The current study utilizes a cross-sectional design to investigate the impact of anxiety and depression on the risk of unintentional injuries among older adult populations in Guangxi, China. Data for this study are sourced from the 2023 National Health Service Survey, which includes comprehensive health-related information from a representative sample of the Chinese population, focusing particularly on rural and urban disparities in health outcomes, healthcare access, and utilization. The survey employs a multistage, stratified, cluster sampling design to ensure representativeness of the national population, including the older adult cohort in Guangxi. The sample includes individuals aged 60 years and above, residing in both urban and rural areas of Guangxi.

The primary independent variables are indicators of anxiety and depression, assessed through validated scales included in the survey. The primary dependent variable is the occurrence of unintentional injuries reported during the survey period. Additional variables such as age, gender, socioeconomic status, urban vs. rural residence, access to healthcare, and lifestyle factors (e.g., exercise frequency, and alcohol use) are controlled for in the analysis to adjust for potential confounders.

The inclusion criteria for participants in this study are based on the demographic data collected through the 2023 National Health Service Survey. Participants included in the analysis meet the following criteria: Age: Individuals aged 60 years and above at the time of the survey. Residency: Residents of the Guangxi region, encompassing both urban and rural areas.

Exclusion Criteria are as follows: Individuals with missing or incomplete data on key variables of interest, such as mental health status (anxiety and depression) or reports of unintentional injuries, are excluded from the analysis. Individuals reported or diagnosed with severe cognitive impairments. Individuals who are not long-term residents of Guangxi or who were temporarily residing in the area during the survey period are excluded.

The data for this study were collected as part of the 2023 National Health Service Survey, a comprehensive health survey conducted under the auspices of the National Health Commission of China. The survey is designed to gather a wide range of health-related information across various demographics and regions within China, including Guangxi.

Survey Instruments includes: The survey utilized structured questionnaires designed to collect detailed information on health status, lifestyle factors, access to healthcare services, and social determinants of health. Specific sections of the questionnaire were dedicated to assessing mental health, using standardized screening tools for anxiety and depression. The tool is EQ-5D-5L, which are widely used and validated instruments for detecting levels of anxiety and depression. The EQ-5D-5L was utilized to assess self-reported levels of anxiety and depression. It captures the presence and severity of anxiety and depressive symptoms but does not provide a clinical diagnosis. Therefore, our findings reflect symptomatology rather than clinically diagnosed mental health disorders. Information on unintentional injuries was collected through specific questions relating to any injuries the participants had sustained over the past 12 months.

Trained interviewers conducted face-to-face interviews with participants, ensuring that each individual understood the questions and provided informed responses. Responses were directly entered into electronic devices with data collection software. All interviewers underwent rigorous training, focusing on the ethical considerations of data collection, the importance of confidentiality, and the specific techniques required to accurately collect and record responses. Supervisors regularly monitored the data collection process to ensure adherence to protocols and to address any issues arising during the interviews.

In this study, the prevalence of anxiety and depression among the older adult population in Guangxi was calculated using percentages, while demographic and other relevant characteristics such as age, gender, socio-economic status, and rural vs. urban residence were summarized using means, standard deviations, and percentages. Inferential statistics included Chi-Square tests to examine the relationship between the presence of mental health conditions and unintentional injuries. Logistic regression was employed to assess the odds of such injuries associated with anxiety and depression, with models progressively adjusting for potential confounders. Multivariate analyses tested interaction effects to see if the impact of mental health on injury risk varied by factors such as rural vs. urban residence, and model fit was assessed using the Hosmer-Lemeshow test. Sensitivity analyses, including multiple imputation for missing data and robustness checks with different model specifications, were also conducted to ensure the reliability of the findings.

The survey was approved by the National Bureau of Statistics of China, and the study protocol received approval from the Medical Ethics Expert Committee of the National Health Commission of China, ensuring compliance with national and international ethical standards. Prior to participation, all participants provided informed consent, fully briefed on the study’s purpose, procedures, risks, and benefits, with assurance of their right to withdraw at any time without penalty, all communicated in a clear and understandable manner. Strict confidentiality and privacy measures were implemented, with all identifiable information anonymized and data access restricted to authorized personnel. Risk assessment determined that participation risks were minimal, but provisions were made to address any potential adverse effects, including referrals to appropriate medical or psychological resources. The authors declared no conflicts of interest, affirming that funding sources did not influence the study’s design, execution, or reporting. The team upheld cultural sensitivity to accommodate the diverse backgrounds of the Guangxi participants and committed to the standards of data integrity and responsible reporting. Findings were reported transparently, irrespective of support or contradiction to initial hypotheses. The manuscript adhered to ICMJE ethical publishing guidelines, including a thorough peer review process to validate its scientific integrity and value.

While this study offers valuable insights into the relationship between mental health and unintentional injury risks among the older adult in Guangxi, China, it is important to acknowledge several limitations. The cross-sectional design restricts the ability to draw causal inferences, with longitudinal data needed to establish a clearer temporal and causal relationship between mental health issues and injury risks. The reliance on self-reported data may introduce recall bias and affect data accuracy, whereas objective measures and clinical evaluations would provide more reliable information. Cultural nuances and language differences might also influence the interpretation of survey questions, potentially leading to underreporting or misclassification of mental health symptoms. Despite efforts to control for various confounders, unmeasured variables such as the severity of depression or anxiety and the presence of other comorbidities might influence the outcomes. While this study provides valuable insights into the older adult population in Guangxi, caution should be exercised when generalizing these findings to other regions due to Guangxi’s unique socio-economic and cultural characteristics. Future research should aim to include diverse regions to enhance generalizability. Additionally, the National Health Service Survey did not categorize specific types of unintentional injuries, which prevented a more detailed analysis of injury types and their associated factors.

In conclusion, the study underscores the multifaceted nature of unintentional injuries in the older adult, highlighting key areas such as mental health, alcohol consumption, gender differences, rural residency, and exercise frequency. These findings can inform the development of targeted interventions and policies aimed at reducing the incidence of UI in this vulnerable population. Future research should continue to explore these associations, considering potential mediating factors and the efficacy of specific preventive measures.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the [patients/participants OR patients/participants legal guardian/next of kin] was not required to participate in this study in accordance with the national legislation and the institutional requirements.

LN: Conceptualization, Formal analysis, Visualization, Writing – original draft. JZ: Investigation, Methodology, Writing – original draft. C-lL: Investigation, Methodology, Writing – original draft. YZ: Data curation, Software, Writing – original draft. X-xM: Investigation, Methodology, Writing – original draft, Resources. RX: Project administration, Validation, Writing – review & editing. H-yL: Conceptualization, Formal analysis, Resources, Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was funded by multiple sources. Hong-ye Luo received funding from the China Medical Board (CMB-OC) under the grant number 20–373, for the project titled “Evaluation of the availability and reasonableness of Psychiatric Drugs for Patients with Severe Mental Disorders in Rural Guangxi.” Additionally, Hong-ye Luo was supported by the 2021 Guangxi Philosophy and Social Science Planning Research Project (grant number 21FGL031) for the project “Evaluation of the Operation Effect of Guangxi Long-term Care Insurance Pilot Area.” Xin-xin Mo was funded by the Regenerative Medicine and Medical Biological Resources Development and Application of the Provincial Collaborative Innovation Center for the young teachers scientific research innovation project, with grant number CICRMMBR-TC-2023006, for the project “Assessment of Graded Care Needs of the Elderly in Guangxi under the Background of Long-term Care Insurance.” Additionally, the authors wish to acknowledge the financial support received for this study, which was funded by the National Health Commission of China.

The authors wish to thank the local health authorities in Guangxi, China, for their cooperation and support in facilitating access to the survey data and for their contributions to the logistical aspects of this study.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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