Specific depressive symptoms, body mass index and diabetes in middle-aged and older Chinese adults: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

Background

This study examined the association between specific depressive symptoms and incident diabetes, and whether overweight or obesity mediates this relationship among middle-aged and older adults in China.

Methods

In a nationally representative prospective cohort study of 11,893 middle-aged and older Chinese adults without baseline diabetes, we used Cox models to assess the association between depressive symptoms and diabetes. The quantile g-computation (qgcomp) model evaluated the contribution of 10 specific depressive symptoms to diabetes risk, and a two-stage regression method explored the mediation effect of overweight or obesity.

Results

Over a median follow-up of 7.1 years, 1,314 cases of diabetes were identified. Elevated depressive symptoms were associated with increased diabetes risk (HR 1.23; 95 % CI 1.09–1.38). Eight out of 10 depressive symptoms were significantly associated to diabetes, with loneliness (weight = 18 %; HR 1.23; 95 % CI 1.10–1.39), restless sleep (weight = 17 %; HR 1.16; 95 % CI 1.04–1.29), and bother (weight = 15 %; HR 1.19; 95 % CI 1.07–1.33) being the primary contributors. Mediation analysis showed that overweight and obesity reduced the depression-diabetes risk association by 8.21 % and 12.61 %, respectively.

Limitations

Diagnosis of diabetes was self-reported.

Conclusions

Eight out of ten specific depressive symptoms were associated to diabetes, overweight and obesity may partially mitigate the effect of depressive symptoms on diabetes among middle-aged and older adults in China.

Clinical implications

Our results highlight the importance of tailoring diabetes prevention and management strategies according to specific depressive symptoms among middle-aged and older adults in China.