The Impact of Falls on Depressive Symptoms in Middle-Aged and Older Chinese Adults: Mediating Effects of Pain

Abstract

Purpose: Based on the biopsychosocial integrated model and the diathesis-stress model, we investigate whether fall experiences prospectively exacerbate depressive symptoms among middle-aged and elderly individuals in China, while also examining whether pain serves as a key somatic pathway. Patients and Methods: A total of 10963 participants aged 45+ were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Falls and pain were assessed by self-report. The causal effect of falls on depressive symptoms was assessed using the Difference-in-Differences (DID) method. Subsample regression analyses and Chow tests were employed to explore heterogeneity in the effect of falls on depressive symptoms across demographic groups. The Karlson, Holm, and Breen (KHB) method was applied to examine the mediating effect of pain. Results: DID analysis indicated that falls were associated with a 0.030 increase in depressive symptoms (P<0.01, 95% CI= 0.008–0.052). Heterogeneity analyses showed that the negative impact of falls on depressive symptoms is more pronounced among urban residents and men. Pain significantly mediated the relationship between falls and depressive symptoms, with an effect size of 0.144 (P<0.001, 95% CI=0.127–0.160), accounting for 26.6% of the total effect. Conclusion: Falls exert a significant causal impact on depressive symptoms among middle-aged and older adults in China. The impact was stronger among urban residents and men and pain partly mediated this effect. This research contributes to cross-cultural understanding of psychological reactions triggered by falls and highlights the necessity of developing prevention and pain management strategies for vulnerable populations.