Cardiometabolic multimorbidity is associated with higher hazards of depressive symptom onset and lower hazards of depressive symptom reversion, and these associations were stronger among those with poor sleep duration.
Key Findings
Results
In Chinese participants, having one cardiometabolic disease was associated with a 13% higher hazard of transitioning from non-depressive symptoms to depressive symptoms compared to those without cardiometabolic diseases.
Sample: 14,468 Chinese participants from CHARLS; mean age 59.3 ± 9.5 years; 52.3% female
HR = 1.13 [95% CI: 1.05–1.22] for one cardiometabolic disease vs. no cardiometabolic disease
Depressive symptoms assessed using CES-D scale
Multi-state Markov models and Cox models were used to estimate transitions among non-DS, DS, and death
Results
In Chinese participants, cardiometabolic multimorbidity (two or more cardiometabolic diseases) was associated with a 29% higher hazard of transitioning from non-depressive symptoms to depressive symptoms.
HR = 1.29 [95% CI: 1.09–1.54] for CMM vs. no cardiometabolic disease
Sample: 14,468 participants from CHARLS
Cardiometabolic multimorbidity defined as having two or more cardiometabolic diseases (CMDs)
Analyses adjusted for relevant covariates using Cox proportional hazards models
Results
In Chinese participants, having one cardiometabolic disease or cardiometabolic multimorbidity was associated with significantly lower hazards of transitioning from depressive symptoms back to non-depressive symptoms (reversion).
One CMD: HR = 0.90 [95% CI: 0.84–0.97], representing a 10% lower hazard of reversion
CMM: HR = 0.79 [95% CI: 0.67–0.94], representing a 21% lower hazard of reversion
Reversion defined as a transition from DS to non-DS based on CES-D thresholds
Sample: 14,468 CHARLS participants
Results
In UK participants, having one cardiometabolic disease was associated with a 10% higher hazard and cardiometabolic multimorbidity with a 21% higher hazard of transitioning from non-depressive symptoms to depressive symptoms.
Sample: 8,551 participants from the English Longitudinal Study of Ageing (ELSA); mean age 66.1 ± 9.4 years; 56.2% female
One CMD: HR = 1.10 [95% CI: 1.02–1.20]
CMM: HR = 1.21 [95% CI: 1.04–1.41]
Findings are consistent in direction with those observed in the Chinese cohort
Results
In UK participants, having one cardiometabolic disease or cardiometabolic multimorbidity was associated with 17% and 26% lower hazards of depressive symptom reversion, respectively.
One CMD: HR = 0.83 [95% CI: 0.76–0.91]
CMM: HR = 0.74 [95% CI: 0.63–0.87]
Sample: 8,551 ELSA participants
Reductions in reversion hazard were larger in the UK cohort than the Chinese cohort for both CMD and CMM categories
Results
Significant additive interactions were observed between cardiometabolic multimorbidity and unhealthy sleep duration on depressive symptom onset and reversion.
P for additive interaction < 0.001
Poor sleep duration defined as less than 6 hours or 9 or more hours per night
Associations between CMM and depressive symptom onset and reversion were stronger among those with poor sleep duration compared to those with good sleep duration
Findings were consistent across both the CHARLS (Chinese) and ELSA (UK) cohorts
Methods
Two large longitudinal cohort studies from China and England were used, with depressive symptom states tracked over time using the CES-D scale.
CHARLS included 14,468 participants; ELSA included 8,551 participants
Multi-state Markov models estimated transitions among three states: non-DS, DS, and death
Cox models evaluated associations with DS onset and reversion
CMM was defined as two or more cardiometabolic diseases at baseline
Sleep duration was assessed at baseline; poor sleep defined as <6 or ≥9 hours
What This Means
This research suggests that having multiple heart- and metabolism-related health conditions at the same time—such as diabetes, heart disease, and stroke—is associated with a meaningfully higher risk of developing depressive symptoms and a lower chance of recovering from depression over time. These findings were consistent across two large groups of older adults, one from China (nearly 14,500 people) and one from England (over 8,500 people), and were tracked over multiple years using established tools for measuring depression.
The study also found that sleep duration plays an important additional role. People who slept too little (fewer than 6 hours) or too much (9 or more hours) and also had multiple cardiometabolic conditions faced an even greater risk of developing depression and had even lower odds of recovering from it compared to those with healthy sleep patterns. The interaction between poor sleep and multiple cardiometabolic conditions was statistically significant, suggesting these two factors may compound each other's effects on mental health.
This research suggests that managing cardiometabolic conditions together—rather than treating each one separately—and paying attention to sleep habits may both be important for the mental health of older adults. The consistency of findings across two culturally distinct populations (China and England) strengthens confidence that these associations are not specific to one country or healthcare system, though the study is observational and cannot prove that cardiometabolic conditions or poor sleep directly cause depression.
Check Your Own Numbers
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
Zhang R, Sun X, Caotian G, Jiang C, Teng W. (2026). Associations of cardiometabolic multimorbidity and sleep duration with depressive symptom onset and reversion: two longitudinal cohort studies.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2026.122408