Association of spousal cardio-pulmo-metabo-disease and sensory impairment with incident depression in middle-aged and older adults: a prospective multi-cohort study

BACKGROUND: Depression in middle-aged and older adults is increasingly recognized as being influenced by spousal health conditions, yet the specific impact of spousal chronic diseases and sensory impairments remains underexplored. This study aimed to investigate the independent and combined effects of spousal cardio-pulmo-metabo-disease (CPMD) and sensory impairments on (1) incident depression, (2) age at onset of depression, and (3) changes in these conditions with depression onset. MATERIALS AND METHODS: This pooled multi-cohort study utilized data from four nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), and the Korean Longitudinal Study of Ageing (KLoSA). Spousal CPMD was defined as the self-reported presence of cardiovascular disease, chronic lung disease, and diabetes, and categorized as none, single, or multimorbidity. Spousal sensory impairments were defined based on self-rated hearing and vision, harmonized into "optimal," "adequate," or "impaired," and further classified as none, single (hearing or vision), or dual impairments (both hearing and vision). We excluded participants with depressive symptoms at baseline. Incident depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders. RESULTS: After adjusting for covariates, spousal CPMD was progressively associated with higher depression risk (HR per one disease increment: 1.10, 95% CI: 1.06-1.14). Similarly, graded increases in risk were observed for spousal sensory impairments (HR per one impairment increment: 1.18, 95% CI: 1.14-1.22). Their combined effects were significantly associated with age at onset of depression across all age groups. Participants whose spouses had persistent CPMD or sensory impairments had a significantly higher risk of depression compared to those whose spouses remained free of these conditions. CONCLUSION: Holistically addressing spousal CPMD and sensory impairments can reduce depression risk and improve quality of life in aging populations.