Vision Change and Risk of Incident Depressive Symptoms in Middle-Aged and Older Adults: Evidence from Four International Longitudinal Cohorts

Background
Vision difficulties in midlife and later life may signal broader functional and psychosocial vulnerability. However, evidence remains limited on whether incident and persistent vision impairment are associated with later depressive symptoms across international aging cohorts. We examined this association in four longitudinal aging studies.

Methods
We analyzed longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS; China, W1–W3), the English Longitudinal Study of Ageing (ELSA; England, W4–W6), the Survey of Health, Ageing and Retirement in Europe (SHARE; Europe, W4–W6), and the Health and Retirement Study (HRS; United States, W10–W12). Reported vision across two consecutive waves was used to classify observed change patterns. Primary contrasts compared incident impairment and persistent impairment with persistently normal vision; improved vision was retained in model fitting when present but was not a primary contrast. Incident depressive symptoms were assessed at follow-up among participants below the depressive-symptom threshold at baseline. ELSA contributed a multiple-imputation main estimate (ELSA-MI) to address covariate missingness. Fully adjusted cohort-specific odds ratios (ORs) were pooled using random-effects meta-analysis.

Results
The analytic sample comprised 47,250 participants (CHARLS: 7,247; ELSA-MI: 6,783; SHARE: 21,010; HRS: 12,210), yielding 6,513 incident depressive symptom cases. Incident impairment was associated with higher odds of incident depressive symptoms across cohorts: CHARLS (OR 1.56, 95% confidence interval [CI] 1.15–2.10), ELSA-MI (OR 1.70, 95% CI 1.25–2.31), SHARE (OR 1.24, 95% CI 1.11–1.39), and HRS (OR 1.56, 95% CI 1.27–1.92). The pooled OR was 1.45 (95% CI 1.23–1.71; I² = 56.5%). Persistent impairment showed a similar pattern (pooled OR 1.53, 95% CI 1.30–1.79; I² = 56.5%). Sensitivity analyses were directionally consistent.

Conclusions
Across four longitudinal aging cohorts, incident and persistent reported vision impairment were associated with increased risk of subsequent incident depressive symptoms in middle-aged and older adults. Repeated vision assessment may provide a practical signal for identifying adults who warrant closer mental health monitoring in population-health, primary-care, and eye-care settings.