Arthritis/Rheumatism and Depressive Symptoms in Middle-Aged and Older Chinese Adults: Regression and Symptom Network Evidence from CHARLS 2018

Background: Arthritis and rheumatic diseases frequently co-occur with depressive symptoms in middle-aged and older adults. However, most previous studies have relied on total depression scores and have paid less attention to symptom-level associations. This study aimed to examine population-level and symptom-level associations between arthritis/rheumatism and depressive symptoms. Methods: Data were drawn from 15,721 adults aged ≥ 45 years from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey in China. Hierarchical linear regression analyses were used to examine the associations between arthritis/rheumatism and depressive symptoms. Network analysis was used to estimate symptom-level networks and compare depressive symptom networks between participants with and without arthritis/rheumatism. Results: After adjustment for sociodemographic and health-related covariates, arthritis/rheumatism remained significantly associated with higher depressive symptom levels (β = 0.07, p < 0.001). Network analysis showed that depressed mood and perceived effort were the most central symptoms, while restless sleep and perceived effort showed the strongest bridge connections with arthritis/rheumatism. Network comparison analyses indicated no significant differences in global network structure or global strength between participants with and without arthritis/rheumatism. However, four symptom connections were significantly stronger, and low hope showed reduced centrality in participants with arthritis/rheumatism. Conclusions: Arthritis/rheumatism was associated with greater depressive symptom burden and with specific symptom-level connections involving sleep disturbance and perceived effort. These findings highlight the potential value of screening for sleep problems and effort-related symptoms in adults with arthritis/rheumatism.