Longitudinal Study of Diabetes and Depressive Symptoms Among Middle-Aged and Older Adults in China: The Mediating Roles of Functional Limitations and Social Interaction.
- 1Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Ireland.
- 2Alliance for Research and Innovation in Wounds, College of Medicine, Nursing & Health Sciences, University of Galway, Ireland.
Abstract
Introduction
Diabetes 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
We 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
In 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
The findings suggest reciprocal prospective associations between diabetes and depressive symptoms, but evidence for depressive symptoms predicting diabetes varied across models and follow-up intervals.
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BibTeX
@article{tao2026longitudinal,
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.}},
author = {Yan Tao and Claire MacGilchrist and Ellen Kirwan and Joanne E Hurst and Caroline McIntosh},
journal = {Endocrinology, diabetes \& metabolism},
year = {2026},
month = nov,
doi = {10.1002/edm2.70378},
url = {https://europepmc.org/article/MED/43008114},
note = {CC BY},
}
RIS
TY - JOUR
TI - Longitudinal Study of Diabetes and Depressive Symptoms Among Middle-Aged and Older Adults in China: The Mediating Roles of Functional Limitations and Social Interaction.
AU - Yan Tao
AU - Claire MacGilchrist
AU - Ellen Kirwan
AU - Joanne E Hurst
AU - Caroline McIntosh
PY - 2026
DA - 2026/11/01
JO - Endocrinology, diabetes & metabolism
DO - 10.1002/edm2.70378
UR - https://europepmc.org/article/MED/43008114
AB - Introduction Diabetes 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 We 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 In 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 The findings suggest reciprocal prospective associations between diabetes and depressive symptoms, but evidence for depressive symptoms predicting diabetes varied across models and follow-up intervals.
SN - 2398-9238
ER -