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To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations. This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults. The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males. Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults. [Display omitted] • Are ACEs associated with falls in older adults and does depression mediate such an association? • Exposure to more ACEs was associated with higher risk of falls, recurrent falls, and more severe falls. • Depression partially mediated the effect of ACEs on falls. • Middle-aged adults were more susceptible to the impact of ACEs on falls than older adults. [ABSTRACT FROM AUTHOR]

Major Depressive Disorder (MDD) poses significant public health challenges globally and in Southeast Asia, with substantial impairment and disease burden. Understanding its prevalence and associated risk factors is crucial for effective intervention. This study aims to describe the prevalence shifts, correlates, and comorbidities of MDD in Singapore. Data were collected from the second Singapore Mental Health Study (SMHS 2016), a national cross-sectional survey comprising 6126 adult residents. The WHO Composite International Diagnostic Interview assessed MDD and comorbidities. Statistical analyses, including logistic regression, were conducted to examine the associations and trends. The lifetime weighted prevalence of MDD in SMHS 2016 was 6.2 %, with an overall increase from 5.8 % in 2010. Significant associations were found between MDD and age, marital status, and comorbid physical disorders. Young adults and divorced/separated individuals exhibited higher MDD prevalence. Chronic pain was significantly associated with MDD. The study's cross-sectional design limits causal inference, and selective non-response might affect prevalence estimates. However, the study benefits from a large, nationally representative sample and standardized methodologies. Young and middle-aged adults, and divorced/separated individuals demonstrate elevated MDD prevalence, warranting targeted interventions. Individuals with comorbidities, particularly chronic pain, constitute a high-risk and vulnerable population. Comprehensive assessment and treatment plans should involve multidisciplinary teams and integrated care approaches to better address the complex needs of these individuals. Our study also highlights specific interventions for schools, families, communities, and workplaces. Despite Singapore's relatively low prevalence compared to Western nations, MDD remains cross-culturally valid emphasizing the need for early intervention and preventive public health measures. • Lifetime weighted prevalence of Major Depressive Disorder (MDD) was 6.2 %. • Young adults, and separated or divorced individuals, exhibited higher MDD prevalence. • Chronic pain showed the highest comorbidity with MDD. [ABSTRACT FROM AUTHOR]

Depression has been found to be associated with cognitive decline, but whether longer depressive durations lead to more severe cognitive declines has not been investigated. We aimed to estimate the association between depressive duration and cognitive decline in middle-aged and older Americans based on a large-scale representative population study. We included 27,886 participants from the Health and Retirement Study (HRS) in 2010–2018. Four datasets with 2-, 4-, 6-, and 8-year consecutive interviews were further derived which involving persistent depressed and persistent depression-free individuals. Multiple linear regressions were constructed to estimate the effects of each depressive duration on the decline in global cognition, memory and mental status. Meta-regressions were performed to test the linear trends and to explore the heterogeneity between sex, age and baseline cognitive function along with subgroup analyses. Depressive durations of 2, 4, 6, and 8 years were associated with reductions in global cognitive scores of 0.62 points (95% CI: 0.51–0.73), 0.77 points (95% CI: 0.60–0.94), 0.83 points (95% CI: 0.55–1.10), and 1.09 points (95% CI: 0.63–1.55), respectively, indicating a linear trend (P = 0.016). More pronounced associations were observed in middle-aged adults and females. Similar patterns were found in the associations between depressive duration and two subdomains, i.e., memory and mental health. This study is essentially a cross-sectional study and therefore cannot provide causal associations. Longer depressive durations were linearly related to more severe cognitive declines. Timely intervention for depression targeted middle-aged adults can more effectively alleviate cognition-related burdens. • This is the first study focusing on the association between depressive duration and cognition based on a large population. • Depressive durations were linearly associated with declines in global cognition, memory and mental status. • Significant linear trends between depressive duration and cognitive function persisted in females and adults aged 51-65. • Considering depressive duration, middle-aged adults showed greater cognitive decline due to depression than older adults. [ABSTRACT FROM AUTHOR]

Cross-sectional and longitudinal studies have inconsistently linked cognitive performance and change over time to an elevated level of homocysteine (Hcy), with few conducted among urban adults. Longitudinal data [Visit 1 (2004–2009) and Visit 2 (2009–2013)] were analyzed from up to 1430 selected Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants. Baseline and follow-up blood Hcy was measured, while 11 cognitive function test scores were assessed at either of these two visits. Overall, sex- and race-stratified associations were evaluated using mixed-effects linear regression models, adjusting for key potential confounders. Interaction effects between Hcy and serum levels of folate and vitamin B-12 were also tested. We found that greater LnHcy v1 was significantly associated with poorer baseline attention based on higher Log e (TRAILS A, in seconds) [β (SE): 0.101 (0.031), P = 0.001]. Heterogeneity was also found by sex and by race. Most notably, among men only, LnHcy v1 was associated with faster decline on the BVRT (# of errors), a measure of visuo-spatial memory (β (SE): 0.297(0.115), P = 0.010, reduced model); while among African American adults only, an elevated and increasing LnHcy over time was associated with faster rate of decline on Log e (TRAILS B, in seconds) [β (SE): +0.012 (0.005), p = 0.008], a measure of executive function. Interactions between Hcy, folate and vitamin B-12 blood exposures were also detected. In summary, sex- and race-specific adverse association between elevated Hcy and cognitive performance over time were detected among middle-aged urban adults, in domains of attention, visuo-spatial memory and executive functioning. • This study analyzed longitudinal data from 1430 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. • Higher levels of homocysteine (Hcy) were associated with poorer baseline attention and slower decline in visuo-spatial memory. • This was particularly true among men and African American adults. • The study also found that increased Hcy was associated with faster decline in executive function. • The findings suggest a sex- and race-specific adverse association between elevated Hcy and cognitive performance in middle-aged urban adults. [ABSTRACT FROM AUTHOR]

Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population. 8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015–2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms. The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19–2.02; 20 % rule: OR 1.71, 95 % CI 1.16–2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: β 0.96, 95 % CI 0.38–1.54; 20 % rule: β 0.94, 95 % CI 0.08–1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance. Depressive assessment was based on self-reported screening instrument. The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions. • The presence of both HGS asymmetry and weakness was strongly associated with incident depression. • HGS asymmetry combined with weakness was related to a significant increase in depression score. • Early recognition and intervention of HGS asymmetry and weakness may help reduce depression risk. [ABSTRACT FROM AUTHOR]

The association between obesity and depressive symptoms remains controversial. The Weight-adjusted waist index (WWI) shows advantages in assessing central obesity. This study aimed to investigate the longitudinal relationship between WWI and depressive symptoms. This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011–2020. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depressive Symptoms Scale (CESD-10) scores. Linear mixed models were used to examine longitudinal associations. A total of 6835 participants over the age of 45 were included. WWI was positively associated with CESD-10 scores (β per 1 SD increase = 0.052SD; 95%CI: 0.021 to 0.083SD) and was linked to a faster increase in CESD-10 scores over time (β = 0.095SD/year; 95%CI: 0.090 to 0.100 SD/year). Conversely, BMI was negatively associated with CESD-10 scores (β per 1 SD increase = −0.067SD; 95%CI: −0.097 to −0.038SD). However, the negative association between BMI and CESD-10 scores weakened over time (β per 1 SD increase = 0.008SD/y; 95%CI: 0.003 to 0.013 SD/y). Nonlinear associations were detected between both WWI and BMI with CESD-10 scores. Self-reported depressive symptoms assessments may have introduced information bias. The observational design limits ruling out unobserved confounding factors. Our findings highlight the association between WWI and the long-term progression of depressive symptoms in middle-aged and older adults. WWI may enhance our understanding of the link between obesity and depressive symptoms and could be superior to BMI in predicting depressive symptom progression. • The association between obesity and depression remains controversial. • Weight-adjusted Waist Index has advantages in reflecting abnormal body composition. • Heterogeneity in depression trajectories was detected among older adults. • Weight-adjusted Waist Index may accelerate the progression of depression. [ABSTRACT FROM AUTHOR]

The use of Smart Screening tools to identify mental health problems has scarce empirical data on their effectiveness. This study aims to explore the response rate of patients to this tool and observe their socio-demographic and healthcare characteristics, and the tool's ability to detect potential mental health diagnoses. The study employed an online survey within patient portal from patients of four teaching hospitals in Madrid. The sample included 8749 patients, comprising 66.77 % females and 31.21 % middle-aged adults. 60.56 % responded to the Smart Screening tool. Respondents were found to be predominantly middle-aged women who had been contacted by mental health services multiple times but had not exhibited suicidal behaviour. These patients demonstrated a higher appointment attendance rate and generated low healthcare costs. The tool identified probable low depression and mild anxiety (72.16 %), and individuals aged 50–65 exhibited higher levels of mental health problems, such as psychosis and suicidality, although these results were not all significant regarding previous mental health diagnoses. The Smart Screening tool collects anonymous online data through short questionnaires to apply sophisticated algorithms and determine probable mental health diagnoses. The response rate to the Smart Screening tool was higher than in previous studies. The respondents' profile was middle-aged and older women with moderate mental health problems, although suicidality was also identified. Future research should focus on those who did not respond to the tool and explore the link between previous psychiatric diagnoses and the accuracy of the Smart Screening tool. • The MEmind Smart Screening tool showed a response rate of 60.56 % among patients. • The profile was largely middle-aged women who had moderate mental health problems. • The profile also had high appointment attendance resulting in lower costs. • Patients aged 50–65 had more serious mental illnesses (e.g., psychosis, suicidality) [ABSTRACT FROM AUTHOR]

The effect of lifestyle factors on cognitive function related to four major noncommunicable diseases (NCDs) including diabetes, cardiovascular disease, cancer, and chronic respiratory diseases, and the relationship between these NCDs and cognitive function have not been fully studied. We aimed to investigate the longitudinal associations between these NCDs and cognitive function in middle-aged and older people, and the combined effects of lifestyle factors. By employing the data from three large-scale cohort studies from the U.S. Health and Retirement Study (2010–2019), English Longitudinal Study of Aging (2014–2019), and China Health and Retirement Longitudinal Study (2011–2019), this study carried out a multi-cohort analysis to 77, 210 participants. Fixed-effects regression models were used to examine associations between NCD status and cognitive function. Margin plots were used to illustrate the effect of lifestyle factors. Our findings revealed the dose-dependent association between mounting these NCDs and declining cognitive performance, ranging from one NCD (β = −0.05, 95 % CI: −0.08 to −0.02) to four NCDs (β = −0.51, 95 % CI: −0.75 to −0.28). Decline in cognitive function associated with NCDs was exacerbated with physical inactivity, current smoking status, and an increase in unhealthy lifestyle behaviors. The observational study design precludes causal interrogation of lifestyles and four NCDs on cognitive function. An increasing number of these NCDs were dose-dependently associated with the decline in cognitive function score. Unhealthy lifestyle factors expedite decline in cognitive function linked to these NCDs. • Rise in 4 major NCDs and decline in cognitive function alarms health. • More NCDs dose-dependently associated with lower cognitive function scores. • Unhealthy lifestyle factors expedite decline in NCD-linked cognitive function. [ABSTRACT FROM AUTHOR]

In the United States, the lifetime prevalence of depression in the US population is 20.6 %. We aimed to understand the temporal trends in the prevalence of depression among adults in the United States during the period 2013–2022 as well as the effects of age, period, and cohort effects on the prevalence of depression. Data from 3,139,488 participants in the U.S. Behavioral Risk Factor Surveillance System (BRFSS) from 2013 to 2022 were used in this study. The joinpoint regression model was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) to learn about the time trends in the prevalence of depression. Age-period-cohort models were used to estimate the effects of age, period, and birth cohort effects on the prevalence of depression. The prevalence of depression among adults in the United States showed an overall increasing trend from 2013 to 2022. The rate of increase was greater in males than females, with AAPC values of 1.44 % (95 % CI: 0.32–2.18), and 1.23 % (95 % CI: 0.32–2.25), respectively. Regarding the age effect, the risk of depression among adults in the United States generally showed an increasing and then decreasing trend with age. The risk of developing the condition reached its maximum at 50–54 years (RR = 1.28, 95 % CI = 1.26–1.30). Regarding the period effect, the risk of depression among US adults was higher during 2018–2022 than during 2013–2017. The overall cohort effect for depression prevalence was a higher risk for those born later, with a maximum RR of 1.51 (95 % CI: 1.47–1.54). The prevalence of adult depression in the United States is showing an increasing trend. Middle-aged people and those born later in life deserve more attention as high-risk groups. It is recommended that the condition burden of depression be reduced with the promotion of healthy lifestyles, the promotion of interpersonal communication, as well as enhanced mental health education and mental health literacy. • This study utilized the latest data collected by the BRFSS and was able to observe the latest trends in depression. • Moreover, the sample size of this study was large and covered a wide range of groups. • Additionally, this study has identified the high-risk groups for depression prevalence through an age-period-cohort model. [ABSTRACT FROM AUTHOR]

Fine particulate matter (PM 2.5) has been implicated in various health concerns. However, a comprehensive understanding of the specific PM 2.5 components affecting depression remains limited. This study conducted a Cox proportional-hazards model to assess the effect of PM 2.5 components on the incidence of depression based on the China Health and Retirement Longitudinal Study (CHARLS). Participants with 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score of 10 or higher were classified as exhibiting depression. Our findings demonstrated a significant positive correlation between long-term exposure to black carbon (BC), sulfate (SO 4 2−), and organic matter (OM) components of PM 2.5 and the prevalence of depression. Per 1 Interquartile Range (IQR) increment in 3-year average concentrations of BC, OM, and SO 4 2− were associated with the hazard ratio (HR) of 1.54 (95 % confidence intervals (CI): 1.44, 1.64), 1.24 (95% CI : 1.16, 1.34) and 1.25 (95% CI : 1.16, 1.35). Notably, females, younger individuals, those with lower educational levels, urban residents, individuals who were single, widowed, or divorced, and those living in multi-story houses exhibited heightened vulnerability to the adverse effects of PM 2.5 components on depression. Firstly, pollutant data is confined to subjects' fixed addresses, overlooking travel and international residence history. Secondly, the analysis only incorporates five fine particulate components, leaving room for further investigation into the remaining fine particulate components in future studies. This study provides robust evidence supporting the detrimental impact of PM 2.5 components on depression. The identification of specific vulnerable populations contributes to a deeper understanding of the underlying mechanisms involved in the relationship between PM 2.5 components and depression. • This study explore the association between PM 2.5 components and depression. • Black carbon, sulfate, and organic matter have significant impacts on depression. • Females, who living in multi-story house were susceptible to the PM 2.5 components. [ABSTRACT FROM AUTHOR]

Amid the COVID-19 pandemic, the mental health of middle-aged and older adults has become an increasing concern, and the role of the internet in addressing this public health crisis has drawn the attention of researchers. This study evaluated the impact of internet access during COVID-19 on depressive symptoms among middle-aged and older adults. Data were derived from China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020. Difference-in-differences analysis was performed to compare changes in depressive symptoms between the internet users during COVID-19 and those who didn't have access to the internet before and during the pandemic. We found that internet access during COVID-19 pandemic significantly reduced middle-aged and older adults' depressive symptoms. Further investigation identified the underlying mechanisms through which internet access helps in alleviating depressive symptoms by reducing the likelihood of experiencing negative emotions about COVID-19. Heterogeneity analyses showed that rural residents and middle-aged individuals benefited more from internet access during the pandemic. Since internet access can alleviate middle-aged and older adults' depressive symptoms amidst public health crisis, policy makers should focus on enhancing their access to the internet. • This paper investigated the impact of internet access on middle-aged older adults' depressive symptoms during the COVID-19. • We found that internet access during COVID-19 was beneficial to alleviate middle-aged and older adults' depressive symptoms. • Mechanism analysis showed that internet access can improve depressive symptoms by reducing negative emotions about COVID-19. • The effects were more salient among middle-aged adults and rural residents. [ABSTRACT FROM AUTHOR]

Depression is very prevalent in middle-aged and older smokers. Therefore, we aimed to identify the risk of depression among middle-aged and older adults with frequent and infrequent nicotine use, as this is quite necessary for supporting their well-being. This study included a total of 10,821 participants, which were derived from the China Health and Retirement Longitudinal Study Wave 5, 2020 (CHARLS-5). Five machine learning (ML) algorithms were employed. Some metrics were used to evaluate the performance of models, including area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), specificity, accuracy. 10,821 participants (6472 males, 4349 females) had a mean age of 60.47 ± 8.98, with a score of 8.90 ± 6.53 on depression scale. For middle-aged and older adults with frequent nicotine use, random forest (RF) achieved the highest AUC value, PPV and specificity (0.75, 0.74 and 0.88, respectively). For the other group, support vector machines (SVM) showed the highest PPV (0.74), and relatively high accuracy and specificity (0.72 and 0.87, respectively). Feature importance analysis indicated that "dissatisfaction with life" was the most important variable of identifying the risk of depression in the SVM model, while "attitude towards expected life span" was the most important one in the RF model. CHARLS-5 was collected during the COVID-19, so our results may be influenced by the pandemic. This study indicated that certain ML models can ideally identify the risk of depression in middle-aged and older adults, which holds significant value for their health management. • To identify the risk of depression in middle-aged and older adults with frequent and infrequent nicotine use. • Random forest and support vector machines are identified as the two best performing models. • Variables affecting the two models' output differ between two groups. [ABSTRACT FROM AUTHOR]

Emerging observational evidence supports a role for higher fruit and vegetable intake in protecting against the development of depression. However, there is a scarcity of research in older adults or in low- to middle-income countries (LMICs). Participants were 7801 community-based adults (mean age 68.6 ± 8.0 years, 55.8 % female) without depression, from 10 diverse cohorts, including four cohorts from LMICs. Fruit and vegetable intake was self-reported via comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated measures, and depression defined applying validated cut-offs. The associations between baseline fruit and vegetable intakes and incident depression over a follow-up period of three to nine years were examined using Cox regression. Analyses were performed by cohort with results meta-analysed. There were 1630 cases of incident depression (21 % of participants) over 40,258 person-years of follow-up. Higher intake of fruit was associated with a lower risk of incident depression (HR 0.87, 95%CI [0.77, 0.99], I2 = 4 %). No association was found between vegetable intake and incident depression (HR 0.93, 95%CI [0.84, 1.04], I2 = 0 %). Diverse measures used across the different cohorts and the modest sample size of our study compared with prior studies may have prevented an association being detected for vegetable intake. Our study supports a role for fruit, but not vegetable intake in protecting against depression. Research investigating different types of fruits and vegetables using standardised measures in larger cohorts of older adults from low- and middle-income countries is warranted. • Higher fruit and vegetable intake may reduce the risk of depression. • There is a lack of research in low- and middle-income countries. • Results for 10 culturally diverse cohorts across six continents were meta-analysed. • Higher intakes of fruit were associated with a reduced risk of incident depression. • No association between vegetable intakes and the risk of incident depression. [ABSTRACT FROM AUTHOR]

This study examines the extent to which depressive symptoms mediate the link between childhood friendship (CF) and physical function among middle-aged and older adults in China. China Health and Retirement Longitudinal Study (CHARLS) data were used; specifically, CHARLS life history survey (conducted from June 1–December 31, 2014) and follow-up health survey (conducted from July 1–September 30, 2015) data were used. The Sobel test, Bootstrap test and multivariable logistic regression were performed to examine the mediating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between CF (measured by a standardized retrospective questionnaire) and physical function, which was measured by basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and grip strength. A total of 12,170 participants aged 45 years or older were included in this cross-sectional study. After controlling for covariates, low-quality CF was associated with an increased prevalence of BADL disability (OR = 1.18; 95 % CI = 1.05–1.32), IADL disability (OR = 1.25; 95 % CI = 1.12–1.40), and low grip strength (OR = 1.21; 95 % CI = 1.09–1.34). The proportion of the mediating effect of depressive symptoms was 48 % for CF and BADL, 40 % for CF and IADL, and 11 % for CF and grip strength. Depressive symptoms and worse CF have a joint effect on BADL disability (OR = 3.30; 95 % CI = 2.82–3.85), IADL disability (OR = 3.52; 95 % CI = 3.03–4.09), and low grip strength (OR = 1.65; 95 % CI = 1.43–1.92). Not all potential confounding factors (such as childhood behavioural problems, genetic factors, and memory function) were measured in the analysis, and there may have been recall bias in the retrospective collection of CF data. Individuals with high-quality CF were more likely to have a decreased prevalence of impaired physical function in later life. Depressive symptoms acted as a mediator associated with the development of CF. • High-quality childhood friendship can protect older people from impaired physical function. • Depression mediates the link between childhood friendship and physical function. • Joint effect of depression and childhood friendship on physical function were found. • We found that depression was more strongly associated with physical function. [ABSTRACT FROM AUTHOR]

We aimed to prospectively examine the association of baseline allostatic load (AL) and longitudinal AL changes with incident cardiovascular disease (CVD) and all-cause mortality among middle-aged and elderly Chinese populations and evaluate the relative contributions of each physiological system of AL. Data from the China Health and Retirement Longitudinal Study (CHARLS) among adults aged 45 years or older were analyzed. Cox regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for the associations between baseline AL/longitudinal AL changes with incident CVD and all-cause mortality. Compared with adults with AL 0–1, HRs of those with baseline AL 2–3 and AL ≥ 4 were 1.24 (95 % CI: 1.06, 1.45) and 1.51 (95 % CI: 1.27, 1.80) for incident CVD, and 1.39 (95 % CI: 1.11, 1.75) and 2.02 (95 % CI: 1.60, 2.54) for all-cause mortality. Similar results were found when we treated baseline AL as a continuous variable. We also found per AL score increase during 4 years of follow-up was related to a 11 % (HR, 1.11; 95 % CI: 1.03, 1.20) and 21 % (HR, 1.21; 95 % CI: 1.10, 1.34) increase in incident CVD and all-cause mortality, respectively. Self-reported physician-diagnosed CVD was used to assess the incident CVD. Both baseline AL and longitudinal increases in AL were positively associated with incident CVD and all-cause mortality in middle-aged and elderly adults. Individuals with high AL need to be dynamically monitored for CVD and pre-mature mortality prevention. • High baseline AL was associated with an increased risk of incident CVD and all-cause mortality. • Positive associations were found between cardiovascular/ metabolic AL with incident CVD, and cardiovascular/metabolic/urinary/inflammation AL with all-cause mortality. • Longitudinal increases in AL were positively associated with incident CVD and all-cause mortality. [ABSTRACT FROM AUTHOR]

Arthritis is relatively common among middle-aged and older people and is a significant public health problem. However, research on the relationship between arthritis and mental health in older populations is currently limited. Data were obtained from the Chinese Longitudinal Healthy Longevity Survey. The 10-item Center for Epidemiologic Studies Depression Scale and 7-item Generalized Anxiety Disorder Scale were used to evaluate depressive and anxiety symptoms. Arthritis status was self-reported. Linear and logistic regression analyses were conducted to assess the impact of arthritis on depression, anxiety, and comorbid depression/anxiety symptoms. A total of 11,104 participants aged ≥65 years (mean age, 83.1 ± 11.1 years) were included in the analysis. We detected positive associations of arthritis with depression symptoms (adjusted odds ratio [OR]: 1.57, 95 % confidence interval [CI] 1.33 to 1.86), anxiety symptoms (adjusted OR: 1.48, 95 % CI: 1.15 to 1.90), and comorbid depression/anxiety symptoms (adjusted OR: 1.88, 95 % CI: 1.41 to 2.5) in the older adult population. Participants with arthritis had higher anxiety (adjusted linear regression coefficient: 0.43, 95 % CI: 0.24 to 0.63) and depression (adjusted linear regression coefficient: 0.87, 95 % CI: 0.57 to 1.14) scores compared with those without arthritis. In addition, there were no significant interaction effects between arthritis and participant characteristics on depression symptoms, anxiety symptoms, or comorbid depression/anxiety symptoms. Arthritis was positively associated with depression symptoms, anxiety symptoms, and comorbid depression/anxiety symptoms among older adults. Further cohort studies are needed to validate these associations. • Given population aging occurring in China, arthritis cases among older adults will continue to increase. • Evidence linking arthritis with anxiety, comorbid depression/anxiety is scarce in elderly adults. • Arthritis is associated with higher risk of depression, anxiety, and comorbid depression/anxiety in the older adults. • More attention should be paid to arthritis in older adults to aid early detection of mental disorders. [ABSTRACT FROM AUTHOR]

Rapid eye movement (REM) sleep and three stages of non-REM (NREM) sleep comprise the full sleep cycle. The changes in sleep have been linked to depression risk. This study aimed to explore the association between sleep architecture and depressive symptoms. A total of 3247 participants from the Sleep Heart Health Study (SHHS) were included in this cohort study. REM and NREM sleep were monitored by in-home polysomnography at SHHS visit 1. Depressive symptoms was reported as the first occurrence between SHHS visits 1 and 2 (mean follow-up of 5.3 years). Multivariable logistic regression was used to investigate the relationship between sleep stages and depressive symptoms. In total, 225 cases of depressive symptoms (6.9 %) were observed between SHHS visits 1 and 2. A significant linear association between NREM Stage 1 and depressive symptoms was found after adjusting for potential covariates. Multivariable logistic regression analysis showed that percentage in NREM Stage 1 was associated with the incidence of depressive symptoms (odds ratio [OR], 1.06; 95 % confidence interval [CI], 1.02–1.10; P = 0.001), as were time in NREM Stage 1 and depressive symptoms (OR, 1.02; 95 % CI, 1.01–1.03; P = 0.001). However, no significant association with depressive symptoms was found for other sleep stage. The specific follow-up time for depressive symptoms diagnosis was missing. Increased time or percentage in NREM Stage 1 was associated with a higher risk of developing depressive symptoms. The early change in sleep architecture were important for incidence of depressive symptoms and warrants constant concerns. • We analyzed a cohort dataset to examine the association between sleep architecture and depressive symptoms. • Those who spent more time in NREM stage 1 had higher incidence of depressive symptoms. • No other associations were found between depressive symptoms and other stages of sleep. • Early changes in NREM stage 1 may be useful in predicting depressive symptoms. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are one of the causes of depression in middle-aged and older adults, but the combined effects of ACEs, cognitive function and ability to perform activities of daily living (ADL) on depression have not been fully explored. This study was based on data from 4 waves (2013, 2014, 2015 and 2018) of data from the China Health and Retirement Longitudinal Study, including 10,995 middle-aged and older adults. ACEs were derived from the 2014 self-report life history module. A latent variable growth curve model was used to assess the mediating effect of cognitive function and ability to perform ADL in the relationship between ACEs and depression. ACEs were significantly associated with lower initial cognitive status (β = −0.156, P <.001), worse ability to perform ADL (β = 0.051, P <.001) and higher severity of depression (β = 0.228, P <.001). The results of mediation analysis indicated that the association between ACEs and the intercept of depression was partly mediated by the initial level of cognitive function and ADL, and the association between ACEs and the slope of depression was total mediated by cognitive (intercept and slope) and ADL (intercept and slope). ACEs were associated with higher severity of depression in part due to lower cognitive function and worse ability to perform ADL. Interventions that focus on reducing ACEs and improving cognitive level and ability to perform ADL may effectively reduce the incidence of depression among middle-aged and older individuals. • ACEs can longitudinally affect the development of depression. • Cognitive function and ADL play a mediating role in the relationship between ACEs and depression. • Efforts to reduce ACEs, increase the level of cognitive function and ADL will help to reduce the occurrence of depression [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons (PAHs) are prevalent organic pollutants in the environment; however, limited research has been conducted to explore their potential effects on sleep disorders. This study aims to investigate the relationship between single and mixed PAHs exposures and sleep disorders. This study analyzed National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2016, involving 7730 adult participants. To examine the relationship between PAHs exposure and sleep disorders, we employed survey-weighted multivariate logistic regression models and restricted cubic spline (RCS) models to evaluate single PAHs exposure. Additionally, we employed three mixed-exposure models to examine the relationship between combined PAHs exposure and sleep disorders. After adjusting for covariates, our analyses revealed positive associations between several urinary PAHs metabolites (1-hydroxynaphthalene (1-NAP), 2-NAP, 3-hydroxyfluorene (3-FLU), 2-FLU, and 1-hydroxypyrene (1-PYR)) and sleep disturbance. Consistency across various analytical methods underscores a discernible positive correlation between simultaneous exposure to PAHs and sleep disorders. This association is predominantly influenced by the presence of NAP and FLU. Remarkably, a positive relationship between combined PAHs exposure and sleep disorders emerged within the younger and middle-aged demographic but did not manifest within the elderly population. In conclusion, our study provides new epidemiological evidence suggesting that both single and mixed PAHs exposures may increase the risk of sleep disorders. Further prospective investigations are necessary to validate these findings. • PAHs exposure was positively associated with sleep disorders risk. • NAP and FLU of PAHs are the main risk factors for sleep disorders. • Elevated PAHs exposure among individuals aged 20–59 is linked to an increased risk of sleep disorders. [ABSTRACT FROM AUTHOR]

Research has estimated the associations of lifestyle at one-time point with the risk of dementia and hippocampal volume, but the impact of lifestyle transition on dementia and hippocampal volume remains unclear. This study aims to examine the associations of lifestyle transition with the risk of dementia and hippocampal volume. Based on data from the UK Biobank, a weighted lifestyle score was constructed by incorporating six lifestyle factors. Within each baseline lifestyle group (i.e., healthy , intermediate , and unhealthy), lifestyle transition was classified into decline , maintenance , and improvement. Cox proportional hazard regression was used to estimate the association of lifestyle transition and incident dementia (N = 16,305). A multiple linear regression model was used to estimate the association between lifestyle transition and hippocampal volume (N = 5849). During a median follow-up period of 8.6 years, 120 (0.7 %) dementia events were documented. Among participants with healthy baseline lifestyles, the improvement group had a lower risk of incident dementia (HR: 0.18, 95 % CI: 0.04–0.81) and a larger hippocampal volume (β = 111.69, P = 0.026) than the decline group. Similar results were observed among participants with intermediate baseline lifestyles regarding dementia risk but not hippocampal volume. No benefits were observed in the improvement group among those with unhealthy baseline lifestyles. A lower incidence of dementia than other cohort study and this may have resulted in an underestimation of the risk of dementia. Earlier transitions to healthier lifestyle were associated with reduced risk of incident dementia and decreased hippocampal atrophy. • Earlier transitions to healthier lifestyle were associated with reduced risk of dementia and decreased hippocampal atrophy • Modifications of lifestyle risk factors can be effectively preventing hippocampal atrophy and dementia • Major efforts are needed to improve the health lifestyles of middle-aged adults and reduce their dementia risks as they age [ABSTRACT FROM AUTHOR]

The optimal multimorbidity measures for predicting disability trajectories are not universally agreed upon. We developed a multimorbidity index among middle-aged and older community-dwelling Chinese adults and compare its predictive ability of disability trajectories with other multimorbidity measures. This study included 17,649 participants aged ≥50 years from the China Health and Retirement Longitudinal Survey 2011–2018. Two disability trajectory groups were estimated using the total disability score differences calculated between each follow-up visit and baseline. A weighted index was constructed using logistic regression models for disability trajectories based on the training set (70 %). The index and the condition count were used, along with the pattern identified by the latent class analysis to measure multimorbidity at baseline. Logistic regression models were used in the training set to examine associations between each multimorbidity measure and disability trajectories. C-statistics, integrated discrimination improvements, and net reclassification indices were applied to compare the performance of different multimorbidity measures in predicting disability trajectories in the testing set (30 %). In the newly developed multimorbidity index, the weights of the chronic conditions varied from 1.04 to 2.55. The multimorbidity index had a higher predictive performance than the condition count. The condition count performed better than the multimorbidity pattern in predicting disability trajectories. Self-reported chronic conditions. The multimorbidity index may be considered an ideal measurement in predicting disability trajectories among middle-aged and older community-dwelling Chinese adults. The condition count is also suggested due to its simplicity and superior predictive performance. • The present study is the first to construct a new multimorbidity index using disability trajectories as the outcome. • The multimorbidity index performed better than count- and pattern-based measures in predicting disability trajectories. • The multimorbidity index may ideally be considered when measuring multimorbidity to predict disability trajectories. • The condition count is also suggested due to its simplicity and superior predictive performance. [ABSTRACT FROM AUTHOR]

Limited research has simultaneously examined the link between adverse childhood experiences (ACEs), short sleep duration, and depressive symptoms among middle-aged or older Chinese adults. This study aims to investigate the association between ACEs and later-life depressive symptoms, and to examine the mediating role of short sleep duration (<6 h/night) in this association. Data of 11,452 participants aged ≥45 years were obtained from the China Health and Retirement Longitudinal Study. Information on ACEs, depressive symptoms, and sleep duration were reported via questionnaires. The mediating effect of short sleep duration in the association between ACEs and depressive symptoms was examined by Baron and Kenny's causal steps method and Karlson/Holm/Breen (KHB) method. Compared to non-exposed group, exposure to ACEs was significantly associated with increased odds of depressive symptoms in a dose-response pattern. The odds ratio of depressive symptoms increased from 1.27 (95 % CI: 1.11–1.46) for one ACE to 3.38 (95 % CI: 2.92–3.90) for ≥4 ACEs. The KHB method identified significant mediating role of short sleep duration in the association between experiencing three or more ACEs and depressive symptoms, with the proportional mediation estimated at 8.96 % and 8.85 % for the groups with 3 ACEs and ≥4 ACEs, respectively. The results were consistent across genders and gender did not moderate these associations. The cross-sectional design limited the ability to make causal inference. ACEs were positively associated with depressive symptoms, and short sleep duration partially mediated this association. Promoting optimal sleep duration among ACE-exposed individuals might improve their mental health. • Adverse childhood experiences (ACEs) are associated with depressive symptoms in later life. • Short sleep duration is a mediator in the association between ACEs and later-life depressive symptoms. • These association and mediation effects appear to be similar between women and men. • Universal interventions are necessary for individuals with experiences of ACEs, irrespective of their genders. [ABSTRACT FROM AUTHOR]

Cognitive frailty and abdominal obesity are deemed to be important targets for disease prevention. However, a possible cardiometabolic multimorbidity (CMM) link with cognitive frailty and abdominal obesity is unknown. The aim of this study was to investigate the association of cognitive frailty and abdominal obesity with CMM in the middle-aged and older people. The sample comprised 11,503 participants aged 45 and over from the China Health and Retirement Longitudinal Study (CHARLS) 2011. Cognitive frailty was defined as the coexisting cognitive impairment and physical frailty. Abdominal obesity was assessed using waist circumference. CMM was defined as the presence of two or more cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke. A total of 9177 participants without CMM recruited from CHARLS 2011 and were followed up in 2018. Compared with 0 CMD, coexisting cognitive frailty and abdominal obesity was associated with the risk of 1 CMD (OR: 1.734, 95 % CI: 1.133–2.655), and ≥ 2 CMDs (OR: 7.218, 95%CI: 3.216–16.198). Longitudinal analysis showed that individuals with both cognitive frailty and abdominal obesity (HR: 2.162, 95%CI: 1.032–4.531) were more likely to have new onset CMM than cognitive frailty alone peers (HR: 1.667, 95 % CI: 0.721–3.853). Among the participants with first CMD, the likelihood of CMM was substantially higher in the co-existence of cognitive frailty and abdominal obesity (HR: 3.073, 95%CI: 1.254–7.527) than in the abdominal obesity alone (HR: 1.708, 95%CI: 1.201–2.427). Cognitive frailty alone was not significantly associated with CMM. Cognitive frailty is not independently associated with the risk of CMM, but cognitive frailty and abdominal obesity together has a greater risk of CMM. • Coexisting cognitive frailty and abdominal obesity were positively associated with incident CMM. • Cognitive frailty alone was not significantly associated with CMM. • Coexisting cognitive frailty and abdominal obesity elevated risk of progression from first CMDs to CMM. [ABSTRACT FROM AUTHOR]

The study sought to examine the impact of longitudinal changes in depressive symptoms in middle-aged adults before and after their first stroke, and the impact of different ages. The study monitored middle-aged patients with a first stroke in the China Family Panel Study (CFPS) survey from 2016 to 2020. This study examined longitudinal changes in depressive symptoms in middle-aged adults and their controls before and after stroke using multilevel models, and also explored factors influencing middle-aged adults at the time of their respective stroke and depressive symptoms using conditional regression models and stepwise regression models, respectively. A chi-square test was used to determine whether long-term changes in depressive symptoms in patients before and after stroke could be attributed to changes in a single depressive symptom. The study identified 582 first-time stroke patients and 5522 controls from a population of 17,588 participants. Middle-aged populations may have an increased risk of depressive symptoms after a first stroke compared to older populations. First-time stroke victims showed increased severity of depressive symptoms in both the two years before and the two years after stroke when depressive symptoms were assessed. Differences in the presentation of a single depressive symptom were most pronounced in sleep-related symptoms. The link between first stroke and changes in the trajectory of increased depressive symptoms is complex and bidirectional. Age is an important factor influencing changes in depressive symptoms, some attention should be paid to the middle-aged population. Special attention should also be paid to sleep-related symptoms in the long-term care of patients. • We sought to investigate the effects of longitudinal changes in depressive symptoms in middle-aged and older adults before and after the first stroke. • Age is an important influence on stroke and PSD, and there is a dual association between first-ever stroke and changes in trajectories related to depressive symptoms. • This paper is the first to reveal the first-time stroke patients and their relationship with depressive symptoms before and after the onset of stroke based on Chinese residents. [ABSTRACT FROM AUTHOR]

We aimed to investigate the association of household crowding in childhood with trajectories of depressive symptoms in middle-aged and older adults. We studied 47,010 participants (56 % women, 63 years at baseline) from SHARE. Using multinomial logistic regression, we estimated odds ratio (OR) with 95 % confidence interval (CI) for the association of household crowding in childhood (number of household members/number of rooms at the age of 10) with trajectories of depressive symptoms (EURO-D scale), which were generated with growth mixture modeling. We adjusted for resources in childhood, sociodemographic and health-related characteristics in mid-life and older age and tested effect modification by sex. We identified four trajectories of depressive symptoms: constantly low (n = 33,969), decreasing (n = 5595), increasing (n = 5574) and constantly high (n = 1872). When compared to the those with constantly low depressive symptoms and adjusting for all covariates, household crowding in childhood was associated with greater odds of constantly high (OR 1.12; 95 % CI 1.08–1.17), decreasing (OR 1.11; 95 % CI 1.07–1.15) and increasing (OR 1.09; 95 % CI 1.06–1.13) depressive symptoms. The associations were stronger in women than in men. Prevention of household crowding in childhood may ameliorate the development of constant as well as transient depressive symptoms during ageing. The effect can be stronger in women than in men. • Childhood household crowding is a risk factor for late-life depressive symptoms. • Four distinct longitudinal trajectories of depressive symptoms were extracted. • Household crowding correlated with constantly high or transient depressive symptoms. • Household crowding had worse effect on women than men. [ABSTRACT FROM AUTHOR]

Many studies have shown that having noncommunicable chronic diseases (NCDs) is strongly associated with depressive symptoms in elderly people; however, the mechanisms of this association are not fully understood. This study aims to investigate whether perceived social support (PSS) mediates the effect of NCDs on depressive symptoms and whether these relationships differ depending on where middle-aged and elderly people live. The study population was from the psychology and behavior investigation of Chinese residents (PBICR). A total of 8732 people aged 45 and older were included in the hypothetical modulated model. Perceived Social Support Scale (PSSS) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate PSS and depressive symptoms. NCDs were positively related to depressive symptoms (β = 0.81, p < 0.01) and indirectly mediated through PSS (β = 0.08). Residency moderated the relationship between NCDs and PSS (β = −0.16, p < 0.01) and between NCDs and depressive symptoms (β = 0.29, p < 0.01). Specifically, the effect of NCDs on PSS and depressive symptoms was greater in rural middle-aged and older adults. NCDs raise the risk of depressive symptoms in middle-aged and older Chinese, with PSS playing a partially protective role. In addition, the area of residence moderated the connection between the number of NCDs and PSS, NCDs, and depressive symptoms in middle-aged and older adults. • Noncommunicable diseases amount to depressive symptoms via perceived social support. • Rural-urban moderated a relation between NCDs' amount, PSS, and depressive symptoms. • NCDs' amount had more role in PSS and depressive symptoms of 45 or older in rural. • The study aims to improve elder mental health and prevent depressive symptoms. [ABSTRACT FROM AUTHOR]

Evidence on the combined effect of sleep duration and grip strength on depressive symptoms is scarce. This study aimed to explore the moderating effect of grip strength on the association between sleep duration and depressive symptoms in a large cohort of middle-aged and older adults. Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018 wave. Grip strength and sleep duration were assessed by dynamometer and self-report, respectively. Depressive symptoms were determined by the Centre for Epidemiological Studies Depression scale (CESD-10). Multivariable cox regression model was used to explore the associations between sleep duration, and depressive symptoms, and assess moderation by grip strength. A total of 4337 participants aged 57.0 ± 8.1 years (45.1 % females) were included in this study. During the 7-year follow up period, 1508 participants developed depressive symptoms. Short sleep duration (<6 h/d) was significantly associated with an increased risk of depressive symptoms [Hazard ratio (HR):1.24, 95 % confidence interval (CI):1.09, 1.40)]. This association remained in individuals with the low (HR:1.22, 95%CI:1.00, 1.49) and middle grip strength (HR:1.32, 95%CI: 1.07, 1.63), but attenuated in individuals with high grip strength (HR:1.11, 95%CI: 0.86, 1.43). High grip strength mitigated the association between short sleep duration and higher risk of depressive symptoms. Thus, improving sleep duration and strengthening muscle strength are recommended to prevent depressive symptoms in middle-aged and older adults. • Short sleep duration significantly increases the risk of depressive symptoms. • High grip strength eliminated the negative effect of short sleep duration on depressive symptoms. • Short sleep duration increased the risk of depressive symptoms only in females or individuals aged 45–60 years. [ABSTRACT FROM AUTHOR]

Early identification of the middle-aged and elderly people with high risk of developing depression disorder in the future and the full characterization of the associated risk factors are crucial for early interventions to prevent depression among the aging population. Canadian Longitudinal Study on Aging (CLSA) has collected comprehensive information, including psychological scales and other non-psychological measures, i.e., socioeconomic, environmental, health, lifestyle, cognitive function, personality, about its participants (30,097 subjects aged from 45 to 85) at baseline phase in 2012–2015. We applied machine learning models for the prediction of these participants' risk of depression onset approximately three years later using information collected at baseline phase. Individual-level risk for future depression onset among CLSA participants can be accurately predicted, with an area under receiver operating characteristic curve (AUC) 0.791 ± 0.016, using all baseline information. We also found the 10-item Center for Epidemiological Studies Depression Scale coupled with age and sex information could achieve similar performance (AUC 0.764 ± 0.016). Furthermore, we identified existing subthreshold depression symptoms, emotional instability, low levels of life satisfaction, perceived health, and social support, and nutrition risk as the most important predictors for depression onset independent from psychological scales. Depression was based on self-reported doctor diagnosis and depression screening tool. The identified risk factors will further improve our understanding of the depression onset among middle-aged and elderly population and the early identification of high-risk subjects is the first step for successful early interventions. • Survey data accurately predicts future depression onset of a large aging cohort. • Two psychological scales with 20 items accurately predict future depression onset. • Subthreshold symptoms, personality, objective feeling, nutrition risk could be potential predictors of depression onset independent from psychological scales. [ABSTRACT FROM AUTHOR]

Life-course disadvantages and unhealthy lifestyles are well-known to independently induce depressive symptoms, but whether adopting healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages remain unknown in China. This population-based cross-sectional study included 5724 middle-aged and older people from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms and healthy lifestyles (including regular exercise, reasonable sleep, never smoking, and no heavy alcohol consumption) were collected in 2018 while life-course disadvantages were collected in 2014. Multiple healthy lifestyles were associated with decreased depressive risks more significantly as the life-course disadvantages increased, with odds ratios (ORs) and 95 % confidence intervals (CIs) of 0.44 (0.25–0.80) and 0.33 (0.21–0.53) for 4 healthy lifestyles in participants with mild and severe life-course disadvantages, respectively. Life-course disadvantages and unhealthy lifestyles had enormous joint effects on depressive symptoms. Finally, adopting multiple healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages and even mask some risks attributed to childhood disadvantages. Given that dietary data were not gathered by the CHARLS, diet was not included in this study. In addition, information on life-course disadvantages was primarily self-reported, which may lead to potential recall bias. Finally, the cross-sectional design of this study cannot capture causal associations well. Adopting multiple healthy lifestyles can well-dilute the depressive risks attributed to life-course disadvantages in middle-aged and older Chinese, which is of great importance for reducing the depressive burden and the construction of healthy aging in China. • Unhealthy lifestyles mediate the effects of life-course disadvantages on depressive symptoms. • Life-course disadvantages and unhealthy lifestyles have joint effects on depressive symptoms. • Healthy lifestyles help reduce depressive risks attributed to life-course disadvantages. • Adopting healthy lifestyles can mask depressive risks attributed to childhood disadvantages. [ABSTRACT FROM AUTHOR]

The American Heart Association Life's Simple 7 (LS7) is a composite metric assessing cardiovascular health on a scale of 0–14 comprised of nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol and glucose. Using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study [ n = 1465, Age at visit 1 (v1: 2004–2009): 30–66 y, 41.7 % male, 60.6 % African American], we investigated associations of trajectories in depressive symptoms (2004–2017) with Life's simple 7 scores after ∼8.6 years follow-up (2013–2017). Analyses used group-based zero-inflated Poisson trajectory (GBTM) models and multiple linear or ordinal logistic regression. GBTM analyses generated two classes of depressive symptoms trajectories ("low declining" and "high declining"), based on intercept and slope direction and significance. Overall, "high declining depressive symptoms" vs. the "low declining" group was associated with −0.67 ± 0.10 lower scores on LS7 total score (P < 0.001) in analyses adjusted for age, sex, race and the inverse mills ratio. This effect was markedly attenuated to −0.45 ± 0.10 score-points (P < 0.001) upon adjustment for socio-economic factors and to −0.27 ± 0.10 score-points (P < 0.010) in fully adjusted analyses, with a stronger association detected among women (β ± SE: −0.45 ± 0.14, P = 0.002). An association between elevated depressive symptoms over time ("high declining" vs "low declining") and LS7 total score was detected among African American adults (β ± SE: −0.281 ± 0.131, p = 0.031, full model). Moreover, the "high declining" vs. "low declining" depressive symptoms group was associated with a lower score on LS7 physical activity (β ± SE: −0.494 ± 0.130, P < 0.001). Poorer cardiovascular health was linked to higher depressive symptoms over time. • Associations between Life' Simple 7 (LS7) and trajectories in depressive symptoms were investigated among urban adults. • Reduced LS7, was linked to "high declining" depressive symptoms trajectory, overall and in women. [ABSTRACT FROM AUTHOR]

Previous studies have shown a longitudinal association between tooth loss and cognitive function. Body mass index (BMI) is an essential applicable indicator of health status screening. However, the underlying mechanism among these factors remains unclear. This study aimed to determine the mediating role of BMI in the tooth loss-cognition relationship by gender among Chinese middle-aged and older adults. This is a prospective and cohort study. We used three waves of follow-up data (2011, 2013, and 2015) from the China Health and Retirement Longitudinal Survey, including 10,013 participants aged 45 years or above. Cognitive function was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing. The cross-lagged panel model was applied to test the hypothesized model. Tooth loss is associated with higher BMI and lower level of cognitive function. We found significant total effects (B = −0.017, P = 0.008), direct effect (B = −0.015, P = 0.022) and indirect effects (B = −0.002, P = 0.010) of tooth loss on cognition mediated through BMI only among middle-aged and older men. For middle-aged and older women, the total effect (B = −0.010, P = 0.125) and direct effect (B = −0.007, P = 0.249) were no more significant. The longitudinal association between tooth loss and cognition was primarily indirect through BMI among middle-aged Chinese males but not women. Public health authorities should remind middle-aged and older males with tooth loss and high BMI to participate in timely medical checkups for improving cognition. • BMI played a mediating role in the association between tooth loss and cognition. • Apparent sex-specific differences were observed in the mediating effect of BMI. • Tooth loss only affected cognition via BMI in middle-aged and older men. • Interventions may consider improving exercise guidance and treatment of edentulism. [ABSTRACT FROM AUTHOR]

To identify the latent groups of multimorbidity trajectories among middle-aged and older adults and examine their associations with healthcare utilization and health expenditures. We included adults aged ≥45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2015 and were without multimorbidities (<2 chronic conditions) at baseline. Multimorbidity trajectories underlying 13 chronic conditions were identified using group-based multi-trajectory modeling based on the latent dimensions. Healthcare utilization included outpatient care, inpatient care, and unmet healthcare needs. Health expenditures included healthcare costs and catastrophic health expenditures (CHE). Random-effects logistic regression, random-effects negative binomial regression, and generalized linear regression models were used to examine the association between multimorbidity trajectories, healthcare utilization, and health expenditures. Of the 5548 participants, 2407 developed multimorbidities during follow-up. Three trajectory groups were identified among those with new-onset multimorbidity according to the increasing dimensions of chronic diseases: "digestive-arthritic" (N = 1377, 57.21 %), "cardiometabolic/brain" (N = 834, 34.65 %), and "respiratory/digestive-arthritic" (N = 196, 8.14 %). All trajectory groups had a significantly increased risk of outpatient care, inpatient care, unmet healthcare needs, and higher healthcare costs than those without multimorbidities. Notably, participants in the "digestive-arthritic" trajectory group had a significantly increased risk of incurring CHE (OR = 1.70, 95%CI: 1.03–2.81). Chronic conditions were assessed using self-reported measures. The growing burden of multimorbidity, especially multimorbidities of digestive and arthritic diseases, was associated with a significantly increased risk of healthcare utilization and health expenditures. The findings may help in planning future healthcare and managing multimorbidity more effectively. • We revealed 3 evolution trajectories of multimorbidity in Chinese adults. • Multimorbidity trajectories were based on combinations of newly diagnosed diseases. • Multimorbidity trajectory groups had increased risk in healthcare utilization. • Digestive-arthritic trajectory group may incurring catastrophic health expenditures. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) has increasing prevalence with age. Both objective measures of cognitive dysfunction and subjective report of cognitive difficulties related to MDD are often thought to worsen with increasing age. However, few studies have directly evaluated these characteristics across the adult lifespan. Participants included 23,594 adults completing objective and subjective measures of cognition on an online research registry. Linear regression including interactions of age group with depression was used to evaluate the association of self-reported MDD with measures of cognition in three age groups: 21–40 years; 41–60 years; 61+ years. MDD (n = 2127) demonstrated poorer objective cognitive performance and greater subjective ratings of cognitive difficulties across all domains assessed compared to non-depressed individuals (ND; n = 21,467). Significant interactions of age group and MDD status with objective and subjective measures of cognition were observed for both middle age and older adults when compared to young adults but few significant differences between middle-aged and older adults were evident. This study relied on self-report of MDD diagnosis, utilized remotely administered and unsupervised measures of cognition, and the sample was not diverse. The magnitude of association between MDD and cognitive correlates appears to plateau in middle age. Our results suggest that increased rates of dementia are not due to greater cognitive consequence of MDD in older adults and that age effects, and not greater effects of depression, may lead to increased diagnosis of MDD based on subjective report of cognitive symptoms. • Adults with depression demonstrated poorer cognition and reported greater cognitive difficulties than non-depressed adults. • The association of depression with measures of cognition was greater in middle-age and older adults compared to younger adults. • Our results suggest that the strength of association between depression and cognition appears to plateau in middle-age. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the associations between the multidimensional health status of one spouse and the onset of depressive symptoms in partner, and whether the associations differed by gender and residence. We analyzed data from 2401 females and their husbands (scenario 1), and 2830 males and their wives (scenario 2) who participated in the 2011/2012 and 2015 waves of China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Multidimensional health indicators included mobility disability, activities of daily living disability, frailty, global cognition, depressive symptoms, comorbidity, and self-reported health. Principal component analysis was used to construct a composite health indicator reflecting overall health status that was then categorized into three groups (poor, moderate, and excellent). Logistic regression models were performed. We observed strong associations of spouse's health status with the onset of depressive symptoms in partner. For instance, females whose husbands had poor overall health status reported more depressive symptoms than those having husbands with excellent overall health after four years (OR: 1.75; 95 % CI: 1.35, 2.26). These associations were statistically significant in rural females and urban males, but surprisingly disappeared in rural males and urban females. No exact timing of depressive symptoms onset. In Chinese middle-aged and older adults, spouse's health status is associated with depressive symptoms in partner and the associations vary by gender and residence. The findings underscore the importance of considering partner's health status to manage one spouse's mental health. • Spouse's health status is associated with the onset of depressive symptoms in partner • Associations between spouse's health status and depressive symptoms in partner vary by gender and residence in China • Considering partner's health status in a couple may improve one spouse's mental health [ABSTRACT FROM AUTHOR]

Multi-national studies in the association between handgrip strength and depression in middle and older aged adults are limited. Hence, Brazil, China, Europe, Korea, United Kingdom (UK) and United States (US) datasets were utilized to investigate this association. A cross-sectional study was conducted with 51,285 participants aged >45 years. Handgrip strength scores were divided into quartiles, groups 1 (highest) to 4 (lowest) in each database, and depression measures converted to binary scores. Males in China and UK reported higher adjusted odds ratios (aORs) of depression for groups 2, 3, and 4 than for group 1. Brazil, US, and Korea reported greater aORs in groups 3 and 4 whereas Europe demonstrated increased aORs for group 4 only. Among females, China, Brazil, US, and Korea showed high aORs across all groups, while UK and Europe reported increased aORs for group 4 only. Highest ORs were reported from Korea in group 4 for males (aOR: 3·09; 95 % CI: 2·15–4·43; p < 0·001) and females (aOR: 3·74; 95 % CI: 2·78–5·03; p < 0·001). When removing the regional factor, aORs were higher in lower groups, with the highest reported from group 4 for males (aOR: 2·32; 95 % CI: 2·09–2·58; p < 0·001) and females (aOR: 2·11; 95 % CI: 1·95–2·29; p < 0·001). Being a cross-sectional study, the results were not able to establish the causal direction between handgrip strength and depression. Lower handgrip strength was associated with an increased likelihood of depression. Early assessment of handgrip strength may identify populations at-risk for depression among middle and older aged adults. • Examined multiple cohort databases of middle to older age adults published globally • An inverse association between handgrip strength and depression was detected. • The findings were not limited to a distinct nationally representative population. • Timely assessment of handgrip strength may lead to early detection of depression. [ABSTRACT FROM AUTHOR]

Introduction: This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA).Methodology: Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n = 2948) and 12 OA papers (participant n = 551), and analysed with the random effects model.Results: No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Qbetween (1) = 0.06, p = .89), with the overall effect favouring CBT over any other treatments (g = 0.48, 95 % CI = 0.29-0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Qbetween (1) = 0.03, p = .86) or passive control conditions (Q (1) = 2.45, p = .12).Discussion: No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults. [ABSTRACT FROM AUTHOR]

Background: Previous studies evaluating the association between leisure activities and cognitive function produced conflicting results. Different types of leisure activities may have different effects on cognition, and very few studies have explored their bidirectional associations. Our study aimed to explore whether intellectual and social activities had bidirectional associations with cognitive function among the middle-aged and elderly adults in China.Methods: Data was derived from the China Health and Retirement Longitudinal Study. The data in this study were based on 11,549 participants aged 45 or older whose intellectual and social activities and cognitive function were assessed at baseline. Cross-lagged panel model was used to examine the temporal relationship of intellectual and social activities with cognitive function.Results: Totally, 5624 participants completed the third follow-up in 2018. The results showed that the better the cognitive function they had at baseline, the more intellectual activities they were engage in (β = 0.044, P < 0.001) and vice versa (β = 0.042, P = 0.001). Additionally, better cognitive function at baseline was significantly associated with more engagement in social activities (β = 0.028, P = 0.030); in contrast, higher engagement in social activities at baseline was not related to better cognitive function (β = -0.008, P = 0.523).Limitations: Engagement in social and intellectual activities was assessed via questionnaire.Conclusions: Our findings indicated that there was a bidirectional relationship between intellectual activities and cognitive function. However, participation in social activities did not slow down the decline in cognitive function. Participating in intellectual activities, compared to social activities, is especially beneficial for cognitive function. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is reported to be associated with depression. Recently, serum creatinine to cystatin C ratio (CCR) has been recommended as a promising biomarker for detecting sarcopenia. The purpose of this study was to explore the relationship between CCR and depressive symptoms among middle-aged and older adults using the baseline data of the China Health and Retirement Longitudinal Study (CHARLS).Methods: This study included 7083 participants aged 45 and older. A score of 10-item Center for Epidemiological Studies Depression Scale (CESD-10) ≥ 12 was used as the cut-off of having depressive symptoms. CCR was calculated by serum creatinine (mg/dL)/cystatin C (mg/L). The t-test and Chi-squared test were applied to compare the differences between the depressive symptoms group and no depressive symptoms group in both sexes. Unadjusted and adjust logistic regression models were used to further investigate the relationship between CCR and depressive symptoms.Results: In the fully adjusted logistic regression models, higher CCR was significantly correlated with a lower incidence of depressive symptoms in males (OR = 0.486, P = 0.001, 95 % CI = 0.314-0.752), but not in females (OR = 0.775 P = 0.184, 95 % CI = 0.532-1.129).Limitations: 1. Self-reported method was used to define depressive symptoms by CESD-10; 2. History of chronic diseases were all self-reported; 3. Residual bias was still possible after controlling for many confounding factors.Conclusions: Lower CCR was significantly correlated with increased depressive symptoms in males, but not in females. More studies are needed to further confirm this conclusion. [ABSTRACT FROM AUTHOR]

Background: Several studies have found a negative association between obesity and depression in Chinese middle-aged and elderly, suggesting the existence of "jolly fat". This study aims to investigate whether "jolly fat" is applicable among middle-aged and elderly with different education levels, and to provide a new perspective for depression screening and obesity interventions in middle-aged and older adults.Methods: 10,018 individuals aged 45 years and over in China Family Panel Study (2018) were selected for analysis. A short version of Center for Epidemiological Research Depression Scale was used to assess depression. Body mass index was applied to define obesity status. Subgroup analysis of multiple logistic regression was performed to explore whether the relationship between obesity and depression was influenced by education levels.Results: The prevalence of obesity and depression was 9.02 % and 22.96 % among participants. Obesity reduced the probability of depression in middle-aged and elderly with primary school education or below (OR = 0.71, 95 % CI = 0.56-0.91) while not affecting those with junior high school education or above (OR = 0.80, 95 % CI = 0.57-1.13).Limitations: The results cannot be interpreted as causality due to the cross-sectional design. Besides, we cannot directly measure the body composition of the participants.Conclusions: "Jolly fat" existed among middle-aged and elderly with low education, but not in those with junior high school education or above. Health care providers need to monitor the psychological status of low-educated middle-aged and older adults who are seen as needing to lose weight, while the underweight group should be the key target of depression screening. [ABSTRACT FROM AUTHOR]

Background: There is currently no evidence of an association between depressive symptoms and asthma among older adults in China. We explored the bi-directional associations between depressive symptoms and asthma, and their changes in middle-aged and elderly adults from a national cohort.Methods: A longitudinal cohort study was conducted with a total of 17,708 individuals from 150 urban communities and 450 rural villages in 28 provinces in China.Results: After making exclusions, 11,492 and 8604 participants were included for incident asthma and incident depressive symptoms analysis, respectively. The incidence density was 4.46 and 10.24 for every 1000 person-years, respectively. Baseline depressive symptoms were associated with a higher risk of incident asthma (Hazard ratio [HR] = 1.60, 95 % confidence interval [CI]: 1.27, 2.02). Decreased depressive symptoms during baseline or follow-ups or both baseline and follow-ups were associated with a lower risk of incident asthma (Pfor trend < 0.0001). Every 1-score increment of CES-D score was associated with a 4 % increase in asthma, with a non-linear association (P = 0.04) between CES-D score (break point = 7) and asthma. Asthma status increased the risk of participants with severe depressive symptoms (HR = 1.51, 95 % CI: 1.19, 1.92), especially in males (Pfor interaction = 0.02).Limitations: Depressive symptoms and asthma were assessed by validated questionnaires instead of clinical diagnosis.Conclusions: Bi-directional associations between asthma and depressive symptoms do exist. Effective measures should be taken to reduce depressive symptoms and the risk of incident asthma in middle aged and elderly adults in China. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of urinary incontinence with depressive symptoms, and to explore the mediating effect of functional limitations on this association.Methods: This cross-sectional study included 7039 adults aged 50 and over from the English Longitudinal Study of Aging (Wave 8). Urinary incontinence was defined as whether the participants experienced urinary incontinence in the past 12 months. Depressive symptoms were assessed based on the Center for Epidemiologic Studies-Depression Scale. Functional limitations included disability of activities of daily living, instrumental activities of daily living, mobility and large muscle groups limitation of the participants. Logistic regression based on Karlson/Holm/Breen (KHB) method was applied to estimate the association of urinary incontinence with depressive symptoms and explore the mediating effect of functional limitations.Results: Urinary incontinence was significantly associated with increased risk of depressive symptoms after controlling covariates (odds ratio = 1.75, 95 % confidence interval: 1.45-2.11). Functional limitations explained 36.96 % of this association.Conclusion: Urinary incontinence might be associated with an increased risk of depressive symptoms among middle-aged and older adults and functional limitations partially mediate this association. Improving physically functional capacity might play an important role in preventing and managing depressive symptoms in elderly people with urinary incontinence. [ABSTRACT FROM AUTHOR]

Background: Prior research has suggested that functional disability was associated with increased risk of incident depressive symptoms in the elderly. However, little is known about the potential role of functional disability on the long-term trajectories of depressive symptoms among middle-aged and older Chinese adults.Methods: Data were drawn from the China Health and Retirement Longitudinal Study. A total of 8415 participants with up to four measurements of depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale (CESD) were included. Functional disability was evaluated by activities of daily living (ADLs) and instrumental ADLs (IADLs) at baseline. We identified the trajectories of depressive symptoms over 7-year follow-up using group-based trajectory modelling, and examined the association between functional disability and depressive symptom trajectories using multinomial logistic regression.Results: We identified four trajectories of depressive symptoms throughout the follow-up, characterized by maintaining a low CES-D score (low symptoms); maintaining a moderate CES-D score (moderate symptoms); increasing progressively and reaching a high CES-D score at the end of follow-up (increasing symptom); and increasing quickly and maintaining a high CES-D score (high symptoms). We found that participants with severe functional disability were at increased likelihood of being in the moderate (odds ratio [OR] = 2.27, 95% confidence interval [CI] 1.68-3.07), increasing (OR = 2.31, 95% CI 1.49-3.59), and high (OR = 4.74, 95% CI 3.07-7.31) depressive symptom trajectories.Limitations: Depressive symptoms and functional disability were evaluated based on self-reported scales.Conclusions: Our findings suggest that functional disability was associated with unfavorable depressive symptom trajectories among middle-aged and older Chinese adults. [ABSTRACT FROM AUTHOR]

Background: The World Alzheimer Report showed that 46.8 million people suffered from dementia in 2015. This study examined how the duration and quality of sleep are associated with cognition among older adults in China.Method: Data were drawn from waves 2011, 2013, and 2015 of the China Health and Retirement Longitudinal Study (CHARLS), including noninstitutionalized adults aged 45 and older (n=10,768). Cognition was measured by interview-based assessments of mental status (TICS-10), episodic memory, and visuospatial abilities. Sleep duration was categorized as long, medium, or short and sleep quality was categorized as good, fair, or poor.Results: Sleep duration had an inverted U-shape relationship with cognitive scores (P <.001); and sleep quality had a positive linear relationship with cognitive scores (P <.001). Short and long sleep durations were associated with consistently lower cognition scores with increasing age (both P <.001); and fair and poor quality of sleep were associated with consistently lower levels of cognition (both P <.001). Tests of interactions between sleep duration and sleep quality showed that participants reporting long durations of sleep with poor quality of sleep had the lowest overall cognitive scores.Limitations: Self-reported methods were used to measure sleep quality and duration and thus our findings underscore the need for more evidence-based research to improve prevention efforts and tailor interventions to reduce cognitive decline among Chinese older adults.Conclusions: Suboptimal sleep duration and quality were associated with poor cognition. Cognitive scores were lowest among those who reported long durations of sleep that were of poor quality. [ABSTRACT FROM AUTHOR]

• People with sensory loss have increased risk of developing depression. • Depression is significantly associated with higher risk of incident sensory loss. • Findings of this study are helpful to improve management strategies for both mental and physical health. Most studies on the relationship between sensory loss and depression focus on the unidirectional association between sensory loss and the risk of depression based on cross-sectional designs. The present study aimed to explore the bidirectional longitudinal associations of vison loss (VL), 1 1 VL: vision loss; hearing loss (HL), 2 2 HL: hearing loss; and dual sensory loss (DSL) 3 3 DSL: dual sensory loss. with depressive symptoms among Chinese population. A longitudinal study was conducted among 13,690 participants aged 45 years and older over four years. VL, HL, and DSL were identified through self-reporting, and depressive symptoms were assessed using a 10-item Center for Epidemiologic Studies Depression Scale. Multivariable Cox proportional hazards regression models were constructed to estimate the bidirectional associations of VL, HL, and DSL with depressive symptoms. Participants with self-reported VL (HR: 1.14, 95%CI: 1.04–1.24), HL (HR: 1.22, 95%CI: 1.07–1.37), and DSL (HR: 1.27, 95%CI: 1.08–1.49) were associated with higher risk of developing depressive symptoms, compared with those without VL, HL, and DSL, respectively. In comparison with those without depressive symptoms, participants with depressive symptoms in the baseline had higher risk of developing VL (HR: 1.43, 95%CI: 1.33–1.54), HL (HR: 1.49, 95%CI: 1.36–1.63), and DSL (HR: 1.76, 95%CI: 1.59–1.95). Sensory loss was defined only based on participants' self-report. Significant bidirectional associations exist between self-reported VL, HL, or DSL and depressive symptoms. The mental health of people with VL and HL should be focused on, and regular assessments of vision and hearing in people with depressive symptoms are recommended. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the associations between muscle strength in different parts of the body and depression is lacking. This study examined whether poor muscle strength is associated with a higher incidence of depression in a large cohort of middle-aged and older adults.Methods: In total, 5,228 middle-aged and older adults from the China Health and Retirement Longitudinal Study without depression at baseline were followed for 7 years. Their demographic characteristics, chronic diseases and lifestyle behaviors were assessed. After adjusting for relevant variables, a Cox regression was used to determine the relationship between muscle strength and incident depression.Results: Over 32,544 person-years of follow-up, 1,490 participants developed depression. Low muscle strength at baseline was associated with a higher 7-year incident of depression, even after excluding those who developed depression within 2 years. After adjusting for confounding factors, it was found that a higher baseline relative handgrip strength was a protective factor against depression (HR [95% CI]=0.575 [0.430-0.768] for the lowest quartile vs. the highest quartile; p<0.001). Longer times on the 5TSTS test were a risk factor for depression (HR [95% CI]=1.321 [1.077-1.621] for the lowest quartile vs. the highest quartile; p = 0.007). When the strengths of the upper and lower limbs were considered together, the hazard ratio for depression in people with relatively greater muscle strength was 0.463 (95% CI=0.307-0.699; p<0.001).Conclusions: Muscle strength could be predictive of depression, and the combined measurement of upper and lower limb muscle strength can improve the predictive ability. [ABSTRACT FROM AUTHOR]

Backgrounds: Adverse childhood experiences are co-occurring factors of multimorbidity and depression in mid-late life, but the combined effect of ACEs and multimorbidity on depression over life has not been fully studied.Methods: We used data from the China Health and Retirement Longitudinal Study which includes 4,440 middle-aged and older adults. Different types of ACEs experienced up to the age of 17 were assessed based on self-reports. We used parallel process Latent Growth Curve modelling to evaluate the longitudinal mediation role of ACEs, multimorbidity and depression.Results: People who had more ACEs were found to have a higher level of multimorbidity (intercept: 0.057, 95% CI: 0.031 to 0.079) and depression (intercept: 0.047, 95% CI: 0.013 to 0.076) at the baseline and a faster increase in multimorbidity (slope: 0.107, 95%CI: 0.078 to 0.136) and depression (slope: 0.074, 95%CI: 0.035 to 0.153). The mediation analysis indicated that there was a positive indirect association of ACEs via the multimorbidity intercept with the intercept of depression (0.028, 95%CI: 0.012 to 0.043), and a small negative association with the slope of depression (-0.002, 95%CI: -0.003 to -0.001). We also found a positive indirect association of ACEs via the multimorbidity slope with the intercept (0.035, 95%CI: 0.021 to 0.049) and slope (0.008, 95%CI: 0.004 to 0.011) of depression.Conclusions: ACEs were related to higher depression partly via elevated multimorbidity. Public health services and behavioural interventions to prevent and reduce the occurrence of ACEs might help to lower the risk of multimorbidity and depression in later life. [ABSTRACT FROM AUTHOR]

• few studies have investigated the association between depression and all-cause mortality in Chinese population. There was only a nationwide study examined the relationship between depression and all-cause death and death from CVD (Meng et al., 2020). Other studies on all-cause mortality have conducted in middle-aged and older people. • Baseline characteristics are measured by Chi-square (χ 2) tests and expressed as the mean±standard deviation or n (%). Participants were classified into three categories by different degrees of depression. We used Cox proportional regression to calculate associated hazard ratios (HRs) and 95% CIs, adjusted for baseline covariates. • With a median follow-up of 7.4 years, a total of 8151 participants (52.6% women) at baseline were included in the analysis. The multivariable models showed that the participants with moderate and major depression had the highest hazard ratio (HR) for risk of all-cause mortality, CVD deaths, and cancer deaths, compared with participants had no or mild depression. Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Past evidence suggests that depression could be associated with the all-cause mortality and other disease mortality in Western populations, but little is known about the relationship in the Chinese population. Therefore, we investigated the associations between self-reported depression and all-cause and specific-cause mortality in Chinese adult populations. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms among 8,151 adult participants drawn from the general population of Guizhou province, China. Participants death and cause of death were determined by linking with the official death records and certificates up to June 2021. Cause of death was coded according to ICD-10 then categorized as either cardiovascular disease (CVD, I00-I99), cancer (C00-C97) or other cause. Cox proportional hazard regression was used to examine the associations of self-reported depression with all-cause mortality and cause-specific mortality. With a median follow-up of 7.4 years, 8,151 participants (52.6% women) at baseline were included in the analysis. The multivariable cox hazard regression models showed that participants with moderate and major depression had the highest hazard ratio (HR) for risk of all-cause mortality (HR=5.65, 95% CI 3.09–10.33), CVD mortality (HR=5.66, 95% CI 2.02–15.84), and cancer mortality (HR=7.21, 95% CI 2.00–25.99), compared with participants had no or mild depression. Our findings suggested that depression was a risk factor for mortality, with greater risk for greater severity. Clinicians should be aware of the increased risk of mortality in populations with depression. [ABSTRACT FROM AUTHOR]

• High baseline pulmonary function is independently associated with a lower incidence of depression in middle-aged and older Chinese, partly mediated by cognitive abilities. • Pulmonary function and sleep time have synergy with the effects of depression. • It is necessary to take measures to prevent and control the risk of depression in potentially susceptible individuals with poor pulmonary function, poor cognitive ability, and abnormal sleep schedules. Depression is a common mental disorder in middle-aged and elderly people, which seriously affects their physical health and life quality.So far, whether pulmonary function is a factor in depression has not been tested.The purpose of this study was to test whether pulmonary function was independently associated with depression and to assess the effects of cognitive ability and sleep time on this association. In this analysis, 5,235 participants from the Chinese Longitudinal Study of Health and Retirement were included. Participants were registered in 2015 and followed up in 2018. The relationship between pulmonary function and depression was estimated by binary logistic regression model. The mediated role of cognitive ability was examined by intermediary analysis, and the interaction between pulmonary function and sleep time on depression was discussed. After adjusting for confounding factors, it was found that higher baseline pulmonary function was the protective factor of depression (OR [95%CI]=0.524 [0.394–0.697] for the lowest quantile vs the highest quantile). Cognitive ability explained 14.55% of the association between pulmonary function and depression, pulmonary function and sleep time on the effects of depression have a combined interaction, RERI (95%CI) = 0.545 (0.053–1.038). High baseline pulmonary function is independently associated with a lower risk of depression, which is partly mediated by cognitive ability. Pulmonary function and sleep time have synergy with the effects of depression. These findings show that pulmonary function, cognitive ability and sleep time are reliable predictors of depression. [ABSTRACT FROM AUTHOR]

Background: Depression is a common mental disorder in middle-aged and elderly people, which seriously affects their physical health and life quality.So far, whether pulmonary function is a factor in depression has not been tested.The purpose of this study was to test whether pulmonary function was independently associated with depression and to assess the effects of cognitive ability and sleep time on this association.Methods: In this analysis, 5,235 participants from the Chinese Longitudinal Study of Health and Retirement were included. Participants were registered in 2015 and followed up in 2018. The relationship between pulmonary function and depression was estimated by binary logistic regression model. The mediated role of cognitive ability was examined by intermediary analysis, and the interaction between pulmonary function and sleep time on depression was discussed.Results: After adjusting for confounding factors, it was found that higher baseline pulmonary function was the protective factor of depression (OR [95%CI]=0.524 [0.394-0.697] for the lowest quantile vs the highest quantile). Cognitive ability explained 14.55% of the association between pulmonary function and depression, pulmonary function and sleep time on the effects of depression have a combined interaction, RERI (95%CI) = 0.545 (0.053-1.038).Conclusions: High baseline pulmonary function is independently associated with a lower risk of depression, which is partly mediated by cognitive ability. Pulmonary function and sleep time have synergy with the effects of depression. These findings show that pulmonary function, cognitive ability and sleep time are reliable predictors of depression. [ABSTRACT FROM AUTHOR]