Analysis of depression status and influencing factors in older women with cardiometabolic-based chronic disease under Health Ecology Model

Depression among older women with cardiometabolic-based chronic disease (CMBCD) is influenced by both biological mechanisms but complex social and environmental determinants. To examine multilevel factors associated with depression among older women with CMBCD in China within the framework of the Health Ecology Model (HEM), and to identify key determinants for targeted interventions. Using mixed cross-sectional data from 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), 2961 women aged ≥60 with CMBCD were included. Guided by the five levels of the HEM, univariable and multivariable linear regressions were conducted, with robustness verified through logistic regression and E -values. Heterogeneity analyses were performed on region, residence, education level, and medical service satisfaction. Depression was primarily driven by midstream (social network level, living and working conditions level) and downstream (behavioral lifestyle level) factors. Heterogeneity analysis revealed significant variation in depression determinants across region, residence, education level, and medical service satisfaction. The protective effect of “with spouse” was more pronounced among rural and western populations, whereas the benefits of higher education and pension insurance were particularly evident in urban and central regions. The mitigating effect of higher medical service satisfaction on depression was particularly evident among women with higher education levels. The HEM provides a valuable framework for designing multilevel, precision interventions. Effective strategies should focus on enhancing physical activity, improving medical service satisfaction, and strengthening community networks to reduce depression risk in older women with CMBCD. • Application of the Health Ecology Model (HEM) to elucidate multilevel drivers of depression in older women with Cardiometabolic-based chronic disease (CMBCD). • Depression was primarily driven by midstream and downstream factors, while upstream factors showed limited direct effects. • Upstream factors indirectly affect individual health by shaping the midstream factors. • Midstream factors directly regulate downstream factors. • The variable of satisfaction with medical services was included, which can independently reduce the risk of depression, and this effect is more pronounced in literate subgroups.