Incident health-related and social-disruption events, cumulative burden, and depressive symptom risk in adults aged 50 years and older: a multinational longitudinal cohort study

Incident health-related and social-disruption events may mark periods of heightened depressive symptom vulnerability in later life. However, cross-national evidence on their co-occurrence, component-level associations, and cumulative burden remains limited, constraining evidence-based risk stratification. This longitudinal study included 121,006 adults aged ≥ 50 years from five ageing cohorts in China, Mexico, the United States, England, and multiple countries across Europe and Israel, contributing 269,146 person-wave observations with a valid immediately preceding interview. Depressive symptom risk was defined using cohort-specific Center for Epidemiologic Studies Depression Scale (CES-D) or European Depression Scale (EURO-D) thresholds. Eight primary shocks were defined as newly recorded transitions between adjacent interviews. Cohort-specific random-intercept logistic models were pooled using random-effects meta-analysis. Secondary analyses examined prospective outcomes, individual components, cumulative burden, a mood-focused outcome, and meta-analytic robustness. In prospective analyses, individual health-related shocks remained associated with depressive symptom risk in lagged (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.26–1.43) and incident-outcome analyses (aOR 1.30, 95% CI 1.21–1.39). Corresponding estimates for social-disruption shocks were 1.26 (1.19–1.34) and 1.19 (1.11–1.28). In the primary same-wave analysis, pooled aORs were 1.79 (1.66–1.94) for overall shocks, 1.59 (1.39–1.82) for health-related shocks, and 1.83 (1.71–1.95) for social-disruption shocks. Marital disruption, transition to living alone, and stroke had the largest component point estimates. Among observations with complete ascertainment of all eight core shock components, the aORs were 1.57 (1.50–1.64), 2.92 (2.34–3.64), and 3.92 (2.84–5.40) for one, two, and ≥ 3 shocks, respectively, compared with no shock. Incident health-related and social-disruption events were associated with elevated depressive symptom risk across five ageing cohorts, with a graded increase according to cumulative shock burden. Associations for both domains persisted in prospective analyses, with greater attenuation observed for social-disruption shocks. Together, these findings suggest that newly documented health and social transitions may serve as practical indicators for depressive-symptom assessment and follow-up during subsequent care.