Bidirectional relationships between cognition and depressive symptoms and effects of sociodemographic and lifestyle factors: random-intercept, cross-lagged panel model

Abstract

Background Existing panel studies on the relationships between cognition and depressive symptoms did not systematically separate between- and within-person components, with measurement time lags that are too long for precise assessment of dynamic within-person relationships. Aims To investigate the bidirectional relationships between cognition and depressive symptoms and examine the effects of sociodemographic characteristics and lifestyle factors via random-intercept, cross-lagged panel modelling (RI-CLPM) in middle-aged and older adults. Method The sample comprised 24 425 community-based residents aged 45 years or above, recruited via five waves of the China Health and Retirement Longitudinal Study (2011–2020). Cognition was evaluated using the Telephone Interview of Cognition Status, and depressive symptoms were assessed by the ten-item Center for Epidemiologic Studies Depression Scale. RI-CLPM included sociodemographic and lifestyle factors as time-invariant and -varying covariates. Subgroup analysis was conducted across gender, age groups and urban/rural regions. Results RI-CLPM showed a superior fit to cross-lagged panel models. Male, higher education, married, urban region, non-smoking, currently working and participation in social activities were linked with better cognition and fewer depressive symptoms. Overall, cognition and depressive symptoms showed significant and negative bidirectional cross-lagged effects over time. Despite similar cross-lagged effects across gender, subgroup analysis across urbanicity found that cross-lagged effects were not significant in urban regions. Conclusions The present study provided nuanced results on negative bidirectional relationships between cognition and depressive symptoms in Chinese middle-aged and older adults. Our results highlight the health disparities in cognitive and emotional health across urbanicity and age groups.

Keywords

• CHARLS
• cognitive function
• depression
• reciprocal effects
• social determinants