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August 30, 2026BMC Public HealthOpen Access

Latent multimorbidity patterns and their longitudinal associations with depressive symptom trajectories and ADL limitations among middle-aged and older adults in China: a longitudinal analysis of the CHARLS

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Key result

Musculoskeletal-digestive multimorbidity links to a steeper rise in depressive symptoms versus a healthy pattern.

  • β 0.099
  • 95% CI 0.016-0.183
  • P=0.020
  • n=15,879

Why the study?

Longitudinal evidence from China on how specific multimorbidity patterns relate to changes in depressive symptoms and functional limitations remains limited.

Do specific baseline multimorbidity patterns affect the trajectories of depressive symptoms and ADL limitations in middle-aged and older adults?

Population

Middle-aged and older adults in China from a nationally representative cohort

Comparison

Baseline multimorbidity patterns vs relatively healthy pattern

Design

Nationally representative longitudinal cohort study

Follow-up

2013 to 2018

Authors

KGKaige GaoYZYanjie ZhaoXZXuehong Zhang

Discussion

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Overview

Musculoskeletal–digestive multimorbidity may flag faster depressive worsening; leaves open pattern-specific monitoring pending confirmatory trials.

Key Points

  • To identify baseline multimorbidity patterns and examine their longitudinal associations with trajectories of depressive symptoms and activities of daily living limitations.
  • Analyzed longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018).
  • Applied latent class analysis to identify baseline patterns across 12 chronic conditions.
  • Used linear and generalized linear mixed-effects models to assess changes in depressive symptoms and ADL limitations from 2013 to 2018, alongside exploratory pain mediation analysis.
  • Identified four distinct patterns: cardiometabolic, respiratory-dominant, musculoskeletal–digestive, and relatively healthy.
  • Participants with the musculoskeletal–digestive pattern exhibited a significantly steeper longitudinal increase in depressive symptoms compared with relatively healthy individuals (β = 0.099, P = 0.020).
  • Risk of ADL limitations increased overall over time (P < 0.001), but the rate of functional decline did not differ significantly across multimorbidity patterns (all class-by-time interaction P > 0.05).

Study Design

Type

Cohort (n=15,879)

Multicenter

Yes

Structured PICO

Do specific baseline multimorbidity patterns affect the trajectories of depressive symptoms and ADL limitations in middle-aged and older adults?

P
Population
15,879 middle-aged and older adults aged 45 years and older in China were followed for 5 years to assess the longitudinal associations between baseline multimorbidity patterns and trajectories of depressive symptoms and ADL limitations.
E
Exposure
Baseline multimorbidity patterns (cardiometabolic, respiratory-dominant, musculoskeletal-digestive) identified via latent class analysis of 12 chronic conditions.
C
Comparator
Relatively healthy class (Class 4).
O
Outcome
Trajectories of depressive symptoms (measured by CES-D-10 total score) and risk of activities of daily living (ADL) limitation from 2013 to 2018.patient reported

Main Result

Effect estimate: β 0.099 (95% CI 0.016-0.183)

p-value: p=0.020

Distinct multimorbidity patterns, particularly the musculoskeletal-digestive pattern, are associated with faster increases in depressive symptoms over time among older adults in China, highlighting the need for symptom-oriented mental health screening.

Limitations

  • Use of self-reported physician diagnoses or medical history for chronic conditions
  • Observational design limits the ability to confirm causal pathways in mediation analysis

Cite This Study

Gao et al. (2026) conducted a cohort in Multimorbidity (n=15,879). Musculoskeletal-digestive multimorbidity pattern vs. Relatively healthy pattern was evaluated on Rate of change in depressive symptom scores (CES-D-10) over time (β 0.099, 95% CI 0.016-0.183, p=0.020). The musculoskeletal-digestive multimorbidity pattern was associated with a significantly steeper increase in depressive symptom scores over time compared to a relatively healthy pattern (β 0.099).

synapsesocial.com/papers/6a93efc06c1a8fb52e79bdcfhttps://doi.org/10.1186/s12889-026-29204-0
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Associations of multimorbidity with body pain, sleep duration, and depression among middle-aged and older adults in China2024 · 14 citations
  2. 2Individual-level transitions between chronic disease multimorbidity clusters and the risk of five-year mortality in longitudinal cohort of Chinese middle-aged and older adults2025 · 7 citations
  3. 3Bidirectional, longitudinal associations between depressive symptoms and IADL/ADL disability in older adults in China: a national cohort study2024 · 21 citations
  4. 4Prevalence and pattern of multimorbidity in China: a cross-sectional study of 224,142 adults over 60 years old2024 · 11 citations
  5. 5Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults2021 · 20 citations