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.