Depressive symptoms, health behaviors and risk of diabetes in Chinese mid-aged and older adults

Objective: While diabetes links with comorbidity of depression, there is no evidence in China regarding whether health behaviors modified the effect of depressive symptoms on diabetes. This study examined the influence of depressive symptoms on the incident diabetes, and investigated whether health behavior was a moderator in the depression-diabetes relationship in Chinese mid-aged and older adults. Methods: Using data from the China Health and Retirement Longitudinal 2011-2015 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms in 47,671 Chinese mid-aged and older adults. Diabetes was diagnosed through self-reported measures. We used random effect logistic regression models to examine the effect of depressive symptoms on the incidence of depressive symptoms. Results: Participants with depressive symptoms were more likely to suffer from diabetes than their non-depressive symptoms counterparts, with an odds ratio (OR) of 1.33 (95% CI: 1.13, 1.58). We found that unhealthy behaviors moderated the influence of depressive symptoms on risk of diabetes (OR = 1.01, 95% CI = 1.01, 1.02), indicating that depressive symptoms patients with two or more unhealthy behaviors had a higher risk of diabetes compared with their peers without unhealthy behaviors. Conclusion: Our findings suggested that depressive symptoms were a risk factor in developing diabetes, and that response to this factor varied by individuals' health behaviors. Clinicians should be aware of increased risk of elevated diabetes in population with depressive symptoms and consider routine screening for depressive symptoms among them.