{
  "abstract": "Introduction\n\nDiabetes and depressive symptoms frequently coexist, but the pathways underlying their longitudinal associations remain unclear. This study examined their reciprocal associations and indirect pathways through functional limitations and social interaction.Methods\n\nWe analysed 6606 adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study in 2013 (T1), 2015 (T2), and 2018 (T3). Diabetes was identified through self-reported diagnosis or treatment; depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. Functional limitations and social interaction were assessed using activities of daily living scales and social activity frequency. Cross-lagged panel models examined reciprocal associations and indirect pathways, with multigroup analyses evaluating invariance across gender and age. Logistic regression sensitivity analyses examined associations between depressive symptoms and incident diabetes.Results\n\nIn the full reciprocal model, direct associations between diabetes and depressive symptoms were significant during T1-T2 in both directions, but neither was significant during T2-T3. Logistic sensitivity analyses supported the depressive symptoms-to-diabetes association only during T1-T2, whereas both reverse adjacent-wave paths were significant in the model without mediators. The direct T1-T3 association was significant only from diabetes to depressive symptoms. Statistically significant indirect associations from T1 diabetes to T3 depressive symptoms were observed through T2 functional limitations and reduced social interaction. Reverse indirect effects were statistically significant but very small. The structural pathways were broadly invariant across gender and age groups.Conclusion\n\nThe findings suggest reciprocal prospective associations between diabetes and depressive symptoms, but evidence for depressive symptoms predicting diabetes varied across models and follow-up intervals.",
  "abstract_shown": true,
  "affiliations": [
    "Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Ireland.",
    "Alliance for Research and Innovation in Wounds, College of Medicine, Nursing & Health Sciences, University of Galway, Ireland."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yan Tao",
      "orcid": "0000-0001-6709-5962"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Claire MacGilchrist"
    },
    {
      "affs": [
        0
      ],
      "name": "Ellen Kirwan",
      "orcid": "0000-0003-1169-8232"
    },
    {
      "affs": [
        0
      ],
      "name": "Joanne E Hurst",
      "orcid": "0000-0003-1175-1216"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Caroline McIntosh",
      "orcid": "0000-0003-1801-9554"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a9k72hqkkfha9.bib",
  "cited_by": 0,
  "doi": "10.1002/edm2.70378",
  "fulltext_url": "https://europepmc.org/articles/PMC13750668",
  "id": "a9k72hqkkfha9",
  "issns": [
    "2398-9238"
  ],
  "landing_url": "https://europepmc.org/article/MED/43008114",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research Article"
    ],
    [
      "openalex",
      "2712|Diabetes Management and Education"
    ]
  ],
  "openalex": "W7225746752",
  "pdf_url": "https://europepmc.org/articles/PMC13750668?pdf=render",
  "pmcid": "PMC13750668",
  "pmid": "43008114",
  "published": "2026-11-01",
  "publisher": "Wiley",
  "ris": "https://research.draconitic.com/paper/a9k72hqkkfha9.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T15:21:48Z",
      "native_id": "MED:43008114",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43008114"
    },
    {
      "first_seen": "2026-11-14T12:23:12Z",
      "native_id": "PMC13750668",
      "source": "pmc",
      "url": "https://doi.org/10.1002/edm2.70378"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes Management and Education",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Longitudinal Study of Diabetes and Depressive Symptoms Among Middle-Aged and Older Adults in China: The Mediating Roles of Functional Limitations and Social Interaction.",
  "title_text": "Longitudinal Study of Diabetes and Depressive Symptoms Among Middle-Aged and Older Adults in China: The Mediating Roles of Functional Limitations and Social Interaction.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-14T12:23:12Z",
  "url": "https://research.draconitic.com/paper/a9k72hqkkfha9",
  "venue": "Endocrinology, diabetes & metabolism",
  "versions": []
}