Pain is the leading cause of disability worldwide, yet no harmonised self-reported reference framework exists to characterise how its burden is distributed across the lifespan and world regions. Here, we harmonised individual-level self-reported pain data from 6,075,021 participants across 894 population-based data sources in 118 countries to establish global reference trajectories of pain. We implemented these trajectories in an open-access benchmarking platform for positioning external datasets against global pain norms. Pain prevalence ranged from 2.5% for facial pain to 45.0% for back pain, was consistently higher in women across all eleven anatomical sites (risk ratio range 1.09 to 1.83), and increased most steeply before age 55 years. Contrary to existing estimates that generally project higher prevalence of pain conditions in higher Human Development Index (HDI) regions, we found that individuals in the lowest HDI countries experienced nearly twice the late-life prevalence of any bodily pain compared with those in the highest (risk difference 31.8 percentage points [95% CI 30.1–33.6]). Globally, 18.3% of pain burden across anatomical sites was attributable to three modifiable risk factors (smoking, obesity, and low income) but this varied from 12.6% in sub-Saharan Africa to 27.1% in eastern Europe, indicating that the drivers of pain in lower-HDI settings remain poorly characterised.

Abstract Pain is the leading cause of disability worldwide, yet no population-based reference exists against which individual cohorts, clinical populations, or countries can be benchmarked. Here, we harmonised individual-level self-reported pain data from 6,075,021 participants across 894 population-based data sources in 118 countries to establish global reference trajectories of pain across the lifespan, implemented in an open-access benchmarking platform. Pain prevalence ranged from 2.5% for facial pain to 45.0% for back pain, was consistently higher in women across all eleven anatomical sites (risk ratio range 1.09 to 1.83), and increased most steeply before age 55 years. Contrary to existing estimates that generally project higher prevalence of pain conditions in higher Human Development Index (HDI) regions, we found that individuals in the lowest HDI countries experienced nearly twice the late-life prevalence of any bodily pain compared with those in the highest (risk difference 31.8 percentage points [95% CI 30.1–33.6]). Globally, 18.3% of site-specific pain burden was attributable to three modifiable risk factors (smoking, obesity, and low income) but this varied from 12.6% in sub-Saharan Africa to 27.1% in eastern Europe, indicating that the drivers of pain in lower-HDI settings remain poorly characterised.

BackgroundMental health professionals (MHPs) are susceptible to fatigue, particularly during public health crises like the COVID-19 pandemic. This study examined nonlinear relationships between fatigue, post-traumatic stress disorder (PTSD), and fear of COVID-19 (FOC) among MHPs.MethodsA multi-site survey was conducted from January to February 2023. Fatigue was assessed using the Fatigue Visual Analogue Scale (VAS), PTSD with the Post-Traumatic Stress Disorder Checklist for Civilians (PCL-C), and FOC with the Fear of COVID-19 Scale (FCV-19S). Data were analyzed using logistic regression and restricted cubic splines to explore non-linear associations.ResultsOf the 9,858 COVID-recovered MHPs, the prevalence of significant PTSD symptoms (PCL-17 ≥ 50) was 6.85% (95% CI: 6.35% - 7.35%), while significant fear of COVID-19 (FOC ≥ 16) was observed in 61.28% (95% CI: 60.32% - 62.24%). Higher fatigue levels were significantly associated with increased odds for exacerbated PTSD symptomatology (OR = 1.75, 95% CI: 1.65 - 1.86, p < 0.001) and FOC severity (OR = 1.19, 95% CI: 1.16 - 1.21, p < 0.001). Restricted cubic splines analysis revealed nonlinear relationships. Specifically, as fatigue rose towards an inflection point of 5.00, its association with PTSD symptoms strengthened, while its association with FOC showed a decelerating growth.ConclusionThis study underscored fatigue as a factor significantly associated with COVID-recovered MHPs, particularly regarding the presence of PTSD and FOC. However, due to the cross-sectional study design, the direction of causality between fatigue, PTSD, and FOC could not be determined. Regular monitoring and targeted interventions are crucial for managing fatigue during public health crises. Healthcare organizations should provide appropriate work-rest schedules and supportive policies during such periods.

Background:Late-life depression (LLD) is a significant global public health challenge among older adults. Exploring central/influential symptoms with longitudinal study designs can enhance the efficacy of detection, early prevention, and interventions for LLD. This study aimed to identify key symptoms of LLD using a panel graphical vector autoregression (panel-GVAR) model based on longitudinal national survey data. Methods:Data from the China Health and Retirement Longitudinal Study (CHARLS) between 2013 and 2020, encompassing four waves, were utilized to construct a longitudinal depressive symptom network. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). In expected influence (in-EI) and out expected influence (out-EI) were identified to characterize the interaction of symptoms within the temporal network, while expected influence (EI) was used to examine the interaction of symptoms in both the contemporaneous network and the between-subjects network. Results:A total of 1393 older adults were assessed. A persistently significant increase in the prevalence of depression was observed over time. In the temporal network, "restless sleep" (CESD7) and "could not get going" (CESD10) were the most influential symptom and most influenced symptom, respectively. In both the contemporaneous network and the between-subjects network, "felt depressed" (CESD3) emerged as the most central symptom within the community of depressive symptoms. Conclusions:Given the challenges associated with treating LLD and its adverse effects on daily life for older adults, timely interventions targeting identified key symptoms may help prevent and mitigate depression in this population.

BACKGROUND:Cognitive frailty, defined as the co-occurrence of physical frailty/prefrailty and cognitive impairment in the absence of dementia, is a potentially reversible condition that may signal high risk for disability and dementia. This systematic review and meta-analysis estimated the global prevalence of cognitive frailty among community-dwelling older adults and examined methodological and contextual moderators of prevalence differences. METHODS:We searched for relevant studies published up to October 22, 2025 in international (PubMed, Web of Science, Embase, PsycINFO) and Chinese (CNKI, Wanfang) databases. Pooled prevalence rates and 95% confidence intervals (CIs) were calculated with random-effects models. Subgroup and meta-regression analyses examined possible sociodemographic, methodological, and clinical moderators. Study quality was assessed with the Joanna Briggs Institute checklist. RESULTS:Sixty-six studies of 127 556 participants were included. The pooled prevalence of cognitive frailty was 12.2% (95% CI: 9.4%-15.7%). Prevalence was higher in studies using the "Fatigue, Resistance, Ambulation, Illness, and Loss of weight" (FRAIL) scale or Fried phenotype and those using the Montreal Cognitive Assessment (MoCA) or composite cognitive criteria, in upper-middle-income countries, and in studies published after 2021. In meta-regression analyses, alcohol use status was significantly associated with cognitive frailty prevalence but most sociodemographic factors were not related to rates of cognitive frailty. Trim-and-fill analysis suggested that potential publication bias may have led to underestimation of prevalence. CONCLUSION:Cognitive frailty is common among community-dwelling older adults worldwide. Given its potential reversibility and strong links to adverse outcomes, systematic identification and targeted multi-domain interventions should be prioritized in aging societies.

Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently linked to functional impairments and deficits in executive functioning. This study investigated inter-relationships between executive functions and functional impairments among children with ADHD from a network analysis perspective to identify key domains for targeted intervention research. Children with ADHD, diagnosed using a semi-structured interview, were recruited from a pediatric hospital in China. Executive functions were assessed using the Behavior Rating Inventory of Executive Function - Parent Form (BRIEF). Functional impairments were measured using the Weiss Functional Impairment Scale-Parent Form (WFIRS-P). Network analysis was performed to examine interactions between executive functions and functional impairments, identifying central and bridge nodes through Expected Influence (EI) and bridge EI indices. Of the 225 participating children with ADHD, functional impairments ranged from 0.4% (95% CI: [0.0%, 1.3%]) for risky behavior to 15.1% (95% CI: [10.4%, 19.8%]) for self-concept. Network analysis revealed executive functions of "Monitoring" (EI = 1.11) and "Planning" (EI = 1.07) had the highest centrality values and were the most influential domains in the network model. The most influential bridge nodes linking executive function and functional impairment communities were impairments related to "Family" (bridge EI = 0.41) and the executive function, "Inhibition" (bridge EI = 0.38). This study highlighted the most influential central and bridge domains within a network model of executive functions and functional impairments among children with ADHD. Findings provide plausible hypotheses for risk factors and targeted interventions. Future research should use longitudinal designs and objective assessments to evaluate our findings further.

BACKGROUND:Depression is prevalent among older adults. Understanding the network structure of depression across diverse cultural contexts is essential to preventing and treating depression. This study evaluated the prevalence and combined network structure of depression among older adults based on national surveys from five countries. METHODS:This study combined data from five national cohort studies. The Center for Epidemiologic Studies Depression (CESD) scale was used to assess depressive symptoms. Meta-analysis was used to estimate the overall prevalence of depression, while network models were constructed using Ising models. The most central depressive symptoms were identified using the Expected Influence (EI) index. RESULTS:In total, 102,202 older adults were included. The pooled prevalence of depression was 18.9% (95% confidence interval (CI):10.3%-27.4%). In the combined network model, the most central symptoms were "Feeling depressed" (CESD1), "Feeling sad" (CESD4), "Lack of happiness" (CESD6) and Loneliness (CESD3), while the strongest positive edge was "Not enjoy life" (CESD7) - "Lack of happiness" (CESD6). CONCLUSIONS:Our findings indicated depressive symptoms are common among older adults across several countries. Moreover, interventions to address feelings of sadness, depressed mood, and lack of happiness as well as loneliness may be beneficial in alleviating depression across older adults in these countries.

Background Given the increased use of network analysis in sleep studies, this systematic review and statistical evaluation aimed to aggregate network studies to identify the most central symptoms in composite network models of sleep-related symptoms. Methods A systematic search of cross-sectional network studies focused exclusively on sleep within community or clinical samples was conducted across PubMed, Web of Science (WOS), PsycINFO, and EMBASE databases up to March 5, 2025. Studies were categorized by topic and measurement instruments. Statistical evaluations extracted the most central symptoms across network models. Results The review included 23 studies of 84,510 participants and 29 network models. Explored topics included insomnia/sleep disturbances, sleep quality, sleep attitudes and behaviors, daytime function, and dream content. Regarding main analyses, key central symptoms in network models of insomnia were "Difficulty staying asleep" [median rank:1.5, Interquartile range (IQR): 1-2], "Distress caused by the sleep difficulties" (median rank:2, IQR: 2-3) and "Interference with daytime functioning" (median rank:3.5, IQR: 2.25-4). For sleep quality, "Subjective sleep quality" (median rank:1, IQR: 1-1), "Daytime dysfunction" (median rank:3, IQR: 2-5.25) and "Sleep disturbance" (median rank:3.5, IQR: 2-4.5) were the most central experiences. Conclusions Identified central symptoms offer plausible targets for intervention across populations and guide future research directions.

Background : Post-stroke depression, anxiety, and cognitive impairment are common in older adults and may adversely affect rehabilitation and quality of life. We compared the relative effects of different exercise interventions on these outcomes and explored the most promising modalities. Methods : We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials by searching five international and two Chinese databases from inception dates to July 2025. Eligible studies included older adults with stroke who received exercise-based interventions. Primary outcomes were depression, anxiety, and cognitive function. Effects were estimated as standardized mean differences (SMDs) with 95% credible intervals (CrIs). Interventions were ranked using surface under the cumulative ranking curve (SUCRA) values. Risk of bias and confidence in the network estimates were assessed using RoB 2 and CINeMA, respectively. Results : A total of 52 randomized controlled trials of 4,170 participants were included; 11 were at low risk of bias. For depression, dual-task training (DTT), mind-body exercise (MBE), and balance/coordination training (BCT) ranked highest (SUCRA: 81.15%, 74.42%, and 72.46%, respectively), and showed statistically credible benefit versus usual care. For anxiety, MBE, resistance/strength training (RST), and DTT ranked highest (88.53%, 85.27%, and 76.79%, respectively); statistically credible benefits versus usual care were observed for RST and DTT while EFR was associated with worse anxiety outcomes. For cognitive function, MBE, general aerobic exercise (GA), and moderate-intensity continuous training (MICT) ranked highest (72.95%, 71.12%, and 70.74%, respectively) while BCT showed a statistically credible improvement versus usual care. Meta-regression analyses suggested that longer time since stroke correlated with smaller benefits for anxiety and cognitive function. Conclusions : Different exercise modalities may offer distinct benefits for psychological and cognitive outcomes after stroke in older adults. These findings support individualized, phase-sensitive exercise prescription in post-stroke rehabilitation.

BACKGROUND:Loneliness is increasingly recognized as a critical factor influencing health outcomes. Previous studies have reported associations between loneliness and increased mortality risk across chronic medical conditions. However, findings remain inconsistent, particularly regarding the predictive role of loneliness on all-cause mortality within mid- to late-life populations. METHODS:This prospective cohort study utilized 2010 to 2020 data from the Health and Retirement Study (HRS) to investigate the impact of loneliness on all-cause mortality among U.S. adults aged 50 years and older. Loneliness was assessed using the 11-item University of California, Los Angeles Loneliness Scale (UCLA-11), and total scores were grouped into quintiles. Cox proportional hazards models were employed to estimate hazard ratios (HRs) for all-cause mortality, adjusting for sociodemographic and health-related covariates. Subgroup and sensitivity analyses were performed to assess interactions and the robustness of findings. RESULTS:A total of 6807 participants were included in this study, with 1561 deaths recorded over a mean follow-up of 7.8 years. Higher baseline loneliness levels (i.e., UCLA-11 total score of ≥15) were associated with increased all-cause mortality across chronic disease groups, with significant HRs for Quintiles 3 to 5 compared to Quintile 1. The loneliness symptom "[not] a lot in common with friends" was significantly associated with all-cause mortality in the diabetes subgroup (adjusted HR: 1.14, 95% CI:1.00-1.30; P = 0.05). Subgroup analyses indicated the association between baseline loneliness scores and all-cause mortality among participants with heart conditions was more pronounced among women (adjusted HR, 1.55; 95% CI:1.22-1.97), compared to men (adjusted HR, 1.04; 95% CI: 0.83-1.31), p for interaction = 0.02. CONCLUSION:Loneliness is a significant predictor of all-cause mortality among middle-aged and older U.S. adults with chronic medical conditions, especially among women with heart conditions. Findings highlight the importance of assessment and tailored interventions to address loneliness in clinical settings, particularly for vulnerable mid- to late-life subgroups. Future research should focus on refining screening and intervention strategies to mitigate loneliness-related mortality risks.

Objectives We investigated neurocognitive mechanisms of pain-related attentional control in individuals with chronic musculoskeletal pain. Methods By simultaneously recording eye movements and event-related potentials (ERPs), we examined pain-related attentional control in a sample with chronic musculoskeletal pain (N = 26) and a matched pain-free control group (N = 26). Using an adapted go/no-go paradigm, the go condition required participants to focus on pain or neutral images to measure attention engagement while the no-go condition required inhibiting attention toward these images to measure attention inhibition. Results In the go condition, participants with chronic musculoskeletal pain exhibited shorter first fixation latencies and longer dwell times on pain images than neutral images, indicating enhanced attentional vigilance and maintained attention engagement. These behavioral effects were fully mediated by enhanced pain image-evoked N2 amplitude biases and partially mediated by pain image-evoked P3 amplitude biases, respectively. N2 amplitudes reflected initial top-down attentional capture, and P3 amplitudes reflected maintained attention engagement regulation. No differences in eye movements or ERPs were observed during the no-go condition in either group. Discussion People with chronic musculoskeletal pain display enhanced pain-related attention engagement that suggests pain-related attention control deficits. Future research that aims to improve pain-related attentional control by targeting maladaptive patterns of attention engagement may lead to better chronic pain outcomes.

BACKGROUND:Situational stressors influence pain empathy levels, but little is known about how interactions of such stressors interact with baseline trait empathy (TE) to influence empathic processing. Toward elucidating this issue, we investigated the effects of a cognitively loading stressor-personal unfairness recollections-on pain empathy levels in high versus low TE groups. METHODS:Undergraduate participants (N = 121) were divided into high versus low TE groups using median Interpersonal Reactivity Index scores. Participants were randomly assigned to recall personal experiences of unfairness (unfairness prime) or boring daily routines (boredom prime) and then evaluate injury images (Task 1) and facial expression images (Task 2), rating pain/joy intensity to index cognitive empathy and unpleasantness/pleasantness to index affective empathy. RESULTS:Cognitive empathy levels remained stable across priming conditions. However, affective empathy was modulated by both priming conditions and TE levels. Within the boredom priming control condition, high TE group members reported significantly more unpleasantness toward injury images and painful facial expressions, and more pleasantness toward joyful facial expressions than low TE group members did. Paradoxically, unfairness priming resulted in reduced affective empathy toward painful and joyful facial expressions in the high TE group and enhanced affective empathy to injury images in the low TE group. CONCLUSIONS:This experiment indicated cognitive empathy ratings remain stable while affective empathy ratings are susceptible to interactions between trait empathy levels and negatively-valenced recollections. Specifically, personal unfairness experiences may diminish effects of baseline empathic sensitivity on pain empathy among high-TE people and magnify affective empathy among those with low TE. SIGNIFICANCE STATEMENT:This experiment demonstrates effects of personal experiences of perceived unfairness (versus boredom) differentially bias affective pain empathy based on individuals' baseline trait empathy levels. By revealing the unique impact of affectively valenced stressors on affective empathy, main findings underscore potential mechanisms by which healthcare providers' occupational stressors may compromise objective pain assessment.

BACKGROUND:Depression and cognitive impairment frequently co-occur in older adults. Network analysis can elucidate inter-relationship between psychiatric disturbances at the symptom level. This study examined the network structure of depressive symptoms and impaired cognitive function among adults aged 60 years or older in India. METHODS:Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cognitive function was evaluated across six domains: Memory, Orientation, Retrieval fluency, Arithmetic function, Executive function, and Object naming. Central symptoms and bridge symptoms were identified using Expected Influence (EI) and Bridge EI, respectively. A flow network was employed to identify symptoms directly associated with cognitive impairment. RESULTS:In this study, 29 224 participants were included. The prevalence of depression (CESD-10 total score ≥ 4) was 27.46% (95% CI: 26.95%-27.97%), while the prevalence of cognitive impairment was 15.55% (95% CI: 15.13%-15.97%). CESD2 ("Felt depressed") emerged as the most central symptom, followed by Ari ("Arithmetic function") and Ori ("Orientation"). Moreover, CESD8 ("Everything was an effort"), CESD2 ("Felt depressed"), and CESD7 ("Bothered by things") served as bridge nodes linking the communities of depressive symptoms and cognitive functions. The flow network indicated that the strongest connections to cognitive impairment were observed for CESD1 ("Trouble focusing"), CESD3 ("Could not get going"), and CESD10 ("Felt unhappy"). CONCLUSION:This study documented the inter-relationship between particular depressive symptoms and impaired cognition among older adults in India. The central symptoms and bridge symptoms identified in this study should be tested in intervention studies aiming to improve depression and cognition among older adults.

BACKGROUND:As the most prevalent malignancy among women, breast cancer has a potentially shattering impact on quality of life (QoL). However, studies comparing QoL between breast cancer survivors and cancer-free peers have been inconsistent and little is known about possible moderators that contribute to inconsistent findings or specific QoL domains that affect breast cancer survivors most. OBJECTIVES:This meta-analysis examined QoL differences between breast cancer survivors and controls without breast cancer ("controls" hereafter) across multiple QoL instruments and domains. METHODS:We searched major international and Chinese databases and identified 36 eligible case-control studies comprising 29,433 participants (12,261 survivors, 17,172 controls). Standardized mean differences were calculated using a random-effects model; subgroup analyses and meta-regression examined potential moderators. RESULTS:QoL impairments varied by assessment instrument. Medical Outcomes Study Short Form surveys showed lower physical component scores in breast cancer survivors (moderate effect size, SMD = -0.52) and small deficits in physical function, emotional role limitations, mental components, and general health domains. The European Organization for Research and Treatment of Cancer questionnaire revealed lower scores in insomnia (SMD = 0.80) and financial difficulties (SMD = 0.77). Regarding the Functional Assessment of Cancer Therapy-General, breast cancer survivors displayed comparatively large impairments across emotional, functional, and physical well-being domains. Short-term survivors (≤ 5 years post-diagnosis) experienced significantly greater deficits than long-term survivors did in physical role limitations and mental health domains. CONCLUSIONS:Breast cancer survivors experience lower QoL than controls do, particularly in physical and emotional domains. This meta-analysis highlights the importance of developing effective interventions targeting specific QoL domains at different survivorship stages.

BackgroundObesity, particularly in high-risk groups for food addiction, adversely impacts the brain’s functional characteristics. However, its underlying neurobiological and molecular mechanisms remain elusive. The current study adopted a data-driven approach to investigate obesity-associated intrinsic functional architecture and neurotransmitter receptor patterns.MethodsResting-state fMRI data were acquired from 198 obese and 291 healthy weight individuals from the Human Connectome Project. Intrinsic connectivity contrast (ICC) and fractional amplitude of low-frequency fluctuations (fALFF) analyses were performed to identify the common altered brain regions and then seeds to whole brain functional connectivity (FC) analyses were conducted to determine obesity-related FC features. Additionally, the relationship between intrinsic functional characteristics and molecular imaging features was assessed to examine neurotransmitter-receptor distribution patterns underlying obesity.ResultsObese individuals, compared to healthy weight individuals, showed aberrant ICC and fALFF in both the right dorsolateral prefrontal cortex (DLPFC) and left insula. For the FC results, the obese group displayed increased FC between the right DLPFC and precuneus, left insula and left inferior parietal lobule, right DLPFC as well as decreased FC between right DLPFC and left precentral, left postcentral gyrus, and bilateral paracentral lobule. Additionally, the fALFF alterations in insula/temploral pole and also the rDLPFC-PCL FC partially mediated the relationship between body mass index and the executive function. Furthermore, cross-modal correlation analyses indicated that ICC and fALFF alterations were related to noradrenaline transporter and dopamine receptor distributions, respectively.DiscussionTogether our findings suggested that obesity is associated with atypical neurotransmitter systems and dysfunctional architecture especially in the prefrontal cortex, insula, sensorimotor cortex, and default mode circuits. These may deepen our understanding the neurobiological basis of obesity and provide novel insights into neuroimaging-based treatment and intervention.

Older adults with heart disease experience higher rates of depression and insomnia compared with heart disease–free peers. Aside from these psychological disturbances, overall health satisfaction, as a key indicator of subjective health status, may be affected by heart disease status. In spite of these overall associations, symptom-level relationships between depression, insomnia, and health satisfaction remain unclear. We aimed to compare the prevalence and symptom network differences of these variables between older adults in the United States with and without heart disease. Network analyses were conducted on data from the 2022 wave of the Health and Retirement Study. Propensity score matching identified 2 demographically similar groups: 2861 cohorts with heart disease and 2861 heart disease–free peers. Depression was measured using the 8-item dichotomous version of the Center for Epidemiologic Studies Depression Scale. Insomnia was assessed using the 4-item Jenkins Sleep Scale. Health satisfaction was evaluated with a standardized self-report item querying perceived overall health status on a 5-point Likert scale ranging from “poor” to “excellent.” Central and bridge symptoms were identified using expected influence and bridge expected influence metrics. Depression prevalence was higher in the heart disease group (19.8%; 95% confidence interval [CI], 18.4%–21.3%) than in the heart disease–free group (11.8%; 95% CI, 10.7%–13.1%; P < .001), with more severe depressive symptoms in the heart disease group (1.8 ± 2.18 vs 1.3 ± 1.83, P < .001). Similarly, the prevalence of having at least 1 insomnia symptom was significantly higher in the heart disease group (48.2%; 95% CI, 46.4%–50.1%) than the heart disease–free group (36.3%; 95% CI, 34.6%–38.1%; P < .001), with more severe insomnia symptoms in the heart disease group (0.9 ± 1.13 vs 0.6 ± 0.92) (P < .001). Network models revealed similar structures between groups. Key central symptoms across these groups included “feeling sad,” “lack of happiness,” and “feeling depressed.” Bridge symptoms were “feeling tired in the morning” and “trouble falling asleep.” “Everything was an effort” was strongly associated with lower health satisfaction across groups. Older adults with heart disease exhibited a higher prevalence of depression and more severe overall depressive and insomnia symptoms. Identified central and bridge symptoms may be potential markers of co-occurring conditions and could inform future intervention research aimed at reducing comorbidity. Given the similar symptom structures, interventions developed for heart disease–free adults may also be applicable to those with heart disease, although randomized control trials are needed to establish causal effects.

BACKGROUND:While links between depression and cancer risk are well documented, specific depressive symptoms involved remain unclear, as does the presence of associations between cognitive function and cancer risk. To address these gaps, we assessed associations of cognitive function levels and depressive symptoms with cancer occurrence among middle-aged and older Chinese adults. METHODS:This prospective cohort study utilized 2011 to 2020 data from the CHARLS, a population-based nationwide survey from China. Adults aged 45 years or older with cognitive function and depressive symptom data and no baseline cancer diagnosis were included for analysis. Global cognitive function scores were calculated for executive function and episodic memory performance using an adapted version of the Telephone Interview for Cognitive Status. Depressive symptoms were assessed using the CESD-10. Risk of events was reported based on adjusted HRs and 95 % CIs for cancer incidence, using a Cox proportional hazards regression model. RESULTS:Of 16,518 cancer-free adults (mean [SD] age: 56.5 [8.9] years) assessed at baseline, 244 new cancer cases were diagnosed (mean [SD] age: 57.6 [8.9] years) during a median follow-up period of 9 years (IQR, 7-9 years). A lower level of executive function (adjusted HR [95 %CI], 0.69 [0.52-0.92]) and higher somatic retardation levels (adjusted HR [95 %CI], 1.34 [1.00-1.79]) were associated with higher subsequent risk of cancer incidence, after controlling for the impact of demographic characteristics, health-related lifestyle factors and medical conditions. CONCLUSION:In this longitudinal cohort study, lower initial levels of executive function and higher somatic retardation depressive symptom levels predicted higher subsequent cancer incidence.

BackgroundBody pain is common among older adults who often experience comorbid depressive symptoms and cognitive impairments. This study examined differences in depressive symptoms and cognitive functions between older adults distressed with body pain and those without pain and explored symptom interrelationships in the pain-distressed group.MethodsData from the 2020 China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale-10 (CESD-10). Cognitive function was evaluated using standardized measures. Network analysis identified both central and bridge symptoms in the pain group.ResultsThis study included 3938 participants of whom 1969 comprised the group distressed by body pain. Depressive symptoms were more prevalent among those with body pain (39.1%; 95% CI: 36.95%, 41.25%]) compared to controls (21.4%; 95% CI: 19.59%, 23.21%], P < 0.01). Conversely, cognitive function scores did not differ between the two groups. In the network model for the pain-distressed group, "feeling depressed" (CESD3) was the most central symptom (strength = 1.01), followed by "everything was an effort" (CESD4) (strength = 0.98) and "inability to get going" (CESD10) (strength = 0.88). "Orientation" (Bridge strength = 1.44) was the most influential bridge symptom linking depressive symptom and cognitive function communities, followed by "memory" (Bridge strength = 1.13) and "attention" (Bridge strength = 0.72).ConclusionFindings highlighted a higher prevalence of depressive symptoms among older adults with body pain compared to their pain-free peers. Results suggest interventions targeting key central and bridge symptoms warrant consideration in future treatment studies.

BACKGROUND:Depression and anxiety are global public health challenges among older adults. Square dancing, a popular activity for older Chinese adults, is believed to relieve these disturbances. This study compared the prevalence, severity, and network structures of depression and anxiety among older square dancers versus non-dancers (i.e., those who do not engage in square dancing). METHODS:Propensity score matching (PSM) created square dancer and non-dancer groups using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depressive and anxiety symptoms were assessed with the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central symptoms and bridge symptoms were estimated in each group using expected influence (EI) and bridge EI, respectively. RESULTS:The study included 401 square dancers and a matched sample of 1163 non-dancers. The prevalence and severity of depression and anxiety were significantly lower among square dancers compared to non-dancers. In contrast, network structures of depressive and anxiety symptoms were similar between the two groups. "Uncontrollable worrying" and "Felt sadness" were the most central symptoms, and "Nervousness", "Bothered by things" and "Felt nervous/fearful" were key bridge symptoms across both groups. CONCLUSION:Participation in square dancing is associated with reduced overall prevalence and severity of depression and anxiety among older adults, but is not associated with a unique network structure of these syndromes compared to non-participation. Consequently, psychosocial interventions developed for depression and anxiety based on the network structure of non-dancers may also be applicable for square dancers who experience anxiety and depression.