Depressive symptoms and risk of all-cause mortality among middle-aged and older populations with and without prediabetes in China

Background: Although depressive symptoms have been associated with increased mortality risk in diabetes patients, the potential implications for individuals with prediabetes remain underexplored. This study aimed to investigate the association between depressive symptoms and all-cause mortality and to determine whether these associations differ between individuals with and without prediabetes in middle-aged and older Chinese adults. Methods: This is a cohort study from the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). All-cause mortality was documented from the baseline through the end of follow-up in 2020. Cox proportional hazards regression was used to evaluate the association of depressive symptoms with all-cause mortality among adults with and without prediabetes, adjusting for potential confounders. Results: After multivariable adjustments, depressive symptoms were associated with a higher risk of all-cause mortality (HR, 1.40; 95 % CI: 1.16-1.68) for those with prediabetes, participants with moderate depressive symptoms exhibited an HR of 1.36 (95 %CI, 1.13-1.65), while those with severe depressive symptoms had an HR of 1.62 (95 %CI, 1.13-2.32) compared to those without depressive symptoms (P for trend <0.001). However, among individuals without prediabetes, depressive symptoms didn't increase the risk of all-cause mortality. Conclusions: Elevated depressive symptoms are significantly associated with an increased risk of all-cause mortality among populations with prediabetes, the risk of death increased with the severity of depressive symptoms. Our findings suggest that careful monitoring and intervention in individuals with both prediabetes and depressive symptoms is needed.