# The association of pain phenotype and providing caregiving with depressive symptom trajectory for older adults: a longitudinal analysis using the health and retirement study

## TL;DR

This study explores how different types of pain and caregiving affect the development of depression in older adults over time.

## Contribution

The study introduces a novel approach to understanding how pain phenotypes and caregiving interact to influence depressive symptoms in older adults.

## Key findings

- Four distinct pain phenotypes were identified among older adults, with pain-free individuals showing the lowest baseline depression symptoms.
- Severe-persistent pain was associated with a slower increase in depressive symptoms over time.
- Caregiving reduced the rate of depression symptom increase for individuals with severe-persistent and back pain.

## Abstract

This study aims to analyze the association between different pain phenotypes and depressive symptom trajectory among community-dwelling older adults, and whether and how providing caregiving render older adults with pain more prone to a deteriorating depressive trajectory.

Data were derived from the Health and Retirement Study between 2008 and 2020. Older adults were classified into different pain phenotypes leveraging four pain characteristics at baseline (i.e. 2008) using latent class analysis, including pain intensity, pain interference, pain location, and pain persistence. Caregiving status was collected at baseline using helper lists. Depressive symptoms were measured biennially from 2008 to 2020. Linear mixed models were constructed to explore the independent and interacted effects of pain phenotypes and providing caregiving on depressive symptom trajectory.

Among 8486 participants aged 60 years old or over (58.8% females, and mean age of 74.28), four pain phenotypes were identified: Severe-persistent pain group (15.0%), Moderate pain group (17.3%), Back pain group (7.0%), and Pain-free group (60.7%). Compared to the Pain-free group, other three pain subtypes exhibited higher baseline depression symptoms with a gradient trend. Older adults with Severe-persistent pain had a significantly slower rate of depression symptom increase. Caregiving did not moderate the impact of any pain subtype on baseline depression symptoms, but it significantly reduced the rate of increase in depression symptoms for both Severe-persistent pain group and Back pain group.

Pain phenotype-informed depression services should be delivered. Promoting the caregiving benefit finding for the elderly would contribute to the remission of depressive symptom.

The online version contains supplementary material available at 10.1186/s12877-025-05926-5.