The longitudinal association between multiple cardiometabolic diseases, socioeconomic status, and depressive symptoms in China.

The aim of this study is to investigate the effect of cardiometabolic diseases (CMDs) on the development of depressive symptoms and to determine whether socioeconomic status (SES) moderates this effect. A total of 6,455 individual free from depressive symptoms were selected from the China Health and Retirement Longitudinal Study (CHARLS). CMDs and SES were self-reported. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD-10). Cox proportional hazards regression models were employed to examine the association between baseline CMDs and subsequent depressive symptoms. Stratified analysis were conducted to explore the moderating effect of SES on this association.Participants with any CMDs exhibited a higher risk of developing depressive symptoms compared to those without CMDs, with a hazard ratio (HR) of 1.10 (95% CI: 1.01, 1.20). Individuals with one CMD (HR = 1.08, 95% CI: 1.00, 1.20) or cardiometabolic multimorbidity (HR = 1.13, 95% CI: 1.02, 1.26) also demonstrated an increased risk. The effect of CMDs on depressive symptoms was observed primarily in adults aged 60 years and older with lower education attainment (HR = 1.28, 95%CI: 1.12, 1.46), lower income (HR = 1.29, 95%CI: 1.11, 1.50) and rural residency (HR = 1.29, 95%CI: 1.12,1.51). These findings emphasize the importance of closely monitoring the mental status of patients with CMDs and considering routine screening and evaluation for depressive symptoms, especially in individuals with low SES.
Competing Interests: Declarations. Ethics approval and consent to participate: Study protocol carried out in this study is followed in accordance with the ethical guidelines laid down as per the Declaration of Helsinki. The study was approved by the Ethics Committee of the Peking University biomedical ethics committee approval (Ethical Approval Number: IRB00001052-11015), and written informed consent was obtained from either the participants. Competing interests: The authors declare no competing interests. CRediT authorship contribution statement: Dan Guo, Yanshang Wang: drafting the manuscript, study design, data analysis and interpretation. Yanan Zhao, Ruoxi Ding, Yanan Luo and Wanwei Dai: drafting the manuscript and critical revision of article for important intellectual content. Ping He: study concept and design, critical revision of article, and supervised the whole process of this work. All authors critically revised successive drafts of the paper and approved the final version. The authors have no possible conflicts of interest to declare.
(© 2025. The Author(s).)