Depression has emerged as a leading cause of disease burden and disability worldwide. This study aimed to investigate the association between depressive symptom trajectories, all-cause mortality, and premature death.

We utilized the data from Health Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA). Depressive symptoms were assessed using the 8-item CESD scale and categorized into somatic and cognitive-affective subtypes. Cox proportional risk mode was employed to estimate the relationship between depressive symptom trajectories and all-cause mortality and premature death.

Among 17,930 enrolled participants, 4543 died, including 1063 premature deaths. Increasing total depressive symptoms had the highest risk for all-cause mortality with HR 2.01 (95 %CI: 1.72–2.35) followed by consistently high with HR 1.53 (95 %CI: 1.36–1.72) adjusted for covariates compared to consistently low. Increasing and consistently high total trajectories had elevated risks for premature death with HR 1.83 (95 %CI: 1.29–2.59) and HR 2.01 (95 %CI: 1.61–2.51). Increasing, consistently high somatic or cognitive-affective depressive symptom trajectories also increased the risks of all-cause mortality and premature death. Decreasing somatic, cognitive-affective, and total trajectories showed no higher risk for premature death (HR 1.56, 95 %CI: 0.90–2.72; HR 1.00, 95 %CI: 0.56–1.78; HR 1.17, 95 %CI: 0.76–1.81).

Increasing or consistently high trajectories of somatic, cognitive-affective, and total depressive symptoms were associated with elevated risks of all-cause mortality and premature death, whereas decreasing trajectories were not associated with increased risks. Early interventions aimed at reducing the duration of depressive symptoms may help to extend lifespan.