Exploring Gender and Urban-Rural Disparities: Investigating the Association between Multimorbidity and Depressive Symptoms in Middle-Aged and Older Chinese Adults Using Cross-Lagged Panel Analysis

Increased risk of multimorbidity has been linked to depressive symptoms, and the onset of multimorbidity can further aggravate these symptoms. However, the lagged relationship between these two factors remains unclear. This study aimed to investigate the bidirectional longitudinal association between multimorbidity and depressive symptoms among middle-aged and older adults in China over time, specifically focusing on gender and urban-rural differences in this relationship. Data from 8692 participants in the China Health and Retirement Longitudinal Study (CHARLS), collected between 2011 and 2020, were analyzed on a biannual basis. The ten-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was utilized to assess depressive symptoms, complemented by self-reported information on 12 chronic diseases to evaluate multimorbidity. Cross-lagged panel models, adjusted for various covariates, were employed to investigate the bidirectional relationship between multimorbidity and depressive symptoms. Furthermore, the analysis examined gender and urban-rural differences across four distinct subgroups: urban men, urban women, rural men, and rural women. A significant bidirectional relationship was identified between multimorbidity and depressive symptoms. Higher levels of multimorbidity were associated with more severe depressive symptoms and vice versa. Path analyses revealed that the influence of multimorbidity on depressive symptoms was stronger than the reverse relationship. Furthermore, subgroup analyses highlighted variability in these associations, with significant bidirectional relationships observed only among rural women across different periods. The findings reveal positive bidirectional associations between multimorbidity and depressive symptoms in middle-aged and older Chinese adults. The results underscore the importance of early monitoring of multimorbidity and depression, especially concerning the mental and physical health of women in rural areas.