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Background Both knee osteoarthritis (KOA) and depressive symptoms (DS) are major public health issues affecting the quality of life. This study aimed to examine the association between KOA and DS. Methods Data were gathered from the China Health and Retirement Longitudinal Study in 2011–2015 which surveyed middle-aged to elderly individuals and their spouses in 28 provinces in China. An adjusted Cox proportional hazards regression model was used to estimate hazard ratios (HRs). Results The analysis for baseline KOA and the subsequent risk of DS was based on 2582 participants without baseline DS. During the follow-up, KOA patients were more likely to have DS than non-KOA participants (adjusted HR = 1.38: 95% CI = 1.23 to 1.83). The analysis for baseline DS and the subsequent risk of KOA was based on 4293 participants without baseline KOA, those with DS were more likely to develop KOA than non-DS participants (adjusted HR = 1.51: 95% CI = 1.26 to 1.81). Subgroup analysis showed sex and age had no significant moderating effect on the KOA-DS association. Conclusions Our results provide evidence that the association between KOA and DS is bidirectional. Therefore, primary prevention and management of KOA and DS should consider this relationship.

Bidirectional association between knee osteoarthritis and depressive symptoms: evidence from a nationwide population-based cohort