Personality, Family Health and Health Literacy Linked in Older Chinese Adults

Depressive symptoms are common in later life, yet large-scale evidence on how personality, family functioning and health knowledge fit together in this age group has been scarce. A new nationwide cross-sectional study from China, published in BMC Public Health, analysed survey data from 4,334 adults aged 60 years or older to test how the Big Five personality traits relate to family health and health literacy, and whether those associations differ between older adults who screen positive for depressive symptoms and those who do not. The study drew on the 2022 Psychology and Behavior Investigation of Chinese Residents, a broad national survey designed to capture psychological and behavioural patterns across the population.

The researchers measured personality with the ten-item Big Five Inventory, which scores extraversion, agreeableness, conscientiousness, neuroticism and openness. Family health was assessed with a short form of the Family Health Scale, and health literacy with the nine-item short form of the European Health Literacy Survey questionnaire. Depressive symptoms were screened using the nine-item Patient Health Questionnaire. The team then built structural equation models containing eleven focal structural paths plus covariate paths, and fitted the identical model separately in each PHQ-9 screening group so that corresponding path coefficients could be compared between groups using critical ratios.

In the model fitted to the full sample, family health showed a strong positive association with health literacy, with a standardised coefficient of 0.498 and a p-value below 0.001. Four of the five personality traits were associated with family health: extraversion, agreeableness, conscientiousness and neuroticism all reached statistical significance at p < 0.001, while openness did not. This pattern suggests that in older Chinese adults, the traits that shape how people connect with others and manage daily life may travel together with how well the family unit functions as a source of health support, whereas intellectual curiosity and openness to experience showed no measurable link in this framework.

The between-group analysis produced a more nuanced picture. Overall structural invariance was supported across the two PHQ-9 screening groups, meaning the broad architecture of the model held in both. However, exploratory unadjusted comparisons identified four paths that met the nominal critical-ratio criterion: the links from extraversion to family health, from family health to health literacy, from conscientiousness to health literacy, and from neuroticism to health literacy. Because multiple comparisons inflate the risk of false positives, the researchers applied a Benjamini-Hochberg false discovery rate correction. After this adjustment, only two paths remained statistically significant: extraversion to family health and neuroticism to health literacy.

The authors are explicit about what these results do and do not show. The findings describe differences in statistical associations only; they do not establish causal moderation or mediation, and they do not confirm depressive symptoms as a formal moderator of the relationships among personality, family health and health literacy. Because the data are cross-sectional, the direction of any association cannot be determined. A gregarious older adult may both enjoy stronger family bonds and report better health understanding, or the causal arrow could run the other way, or a third factor could drive both. The team frames the results as exploratory and hypothesis-generating, warranting confirmation in future longitudinal or intervention studies that follow older adults over time.

Within those limits, the study offers a rare large-scale snapshot of how psychological dispositions, the family environment and the ability to find and use health information cluster together in later life. The persistence of the extraversion-to-family-health and neuroticism-to-health-literacy associations after correction suggests these two pathways deserve priority in follow-up research, while the paths that faded under FDR correction should be treated with caution. The work was reported according to the STROBE Statement, the standard checklist for strengthening the reporting of observational studies in epidemiology, and the article is available open access.

Subject of Research: Associations among Big Five personality traits, family health and health literacy in older adults with and without depressive symptoms

Article Title: 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

Article References: Tian, Z., Li, M., Yang, X., Shen, B., Chen, J., Li, J., & Shi, C. (2026). 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. BMC Public Health. https://doi.org/10.1186/s12889-026-29698-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29698-8

Keywords: Big Five personality traits, family health, health literacy, depressive symptoms, older adults, cross-sectional study, structural equation modeling, PHQ-9, BMC Public Health, China survey, path analysis, five