with missing values in the selected variables. Out of the 37,500 selected households with a total of 22,072 individuals, the final sample reached 1,076 individuals after applying the inclusion and exclusion criteria. The explored variables and categories included gender, age, marital status, education level, occupation, perceived health, being diagnosed with depression in the past 12 months, severity of depressive symptoms, difficulty in performing light household tasks, body mass index (BMI), leisure-time physical activity (LTPA) and being user of substances or alcohol. Ethical and legal considerations The use of data from the European Health Survey in Spain 2020 (EESE2020) does not require approval from an ethics committee. According to Regulation (EU) 2016/679, public-use files are not considered confidential. The survey provides anonymized microdata files to the public, which makes it impossible to directly or indirectly identify the respondents. Statistical analysis IBM SPSS Statistics 26.0 software (IBM, Chicago, IL, USA) and Jamovi version 2.3 were used for the statistical analysis. Quantitative variables were expressed as mean and standard deviation, while qualitative variables were summarized using absolute frequencies and percentages. The Kolmogorov–Smirnov test with Lilliefors correction was applied to check for normality. Comparing age between groups was performed using one-way ANOVA. The analysis of contingency tables with dichotomous and nominal polytomous variables was conducted using the chi-square test and Fisher’s exact test. The Mann–Whitney U test was used for comparing groups with ordinal variables. The analysis of simple moderation was conducted using the PROCESS 4.0 macro for SPSS (Model 1), with 10,000 bootstrap samples (95% confidence interval). The Johnson–Neyman method was selected to identify and represent regions of significance. VOL. 23 NO. 1 2024 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 79 Results Description of the sample Table 1 presents the variables and categories of the total analyzed sample. With a mean age of 70 years (SD 9.88), the highest percentages are observed in the married category (46.2%), with completed primary education (30.7%), engaged in unskilled or semi-skilled occupations (35.6%), overweight (40.2%), nonsmokers (59.9%), nondrinkers (31.3%), not engaging in physical activities (51.9%), having experienced a depressive crisis in the past 12 months (75.3%), perceiving their health as regular (45.2%) and reporting no difficulty in performing light household activities (67.4%). Unifactorial inferential analysis Table 2 presents the variables analyzed according to gender. Differences are notable in terms of marital status, with women comprising 36.7% of widows compared to 10.5% of men being widowers (p<0.001). Women show lower percentages in higher education (ranging from secondary education to university) (p<0.001). They also constitute the majority in unskilled occupations (p¼0.004). Notable is the 70.8% and 39.6% of women who have never smoked or consumed alcohol compared to 30.8% and 9.5% of men, respectively (p<0.001). Higher percentages are found among women in the categories of having some or much difficulty in performing light household activities compared to men (p¼0.007). No significant differences were found between genders in the variables BMI, LTPA, depression in the past 12 months, degree of depressive severity or perceived health. Variables were also compared between those who reported having a depressive crisis in the past 12 months and those who did not. Notables are higher percentages of depression among those with lower education levels (p¼0.003) and among those with less skilled occupations (p¼0.023). Regarding BMI, the percentage of obese individuals was higher among those who reported a depressive crisis, while the percentage of normal weight individuals was higher among the group that did not report a crisis in the past 12 months (p¼0.012). Notably, with high significance (p<0.001), the variable of physical activity stands out (higher percentages from occasional exercise to exercising multiple times a week in the group without a depressive crisis compared to a higher percentage of no exercise and having a crisis). Poorer perceived health (among those with depressive crises) and experiencing some too much difficulty in performing light household activities also stand out among those who had a depressive crisis (Table 3). Moderation analysis Figure 1 shows the conceptual diagram followed in the analysis. Table 4 displays the coefficients, upper and lower confidence intervals and p-values. The statistical diagram (Figure 2) visually represents these coefficients and p-values. The conditional effect of the predictor on the moderator values can be seen in Table 5.Itis observed that the effect is significant up to the value of 2.315 (p¼0.05), and beyond this point, the significance is lost. Figure 3 displays the conditional effect of depression on the difficulty of performing daily household activities based on the significant values of the moderating variable (not engaging in physical activities and engaging in them occasionally). Table 6 presents the moderation analysis for women only. It is noteworthy that the interaction between depression and physical activity is marginally significant (p¼0.07). PAGE 80 jJOURNAL OF PUBLIC MENTAL HEALTH jVOL. 23 NO. 1 2024 Table 1 Description of the sample (N¼1,076) Variable Categories Mean (SD) or n (%) Age 70 (9.88) Marital status Single 112 (10.4%) Married 497 (46.2%) Widowed 318 (29.6%) Separated 47 (4.4%) Divorced 102 (9.5%) Education level Illiterate 27 (2.5%) Incomplete primary education 202 (18.8%) Complete primary education 330 (30.7%) Secondary education 250 (23.2%) High school 86 (8%) Medium vocational training 43 (4%) Higher vocational training 43 (4%) University degree 95 (8.8%) Occupation Directors and managers þ10 employees 69 (6.4%) Directors and managers 10 employees 68 (6.3%) Intermediate occupations or self-employed 181 (16.8%) Supervisors and skilled technicians 183 (17%) Semiskilled primary sector occupations 383 (35.6%) Unskilled occupations 192 (17.8%) BMI Underweight 22 (2%) Normal weight 331 (30.8%) Overweight 433 (40.2%) Obesity 290 (27%) Smoking Daily 154 (14.3%) Yes, but not daily 10 (0.9%) Former smoker 268 (24.9%) Never smoked 644 (59.9%) Alcohol consumption Daily or almost daily 166 (15.4%) 5–6 days per week 11 (1%) 3–4 days per week 36 (3.3%) 1–2 days per week 76 (7.1%) 2–3 days per month 52 (4.8%) Once a month 47 (4.4%) Less than once a month 113 (10.5%) I have quit (past 12 months) 238 (22.1%) Never consumed alcohol 337 (31.3%) Leisure-time physical activity (LTPA) I do not do any 558 (51.9%) Occasional 391 (36.3%) Several times per month 51 (4.7%) Several times per week 76 (7.1%) Depression (past 12 months) Yes 810 (75.3%) No 266 (24.7%) Depressive severity None 413 (38.4%) Mild 355 (33%) Moderate 185 (17.2%) Moderately severe 78 (7.2%) Severe 45 (4.2%) Perceived health Very good 23 (2.1%) Good 236 (21.9%) Fair 486 (45.2%) Poor 270 (25.1%) Very poor 61 (5.7%) Difficulty performing light household tasks None 725 (67.4%) Some 133 (12.4%) A lot 103 (9.6%) I cannot do it at all 115 (10.7%) Source: Authors’ own work VOL. 23 NO. 1 2024 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 81 Table 2 Gender differences (N¼1,076) Variable Categories Men (n ¼295) Women (n ¼781) p-value Age 68.1 (9.49) 71.1 (9.9) <0.001 Marital status Single 50 (16.9%) 62 (7.9%) <0.001 Married 159 (53.9%) 338 (43.3%) Widowed 31 (10.5%) 287 (36.7%) Separated 16 (5.4%) 31 (4%) Divorced 39 (13.2%) 63 (8.1%) Education level Illiterate 1 (0.3%) 26 (3.3%) <0.001 Incomplete primary education 43 (14.6%) 159 (20.4%) Complete primary education 79 (26.8%) 251 (32.1%) Secondary education 75 (25.4%) 175 (22.4%) High school 25 (8.5%) 61 (7.8%) Medium vocational training 14 (4.7%) 29 (3.7%) Higher vocational training 18 (6.1%) 25 (3.2%) University degree 40 (13.6%) 55 (7%) Occupation Directors and managers þ10 employees 32 (10.8%) 37 (4.7%) 0.004 Directors and managers 10 employees 18 (6.1%) 50 (6.4%) Intermediate occupations or self-employed 44 (14.9%) 137 (17.5%) Supervisors and skilled technicians 54 (18.3%) 129 (16.5%) Semiskilled primary sector occupations 106 (35.9%) 277 (35.5%) Unskilled occupations 41 (13.9%) 15 (19.3%) BMI Underweight 4 (1.4%) 18 (2.3%) 0.228 Normal weight 75 (25.4%) 256 (32.8%) Overweight 142 (48.1%) 291 (37.3%) Obesity 74 (25.1%) 216 (27.7%) Smoking Daily 60 (20.3%) 94 (12%) <0.001 Yes, but not daily 5 (1.7%) 5 (0.6%) Former smoker 139 (47.1%) 129 (16.5%) Never smoked 91 (30.8%) 553 (70.8%) Alcohol consumption Daily or almost daily 89 (30.2%) 77 (9.9%) <0.001 5–6 days per week 5 (1.7%) 6 (0.8%) 3–4 days per week 14 (4.7%) 22 (2.8%) 1–2 days per week 16 (5.4%) 60 (7.7%) 2–3 days per month 12 (4.1%) 40 (5.1%) Once a month 11 (3.7%) 36 (4.6%) Less than once a month 39 (13.2%) 74 (9.5%) I have quit (past 12 months) 81 (27.5%) 157 (20.1%) Never consumed alcohol 28 (9.5%) 309 (39.6%) Leisure-time physical activity (LTPA) I do not do any 144 (48.8%) 414 (53%) 0.632 Occasional 116 (39.3%) 275 (35.2%) Several times per month 14 (4.7%) 37 (4.7%) Several times per week 21 (7.1%) 55 (7%) Depression (past 12 months) Yes 214 (72.5%) 596 (76.3%) 0.201 No 81 (27.5%) 185 (23.7%) Depressive severity None 130 (44.1%) 283 (36.2%) 0.068 Mild 86 (29.2%) 269 (34.4%) Moderate 45 (15.3%) 140 (17.9%) Moderately severe 22 (7.5%) 56 (7.2%) Severe 12 (4.1%) 33 (4.2%) Perceived health Very good 9 (3.1%) 14 (1.8%) 0.215 Good 71 (24.1%) 165 (21.1%) Fair 128 (43.4%) 358 (45.8%) Poor 72 (24.4%) 198 (25.4%) Very poor 15 (5.1%) 46 (5.9%) Difficulty performing light household tasks None 220 (74.6%) 505 (64.7%) 0.007 Some 27 (9.2%) 106 (13.6%) A lot 14 (4.7%) 89 (11.4%) I cannot do it at all 34 (11.5%) 81 (10.4%) Source: Authors’ own work PAGE 82 jJOURNAL OF PUBLIC MENTAL HEALTH jVOL. 23 NO. 1 2024 Table 3 Differences between those who have had or have not had a depressive episode in the past 12 months (N¼1076) Variable Categories Yes (n ¼810) No (n ¼266) p-value Age 70.6 (9.94) 69.4 (9.63) 0.08 Marital status Single 79 (9.8%) 33 (12.4%) 0.418 Married 376 (46.4%) 121 (45.5%) Widowed 245 (30.2%) 73 (27.4%) Separated 38 (4.7%) 9 (3.4%) Divorced 72 (8.9%) 30 (11.3%) Education level Illiterate 23 (2.8%) 4 (1.5%) 0.003 Incomplete primary education 163 (20.1%) 39 (14.7%) Complete primary education 262 (32.3%) 68 (25.6%) Secondary education 180 (22.2%) 70 (26.3%) High school 54 (6.7%) 32 (12%) Medium vocational training 35 (4.3%) 8 (3%) Higher vocational training 29 (3.6%) 14 (5.3%) University degree 64 (7.9%) 31 (11.7%) Occupation Directors and managers þ10 employees 45 (5.6%) 24 (9%) 0.023 Directors and managers 10 employees 46 (5.7%) 22 (8.3%) Intermediate occupations or self-employed 129 (15.9%) 52 (19.5%) Supervisors and skilled technicians 150 (18.5%) 33 (12.4%) Semi-skilled primary sector occupations 289 (35.7%) 94 (35.3%) Unskilled occupations 151 (18.6%) 41 (15.4%) BMI Underweight 15 (1.9%) 7 (2.6%) 0.015 Normal weight 238 (29.4%) 93 (35%) Overweight 325 (40.1%) 108 (40.6%) Obesity 232 (28.6%) 58 (21.8%) Smoking Daily 114 (14.1%) 40 (15%) 0.012 Yes, but not daily 4 (0.5%) 6 (2.3%) Former smoker 191 (23.6%) 77 (28.9%) Never smoked 501 (61.9%) 143 (53.8%) Alcohol consumption Daily or almost daily 116 (14.3%) 50 (18.8) <0.001 5–6 days per week 6 (0.7%) 5 (1.9%) 3–4 days per week 23 (2.8) 13 (4.9%) 1–2 days per week 55 (6.8%) 21 (7.9%) 2–3 days per month 30 (3.7%) 22 (8.3%) Once a month 35 (4.3%) 12 (4.5%) Less than once a month 80 (9.9%) 33 (12.4%) I have quit (past 12 months) 186 (23%) 52 (19.5%) Never consumed alcohol 279 (34.4%) 58 (21.8%) Leisure-time physical activity (LTPA) I do not do any 452 (55.8%) 106 (39.8%) <0.001 Occasional 279 (34.4%) 112 (42.1%) Several times per month 30 (3.7%) 21 (7.9%) Several times per week 49 (6%) 27 (10.2%) Depressive Severity None 247 (30.5%) 166 (62.4%) <0.001 Mild 282 (34.8%) 73 (27.4%) Moderate 162 (20%) 23 (8.6%) Moderately severe 74 (9.1%) 4 (1.5%) Severe 45 (5.6%) 0 (0%) Perceived health Very good 14 (1.7%) 9 (3.4%) <0.001 Good 144 (17.8%) 92 (34.6%) Fair 366 (45.2%) 120 (45.1%) Poor 233 (28.8%) 37 (13.9%) Very poor 53 (6.5%) 8 (3%) Difficulty performing light household tasks None 514 (63.5%) 211 (79.3%) <0.001 Some 107 (13.2%) 26 (9.8%) A lot 89 (11%) 14 (5.3%) I cannot do it at all 100 (12.3%) 15 (5.6%) Source: Authors’ own work VOL. 23 NO. 1 2024 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 83 Discussion The purpose of this study was to examine the moderating effect of physical activity on the relationship between experiencing a crisis in the past 12 months and the difficulty in performing light household activities. Gender differences and differences between individuals with and without a depressive crisis in the past year have been identified. The moderating effect of LTPA on the relationship between experiencing a crisis in the past 12 months and experiencing difficulty in performing light household activities has been confirmed. The sample has a mean age of 70 years, with a higher percentage of married or widowed individuals, primary education level, no engagement in physical activity, experiencing a depressive crisis in the past 12 months and predominantly perceiving their health as fair or poor. These results can be explained by the advanced age of the sample, which entails physiological aging processes that increase health problems, vulnerability and functional burden, leading to a more negative perception of their health (Navarro et al., 2020). Figure 1 Conceptual diagram of moderation Table 4 Moderation analysis Coeff. P LLCI ULCI Depression-Difficulty 0.5812 0.002 0.6216 0.3963 LTPA-Difficulty 0.3096 <0.001 0.5279 0.7609 Depression LTPA 0.1831 0.0169 0.2662 0.1298 Notes: Depression crisis in the past 12 months; Difficulty performing light household tasks; Leisuretime physical activity Source: Authors’ own work Figure 2 Statistical diagram PAGE 84 jJOURNAL OF PUBLIC MENTAL HEALTH jVOL. 23 NO. 1 2024 Vigo, D., Thornicroft, G. and Atun, R. (2016), “Estimating the true global burden of mental illness”, The Lancet Psychiatry, Vol. 3 No. 2, pp. 171-178, doi: 10.1016/S2215-0366(15)00505-2. Author affiliations Domingo de-Pedro-Jim enez and Esther Foncubierta-Sierra are both based at the Department of Nursing and Physiotherapy, University of C adiz, C adiz, Spain Esther Domı ´nguez-Romero is based at the Occupational Health Service, Juan Ram on Jim enez University Hospital, Huelva, Spain Juan Vega-Escan ˜o is based at the Schools of Nursing, Physiotherapy and Podiatry, University de Seville, Seville, Spain Marta Hern andez Martı ´n is based at the Department of Nursing, Complutense University of Madrid, Madrid, Spain Cristina Gavira Fern andez is based at the Deparment of Nursing and Physiotherapy, University of C adiz, C adiz, Spain. Corresponding author Juan Vega-Escan ˜o can be contacted at: [email protected] For instructions on how to order reprints of this article, please visit our website: www.emeraldgrouppublishing.com/licensing/reprints.htm Or contact us for further details: [email protected] VOL. 23 NO. 1 2024 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 91