Trajectories of covarying depression and multiple physical health problems in middle-aged and older adults based on GBMTM

Depression in middle-aged and older adults often co-occurs with multiple physical health problems, yet its long-term co-evolution patterns remain unclear. Using data from 4 waves of the China Health and Retirement Longitudinal Study from 2011 to 2018, group-based multi-trajectory modeling was employed to identify covarying trajectories of depressive symptoms, number of chronic diseases, chronic pain, and functional disability. Multinomial logistic regression was used to analyze predictive factors. A total of 8961 participants aged 45 and above were included. Four distinct trajectories were identified: stable low-risk group (40.84%), low-risk improving group (11.24%), high-risk deteriorating group (23.96%), and high-risk fluctuating group (23.96%). Older age, female gender, and rural residence were risk factors for unfavorable trajectories, while higher education level, nonagricultural household registration, and social participation were protective factors. The long-term evolution of physical and mental health in middle-aged and older adults exhibits heterogeneous trajectories, with high-risk subgroups showing synchronous deterioration across multiple health dimensions. Identifying key predictive factors can inform stratified interventions and precision health management.