Association of chronic diseases with depressive symptom trajectories in postmenopausal women: a population-based cohort study

Postmenopausal women are particularly susceptible to depressive symptoms, yet the longitudinal impact of chronic diseases on their depressive symptom trajectories remains poorly understood. We conducted a longitudinal study using data from the China Health and Retirement Longitudinal Study, including postmenopausal women aged ≥ 45 years with complete follow-up from 2011 to 2020. Group-based trajectory modeling identified distinct depressive symptom trajectories. Adjusted multivariable logistic regression was applied to estimate the associations between chronic diseases and depressive symptom trajectory groups. Mediation analyses were conducted to examine whether sleep duration and cognitive function were associated with the relationship between chronic diseases and depressive symptoms. Four trajectories of depressive symptoms were identified: no symptoms (62.2%), increasing symptoms (19.7%), remitting symptoms (10.0%), and persistently severe symptoms (8.2%). Chronic diseases showed association with membership in adverse depressive trajectories, specifically > 3 diseases for persistently severe symptoms (OR = 8.47, 95% CI : 5.79–12.47). Stroke, kidney disease, and arthritis/rheumatism were identified as strongly associated with the persistently severe depressive symptom trajectory. Additionally, elevated odds of belonging to adverse depressive trajectories were observed in women with lower education, rural residence, and a history of premature menopause. In addition, sleep duration (ES = 0.206, p <.001) and cognitive function (ES = 0.099, p <.001) accounted for part of the association between chronic diseases and depressive symptoms. The long-term trajectory of depressive symptoms in Chinese postmenopausal women is substantially associated with chronic disease burden. These findings highlight the need for an integrated multidisciplinary treatment model for postmenopausal women.