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Network analysis of depressive and anxiety symptoms in older Chinese adults with diabetes mellitus

  • Zhang, Yajuan1
  • Cui, Yi2
  • Li, Yijun1
  • Lu, Hongliang1
  • Huang, He1
  • Sui, Jiaru1
  • Guo, Zhihua1
  • Miao, Danmin1
  • 1 Department of Military Medical Psychology, Air Force Medical University, Xi’an , (China)
  • 2 Department of Nursing, Air Force Medical University, Xi’an , (China)
Published Article
Frontiers in Psychiatry
Frontiers Media SA
Publication Date
Jan 29, 2024
DOI: 10.3389/fpsyt.2024.1328857
  • Psychiatry
  • Original Research


Background The move away from investigating mental disorders as whole using sum scores to the analysis of symptom-level interactions using network analysis has provided new insights into comorbidities. The current study explored the dynamic interactions between depressive and anxiety symptoms in older Chinese adults with diabetes mellitus (DM) and identified central and bridge symptoms in the depression-anxiety network to provide potential targets for prevention and intervention for depression and anxiety. Methods This study used a cross-sectional design with data from the 2017–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A regularized partial correlation network for depressive and anxiety symptoms was estimated based on self-reported scales completed by 1685 older adults with DM aged 65 years or older. Depressive and anxiety symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the Seven-Item Generalized Anxiety Disorder Scale (GAD-7), respectively. Expected influence (EI) and bridge expected influence (BEI) indices were calculated for each symptom. Results According to cutoff scores indicating the presence of depression and anxiety, the prevalences of depression and anxiety in our sample were 52.9% and 12.8%, respectively. The comorbidity rate of depression and anxiety was 11.5%. The six edges with the strongest regularized partial correlations were between symptoms from the same disorder. “Feeling blue/depressed”, “Nervousness or anxiety”, “Uncontrollable worry”, “Trouble relaxing”, and “Worry too much” had the highest EI values. “Nervousness or anxiety” and “Everything was an effort” exhibited the highest BEI values. Conclusion Central and bridge symptoms were highlighted in this study. Targeting these symptoms may be effective in preventing the comorbidity of depressive and anxiety symptoms and facilitate interventions in older Chinese adults with DM who are at risk for or currently have depressive and anxiety symptoms.

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