Trajectories of depressive symptoms and the risk of cardiovascular, dementia, and pulmonary events in older adults: Evidence from the English Longitudinal Study of Ageing

Purpose: This research investigates the relationship between patterns of depressive symptoms over time and the likelihood of developing cardiovascular disease, dementia, and pulmonary conditions. Methods: We examined 11,577 participants aged 50 and older. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale-8 (CESD-8). Group-based trajectory modeling was employed to categorize patterns of depressive symptoms, while Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI). Sensitivity analysis for missing data was conducted using multiple imputation and data deletion methods, and the model's timeliness and stability were evaluated through time sensitivity analysis. Results: Five distinct trajectories of depressive symptoms were identified: consistently low (n = 3353), decreasing (n = 127), increasing (n = 128), fluctuating (n = 7674), and consistently high (n = 295). Compared to the consistently low group, individuals with consistently high depressive symptoms faced significantly elevated risks of cardiovascular disease (HR = 1.65, 95 % CI = 1.38-1.98, P = 0.00), dementia (HR = 2.09, 95 % CI = 1.16-3.79, P = 0.02), and pulmonary diseases (HR = 3.12, 95 % CI = 2.41-4.05, P = 0.00). Fluctuating and increasing trajectories were also associated with higher risks, while the decreasing trajectory correlated with a reduced risk of dementia (HR = 0.77, 95 % CI = 0.62-0.95, P = 0.01). Conclusion: Long-term patterns of depressive symptoms are strongly linked to the development of cardiovascular disease, dementia, and pulmonary diseases.