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Background The coronavirus disease (COVID-19) pandemic exacerbated depression and anxiety worldwide. Resilience is important to maintain mental health during uncertain times, but limited study has systematically reviewed its association with depression or anxiety with an emphasis on the general population. Methods We searched PubMed and Embase for quantitative or mixed-methods studies on the general adult population published between 1 January 2020 and 31 April 2022 (PROSPERO ID: CRD 42022340935). National Institute of the Health quality assessment tools was used to assess the risk of bias. We qualitatively synthesized findings by outcome and study design. Results A total of 2945 studies were screened and 35 studies were included in the narrative analysis (5 on depression, 9 on anxiety, and 21 on both). Overall, 21 studies identified statistically significant inverse associations between resilience and depression, while 24 studies found statistically significant inverse associations between resilience and anxiety. Eight studies reported no statistically significant relationships between resilience with depression or anxiety. Conclusions Resilience was found to be inversely associated with depression and anxiety during the COVID-19 pandemic. The findings highlight the importance of resilience-enhancing intervention in migrating the global mental health burden from outbreaks of infectious diseases.

Background: Studies on whether lifestyle factors could explain urban-rural differences in mortality risks among Chinese adults 65 years or older are limited. We aim to assess whether and to what extent individual-level lifestyle factors contribute to urban-rural disparity in mortality among older Chinese adults. Methods: Our study included a total of 37,083 adults 65 years or older residents (8,522 city, 8,022 urban and 20,539 rural) from seven waves of the Chinese Longitudinal Healthy Longevity Survey (1998-2014), with follow-up to the latest wave (2018). Five lifestyle factors were examined: smoking, drinking, physical activity, diet and leisure activities. All-cause mortality was ascertained through death registry and information from next of kin. We conducted multivariable Cox proportional hazard models to examine mortality risks and used two measures to estimate the contributions to urban-rural mortality disparity from lifestyle factors, PERM (percentage excess risk mediated) calculated by the change of hazard ratio of the different models divided by the hazard ratio of the adjusted demographics model and AUC (area under the receiver-operating curve). Results: During a median follow-up of 3.24 years, 23,576 death cases were recorded. Report crude differences (death rates by the 3 groups city, town, rural) before adjusting for any vars. After adjusting for demographics, the hazards for town and rural residents were 8.8% and 17.2% higher than city residents, respectively (Table 1, Model 1). Adjustment for leisure activities made the largest difference in explaining the urban-rural disparities (Model 6). Adjustment for all five lifestyle factors explained 36.6% of city-town and 26.1% of city-rural differences (Model 7). AUCs for all models were > 0.7. Conclusion: Lifestyle factors, especially leisure activities, physical activities and diet, contributed substantially to the urban-rural disparity in all-cause mortality of adults aged 65 years or older in China.

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