Depressive trajectories and their associations with chronic diseases among older adults: a national longitudinal cohort study from China

BACKGROUND: Chronic diseases and depression pose significant health challenges among older adults, but their dynamic relationship is not fully understood. This study explores how chronic diseases affect depressive trajectories in older adults using a comprehensive health ecology model. METHODS: We conducted a longitudinal analysis using data from 21,541 adults aged 60 + from the China Family Panel Studies (CFPS). The baseline sample (2012) included 3709 older adults, with an average age of 65.88 years, and 1912 (51.45%) male and 1797 (48.45%) female participants. Depressive status was assessed using the CES-D20 scale, and depressive trajectories were identified through group-based trajectory modeling (GBTM). Based on the health ecology model, personal characteristics, behavioral lifestyle, family networks, living environment, and policy environment factors were included. Logistic regression was used to examine the factors influencing depressive trajectories. RESULTS: Chronic disease prevalence increased with age, peaking in the 75-79 age group. GBTM identified two distinct depressive trajectories: low-level (84.3%) and high-level (15.7%). Older adults with chronic diseases were more likely to be in the high-level depressive group (20.51% vs. 11.32%). Risk factors for high-level depression included female gender, impaired ADL, poor self-rated health, smoking, living in rural areas, and lower family income levels. Protective factors included alcohol consumption, regular exercise, being married, and having urban/rural residence medical insurance or employee medical insurance. CONCLUSION: The study identified two distinct depressive trajectories, with chronic diseases significantly increasing the risk of persistent high-level depression in older adults.