Depressive Symptoms Trajectories Across the Transition to Cardiovascular Disease in Middle-Aged and Older Adults: A Multicohort Study

AIMS: The long-term depressive symptoms trajectories across the transition to diagnosed cardiovascular disease (CVD) remain poorly characterized. We aimed to investigate trajectories of depressive symptoms before and after incident CVD in multinational aging populations. METHODS AND RESULTS: In this multicohort study, we analyzed longitudinal data from the Health and Retirement Study (HRS, 2002-2018), English Longitudinal Study of Ageing (ELSA, 2002-2019), and China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). Depressive symptoms were measured biennially by the 8-item (HRS and ELSA) and 10-item (CHARLS) Centre for Epidemiological Studies Depression scale and standardized to Z-scores. Incident CVD was ascertained by medical history. Data were analyzed using discontinuous growth curve modeling and pooled using meta-analysis. Among 28 704 included participants (mean [SD] age, 62.3 [9.8] years; 43.4% male), 7363 developed CVD during follow-up. Participants who developed CVD had higher levels of depressive symptoms than those without CVD (pooled β [95% confidence interval]: 0.161 SD [0.086-0.236]). A significant increase in depressive symptoms scores was observed around the time of CVD diagnosis (pooled β: 0.089 SD [0.060-0.118]). Additionally, depressive symptoms scores increased both in the years preceding CVD onset (pooled β: 0.007 SD/year [0.004-0.010]) and following diagnosis (pooled β: 0.009 SD/year [0.004-0.013]). CONCLUSION: Depressive symptoms show a gradual increase before CVD diagnosis, elevate further around the time of diagnosis, and continue to worsen thereafter. These findings call for the integration of mental health screening and management into CVD care at all stages, from primary prevention to long-term disease management.