Relationship Between Pain and Depressive Symptoms in Middle-aged and Older Chinese Adults: A Cross-Lagged Longitudinal Analysis

Objective To investigate the longitudinal association between pain and depressive symptoms in middle-aged and older adults in China, and to provide a scientific basis for the management of pain and depression in this population.

Methods Data from 5 follow-up waves (conducted between 2011 and 2020) of the China Health and Retirement Longitudinal Study (CHARLS) were used in the study. A total of 7876 middle-aged and older adults aged 45 years or older who completed all 5 surveys were enrolled. A Random Intercept Cross-Lagged Panel Model (RI-CLPM) was applied to analyze the longitudinal relationship between pain and depressive symptoms across the 5 time points. The potential confounders controlled for in the model in a stepwise manner included time-invariant variables (sex, marital status, and household registration) and time-varying covariates (age, comorbidity, activities of daily living scores, smoking, drinking, and physical activity).

Results The RI-CLPM demonstrated a good model fit (Comparative Fit Index CFI = 0.906, Tucker and Lewis Index TLI = 0.879, Root Mean Square Error of Approximation RMSEA = 0.036, and Standardized Root Mean Square Residual SRMR = 0.060). After controlling for between-person differences, the RI-CLPM results showed that the lagged effects of pain on depressive symptoms were statistically significant across all time points from T1 to T5 (T1 to T2: β = 0.043, 95% CI 0.020–0.067; T2 to T3: β = 0.047, 95% CI 0.023–0.070; T3 to T4: β = 0.056, 95% CI 0.034–0.078; T4 to T5: β = 0.050, 95% CI 0.028–0.071). Additionally, the lagged effects of depressive symptoms on pain were statistically significant from T2 to T5 (T2 to T3: β = 0.121, 95% CI 0.099–0.143; T3 to T4: β = 0.112, 95% CI 0.091–0.134; T4 to T5: β = 0.070, 95% CI 0.049–0.090), and the predictive effects of depressive symptoms on pain were greater.

Conclusion Pain and depressive symptoms have a bidirectional predictive relationship over time. The predictive performance of pain for depressive symptoms remains stable over time, while the predictive performance of depressive symptoms for pain is stronger. These findings suggest that screening for depressive symptoms should be emphasized in the diagnosis and treatment of patients presenting with pain.