Pain–depression co-occurrence, longitudinal transitions, and incident ADL disability: a two-cohort study
Abstract
BackgroundPain and depressive symptoms frequently co-occur in middle-aged and older adults, but whether changes in their co-occurrence identify different risks of subsequent disability is unclear.MethodsWe analyzed two population-based longitudinal cohorts: the Health and Retirement Study (HRS; United States; N = 9,227; 1,524 incident cases) and the Mexican Health and Aging Study (MHAS; Mexico; N = 8,633; 1,218 incident cases). Participants were free of activities of daily living (ADL) disability at baseline. We examined a four-level baseline pain–depression phenotype and four two-point transition profiles: persistently non-co-occurring, resolved, incident, and persistent co-occurrence. Incident ADL disability was assessed at the final wave. Association models used complete cases. As a secondary analysis, a prediction model developed in HRS was evaluated in MHAS.ResultsCo-occurring pain and depressive symptoms were associated with higher odds of incident ADL disability than either symptom alone in both cohorts (HRS adjusted OR 3.15, 95% CI 2.39–4.16; MHAS 3.00, 2.33–3.85, versus neither symptom). Incident and persistent co-occurrence were each associated with elevated odds (HRS OR 3.55, 2.66–4.74 vs. 3.55, 2.37–5.33; MHAS 3.46, 2.62–4.58 vs. 4.16, 2.91–5.96), while resolved co-occurrence remained associated with elevated risk (HRS OR 2.28, 1.59–3.27; MHAS 2.17, 1.60–2.96). Findings persisted after excluding participants with ADL difficulty at the intermediate assessment. The secondary prediction model achieved an AUC of 0.775 in HRS and 0.725 (95% CI 0.710–0.741) in MHAS.ConclusionRepeated assessment of pain and depressive symptoms identified reproducible transition profiles associated with subsequent ADL disability across two national aging cohorts. Both incident and persistent co-occurrence were associated with elevated risk, supporting repeated symptom assessment as a potential population-level approach to identifying adults at increased risk of loss of independence.
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BibTeX
@article{xu2026paindepression,
title = {{Pain–depression co-occurrence, longitudinal transitions, and incident ADL disability: a two-cohort study}},
author = {Kongfan Xu and Zhengqin Wang and Shougang Li and Qin Wang and Bin Shao},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.2010970},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.2010970},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pain–depression co-occurrence, longitudinal transitions, and incident ADL disability: a two-cohort study
AU - Kongfan Xu
AU - Zhengqin Wang
AU - Shougang Li
AU - Qin Wang
AU - Bin Shao
PY - 2026
DA - 2026/11/09
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.2010970
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.2010970
AB - BackgroundPain and depressive symptoms frequently co-occur in middle-aged and older adults, but whether changes in their co-occurrence identify different risks of subsequent disability is unclear.MethodsWe analyzed two population-based longitudinal cohorts: the Health and Retirement Study (HRS; United States; N = 9,227; 1,524 incident cases) and the Mexican Health and Aging Study (MHAS; Mexico; N = 8,633; 1,218 incident cases). Participants were free of activities of daily living (ADL) disability at baseline. We examined a four-level baseline pain–depression phenotype and four two-point transition profiles: persistently non-co-occurring, resolved, incident, and persistent co-occurrence. Incident ADL disability was assessed at the final wave. Association models used complete cases. As a secondary analysis, a prediction model developed in HRS was evaluated in MHAS.ResultsCo-occurring pain and depressive symptoms were associated with higher odds of incident ADL disability than either symptom alone in both cohorts (HRS adjusted OR 3.15, 95% CI 2.39–4.16; MHAS 3.00, 2.33–3.85, versus neither symptom). Incident and persistent co-occurrence were each associated with elevated odds (HRS OR 3.55, 2.66–4.74 vs. 3.55, 2.37–5.33; MHAS 3.46, 2.62–4.58 vs. 4.16, 2.91–5.96), while resolved co-occurrence remained associated with elevated risk (HRS OR 2.28, 1.59–3.27; MHAS 2.17, 1.60–2.96). Findings persisted after excluding participants with ADL difficulty at the intermediate assessment. The secondary prediction model achieved an AUC of 0.775 in HRS and 0.725 (95% CI 0.710–0.741) in MHAS.ConclusionRepeated assessment of pain and depressive symptoms identified reproducible transition profiles associated with subsequent ADL disability across two national aging cohorts. Both incident and persistent co-occurrence were associated with elevated risk, supporting repeated symptom assessment as a potential population-level approach to identifying adults at increased risk of loss of independence.
SN - 2296-2565
ER -