Work

Association between creatinine to cystatin C ratio and the incidence of depressive symptoms among middle-aged and older adults: insight from the CHARLS study

Year: 2025

Type: article

Abstract: BACKGROUND: Depressive symptoms constitute a pressing public-health concern that significantly undermines the mental well-being of older adults. There is a robust association between depression and the progressive loss of muscle mass and strength that characterizes sarcopenia. However, few studies have examined the association between the creatinine-to-cystatin C ratio (CCR), a robust biomarker of sarcopenia, and depression. This study aims to investigate the relationship between CCR and the incidence of depressive symptoms (DS). METHODS: We conducted a cohort study utilizing data from Wave 1 (2011) and Wave 3 (2013) of the China Health and Retirement Longitudinal Survey (CHARLS). A total of 4,955 individuals aged 45 years and above who were free of DS at baseline were included. The CCR was calculated as serum creatinine divided by cystatin C and categorized into quartiles. The 10-item Center for Epidemiological Studies Depression Scale (CESD-10) was used to assess DS, with a cutoff score of ≥ 12 indicating DS. Multivariate logistic regression models were employed to evaluate the association between the baseline CCR and incident DS over a two-year follow-up period. A restricted cubic splines (RCS) analysis was applied to explore the dose‒response relationship, while sensitivity and subgroup analyses were performed to test the robustness of the findings. RESULTS: Compared to participants in the lowest quartile of CCR, those in the third and fourth quartiles had 27.9% (OR = 0.721, 95% CI: 0.570-0.913) and 29.7% (OR = 0.703, 95% CI: 0.548-0.902) lower risks of incident DS, respectively. Each one-unit increase in the CCR was associated with a 5.6% reduction in DS risk (OR = 0.944, 95% CI: 0.901-0.990). RCS analysis revealed a linear relationship between the CCR and DS risk (P for nonlinearity = 0.477). These findings remained consistent in sensitivity and stratified analyses. CONCLUSION: The CCR is inversely associated with the risk of incident DS over 2 years, suggesting that the CCR may serve as a useful biomarker for predicting and managing mental health in middle-aged and older adults.

Source: BMC Psychology

DOI: 10.1186/s40359-025-03785-8