Open Access

ARTICLE

The Association between eHealth Literacy and Depression among Young and Middle-Aged Adults: Mediations of Lifestyle Behaviors

Tianran Wang^1,#, Yiran Wang^1,2,#, Wenwen Liu¹, Chenyu Yan¹, Ning Zhang^1,3, Yangxin Huang^4,*, Sijiu Wang^1,*, Wannian Liang^1,5,*
1 Vanke School of Public Health, Tsinghua University, Beijing, China
2 T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
3 Walter H. Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, CA, USA
4 School of Management, Fudan University, Shanghai, China
5 College of General Practice, Southern University of Science and Technology, Shenzhen, China
* Corresponding Author: Yangxin Huang. Email: ; Sijiu Wang. Email: ; Wannian Liang. Email:
# These authors contributed equally to this work

International Journal of Mental Health Promotion https://doi.org/10.32604/ijmhp.2026.084709

Received 28 April 2026; Accepted 25 June 2026; Published online 05 August 2026

Abstract

Background: Young and middle-aged adults are susceptible to depression, which may impose health and economic burdens on both individuals and society. eHealth literacy is the ability for individuals to obtain health information through digital channels, which may be beneficial to their mental health. This study aims to investigate the association between eHealth literacy and depression, as well as the mediating roles of lifestyle behaviors. Methods: The study adopted a cross-sectional survey to collect data from 1280 young and middle-aged participants (Mean_age = 39.55 years, 56.72% females) in China. The Chinese version of the eHealth Literacy Scale (eHEALS) and the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) were used to measure eHealth literacy and depression, respectively. Correlation analysis and ordinary least squares regression were conducted to analyze the data. A parallel-mediation model was established to examine the mediating roles of four lifestyle behaviors: smoking, alcohol consumption, sleeping, and exercising. Results: The results showed that eHealth literacy was significantly negatively associated with depression among young and middle-aged adults in China (β = −0.294, 95%CI [−0.330, −0.258], p < 0.001). In addition, the results statistically suggest the mediating roles of smoking (β = −0.010, 95%CI [−0.019, −0.002]), alcohol consumption (β = −0.010, 95%CI [−0.021, −0.002]), sleeping (β = −0.017, 95%CI [−0.026, −0.009]), and exercising (β = −0.016, 95%CI [−0.026, −0.007]) in the association between eHealth literacy and depression. Conclusions: These results suggest that higher levels of eHealth literacy are associated with lower levels of depression, indicating that eHealth literacy could be beneficial to mental health. Healthy lifestyle behaviors in terms of smoking, alcohol consumption, sleeping, and exercising may be mediators in the association.

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Keywords

eHealth literacy; depression; lifestyle behavior; smoking; alcohol consumption; sleeping; exercising

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