Linking chronic diseases, cognitive impairment and depressive symptoms in Chinese older adults: A three-wave population-based longitudinal study

Despite previous studies illustrate that chronic diseases are risk factors for older adults' psychological health, little is known about its mediating mechanism. This study aims to examine the mediating effect of cognitive impairment. Also, a particular emphasis is placed on whether the Hukou system in China contributes to the adverse effect of chronic diseases on depressive symptoms.Using the 2014, 2016 and 2018 rounds of the China Longitudinal Aging Social Survey (CLASS), this study estimates fixed-effect panel models for the effect of chronic diseases on depressive symptoms and the mediating effect of cognitive impairment. Meanwhile, the interaction effect of chronic diseases and hukou status on depressive symptoms is also examined.The significant relationship between chronic diseases and depressive symptoms is supported in Chinese older adults and this association is found to be mediated by cognitive impairment. Moreover, no urban-rural disparities exist in the effect of chronic diseases on depressive symptoms.All of the measures in this study are relied on self-report, which may result in reporting biases.This study contributes to our understanding of the relationship between chronic diseases and depressive symptoms and extends the previous literature by considering the Hukou status, a highly distinctive Chinese variable. Practical implications for policy development and intervention design are also provided.