Inter-relationships of depression and anxiety symptoms among widowed and non-widowed older adults: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) based on network analysis and propensity score matching

Yinglin Li ¹ Doudou Lin ¹ Xuan Gong ¹ Dou Fu ¹ Ling Zhao ¹ Weibing Chen ¹ Jie Chen ² Shanshan Liu ¹ Guirong Yang ³ Zhongxiang Cai ^1*

• ¹ Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
• ² Florida State University, Tallahassee, Florida, United States
• ³ Hubei Polytechnic Institute, xiaogan, China

Background: Depression and anxiety are prevalent mental health issues among elderly widowed adults. However, the symptom-level relationships between these conditions remain unclear. Due to the high correlations and complex relationships among various symptoms, this study employs network analysis to explore differences in the network structures of depression and anxiety symptoms between widowed and non-widowed older adults.Methods: Propensity score matching was used to identify widowed older adults with similar demographic characteristics. Data from 1736 widowed and 1736 matched controls were analyzed using the Chinese Longitudinal Healthy Longevity Survey (2017)(2018). Depression and anxiety were measured by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central and bridge symptoms were evaluated using expected influence (EI) and bridge expected influence (BEI), respectively.Results: Network analysis revealed similarities in central symptoms between widowed and nonwidowed older adults, with both groups exhibiting "Feeling depressed or down" (CESD3), "Feeling tense and having difficulty relaxing" (GAD4), and "Being unable to stop or control worrying" (GAD2) as core symptoms. However, differences emerged in bridge symptoms. In the widowed group, "Feeling anxious, worried, or distressed" (GAD1) was most strongly connected to "Felt lonely" (CESD8); "Worrying too much about various things" (GAD3) was strongly linked to "Feeling increasingly exhausted and useless with age" (CESD4); and "Feeling depressed or down" (CESD3) had a strong association with "Becoming easily annoyed or irritable" (GAD6). In the non-widowed group, "Feeling anxious, worried, or distressed" (GAD1) exhibited the strongest association with "Having good sleep quality" (CESD10); "Getting upset over small matters" (CESD1) was closely connected to "Feeling anxious, worried, or distressed" (GAD1); and "Worrying too much about various things" (GAD3) was most strongly connected to "Feeling depressed or down" (CESD3).This study revealed similar central symptoms, but significant different bridge symptoms between widowed and non-widowed older adults, offering a foundation for future targeted interventions.Addressing "Feeling depressed or down" in widowed and "Getting upset over small matters" in nonwidowed older adults may help prevent depression-anxiety comorbidity. These findings support targeted interventions to improve mental health outcomes. Future research should evaluate tailored intervention effectiveness.