Disability and its correlates among older adults with common mental disorders in China: a 5-year follow-up study

Common mental disorders (CMDs) represent a category of conditions characterized by a high rate of disability and a significant social burden. This study aims to describe disability at baseline and five years later among older adults with 12-month CMDs and to investigate its correlates.

Based on the nationally representative China Mental Health Survey (CMHS), a five-year follow-up cohort study was conducted, in which older adults with 12-month common mental disorders (CMDs) at baseline were reassessed. Follow-up assessments were conducted by telephone, and disability was measured using the World Health Organization Disability Assessment Schedule 2.0. Disability prevalence at baseline and five-year follow-up and its correlates were analysed.

The baseline analyses included 582 older adults with CMDs, of whom 134 completed the five-year follow-up and were included in the follow-up analyses. The prevalence of disability at baseline and five years later were 57.1% and 19.3%, respectively. Older age (≥70 years vs. 60-64 years: RR = 1.12, 95% CI: 1.06-1.19), residence in the Western region (vs. Eastern: RR = 1.09, 95% CI: 1.02-1.16), physical comorbidity (1-2 diseases: RR = 1.10, 95% CI: 1.02-1.18; ≥3 diseases: RR = 1.31, 95% CI: 1.22-1.41), comorbidity of multiple CMDs (RR = 1.21, 95% CI: 1.14-1.29), and sleep disturbances (RR = 1.17, 95% CI: 1.10-1.24) were associated with higher disability scores. Higher educational level (junior high school and above vs. literate or below primary school) was associated with lower long-term disability among participants with CMDs (RR = 0.85; 95% CI: 0.74-0.97). Living in urban areas (RR = 0.80; 95% CI: 0.69-0.92) was associated with lower long-term disability among individuals with anxiety disorders.

Long-term disability persists among older adults with CMDs who survived and were reachable despite an overall decline. Modifiable factors, including physical and mental comorbidity and sleep disturbances, were associated with higher baseline disability, whereas higher education and urban living were associated with a reduced risk of long-term disability. Integrated interventions are needed to reduce disability burden.