Bidirectional associations and a causal mediation analysis between depressive symptoms and chronic digestive diseases: A longitudinal investigation

Jiali Zheng; Jingmeng Li; Tianduo Pei; Tianren Zhu; Xiaoguang Li; Hui Wang

doi:10.1016/j.jad.2023.04.025

Bidirectional associations and a causal mediation analysis between depressive symptoms and chronic digestive diseases: A longitudinal investigation

J Affect Disord. 2023 Jul 15:333:278-289. doi: 10.1016/j.jad.2023.04.025. Epub 2023 Apr 25.

Authors

Jiali Zheng¹, Jingmeng Li¹, Tianduo Pei¹, Tianren Zhu¹, Xiaoguang Li², Hui Wang³

Affiliations

¹ School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
² School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Electronic address: lixg@shsmu.edu.cn.
³ School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Electronic address: huiwang@shsmu.edu.cn.

PMID: 37105468
DOI: 10.1016/j.jad.2023.04.025

Abstract

Background: Chronic digestive diseases (CDDs) and depression shared major pathogeneses. We aimed to prospectively examine the bidirectional incidence associations between depressive symptoms and CDDs and explore biologically and behaviorally relevant mediators in the bidirectional associations.

Methods: Multivariable-adjusted Cox proportional hazard models were used to examine baseline depressive symptoms in relation to incident CDDs among 10,974 adults and the relation of baseline CDDs with new-onset elevated depressive symptoms among 7489 participants in the China Health and Retirement Longitudinal Study of nationally representative middle-aged and older adults. Elevated depressive symptoms were defined as the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10) score at or higher than 10 and CDDs (except for tumor and cancer) were determined by self-reported physician diagnoses. Causal mediation analysis was performed to assess the mediated effects of a priori selected blood biomarkers and lifestyle factors in the bidirectional associations.

Results: Prevalence of elevated depressive symptoms and nonmalignant CDDs at baseline was 33.05 % and 17.8 % respectively. During a mean of 5.47 years of follow-up, elevated depressive symptoms significantly increased hazard of CDDs by 1.66 folds (95%CI = 1.49-1.84). Having CDDs at baseline was associated with a 27 % (95%CI = 16 %-39 %) increased hazard of developing elevated depressive symptoms. Shorter sleeping duration at night nominally significantly mediated 8.76 % of the association between depressive symptoms and incident CDDs while no significant mediators were identified in the converse association.

Limitations: Limited mediator information and inadequately long follow-up may reduce chance of identifying significant mediators.

Conclusions: Depressive symptoms and CDDs were mutual independent risk factors. Early screening and management of depressive symptoms and sleep disturbance are suggested in the prevention of CDDs and related comorbidities.

Keywords: Bidirectional associations; Causal mediation; Chronic digestive diseases; Depressive symptoms; Longitudinal study.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease
Depression* / complications
Depression* / epidemiology
Humans
Longitudinal Studies
Mediation Analysis*
Middle Aged
Retirement
Risk Factors