Exploring the reciprocal relationship between activities of daily living disability and depressive symptoms among middle-aged and older Chinese people: a four-wave, cross-lagged model

Abstract

Background Early studies have shown a relationship between activities of daily living (ADL) disability and depressive symptoms in older people. However, discussions on the direction of this relationship are insufficient. The study’s objective was to assess the reciprocal relationship between ADL disability and depressive symptoms among middle-aged and older Chinese people. Method Data was collected in four waves of a nationwide survey, the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2011, 2013, 2015, and 2018. In total, this study included 4,124 participants aged ≥ 45 years at baseline. A summing score of the eleven items for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) was calculated to indicate the degree of ADL disability. The 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) was adopted to measure depressive symptoms. The reciprocal relationship between ADL disability and depressive symptoms was tested by cross-lagged models. Result At baseline, 911 (22.1%) participants were classified as having difficulties with ADL, and the prevalence of depressive symptoms was 34.4% (1,418). Among middle-aged and older people in China, there was a significant reciprocal and longitudinal relationship between ADL disability and depressive symptoms. People who had difficulty with ADL faced a higher risk of depressive symptoms, and those who suffered from depressive symptoms were accompanied by an increase in ADL disability in the following years. The subgroup analysis on age also showed that ADL disability was reciprocally and longitudinally related to depressive symptoms. However, only women showed similar results in the subgroup analysis on gender. Conclusion This study shows that ADL disability is bi-directionally related to depressive symptoms in middle-aged and older Chinese people over time. The results suggest we should identify ADL disability and bad psychological conditions in time to prevent subsequent mutual damage among middle-aged and older Chinese people, a vulnerable group rising in the future.

Disability risk prediction model based on machine learning among Chinese healthy older adults: results from the China Health and Retirement Longitudinal Study

“…We found that depressive symptoms are a key predictor of disability in older adults. This finding is consistent with previous research (44)(45)(46), which demonstrates a longitudinal association between depressive symptoms and disability in older adults. Over time, individuals with higher baseline depression levels are more likely to report difficulties in ADL abilities.…”

Association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China: the mediation effect of activities of daily living (ADL) disability

“…Consequently, early identification and intervention for depressive symptoms, along with the promotion of self-care abilities and ADL functioning, are crucial in this population. In comparison to previous studies [ 57 , 58 ], our findings align with established links between depressive symptoms and ADL disability while shedding further light on the role of ADL disability in sarcopenia development. It is crucial to consider the magnitude of these associations, as they hold clinical significance, underscoring the need for targeted interventions.…”

The bidirectional association between the disability in activities of daily living and depression: a longitudinal study in Chinese middle-aged and older adults

“…There seems to be a bidirectional relationship between disability in ADL and depression in middle-aged and older people [ 22 ]. However, most previous studies have been cross-sectional, making it difficult to determine cause and effect.…”