Bidirectional Associations between Daily Activity Limitations and Depressive Symptoms among Middle-aged and Older Adults with Multimorbidity in China: A Cross-Lagged Panel Network Analysis

This study was based on the 2018 and 2020 rounds of the China Health and Retirement Longitudinal Study (CHARLS). A total of 5,850 middle-aged and elderly people aged 50 years and above with two or more chronic diseases were included. A cross-lagged panel network model was used to analyse the longitudinal predictive relationship between activities of daily living (ADL) and depressive symptoms (DS), stratified by sex. The results revealed that ADL functional limitations were used mainly as predictors, whereas depressive symptoms were mostly in the affected position. Among them, "Housework" (A7) and "Money management" (A12) had strong outwards predictive effects, especially with depression symptoms such as "Effortlessness" (D6) and "Inertia" (D7). A gender comparison revealed that basic ADL nodes such as "Dressing" (A1) and "Getting up" (A4) were more predictive in the female network, whereas "Housework" (A7) was the core predictive node in the male network. The network edge weights and node centrality are estimated with acceptable accuracy and stability. This study highlights that impaired functioning in complex instrumental daily activities (e.g., housework, money management) may be a prodromal indicator of depressive symptoms in middle-aged and older adults with multimorbidity. Gender heterogeneity exists in the association path between functional status and depressive symptoms, suggesting that targeted strategies should be implemented according to gender characteristics in interventions. Early monitoring of functional status is helpful for identifying and preventing mental health risks.