Abstract
BACKGROUND: Chronic liver diseases and depression are both major public health concerns worldwide, particularly among aging populations. However, evidence on the prospective association between depressive symptoms and the risk of developing chronic liver diseases remains limited. The aim of this study is to explore the potential association in middle-aged and older Chinese adults. METHODS: Data for this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), and 11,272 participants without prior liver disease were finally included in this study. Depression was assessed using the CESD-10, with scores analyzed as continuous variables and chronic liver diseases were self-reported based on physician diagnosis. By adjusting for multiple covariates, Cox proportional hazards regression models were used to estimate hazard ratios and restricted cubic spline models were applied to assess the potential non-linear relationships. FINDINGS: Over a mean follow-up period of 6.85 years, a total of 570 participants were finally diagnosed with chronic liver diseases. Multivariate regression analyses revealed a significant association between CESD scores and the risk of liver diseases among study participants even accounting for all potential covariates (HR: 1.020, 95% CI: 1.006-1.033, p = 0.004). CONCLUSION: We identified a significant association between depressive symptoms and subsequent development of chronic liver diseases. Based on observational findings, depressive symptoms may represent a potential early marker of liver disease risk. These findings highlight the importance of integrating mental health assessments into early routine clinical care.