Depressive symptoms affect frailty through attitudes to aging: a cross-lagged analysis

The bidirectional causality between frailty and depressive symptoms (DS) in older adults were investigated, while the potential psychological mechanism remains unclear. This study aimed to explore the mediation role of attitudes to aging (AA) in their reciprocal relationships.

Data was collected from a community-based prospective cohort in Shanghai, which included 4,082 participants aged 60 and above. Frailty, DS, and AA were assessed using the Chinese Frailty Screening Scale-10, the Patient Health Questionnaire-9, and the Attitudes to Aging Questionnaire-12, respectively. A cross-lagged model was employed to investigate the reciprocal relationship between frailty and DS, as well as to estimate the mediating effect of AA.

The findings revealed significant correlations between frailty, DS, and AA at both measurement points. In the cross-lagged model, after controlling for covariates, we observed a bidirectional causality between frailty and DS. Specifically, greater frailty was associated with higher levels of DS (β = 0.142, P < 0.001), and higher levels of DS similarly predicted increased frailty (β = 0.058, P = 0.006). When AA were included in the cross-lagged model, results showed that older adults with more positive AA significantly predicted lower future levels of DS (β=-0.051, P < 0.001) and frailty (β=-0.055, P < 0.001). Mediation analyses indicated that AA had a significant mediating effect (β = 0.003, P = 0.029) between DS and frailty, although this effect was not reciprocated (P = 0.242).

These findings underscored the importance of promoting positive AA as preventive measures against both frailty and DS. They also provided valuable insights into the mechanisms underlying the relationship between depression and frailty in older adults.