Bridge symptoms of depression and anxiety among older adults in China: a longitudinal network comparison by living arrangements

TL;DR

This study explores how living arrangements affect the connection between depression and anxiety symptoms in older Chinese adults over time.

Contribution

It identifies distinct symptom pathways linking depression and anxiety based on living arrangements using longitudinal network analysis.

Findings

Older adults living alone show a strong 'sleep–anxiety' pathway between depression and anxiety symptoms.

Those living with family exhibit a 'tension–worry' pathway linking depressive and anxiety symptoms.

Network structures differ significantly between living arrangements in specific cross-cluster edges.

Abstract

Comorbidity of depression and anxiety is highly prevalent among older adults, yet longitudinal evidence on how different living arrangements shape the interactions between these symptoms remains scarce.

Data were drawn from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Participants aged ≥60 years who completed both the CES-D-10 and GAD-7 were included. After 1:1 propensity score matching (PSM) on key demographic variables, the final analytic sample comprised 834 older adults. Bayesian Gaussian Graphical Models were applied to construct contemporaneous and lag-1 temporal networks. Bridge edges linking depressive and anxiety clusters were identified, and group differences were examined using the Network Comparison Test (NCT).

The mean age of the sample was 84.5 years; 61.7% were female, and 84.5% held rural hukou. In the overall sample, the strongest bridge edge was between CESD10 (poor sleep quality) and GAD1 (feeling nervous, anxious, or on edge) (r = 0.105). Subgroup analyses revealed distinct bridge-symptom pathways: a “sleep–anxiety” pathway in those living alone (CESD10–GAD1, r = 0.161) and a “tension–worry” pathway in those living with family (CESD6–GAD6, r = 0.130). The NCT indicated no significant difference in global network strength (Δ = 0.131, p = 0.706), but five cross-cluster edges differed significantly between groups (p < 0.05).

Living arrangements shape the bridge-symptom mechanisms linking depressive and anxiety symptoms in later life. Interventions for older adults living alone should prioritize improving sleep, whereas those for older adults living with family should emphasize emotional regulation and family support. These findings provide longitudinal, network-based evidence on context-specific comorbidity mechanisms and offer empirical guidance for tailored public health and clinical interventions.

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