The gender difference in the comorbidity of chronic pain and depression, a longitudinal study

Chronic pain and depression are closely related among older adults. However, little is known about gender differences in the comorbidity of chronic pain and depression, as well as the underlying mechanisms.

Using data from the China Health and Retirement Longitudinal Study (CHARLS, N = 13,712), this study combined cross-sectional network analysis and longitudinal linear mixed-effects models (LME) to investigate gender-specific patterns in the pain-depression interaction across three waves (2011-2015).

Chronic pain significantly predicted depressive symptoms (pain: β = 0.88, p < 0.001), but this association weakened with advancing age (pain × age interaction: β = -0.005, p < 0.001). Additionally, pain exerted a stronger impact on depression in females (pain × gender interaction: β = -0.36, p < 0.05). Network analysis identified "depressed" as the most central symptom in the pain-depression comorbidity network for both male and female. However, gender differences were observed, with the global strength of the pain-depression comorbidity network being significantly higher in females. Specifically, females exhibited stronger connections between "pain" and "depressed" as well as "pain" and "poor sleep quality", whereas males showed stronger links between "pain" and "lonely".

Overall, while chronic pain and depression are closely interrelated, their relational patterns differ markedly across gender groups. These findings provide actionable insights from a symptom network perspective for gender-stratified interventions, emphasizing sleep-focused strategies for women and targeted social support to alleviate loneliness in men.