Relationship between multimorbidity burden and depressive symptoms in older Chinese adults: A prospective 10-year cohort study.

Background: Recent research indicates that multimorbidity clusters due to common mechanisms and risk factors, leading to different effects on the development of depressive symptoms (DS) in older populations. This study innovatively examined the association of both the number and specific patterns of multimorbidity with DS.

Methods: A total of 1988 participants aged 60 years and older were selected from the China Health and Retirement Longitudinal Study (CHARLS) and monitored for DS between June 2011 and September 2020. Twelve chronic conditions were assessed through self-reports. DS was evaluated using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Latent class analysis (LCA) was used to identify multimorbidity patterns, and Cox proportional hazards regression models examined the associations of specific diseases, multimorbidity count and multimorbidity patterns with DS.

Results: During the 9.17-year follow-up period, 986 cases of DS were identified. Hypertension (adjusted hazard ratio [HR] = 1.21, 95 % confidence interval [CI] = 1.05-1.39), stroke (HR = 1.77, 95%CI = 1.20-2.63), stomach or other digestive disease (HR = 1.28, 95%CI = 1.11-1.48), arthritis or rheumatism (HR = 1.41, 95%CI = 1.24-1.60), chronic lung diseases (HR = 1.25, 95%CI = 1.03-1.52) and kidney disease (HR = 1.38, 95%CI = 1.07-1.78) were significantly associated with increased DS risk. Each additional chronic condition increased the DS hazard by 13 % (adjusted HR = 1.13, 95 % CI = 1.08-1.18). Four multimorbidity patterns were identified by LCA, with the digestion/arthritis pattern (HR = 1.47, 95 % CI = 1.22-1.77) and respiratory pattern (HR = 1.47, 95 % CI = 1.07-2.04) showing higher DS risk compared to the relatively healthy group.

Conclusion: The number and patterns of multimorbidity are significantly associated with heightened DS risk in older populations. Older adults in complex health conditions, particularly those with digestion/arthritis and respiratory multimorbidity patterns, should receive closer mental health monitoring.