Objective  To identify the development trajectory of depression of diabetes patients in middle-aged and elderly Chinese, explore the possible gender, urban-rural area specific differences in the development trajectory of depression in this population, and provide evidence for the prevention and management of depression in diabetes patients.

  Methods  The data from four phases of a longitudinal health study in elderly population in China from 2011 to 2018 were used to analyze the development trajectory of depression of diabetes patients aged ≥45 years. The Growth Mix Model was used to evaluate the fitness of the potential models, and the development trajectories of depression in men and women, in urban and rural residents in this population were analyzed.

  Results  A total of 481 middle-aged and elderly diabetes patients were included in the analysis. The results showed that the mean depressive symptom scores of men (7.17–7.81) and urban residents (7.50–8.38) were generally lower than those of women (9.07–10.27) and rural residents (9.06–10.11). The development trajectory of depression showed high-decreasing and low-increasing patterns in men, high-stable and low-increasing patterns in women, high-decreasing and low-increasing patterns in urban residents and low-stable and low-increasing patterns in rural residents.

  Conclusion  The incidence of depressive symptoms in middle-aged and elderly diabetes patients in China showed an increasing trend, and the development trajectories of depression in different groups were heterogeneous. Women and rural residents had more severe depressive symptoms, suggesting the necessity of psychological intervention in this group.