The Relationship Between Depression Trajectories And Cognitive Function In Middle-aged And Elderly European Adults

BackgroundDepression is characterized by conspicuous and constant down in spirits.Depressive episodes are often accompanied by mental retardation and decreased volitional activity,as well as physical discomfort.Depression,as a common psychological illness,has brought a heavy disease burden to the globe.Meanwhile,the aging population and extension of life expectancy have posed challenges to countries around the world.The elderly with depression may face adverse outcomes,such as the increased risk of functional decline,physical disability and disease death,seriously affecting the quality of life of the elderly and increasing the pressure of medical-health institutions,and socio-economic conditions.Lots of epidemiological studies have shown the gender differences in depression,which the prevalence of depression in women is higher than that in men.However,some studies have found that the prevalence of depression in men is higher than in women by the age of 55.Other studies have revealed that the effect of gender on depression gradually diminishes with age increasing,and the gender difference in depression eventually almost disappears.In addition,few studies have focused on the influence of gender on the long-term development trend of depression in middle-aged and elderly people,and the research on the influencing factors of the long-term trajectory of depression between different genders is still relatively lacking.The relationship between depression and cognitive function has always been a research hotspot.Related studies have demonstrated that depression could predict cognitive decline,while other studies have displayed that depression is associated with an inability to predict cognitive decline,especially memory.The relationship between depression and cognitive function is inconsistent.The association of gender-specific depression trajectories with cognitive function is still unclear.Objectives1.To explore the gender differences on the trajectory of depression in middle-aged and elderly people.2.To exam the influencing factors of gender-specific depression trajectory in middle-aged and elderly people.3.To figure out the relationship between depression trajectory and cognitive function in middle-aged and elderly people by gender.MethodsThe data in this study were derived from the European Health,Ageing and Retirement Survey.The baseline survey was started in 2004,and a total of six follow-up visits were conducted in the survey.The second follow-up was a life course survey,so the baseline survey and five routine follow-up surveys were used in this study,which was compiled into balanced panel data.Finally,a total of 3990 subjects were included.Group-based trajectory modeling was used to explore depression trajectory in the general population,and then univariate and multinominal logistic regression analyses were used to screen confounders according to depression trajectory groups.The depression trajectory was reevaluated to determine the impact of gender on depression trajectory.Then the gender-specific depression trajectories were explored,and the influencing factors of depression trajectories were investigated by univariate and multinominal logistic regression.At last,generalized estimation equations were used to figure out the association of depression trajectory with cognitive function in the general population and between different genders.Main outcomes1.Four depression trajectories were found in the general population:non-depression trajectory(45.10%),mild depression trajectory(37.49%),high depression trajectory(8.90%)and increased depression trajectory(4.51%).After controlling for other confounding factors,compared with men,the woman could decrease the probability of mild depression trajectory(β=-1.69,P=0.002)but increase the probability of increased depression trajectory(β=0.94,P=0.016)with high depression trajectory as reference.2.The percentages of the trajectory of non-depression,moderate depression and high depression in males and females were 73.11%and 50.30%,23.76%and 32.12%,3.13%and 17.58%,respectively.3.Age,European location,family economic level,social support and chronic disease were the influencing factors of male depression trajectory,while age,European location,family economic level,exercise,chronic disease,daily activities and instrumental daily activity restriction affect female depression trajectory.4.After adjusting for related confounding factors,compared with the non-depression trajectory,the highly depressed trajectory was negatively correlated with memory scores(β=-0.52,95%CI:-0.88--0.17,P=0.004)and verbal fluency scores(β=-1.31,95%CI:-2.05--0.57,P=0.001)only in middle-aged and older females.Conclusions1.There were gender differences in depression trajectory among middle-aged and elderly people,and the proportion of high depression trajectory in women was higher than that in men.2.The influencing factors of depression trajectory were different by gender.Compared with middle-aged and elderly men,women’s depression trajectory was affected by more factors.3.Only middle-aged and older women were found a high depression trajectory increased the risk of cognitive impairment.