Examining the association between neck pain and depressive symptoms in middle-aged and older Chinese adults: findings from the China Health and Retirement Longitudinal Study (CHARLS)

Neck pain is a prevalent musculoskeletal condition among middle-aged and older adults and may contribute to the development of depressive symptoms. However, evidence on the longitudinal relationship between neck pain and depression remains limited in large population-based cohorts. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), including adults aged ≥ 45 years who participated in the 2011 baseline survey. Cross-sectional associations between neck pain and depressive symptoms were evaluated using multivariable logistic regression, while longitudinal associations over a 9-year follow-up (2011–2020) were examined using Cox proportional hazards models. An elastic net (ENET) regularization method was used for predictor selection. Subgroup and interaction analyses were performed to assess effect modification, and E-values were calculated to evaluate robustness to unmeasured confounding. At baseline in 2011, 9,452 participants (mean age 59.11 ± 9.56 years; 49.97% women) were included in the cross-sectional analysis, and 3,530 participants free of depressive symptoms at baseline were included in the longitudinal analysis. In cross-sectional analyses, neck pain was independently associated with increased odds of depressive symptoms (adjusted OR = 3.019, 95% CI: 2.341–3.899). In longitudinal analyses, neck pain predicted a higher risk of developing depressive symptoms over time (adjusted HR = 1.102, 95% CI: 1.081–1.124). Subgroup analyses confirmed the robustness of these associations across sociodemographic and health strata, with no significant interactions observed. Sensitivity analysis showed moderate to strong resistance to unmeasured confounding. Neck pain is significantly associated with the presence and future development of depressive symptoms in middle-aged and older Chinese adults. These findings highlight the importance of early identification and integrated management of neck pain in efforts to prevent late-life depression.