Association of Depressive Symptoms With Incidence of Edentulous Jaw in Middle‐Aged and Older Chinese Adults

BACKGROUND: This study investigates the association between depressive symptoms and the incidence of edentulous jaw in middle-aged and older Chinese adults from a nationally representative cohort, emphasising the longitudinal effects of mental health on oral health. METHODS: Data from 13 217 participants aged ≥ 45 years were analysed using the China Health and Retirement Longitudinal Study (CHARLS) over a seven-year follow-up period. Depressive symptoms were assessed using the 10-item CES-D short form and categorised into quartiles. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for sociodemographic factors, health behaviours, and comorbidities. Changes in depressive symptom scores over time were also analysed to explore their influence on edentulous jaw risk. RESULTS: Higher depressive symptom scores were significantly associated with an increased risk of edentulous jaw. Compared to the lowest quartile, participants in the third and fourth quartiles had a 21% (HR, 1.21; 95% CI, 1.06-1.39) and 17% (HR, 1.17; 95% CI, 1.01-1.34) higher risk, respectively. Specific symptoms like "everything was an effort" and "trouble concentrating" independently increased the risk by 5% and 7%, respectively. Participants whose depressive symptoms improved (score reduction > 3 points) had a 24% reduced risk (OR, 0.76; 95% CI, 0.59-0.97), while worsening symptoms (score increase > 5 points) elevated the risk by 26% (OR, 1.26; 95% CI, 1.02-1.55). CONCLUSIONS: Depressive symptoms, especially effort and concentration difficulties, increase edentulous jaw risk, highlighting the importance of integrating mental and dental care to prevent tooth loss in aging populations.