Associations of depressive symptom trajectories with incident cardiometabolic multimorbidity: Evidence from longitudinal cohort studies in China and the United States

Abstract Background Depressive symptoms have been associated with incident cardiometabolic multimorbidity (CMM), but most studies relied on single-time assessments, which cannot capture the dynamic nature of depressive symptoms. We identified depressive symptom trajectories and examined their associations with incident CMM in China and the United States. Methods We included 8,952 participants from CHARLS (527 incident CMM events) and 10,812 from HRS (811 events), all free of CMM at baseline. Group-based trajectory modeling identified depressive symptom trajectories from three CES-D waves. Cox models estimated associations with incident CMM. Fine-Gray models and component outcome analyses were supplementary. Results Four trajectories were identified in both cohorts: low-stable, decreasing, increasing, and high-stable. In CHARLS, the decreasing (HR = 1.44, 95% CI: 1.14–1.82), increasing (HR = 1.64, 95% CI: 1.28–2.10), and high-stable (HR = 1.91, 95% CI: 1.41–2.59) groups had elevated CMM risk. In HRS, only high-stable remained significant (HR = 1.59, 95% CI: 1.21–2.07). Competing risk models were consistent. Component analyses showed the strongest association with heart disease. Conclusions Persistent high depressive symptoms were significantly associated with incident CMM in both cohorts, primarily driven by heart disease. Dynamic monitoring of depressive symptoms may improve risk stratification beyond single-time assessment.