Chronic Lung Diseases and Depressive Symptoms in Older Adults: Insights from Observational Studies and Mendelian Randomization

Huifang Liu; Yisong Yao; Yujuan Yang; Jianwei Wang; Jingyi Yu; Xinjun Xu; Xianghuang Luo; Yu Zhang; Xicheng Song

doi:10.2147/JMDH.S515745

Chronic Lung Diseases and Depressive Symptoms in Older Adults: Insights from Observational Studies and Mendelian Randomization

J Multidiscip Healthc. 2025 Jun 15:18:3465-3475. doi: 10.2147/JMDH.S515745. eCollection 2025.

Authors

Huifang Liu^#^{1

2

3

4

5}, Yisong Yao^#^{2

3

4

5}, Yujuan Yang^#^{2

3

4

5}, Jianwei Wang^{2

3

4

5}, Jingyi Yu^{2

3

4

5}, Xinjun Xu^{2

3

4

5}, Xianghuang Luo^{2

3

4

5

6}, Yu Zhang^{2

3

4

5}, Xicheng Song^{2

3

4

5}

Affiliations

¹ Second Clinical Medicine College, Binzhou Medical University, Yantai, People's Republic of China.
² Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
³ Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, People's Republic of China.
⁴ Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, People's Republic of China.
⁵ Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, People's Republic of China.
⁶ School of Clinical Medicine, Weifang Medical University, Weifang, People's Republic of China.

^# Contributed equally.

Abstract

Introduction: To elucidate the currently unknown relationship between chronic lung diseases (CLDs) and depressive symptoms among older adults.

Methods: A total of 8079 older adults from China Longitudinal Aging Social Survey (CLASS) and 1119 individuals from a Sichuan Province cohort were included in this study. We used regression analysis and propensity score matching (PSM) to assess the association between CLDs and depressive symptoms among older adults, while the causal relationship was assessed using Mendelian randomization (MR). Our sensitivity analyses included heterogeneity tests, tests of multiple validity, and leave-one-out tests. A two-way mediation analysis was also used to assess the mediating role of basic activities of daily living (BADL) between CLDs and depressive symptoms.

Results: In this cross-sectional study, we found that depressive symptoms significantly (P < 0.001) increased the risk of CLDs (β = 0.047). The robustness test showed that there were significant association between CLDs and depressive symptoms (β = 0.220, P < 0.001), Qi depression constitution (β = 8.564, P < 0.001). This finding was also confirmed through robustness tests using different PSM methods. The results of the inverse-variance weighting (IVW) analysis showed that depression increased the risk of idiopathic pulmonary fibrosis and asthma, with Beta coefficients of 2.822 [standard error (SE) = 1.087; P = 0.009] and -1.090 (SE = 0.491; P = 0.027), accordingly. The results of the IVW analysis showed that idiopathic pulmonary fibrosis and asthma increased the risk of depression, with Beta coefficients of 2.822 [standard error (SE) = 1.087; P = 0.009] and -1.559 (SE = 0.633; P = 0.013). The sensitivity analysis results confirmed the reliability of this conclusion. The mediating role of BADL was observed from depressive symptoms to CLDs.

Conclusion: Depressive symptoms are associated with an increased risk of CLDs, reduced BADL promote the risk of CLDs in older adults with depressive symptoms, but the underlying pathological mechanism still needs to be clarified in future research.

Keywords: Mendelian randomization; chronic lung diseases; cross-sectional study; depressive symptoms; propensity score matching.