Restricted accessResearch articleFirst published online 2026
Longitudinal Bidirectional Relationship Between Pain Burden and Depressive Symptoms Among Middle-Aged and Elderly Individuals: A Cross-Lagged Panel Model
Pain and depressive symptoms are highly prevalent among middle-aged and older adults and frequently co-occur, yet the temporal ordering and directionality of the relationship between pain and depressive symptoms are inconsistent. This study aimed to examine the longitudinal bidirectional relationship between pain burden and depressive symptoms among middle-aged and older adults in China.
Methods
Data were derived from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS). Pain burden was assessed as the number of body sites with pain (range: 0-15), and depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10; range: 0-30). Cross-lagged panel models (CLPM) were applied to evaluate the temporal associations between pain burden and depressive symptoms across five waves, while adjusting for baseline sociodemographic characteristics, health behaviors, self-rated health, function limitation, and number of chronic diseases.
Results
A total of 7288 participants were included in the study. Pain burden demonstrated significant autoregressive stability over time and consistently predicted higher levels of depressive symptoms at subsequent waves. These prospective associations remained robust after adjustment for covariates. In contrast, depressive symptoms did not show a significant or consistent longitudinal effect on subsequent pain burden. Overall, the findings indicated a predominantly unidirectional temporal relationship, with pain burden preceding and contributing to later depressive symptoms.
Conclusions
These findings highlight the importance of considering cumulative pain as an early risk signal for depression and underscore the need to integrate pain assessment into mental health screening and chronic disease management strategies for aging populations.
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