Association Between Depressive Symptoms and Risk of New-Onset Chronic Liver Disease Among Middle-Aged and Elderly Chinese Adults: A Prospective Cohort Study Based on the China Health and Retirement Longitudinal Study
Across the total population, the analyses consistently demonstrate an independent, graded association between baseline depressive symptom severity and incident CLD that persists after multivariable adjustment that is primarily driven by female participants and middle-aged adults (45–60 years).
Abstract
Background: Chronic liver disease (CLD) imposes a heavy global burden, particularly among middle-aged and elderly adults. Prospective evidence on whether depressive symptoms independently predict new-onset CLD remains scarce. Methods: This prospective cohort study used CHARLS (2011–2020) data and enrolled 9549 participants without baseline CLD. Depressive symptoms were assessed using the CES-D-10 and categorized into four severity levels. Multivariable Cox regression, Kaplan–Meier analysis, and ROC curves were used. Subgroup analyses were conducted across demographic and behavioral strata to assess consistency. Results: During a mean follow-up of 8.77 years, 746 (7.8%) participants developed new-onset CLD. Higher baseline depression severity was associated with increased CLD risk. In the fully adjusted model, compared with the non-depressed group, the HR for mild depression was 1.34 (95% CI: 1.12–1.59, p = 0.001), for moderate depression 1.65 (95% CI: 1.34–2.04, p < 0.001), and for severe depression 2.16 (95% CI: 1.26–3.72, p = 0.005). Cumulative incidence increased with depression severity, with group differences widening over time (log-rank p < 0.0001). Subgroup analyses showed consistent associations across different demographic and behavioral strata. Conclusions: Across the total population, the analyses consistently demonstrate an independent, graded association between baseline depressive symptom severity and incident CLD that persists after multivariable adjustment. The stratified analyses further reveal that this association is primarily driven by female participants and middle-aged adults (45–60 years), highlighting these subgroups as priority populations for depression-informed CLD prevention and screening strategies.
BACKGROUND
Depressive symptoms are dynamic, but their longitudinal patterns in relation to chronic respiratory disease (CRD) remain unclear. We examined whether depressive symptom trajectories were associated with incident CRD in middle-aged and older Chinese adults.
METHODS
Data from the China Health and Retirement Longitudinal Study were analyzed using a 2015 landmark design. Depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression Scale in 2011, 2013, and 2015 among participants free of self-reported physician-diagnosed CRD through 2015. Incident CRD was assessed in 2018 and 2020. Group-based trajectory modeling was used to identify symptom patterns, and multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
Among 7261 participants, 611 (8.4%) developed CRD. Five trajectories were identified: low-stable (64.4%), decreasing (12.1%), fluctuating (5.3%), increasing (11.2%), and high-stable (7.0%). Compared with the low-stable group, all four non-low-stable trajectories were associated with higher odds of incident CRD after full adjustment (ORs 1.32-2.32), with the strongest association in the high-stable group (OR 2.32, 95% CI 1.75-3.06). At single assessments, 14.1%-18.6% of participants with CES-D-10 scores <10 belonged to non-low-stable trajectories. Associations were broader for CRD and chronic lung disease than for asthma. Persistently high somatic and affective-cognitive trajectories were also associated with CRD and chronic lung disease. Findings were robust in sensitivity analyses.
CONCLUSION
Depressive symptom trajectories were associated with CRD and captured heterogeneity not fully reflected by single-time assessments. Repeated assessment may help identify middle-aged and older adults at elevated respiratory risk.
Hao Zhou, Yan-Tong Li, Peng Chen et al.· Journal of Affective Disorde...· 0 citations
Among middle‑aged and older Chinese adults with depressive symptoms, the CHG index shows a significant non-linear positive association with the risk of new-onset stroke, and the risk increases sharply when the index is below 5.59, a potential indicator for the early risk of stroke in this high-risk population.
Yishu Wen, Wei Zhang, Lanxiang Wu et al.· Lipids in Health and Disease· 0 citations
The co-occurrence of chronic pain and cardiometabolic multimorbidity (CMM) is increasingly prevalent among middle-aged and older adults, yet the extent to which CMM shapes the longitudinal course of depressive symptomatology in this population remains poorly understood.
Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS; participants aged 45 years and older) and the English Longitudinal Study of Ageing (ELSA; participants aged 50 years and older). Group-based trajectory modeling (GBTM) was applied to identify distinct depressive symptom trajectories, and multinomial logistic regression was used to examine associations between CMM and trajectory group membership, with subgroup analyses conducted to assess potential effect modification.
Three stable depressive symptom trajectories were identified in both cohorts: persistently low-, moderate-, and high-symptom groups. In ELSA, CMM was significantly associated with both moderate- (OR: 1.56, 95% CI: 1.24–1.96) and high-symptom trajectories (OR: 2.20, 95% CI: 1.61–3.02) after full covariate adjustment. In CHARLS, the association was confined to the high-symptom trajectory (OR: 1.39, 95% CI: 1.03–1.86). Subgroup analyses indicated a more pronounced association among female participants in CHARLS and among those younger than 65 years in ELSA.
CMM is significantly associated with more severe depressive symptom trajectories among middle-aged and older adults with chronic pain, with cross-cohort heterogeneity reflecting differences in population characteristics and sociocultural context. Systematic CMM screening within chronic pain management may help identify individuals at elevated risk for adverse psychological outcomes.
Haotian Zhang, Liqin Deng· Archives of Medical Science· 0 citations
This study aimed to investigate whether the coexistence of heart disease and high C-reactive protein (CRP) levels increases the risk of new-onset stroke among middle-aged and elderly Chinese individuals.
The analysis incluCombined Effect of Heart Disease and high CRP levels on New-Onset Stroke in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study from CHARLSded 7,995 Chinese participants aged 45 years or older from the China Health and Retirement Longitudinal Study (CHARLS). Multivariable Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of new-onset stroke according to heart disease and CRP levels. In addition, incremental predictive values were also assessed using the net reclassification index (NRI), and integrated discrimination improvement (IDI).
Compared with participants free of both conditions, multivariable-adjusted models showed that new-onset stroke risk did not increase significantly in those with heart disease alone (HR = 1.17, 95% CI: 0.93–1.48) or high CRP levels alone (HR = 1.19, 95% CI: 0.96–1.49). In contrast, participants with both heart disease and high CRP levels showed a 58% increased risk of new-onset stroke (HR, 1.58; 95%
CI
, 1.11–2.26), demonstrating a significant independent association (
P
value = 0.008). This combined association was further modified among participants aged < 65 years (HR = 1.20, 95%
CI
: 1.07–1.34), with systolic blood pressure ≥ 140 mmHg (HR = 1.21, 95%
CI
: 1.05–1.39), and fasting glucose ≥ 6.1 mmol/L at baseline (HR = 1.20, 95%
CI
: 1.03–1.40).
The coexistence of heart disease and high CRP levels significantly increases the risk of new-onset stroke, serving as potential predictors for new-onset stroke.
OBJECTIVE
Diabetes mellitus (DM) and cognitive impairment (CoI) are correlated, but the combined impact of depressive symptoms on CoI risk in older adults remains unclear.
METHODS
This study included 1,200 U.S. adults aged ≥60 years (National Health and Nutrition Examination Survey, NHANES) and 1,500 Chinese adults (China Health and Retirement Longitudinal Study, CHARLS). DM was defined by laboratory measures or self-report; depressive symptoms were assessed via the Patient Health Questionnaire-9 (PHQ-9) (NHANES) and CES-D-10 (CHARLS); CoI was measured using the CERAD battery (NHANES) and situational memory/mental integrity scores (CHARLS). Multivariate logistic regression estimated associations of DM and depressive symptoms with CoI. Additive interaction was evaluated by the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S). Restricted cubic spline (RCS) analyses examined nonlinear DM-depressive symptoms interactions.
RESULTS
Both DM and depressive symptoms were independently and significantly associated with CoI. After multivariate adjustment, diabetic patients exhibited significantly increased CoI risk; depressive symptoms similarly elevated CoI risk. Interaction analysis revealed an additive effect when DM co-occurred with depressive symptoms in CHARLS but not in NHANES. Mediation analyses further suggest bidirectional associations: in CHARLS, diabetes and depressive symptoms appear to mediate each other's effects on CoI. Additionally, RCS analysis in NHANES indicated a nonlinear interaction between depressive symptom severity (PHQ-9) and DM on CoI (p<0.05).
CONCLUSION
The observed associations varied across cohorts, with a significant additive interaction between diabetes and depressive symptoms found only in the CHARLS cohort. Integrating metabolic and mental health screening and interventions may optimize cognitive outcomes in high-risk older adult populations.
Sleep deprivation, as well as different types of social engagement, physical activity, physical activity, and digital behavior, exhibit distinct associations with depressive symptoms in middle-aged and older adults in China.
Shu Wang, Y. Shirayama, Ishtiaq Ahmad et al.· Behavioral Science· 0 citations
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