Depressive symptom trajectories and the risk of cardiometabolic multimorbidity in Chinese middle-aged older adults

Cardiometabolic multimorbidity (CMM) and depression are major public health concerns, especially among aging populations. While their bidirectional association is recognized, little is known about how long-term depressive symptom trajectories influence the risk of incident CMM. This 10-year longitudinal study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Depressive symptoms were assessed using the CES-D-10 scale, and group-based trajectory modeling identified distinct symptom trajectories. Cox and logistic regression models examined associations between depressive trajectories and new-onset CMM, adjusting for sociodemographic, behavioral, and clinical covariates. Three depressive trajectories were identified: Low-Stable (27.7%), Moderate-Stable (46.3%), and High-Stable (25.9%). Compared to the Low-Stable group, the Moderate-Stable and High-Stable trajectories were associated with significantly increased risks of CMM (adjusted HR = 1.76 and 4.08, respectively). A dose-response relationship was observed between higher CES-D-10 scores and CMM risk. Results remained consistent across subgroups and in sensitivity analyses. Long-term depressive symptom trajectories are independently associated with incident CMM in Chinese middle-aged and older adults. Monitoring depressive symptom dynamics, rather than single assessments, may improve early identification of high-risk individuals and inform integrated prevention strategies targeting both mental and cardiometabolic health.