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Objective This study aims to examine the longitudinal relationship between fear of disease recurrence and depressive symptoms in elderly patients who have experienced postoperative adjacent vertebral refractures, as well as in their spouses, using the actor-partner interdependence model (APIM) to assess both individual and mutual psychological influences.Design A prospective longitudinal study in China.Participants A total of 230 osteoporotic vertebral compression fractures (OVCF) and their spouses were selected by convenience sampling method.Methods Simplified fear disease Progression Scale and 9-item Patient Health Questionnaire were used at admission (T1), before discharge (T2) and 1 month after discharge (T3), respectively. Equivalence test and cross-lagged analysis of APIM were used for statistical examination.Results A total of 224 valid questionnaires were collected in this study, yielding an effective recovery rate of 97.31%. Across the measurement stages, both patients and their spouses exhibited a decreasing trend in scores for fear of disease recurrence and depressive symptoms. The subjective effect analysis revealed that, in elderly patients with postoperative adjacent vertebral refracture, fear of disease recurrence significantly and positively predicted depressive symptoms at the subsequent stage (T1→T2: β=0.18, T2→T3: β=0.17, p<0.01), while spouses’ fear of disease recurrence similarly predicted their own depressive symptoms in the following stage (T1→T2: β=0.16, T2→T3: β=0.17, p<0.01). The main effect analysis indicated that patients’ depressive symptoms significantly predicted their own subsequent fear of disease recurrence (T1→T2: β=0.21, T2→T3: β=0.20, p<0.001), and spouses’ depressive symptoms likewise predicted their own subsequent fear of disease recurrence (T1→T2: β=0.20, p<0.001; T2→T3: β=0.18, p<0.01). Furthermore, the partner (or cross) effects were significant, with patients’ depressive symptoms positively predicting their spouses’ depressive symptoms in the next stage (T1→T2: β=0.21, T2→T3: β=0.20, p<0.001), and spouses’ depressive symptoms similarly predicting patients’ depressive symptoms in the following stage (T1→T2: β=0.17, T2→T3: β=0.16, all p<0.01).Conclusions It is recommended that medical staff prioritise the assessment and management of fear of disease recurrence and depressive symptoms in elderly patients with OVCF and their spouses, and strategically leverage the mutual influence between them to minimise depressive symptom levels as much as possible.