Site-specific pain, sleep duration, and depressive symptom trajectories among middle-aged and older Chinese adults with baseline depressive symptoms: A CHARLS-based longitudinal study.

Background

Pain at specific anatomical sites and depressive symptoms commonly co-occur in middle-aged and older adults, but their longitudinal association and the potential role of sleep duration remain unclear. This study examined whether site-specific pain was associated with depressive symptom trajectory membership among Chinese adults with baseline depressive symptoms.

Methods

Data were drawn from the China Health and Retirement Longitudinal Study from 2011 to 2018. A total of 1047 adults aged ≥45 years with baseline depressive symptoms were included. Group-based trajectory modeling was used to identify depressive symptom trajectories. Multinomial logistic regression examined associations between pain at 15 anatomical sites and trajectory membership. Exploratory indirect-effect analyses with 2000 bootstrap samples estimated indirect effects through self-reported sleep duration.

Results

Three trajectories were identified: Mild-Stable (13.2%), Moderate-Increasing (57.5%), and High-Persistent (29.4%). Pain at several anatomical sites was associated with higher odds of unfavorable depressive symptom trajectories, with stronger associations for the High-Persistent trajectory. In fully adjusted models, the strongest associations with the Moderate-Increasing trajectory were observed for finger, wrist, arm, head, and neck pain, whereas head, arm, neck, toe, and stomach pain showed the strongest associations with the High-Persistent trajectory. Exploratory indirect-effect analyses suggested modest indirect effects through sleep duration for several pain sites, with the largest estimated indirect-effect proportion being approximately 8.9%.

Conclusions

Site-specific pain was associated with unfavorable depressive symptom trajectories, particularly the High-Persistent trajectory. Sleep duration showed only modest exploratory indirect effects.