Arthritis and Longitudinal Trajectories of Depressive Symptoms and Cognition in Middle-Aged and Older Adults: A Prospective Tri-Cohort Study

Arthritis and Longitudinal Trajectories of Depressive Symptoms and Cognition in Middle-Aged and Older Adults: A Prospective Tri-Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Arthritis and Longitudinal Trajectories of Depressive Symptoms and Cognition in Middle-Aged and Older Adults: A Prospective Tri-Cohort Study Siyi Chen, Yushan Zhao, Shumin Huang, Yanfen Guo, Yize Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8862027/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background The long-term effects of arthritis on psychological well-being and cognitive trajectories across diverse cultural contexts remain inadequately characterized. This study systematically examines the associations between baseline arthritis and the subsequent risk of developing depressive symptoms and cognitive impairment, as well as the longitudinal evolution of these outcomes over time. Methods We utilized harmonized longitudinal data from three large prospective cohort studies: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study (HRS). Cox proportional hazards models were applied to estimate hazard ratios (HRs) for incident depressive symptoms and cognitive impairment. Longitudinal changes in depressive symptoms (measured by CES-D scores) and global cognitive function were assessed using linear mixed-effects models. Results Across all three cohorts, arthritis was consistently associated with a significantly elevated risk of incident depressive symptoms, with fully adjusted HRs ranging from approximately 1.2 to 1.6. Trajectory analyses further indicated that individuals with arthritis not only had higher levels of depressive symptoms at baseline but also experienced a more rapid worsening of symptoms over time compared with those without arthritis. In contrast, associations between arthritis and cognitive impairment were modest and inconsistent. Slight increases in risk were observed in ELSA and HRS (HRs approximately 1.1–1.2), whereas no significant association was detected in CHARLS. Correspondingly, longitudinal cognitive trajectories demonstrated minimal and clinically negligible differences between groups. Conclusion Arthritis is strongly associated with an accelerated onset and progression of depressive symptoms among older adults, while its direct influence on cognitive decline appears limited. These findings underscore the importance of incorporating routine mental health screening and management into rheumatologic and geriatric care to reduce the cumulative burden of coexisting physical and psychological conditions. Arthritis Depressive Symptoms Cognitive Impairment Longitudinal Trajectories Cross-national Study Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 21 Apr, 2026 Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviews received at journal 23 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers invited by journal 03 Mar, 2026 Editor assigned by journal 19 Feb, 2026 Submission checks completed at journal 19 Feb, 2026 First submitted to journal 12 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8862027","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":600188836,"identity":"7f02faf6-a24a-46a3-8c95-414b1f5086ee","order_by":0,"name":"Siyi Chen","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Siyi","middleName":"","lastName":"Chen","suffix":""},{"id":600188837,"identity":"6be9f2ab-219a-4fc7-be68-02a9bc1658a2","order_by":1,"name":"Yushan Zhao","email":"","orcid":"","institution":"Fujian Province Second People's Hospital: The 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Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Arthritis, Depressive Symptoms, Cognitive Impairment, Longitudinal Trajectories, Cross-national Study","lastPublishedDoi":"10.21203/rs.3.rs-8862027/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8862027/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe long-term effects of arthritis on psychological well-being and cognitive trajectories across diverse cultural contexts remain inadequately characterized. This study systematically examines the associations between baseline arthritis and the subsequent risk of developing depressive symptoms and cognitive impairment, as well as the longitudinal evolution of these outcomes over time.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe utilized harmonized longitudinal data from three large prospective cohort studies: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study (HRS). Cox proportional hazards models were applied to estimate hazard ratios (HRs) for incident depressive symptoms and cognitive impairment. Longitudinal changes in depressive symptoms (measured by CES-D scores) and global cognitive function were assessed using linear mixed-effects models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAcross all three cohorts, arthritis was consistently associated with a significantly elevated risk of incident depressive symptoms, with fully adjusted HRs ranging from approximately 1.2 to 1.6. Trajectory analyses further indicated that individuals with arthritis not only had higher levels of depressive symptoms at baseline but also experienced a more rapid worsening of symptoms over time compared with those without arthritis. In contrast, associations between arthritis and cognitive impairment were modest and inconsistent. Slight increases in risk were observed in ELSA and HRS (HRs approximately 1.1\u0026ndash;1.2), whereas no significant association was detected in CHARLS. Correspondingly, longitudinal cognitive trajectories demonstrated minimal and clinically negligible differences between groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eArthritis is strongly associated with an accelerated onset and progression of depressive symptoms among older adults, while its direct influence on cognitive decline appears limited. These findings underscore the importance of incorporating routine mental health screening and management into rheumatologic and geriatric care to reduce the cumulative burden of coexisting physical and psychological conditions.\u003c/p\u003e","manuscriptTitle":"Arthritis and Longitudinal Trajectories of Depressive Symptoms and Cognition in Middle-Aged and Older Adults: A Prospective Tri-Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-06 17:52:35","doi":"10.21203/rs.3.rs-8862027/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-21T06:04:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T19:07:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84363741530933156902440537552873920149","date":"2026-03-30T17:43:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T21:32:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44171809649615957696895968417701332241","date":"2026-03-03T18:22:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-03T09:57:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-19T12:21:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-19T12:16:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2026-02-12T12:11:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7fbaede5-93a0-4165-bc56-85e81ad42ef5","owner":[],"postedDate":"March 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T06:10:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-06 17:52:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8862027","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8862027","identity":"rs-8862027","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}