Multimorbidity, depressive symptoms and disability in activities of daily living amongst middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study

Background: Given that multimorbidity is strongly associated with disability in activities of daily living (ADL) and the mechanism still remains unclear, this study sought to investigate the mediating effect of depressive symptoms on such association. Methods: A longitudinal dataset was drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015), including 3951 adults aged 45 years and above. By sex, logistic regression and mediation analysis (the Karlson, Holm, and Breen Method) were employed. Results: The presence of multimorbidity was associated with increased odds of having depressive symptoms and developing ADL disability, and depressive symptoms was significantly associated with ADL disability among middle-aged and older women. Mediation analysis illustrated that depressive symptoms accounted for 6.36% of the effect of multimorbidity on ADL disability in women. Limitations: Results might not generalize to all middle-aged and older Chinese due to missing data on depressive symptoms and ADL. Conclusions: Multimorbidity increased the likelihood of ADL disability onset partially through depressive symptoms in middle-aged and older women, suggesting that emphasizing mental wellness of females with multimorbidity are necessary to prevent impairments in physical function.

Automated summary

This study found that multimorbidity increased the likelihood of developing activities of daily living (ADL) disability in middle-aged and older women, partially through the mediation of depressive symptoms. The results emphasize the importance of focusing on mental wellness in females with multimorbidity to prevent impairments in physical function.