Depression as an Independent Predictor of Incident Pain: Longitudinal Evidence From CHARLS

This study employs a longitudinal research design to investigate the impact of depression as an independent risk factor on the incidence of pain among middle-aged and elderly populations, with the objective of providing evidence for early intervention strategies to reduce pain-related disability and improve quality of life in aging populations.

This study utilized baseline data from the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS). Participants aged ≥45 years without baseline pain were included (n = 4,966), with three follow-up assessments conducted in 2013, 2015, and 2018. Pain occurrence was defined as the first self-reported pain episode during follow-up. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) (score ≥10). Multivariable Cox regression was used to assess the impact of depression and various demographic factors on pain occurrence, and stratified analysis was conducted to further clarify the independence of depression as a risk factor.

Among 4,966 participants, depressive symptoms were significantly associated with higher pain incidence (HR = 1.35, 95% CI: 1.25-1.47). Other predictors included female sex (HR = 1.55), arthritis (HR = 1.61), Activities of Daily Living/ Instrumental Activities of Daily Living (ADL/IADL) dysfunction (HR = 1.23), and chronic diseases (lung/kidney/digestive). Subgroup analyses identified a significant ADL/IADL-pain interaction (P = 0.001), with no other depression-related interactions observed.

Depression serves as an independent predictor of pain onset among middle-aged and elderly populations in China, and this relationship is further complicated by functional decline. Early screening for depressive symptoms and functional decline may help alleviate pain-related disability in elderly populations. Future research should investigate the dynamic relationship between pain and depression across different disease subtypes and treatment contexts.