Differential associations of cataracts with somatic and cognitive-affective symptoms of depression: longitudinal findings from the English Longitudinal Study of Ageing.

BACKGROUND

Global population aging elevates the importance of identifying modifiable risk factors for late-life depression. This study uniquely investigates the prospective association between cataracts and incident depressive symptoms, specifically differentiating between somatic and cognitive-affective domains.

METHODS

Using data from the English Longitudinal Study of Ageing (ELSA), we analyzed 4,584 participants. Cataract exposure was self-reported at wave 2, with incident depressive symptoms assessed at wave 4 using the CES-D-8 (cutoff ≥ 3). Multivariable logistic regression models adjusted sequentially for sociodemographics, health behaviors, and comorbidities were used to estimate associations, with sensitivity analyses (stratification, interaction tests) and multiple imputation for missing data.

RESULTS

After multiple imputation, our cohort comprised 4,584 participants, of whom 581 (12.7%) developed incident depressive symptoms. In the fully adjusted model, baseline cataract was significantly associated with an increased risk of overall incident depression (OR 1.55, 95% CI 1.13-2.12; P = 0.007), which survived the Bonferroni-corrected threshold (P < 0.0167). Domain-specific analyses showed that cataract was associated with increased odds of somatic symptoms (OR 1.48, 95% CI 1.07-2.03; P = 0.018), whereas the association with cognitive-affective symptoms was not significant (OR 1.18, 95% CI 0.79-1.77; P = 0.420). Item-level analyses revealed that specific manifestations including 'could not enjoy life', 'restless sleep' and 'could not get going' reached nominal significance, though they did not survive strict multiple testing correction.

CONCLUSION

Cataracts are independently associated with increased risk of incident depressive symptoms in older adults, particularly somatic manifestations. These findings highlight the importance of integrated ophthalmologic and mental healthcare pathways, suggesting that timely cataract treatment may represent a potential intervention point for mitigating depressive symptoms in aging populations.