Association of Chronic Pain Trajectories with Incident Depressive Symptoms Among Older Adults: Evidence from National Cohorts in the UK and the US

Objective Chronic pain and depression are common in older adults, yet pain is dynamic and may follow distinct longitudinal courses. This study examined whether chronic pain trajectories are associated with incident depressive symptoms among adults aged 50 years and older. Methods Analyzed were two prospective cohorts of community-dwelling adults: the English Longitudinal Study of Ageing (ELSA) and the US Health and Retirement Study (HRS). Biennial self-reported pain (yes/no) across four waves was used to classify five mutually exclusive pain trajectories: no pain, decreasing pain, fluctuating pain, increasing pain, and consistent pain. Participants with depressive symptoms at baseline were excluded. Incident depressive symptoms were defined as a Center for Epidemiologic Studies Depression scale (CESD-8) score ≥3. Cox proportional hazards models estimated hazard ratios (HRs) adjusted for sociodemographic characteristics, health behaviors, and chronic conditions. Results The analytic samples included 2476 participants in ELSA and 6238 in HRS, with a mean follow-up of 6.3 years and 6.1 years, respectively; incident depressive symptoms occurred in 19.7% and 18.3%, respectively. Compared with the no-pain trajectory, fluctuating, increasing, and consistent pain were associated with higher risk of depressive symptoms in ELSA (HRs, 1.70 [95% CI, 1.37-2.10], 1.76 [95% CI, 1.27-2.45], and 2.60 [95% CI, 1.98-3.43], respectively) and HRS (HRs, 1.48 [95% CI, 1.29-1.71], 1.84 [95% CI, 1.47-2.29], and 2.15 [95% CI, 1.78-2.59], respectively). Decreasing pain was not significantly associated with risk in either cohort. Conclusions Persistent or worsening pain trajectories were consistently predicted subsequent depressive symptoms in older adults, whereas improving pain was not. Longitudinal pain monitoring may help identify high-risk individuals through earlier depression screening, along with integrated pain–mental health care.