Co-occurring pain patterns and depressive symptoms in middle-aged and older adults: A cross-lagged analysis from a national longitudinal study.

BACKGROUND

As global aging intensifies, multisite pain and depression are critical health issues in middle-aged and older adults. While their bidirectional relationship is acknowledged, the pathways and effects of specific pain site combinations remain unclear.

METHODS

Using three waves (2015-2020) of CHARLS data from 10,077 adults aged 45+, we applied cross-lagged mediation models to analyze the bidirectional relationship between the number of pain sites and depression, with Instrumental Activities of Daily Living (IADL) as a mediator. Restricted cubic splines and association rule mining identified critical pain counts and co-occurrence patterns.

RESULTS

A significant bidirectional relationship existed between pain sites and depression, mediated by IADL. Depression risk rose rapidly from 0 to 3 pain sites, then plateaued. Co-occurrence of pain in the lower back, ankles, knees, and back carried the highest risk. Women were more likely to develop depression via IADL impairment, whereas men were more directly affected by multisite pain.

CONCLUSION

Multi-site pain and depression interact bidirectionally in middle-aged and older adults, mediated by IADL, with risk influenced by pain profiles and gender. Integrated and personalized pain management addressing both physical and mental health is warranted.