Frailty and Incident Depressive Symptoms During Short- and Long-Term Follow-Up Period in the Middle-Aged and Elderly: Findings From the Chinese Nationwide Cohort Study

Haiyang Liu; Xu Yang; Lei-Lei Guo; Jin-Long Li; Guang Xu; Yunxiao Lei; Xiaoping Li; Lu Sun; Liu Yang; Ting Yuan; Congzhi Wang; Dongmei Zhang; Huanhuan Wei; Jing Li; Mingming Liu; Ying Hua; Yuanzhen Li; Hengying Che; Lin Zhang

doi:10.3389/fpsyt.2022.848849

Frailty and Incident Depressive Symptoms During Short- and Long-Term Follow-Up Period in the Middle-Aged and Elderly: Findings From the Chinese Nationwide Cohort Study

Front Psychiatry. 2022 Apr 7:13:848849. doi: 10.3389/fpsyt.2022.848849. eCollection 2022.

Authors

Haiyang Liu¹, Xu Yang², Lei-Lei Guo³, Jin-Long Li⁴, Guang Xu⁵, Yunxiao Lei⁶, Xiaoping Li⁷, Lu Sun⁷, Liu Yang⁸, Ting Yuan⁶, Congzhi Wang⁸, Dongmei Zhang⁹, Huanhuan Wei⁶, Jing Li¹⁰, Mingming Liu¹⁰, Ying Hua¹¹, Yuanzhen Li⁷, Hengying Che¹², Lin Zhang⁸

Affiliations

¹ Student Health Center, Wannan Medical College, Wuhu, China.
² Department of Radiotherapy, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
³ Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, Jinzhou, China.
⁴ Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, China.
⁵ Department of Radiotherapy, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
⁶ Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, China.
⁷ Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, China.
⁸ Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, China.
⁹ Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, China.
¹⁰ Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, China.
¹¹ Rehabilitation Nursing, School of Nursing, Wannan Medical College, Wuhu, China.
¹² Department of Nursing, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.

Abstract

Objective: Prefrailty and frailty are two common conditions among older individuals. Recent studies have reported the association between frailty and depressive symptoms, but whether those conditions could predict depressive symptoms is still inconsistent in a few longitudinal studies. In our study, we aimed to estimate the cross-sectional and longitudinal associations between frailty and incident depressive symptoms in a nationally representative sample of community-dwelling middle-aged and older Chinese adults.

Method: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which included 17,284 adults aged ≥ 45 years. Participants were followed every two years using a face-to-face, computer-aided personal interview (CAPI) and structured questionnaire. We excluded participants with no follow-up data. The numbers of individuals who completed the baseline surveys were 2,579 and follow-up surveys were 839 for the short-term (2 years from 2011 to 2013) and 788 for the long-term (4 years from 2011 to 2015). In addition, Frailty was measured by the Fried criteria and depressive symptoms were estimated by the Chinese version of the Center for Epidemiologic Studies-Depression scale (CES-D). Logistic regression was used to analyze the odds ratio (OR), and 95% confidence interval (CI) for the cross-sectional associations of frailty and its components with depressive symptoms in the participants at baseline. Cox proportional hazards analysis was conducted using the hazard ratio (HR), and 95% confidence interval (CI) for the prospective associations of baseline frailty and pre-frailty and its component in the participants without depressive symptoms at baseline.

Results: At baseline, 57.93% of participants had depressive symptoms and 55.84% had pre-frail and 11.63% had frailty. In the cross-sectional analysis, both pre-frailty (OR = 5.293, 95%CI 4.363-6.422) and frailty (OR = 16.025, 95%CI 10.948-23.457) were associated with depressive symptoms. In the longitudinal analysis, frailty [HR = 1.395 (0.966-2.013)] and pre-frailty [HR = 2.458 (0.933, 6.479)] were not significantly associated with incident depressive symptoms in a full-adjusted model among participants free of baseline depressive symptoms during the short-term. However, frailty [HR = 1.397 (1.017, 1.920)] and pre-frailty [HR = 2.992 (1.210, 7.397)] were significantly associated with incident depressive symptoms during the short term. In the components of frailty, slowness [HR = 1.597 (1.078, 2.366)] was associated with an increased risk of depressive symptoms onset during the short-term. Weakness [HR = 2.08 (1.055, 4.104)] and exhaustion [HR = 1.928 (1.297, 2.867)] were associated with increased risk of depressive symptoms onset during the short-term.

Conclusion: Among the middle-aged and older adults, frailty, pre-frailty did not predict depressive symptoms during 2 years of follow-up, when accounting for the potential confounders, slowness considered alone predicted depressive symptoms. Additionally, frailty, pre-frailty predicted depressive symptoms during 4 years of follow-up, when accounting for the potential confounders, weakness and exhaustion considered alone predicted depressive symptoms.

Keywords: cohort study; depressive symptoms; frailty; incidence; middle-aged and elderly.